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Saraluck A, Aimjirakul K, Jiet NJ, Chinthakanan O, Mangmeesri P, Manonai J. Defecatory dysfunction and anal incontinence symptoms among women with pelvic organ prolapse: 5-year retrospective study in a tertiary center. Arch Gynecol Obstet 2024; 309:2237-2245. [PMID: 38441602 DOI: 10.1007/s00404-024-07426-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/10/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To investigate the prevalence of DD and AI with POP symptoms in females attending a urogynecology clinic, and to identify factors associated with DD and AI in POP symptoms patients. METHODS Computer-based medical records of women with POP symptoms attending a urogynecology clinic in a referral tertiary center between January 2016 and December 2020 were reviewed. Demographic data were collected. Selected defecatory dysfunction (DD) and anal incontinence (AI) were recorded. The associations between patient characteristics, site and severity of prolapse, and DD and AI symptoms in POP patients were investigated for identified associated factors. RESULTS The mean age of the 754 participants was 65.77 ± 9.44 years. Seven hundred and fifteen (94.83%) were menopause. The prevalence of DD and AI in patients with POP symptoms was 44.03% (332/754) and 42.04% (317/754) according to the PFBQ and medical history records, respectively. Advanced posterior wall prolapse (OR 1.59, 95% CI 1.10-2.30) and wider GH (OR1.23, 95% CI 1.05-1.43) were identified as risk factors for DD by multivariate analysis. Additionally, single-compartment prolapse (OR 0.4, 95% CI 0.21-0.76) and a stronger pelvic floor muscle assessed with brink score (OR 0.94, 95% CI 0.88-0.98) are protective factors for AI. CONCLUSION DD and AI are prevalent among women with POP symptoms who visit a urogynecology clinic. DD should be evaluated in women with POP symptoms especially in women with increased genital hiatus and point Ap beyond the hymen. To prevent AI, women with POP should be encouraged to perform pelvic floor muscle training in order to increase pelvic floor muscle strength.
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Affiliation(s)
- Apisith Saraluck
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
| | - Komkrit Aimjirakul
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Ng Jun Jiet
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
- Department of Obstetrics and Gynaecology, Kuala Lumpur Hospital, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Orawee Chinthakanan
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Peeranuch Mangmeesri
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Jittima Manonai
- Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Goni S, Matan R, Shanny S, Ilana SV, Adi YW. The effect of advanced age on peri- and post-operative complications following pelvic floor repair surgeries. Arch Gynecol Obstet 2024; 309:2247-2252. [PMID: 38503851 DOI: 10.1007/s00404-024-07437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To assess whether advanced age is a risk factor for complications following pelvic organ prolapse (POP) repair surgeries using the Clavien-Dindo classification system. METHODS In this retrospective cohort study, 260 women who had undergone POP repair surgery at the Soroka University Medical Center (SUMC) between the years 2014-2019 were included. A univariate analysis was conducted to compare the demographical, clinical, obstetrical and operative characteristics of patients by age group (younger or older than 70 years). We performed a similar analysis to assess for the possible association between several variables and post-operative complications. Variables that were found to be associated with post-operative complications (P < 0.2) were included in a multivariate analysis along with advanced age. RESULTS During the 12 months follow-up period, more than half of the women had experienced at least one post-operative complication. Minor complications (grades 1-2 according to the Clavian-Dindo classification system) were the most common. One woman had died during the follow-up period, and none had experienced organ failure (grade 4). Hysterectomy, as part of POP surgery, was found to be significantly associated with post-operative complications. Additionally, grandmultiparity (> 5 births) showed a tendency towards an increased risk for post-operative complications, however this reached only borderline significance. We found no association between advanced age and post-operative complications. CONCLUSIONS POP repair surgeries are safe for women of all ages. Major complications (grades 3-5) are rare in all age groups. Although advanced age was associated with a higher prevalence of comorbidity and a higher grade of prolapse, no significant difference in the post-operative complications was found between age groups. Concomitant hysterectomy at the time of POP repair surgery is a risk factor for post-operative complications.
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Affiliation(s)
- Shelef Goni
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Rotchild Matan
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Sade Shanny
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shoham Vardi Ilana
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Y Weintraub Adi
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Zhao H, Liu XN, Liu LN. Effect of structured pelvic floor muscle training on pelvic floor muscle contraction and treatment of pelvic organ prolapse in postpartum women: ultrasound and clinical evaluations. Arch Gynecol Obstet 2024; 309:2177-2182. [PMID: 37755534 DOI: 10.1007/s00404-023-07226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. METHODS Sixty patients who volunteered for a PFMT assessment at 6-8 weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). RESULTS Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. CONCLUSIONS Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women.
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Affiliation(s)
- Hui Zhao
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China
| | - Xiu-Ni Liu
- Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Lin-Na Liu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China.
- Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China.
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, 301 Yanchang Middle Road, Jing'an District, Shanghai, China.
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Kowalski JT, Maetzold E, Kenne KA, Bradley CS. Impact of Sling at Time of Prolapse Surgery on Overactive Bladder. Urogynecology (Phila) 2024; 30:420-424. [PMID: 37737833 PMCID: PMC10950836 DOI: 10.1097/spv.0000000000001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
IMPORTANCE Prolapse surgery and sling surgery both lead to improvement in overactive bladder. However, less is known regarding how slings performed concurrently with less is know about how overactive bladder symptoms change in patients having prolapse surgery with a sling compared to prolapse surgery without a sling. OBJECTIVE The primary aim was to compare change in postoperative overactive bladder symptoms in patients with preoperative overactive bladder who underwent sling placement versus no sling with prolapse surgery. STUDY DESIGN This was a secondary analysis of a cohort study evaluating overactive bladder in patients undergoing prolapse surgery. Sling procedures were performed concomitantly for treatment or prevention of stress incontinence. Baseline and 3-month follow-up urinary symptoms were assessed with the Overactive Bladder Questionnaire Short Form (OAB-q SF) and Urinary Distress Inventory-6 (UDI-6). RESULTS Of patients with overactive bladder, 26 (40.0%) underwent midurethral sling (MUS) placement and 39 (60.0%) no sling. Preoperative OAB-q SF bother (score [SD], 46.8 [20.2] vs 40.2 [22.1]; P = 0.23) was similar between groups, but UDI-6 scores (59.2 [28.8] vs 43.8 [29.1]; P = 0.04) were higher in the sling group. At 3 months, the change (improvement) in OABq-SF bother (-16.9 [24.1] vs -22.4 [23.0]; P = 0.36), OABq-SF health-related quality of life (22.8 [28.6] vs 22.9 [23.9]; P = 0.99), and UDI-6 (-38.8 [32.9] vs -34.0 [27.8]; P = 0.53) were similar in the MUS and no MUS groups. CONCLUSION Patients with prolapse and overactive bladder undergoing prolapse surgery with a sling had similar improvements in OAB-q SF bother scores compared with those who did not have a sling.
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Affiliation(s)
- Joseph T Kowalski
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, IA
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Soda T, Kiuchi H, Koida Y, Imanaka T, Oida T, Matsuoka Y, Sekii K. Transvaginal Polytetrafluoroethylene Mesh Surgery for Pelvic Organ Prolapse: One-Year Safety and Efficacy Results. Urology 2024; 186:131-138. [PMID: 38367711 DOI: 10.1016/j.urology.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of the polytetrafluoroethylene (PTFE) mesh by comparing conventionally used polypropylene (PP) mesh in tension-free vaginal mesh (TVM) surgery for pelvic organ prolapse (POP). METHODS We conducted an observational cohort study of patients who underwent TVM using a PTFE or PP mesh. PTFE was used from June 2019 to May 2021, and PP mesh from January 2018 to May 2019. Outcomes included POP recurrence, perioperative complications, and patient satisfaction. Restricted mean survival time was used to analyze POP recurrence, comparing the time to recurrence between the two groups at 1year after TVM. RESULTS Of 171 patients, 104 underwent PP mesh placement (PP group) and 67 underwent PTFE mesh placement (PTFE group). POP recurrence was observed in 10 and nine patients in the PP and PTFE groups, respectively. The mean time until the recurrence in the PTFE group was significantly shorter than that in the PP group (restricted mean survival time difference: -20.3days; 95% CI, -40.1 to -0.5; P = .044). Subgroup analysis revealed the meantime until recurrence was significantly shorter in the PTFE group for postoperative periods 3months or less, ages >70years, and POP stage ≥3. There were no intervention cases in either group and no significant differences in the perioperative complications. Patient satisfaction was greater in the PTFE group after 3months postoperatively. CONCLUSION TVM surgery with a PTFE mesh is more prone to recurrence than that with a PP mesh, but with higher patient satisfaction. Within 3months of surgery, elderly patients and those with advanced-stage POP require care to prevent recurrence.
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Affiliation(s)
- Tetsuji Soda
- Department of Urology, Osaka Central Hospital, Osaka, Japan
| | - Hiroshi Kiuchi
- Department of Urology, Osaka Central Hospital, Osaka, Japan.
| | - Yohei Koida
- Department of Urology, Osaka Central Hospital, Osaka, Japan
| | - Takahiro Imanaka
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Oida
- Department of Urology, Suita Tokushukai Hospital, Suita, Japan
| | - Yasuhiro Matsuoka
- Department of Urology, Japan Community Health Organization Osaka Hospital, Osaka, Japan
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Chapman HL, Dholakia JJ, Marcrom S, Liang M, Richter HE. Treatment of Cervical Cancer Complicated by Advanced Pelvic Organ Prolapse: A Case Report. Urogynecology (Phila) 2024; 30:309-313. [PMID: 38484247 DOI: 10.1097/spv.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
ABSTRACT Concurrent cervical cancer with advanced pelvic organ prolapse is rare: there are no well-established treatment recommendations. It is hypothesized that chronic irritation, as with long-standing pelvic organ prolapse, may lead to dysplasia and human papillomavirus-independent carcinoma, which represents only 5% of cervical cancers. Two patients with complete uterine procidentia were referred to gynecologic oncology with cervical squamous cell carcinoma; both were clinically staged as International Federation of Gynaecology and Obstetrics IB3. Treatment planning was complicated by procidentia in both cases. Standard definitive treatment of locally advanced cervical cancer is radiation therapy and concurrent chemotherapy; however, the mobility and externalization of the target lesion raised concerns regarding anatomic reproducibility during radiation treatment. After multidisciplinary team discussion (gynecologic oncology, urogynecology, radiation oncology), surgical resection and co-management with gynecologic oncology and urogynecology were successfully performed for definitive management for both patients. Although rare, this case study demonstrates the importance of multidisciplinary coordination in these complex clinical scenarios.
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Affiliation(s)
| | | | - Samuel Marcrom
- Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Maggie Liang
- From the Departments of ∗Obstetrics and Gynecology
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Bai S, Lu C, Kong Q, Shen Z, Li R, Xiao Z. Establishing a Rat Model of Pelvic Organ Prolapse with All Compartment Defects by Persistent Cervical Tension. Int Urogynecol J 2024; 35:615-625. [PMID: 38265454 PMCID: PMC11024045 DOI: 10.1007/s00192-024-05734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized that applying cervical suction and persistent tension can develop a novel and efficient rat model of pelvic organ prolapse. METHODS Fifteen rats underwent pilot testing to optimize the protocol. Sixteen rats were subjected to pelvic organ prolapse induction by cervical suction and constant traction, while five rats served as controls. The pelvic organ prolapse rats were assessed by a Rat Pelvic Organ Prolapse Quantification system at different time points, and their diet, urine, and stool were monitored for 21 days. The pelvic organ prolapse rats were also evaluated for urinary incontinence, urinary retention, leak point pressure, and vaginal histopathology at 21 days after operation. RESULTS This rat model demonstrated pelvic floor prolapse in anatomic level, as well as physiological variations (urine incontinence, urinary retention) and pathological changes (collagen fracture, decreased collagen density). CONCLUSIONS This is the first establishment of the pelvic organ prolapse rat model with all compartment defects, which provides a valuable tool for elucidating pelvic organ prolapse mechanisms and evaluating potential interventions.
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Affiliation(s)
- Siqi Bai
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Chenxi Lu
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Qingyu Kong
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Zhuowei Shen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Rui Li
- Department of Physics, Dalian University of Technology, Dalian, China.
| | - Zhen Xiao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.
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Nahshon C, Karmakar D, Abramov Y, Kugelman N, Lavie O, Zilberlicht A. Risk factors for pelvic organ prolapse recurrence following colpocleisis: A meta-analysis. Int J Gynaecol Obstet 2024; 164:848-856. [PMID: 37488940 DOI: 10.1002/ijgo.14999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Studies aimed to assess risk factors for pelvic organ prolapse (POP) recurrence following colpocleisis with nonconclusive results. OBJECTIVE To investigate risk factors for POP recurrence following colpocleisis. SEARCH STRATEGY MEDLINE, PUBMED, Embase, Web of Science, and Cochrane databases were systematically searched. SELECTION CRITERIA Experimental and non-experimental studies investigating POP recurrence following colpocleisis. DATA COLLECTION AND ANALYSIS We assessed the association between preoperative and postoperative physical examination findings, demographics and medical history, and the risk of recurrence following colpocleisis. MAIN RESULTS A total of 954 studies were identified, of which five studies comprising 2978 patients were eligible for analysis. Both preoperative and postoperative genital hiatus length were significantly longer in the recurrence group (mean difference [MD] 0.48, 95% confidence interval [CI] 0.01-0.94, P = 0.04, I2 = 0% and MD 1.15, 95% CI 0.50-1.81, P = 0.005, I2 = 0%; respectively). Preoperative total vaginal length (TVL) did not differ between groups (MD 0.05, 95% CI -0.40 to 0.50, P = 0.83, I2 = 6%), postoperative TVL was found significantly longer in the recurrence group (MD 0.07, 95% CI -0.03 to 1.38, P = 0.04, I2 = 68%). Both preoperative and postoperative perineal body did not differ between groups. Women with a previous POP surgery were more likely to experience recurrence following colpocleisis (relative risk 2.09, 95% CI 1.18-3.69, P = 0.01, I2 = 0%). Patient's age and previous hysterectomy did not affect recurrence rates. CONCLUSION Wider preoperative and postoperative genital hiatus as well as longer post-operative TVL and previous POP surgery were associated with a higher risk for recurrence following colpocleisis, highlighting the importance of appropriate patient selection and surgical technique in minimizing this risk.
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Affiliation(s)
- Chen Nahshon
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Yoram Abramov
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Kugelman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Martínez-Galiano JM, Peinado-Molina RA, Martínez-Vazquez S, Hita-Contreras F, Delgado-Rodríguez M, Hernández-Martínez A. Influence of pelvic floor disorders on sexuality in women. Int J Gynaecol Obstet 2024; 164:1141-1150. [PMID: 37830235 DOI: 10.1002/ijgo.15189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To determine the association between different pelvic floor disorders and the presence of sexual dysfunction in women. METHOD An observational study of non-pregnant women was carried out in Spain in 2021 and 2022. To assess the presence of pelvic floor problems, the Pelvic Floor Distress Inventory (PFDI-20) was used, consisting of the subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6; prolapse symptoms), Colorectal-Anal Distress Inventory (CRADI-8; colorectal symptoms), and Urinary Distress Inventory-6 (UDI-6; urinary symptoms). The validated tool, Female Sexual Function (FSF), was used to evaluate female sexual function. RESULTS In total, 1008 women participated. Of these, 288 (28.6%) had some type of sexual dysfunction. Regarding symptoms, 52 (5.2%) stated that they do not reach orgasm and 172 (17.1%) said they had never or occasionally felt sexual desire in the last month. Women with sexual dysfunctions had higher mean scores on the POPDI-6, CRADI-8, and UDI-6 subscales than those who did not have sexual dysfunction (P ≤ 0.005). Risk factors identified included being postmenopausal, with an adjusted odds ratio (aOR) of 2.98 (95% confidence interval [CI] 2.12-4.18), and a greater impact of the symptoms of pelvic floor problems as assessed by the PFDI-20 scale, in such a way that for each point increase the probability of sexual dysfunction increases with an aOR of 1.008 (95% CI 1.005-1.011). CONCLUSION Women with pelvic floor disorders and postmenopausal women present sexual dysfunction more frequently.
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Affiliation(s)
- Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, Jaen, Spain
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
| | | | | | | | - Miguel Delgado-Rodríguez
- Consortium for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Health Sciences, University of Jaen, Jaen, Spain
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
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Rahman S, Wang SM, Ling Y, Cheng Y, Chappell NP, Carter-Brooks CM. Short-Term Outcomes After Hysterectomy for Endometrial Cancer/EIN With Concomitant Pelvic Floor Disorder Surgery. Urogynecology (Phila) 2024; 30:223-232. [PMID: 38484235 DOI: 10.1097/spv.0000000000001455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Endometrial cancer and precancer are common gynecologic problems for many women. A majority of these patients require surgery as the mainstay of treatment. Many of these patients often have concurrent pelvic floor disorders. Despite the prevalence and shared risk, fewer than 3% of women undergo concomitant surgery for PFDs at the time of surgery for endometrial cancer or endometrial intraepithelial neoplasia/hyperplasia. OBJECTIVE This study aimed to evaluate postoperative morbidity of concomitant pelvic organ prolapse (POP) and/or urinary incontinence (UI) procedures at the time of hysterectomy for endometrial cancer (EC) or endometrial intraepithelial neoplasia/endometrial hyperplasia (EIN/EH). METHODS This retrospective analysis of women undergoing hysterectomy for EC or EIN/EH between 2017 and 2022 used the American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome was any major complication within 30 days of surgery. Comparisons were made between 2 cohorts: hysterectomy with concomitant pelvic organ prolapse/urinary incontinence procedures (POPUI) versus hysterectomy without concomitant POP or UI procedures (HYSTAlone). A subgroup analysis was performed in patients with EC. A propensity score matching cohort was also created. RESULTS A total of 23,144 patients underwent hysterectomy for EC or EIN/EH: 1.9% (n = 432) had POP and/or UI procedures. Patients with POPUI were older, were predominantly White, had higher parity, and had lower body mass index with lower American Society of Anesthesiologists class. Patients with POPUI were less likely to have EC (65.7% vs 78.3%, P < 0.0001) and more likely to have their hysterectomy performed by a general obstetrician- gynecologists or urogynecologists. Major complications were low and not significantly different between POPUI and HYSTAlone (3.7% vs 3.6%, P = 0.094). A subgroup analysis of EC alone found that the HYSTAlone subset did not have more advanced cancers, yet the surgeon was more likely a gynecologic oncologist (87.1% vs 68.0%, P < 0.0001). There were no statistically significant differences between the 2 cohorts for the primary and secondary outcomes using propensity score matching analysis. CONCLUSIONS Concomitant prolapse and/or incontinence procedures were uncommon and did not increase the rate of 30-day major complications for women undergoing hysterectomy for EC/EH.
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Affiliation(s)
| | | | | | | | | | - Charelle M Carter-Brooks
- Department of Obstetrics and Gynecology, Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC
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Wang Q, Lin H, Wu N, Li Y, Zhao R, Xu Y, Lin C. Outcomes of a novel modified total colpocleisis for advanced pelvic organ prolapse in elderly women and its efficacy on lower urinary tract symptoms. Int J Gynaecol Obstet 2024; 164:1132-1140. [PMID: 37776064 DOI: 10.1002/ijgo.15161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of modified total colpocleisis for advanced pelvic organ prolapse (POP) in elderly women and to assess the improvement in lower urinary tract symptoms (LUTS) of the patients. METHODS An observational cohort study was conducted, including 105 POP patients who underwent modified total colpocleisis between April 2020 and December 2022. The study analyzed the patients' demographic characteristics, perioperative outcomes, and follow-up outcomes, including complications, remission of LUTS, satisfaction rates, and regret rates. Confirming the safety, durability, and patient satisfaction of modified total colpocleisis. RESULTS Most patients (95/105, 90.5%) had more than one comorbidity. Eighty-six (81.9%) had a concomitant hysterectomy, the average operative time was 112.78 ± 34.92 min, with a median estimated bleeding of 50 mL (10-300 mL). Perioperative changes in hemoglobin and hematocrit were 11.64 ± 10.03 g/L and 3.87% ± 3.05%, respectively. Urinary retention was the most common complication (10/105, 9.5%). With a median follow up of 16 months (3-35 months), 101 patients (96.2%) reported satisfaction with the results of the procedure, with none reporting regret. Both subjective and anatomical recurrence rates were quite low (2.9% and 5.7%, respectively). Twenty-three (21.9%) had de novo urinary incontinence, and the remaining LUTS such as frequent, urgent, hesitation, and difficulty emptying were significantly improved (P < 0.05). CONCLUSION Modified total colpocleisis is an effective treatment option for elderly women with severe POP. This procedure can significantly improve several LUTS, and most de novo incontinence is mild and has a limited impact on patients' quality of life.
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Affiliation(s)
- Qi Wang
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Hongbiao Lin
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Nengxiu Wu
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ying Li
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Rong Zhao
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ying Xu
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Chaoqin Lin
- Department of Gynecology, Fujian Provincial Key Laboratory of Women and Children's Critical Diseases Research, Fujian Province Key Clinical Specialty for Gynecology, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Malekzadeh M, Ramirez-Caban L, Garcia-Ruiz N, Ossin DA, Hurtado EA. Effect of age in women undergoing laparoscopic sacrocolpopexy: A retrospective study. Int J Gynaecol Obstet 2024; 164:1117-1124. [PMID: 37794775 DOI: 10.1002/ijgo.15164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To determine whether elderly women (≥65 years) have an increased risk of complications and lower success when undergoing laparoscopic sacrocolpopexy (LSC) compared with younger women (<65 years). METHODS This was a retrospective study of all LSC procedures performed from August 2014 to February 2021 by a single urogynecologic surgeon in an academic affiliated hospital system. Charts were identified through procedure codes. Patient demographics, clinical, surgical, and postoperative data were collected. The primary outcome of this study was to compare complications associated with LSC, including intraoperative and postoperative complications. Secondary outcomes included subjective, objective, and composite success. RESULTS In total, 312 participants met the criteria. The mean age of the group who were younger than 65 years was 55.7 years (±6.5) and of the group aged 65 years or older was 69.3 years (±3.5). Racial demographics revealed no differences between the two groups. Patients aged 65 years or older had a statistically significant lower body mass index (calculated as weight in kilograms divided by the square of height in meters), a higher rate of hypertension, smaller genital hiatus, and a larger anterior vaginal wall prolapse compared with the younger cohort. They also less often underwent a posterior repair. No statistically significant differences were found with regards to intraoperative and postoperative complications, including 30-day re-admission, between the two age groups. Both groups had high anatomic success rates, with no significant difference (<65 = 96.3%; ≥65 = 98.4%; P = 0.326). Those aged younger than 65 years compared with those aged 65 years or older had lower subjective success that was not significantly different (<65 = 62.8%; ≥65 = 71.0; P = 0.134). Composite success was noted to reach the threshold of a statistically significant difference in the group aged younger than 65 years compared with those aged 65 years or older (60.1% vs 71.0%; P = 0.0499). CONCLUSION In this study, elderly patients did not have increased intraoperative and postoperative complications after undergoing LSC. Similar rates of anatomic and subjective success were also found with younger patients having a lower composite success. Proper candidates for LSC should not be excluded based upon age.
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Affiliation(s)
| | | | - Nuria Garcia-Ruiz
- Department of Gynecology, Stanford Medicine, Pleasanton, California, USA
| | - David A Ossin
- Department of Gynecology, HCA Florida Women's Health Group, Orlando, Florida, USA
| | - Eric A Hurtado
- Department of Gynecology, Cleveland Clinic Florida, Weston, Florida, USA
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Donaldson K, Meilan J, Rivers T, Rutherford K, Shine K, Manríquez V, Digesu GA, Edenfield A, Swift S. The Incidence of Pelvic and Low Back Pain in Patients with Pelvic Organ Prolapse. Int Urogynecol J 2024; 35:609-613. [PMID: 38265453 DOI: 10.1007/s00192-024-05732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS To define the prevalence and incidence of pelvic/low back pain in patients with pelvic organ prolapse (POP). METHODS Patients presenting for POP to three urogynecology centers in the US, UK, and Chile were enrolled in an IRB-approved cross-sectional study assessing pain, GU, GI and sexual function symptoms. For prevalence, symptoms were noted as present if the participant recorded the symptom and reported the degree of bother as "somewhat," "a moderate amount," or "a lot." For incidence, participants were queried if the symptom's onset concurred with the POP. We also queried if they perceived the symptom was worsened by their POP. RESULTS Two hundred five participants were recruited: 100 from the US, 46 from the UK, and 59 from Chile. One US participant was excluded due a missing examination. The prevalence of pelvic pain was 42%. Seventy-three percent of these participants reported the onset of pelvic pain coinciding with prolapse onset, and 81% endorsed worsening pelvic pain with POP. The prevalence of low back pain was 46%, with 30% reporting the onset coincided with the onset of POP and 44% responded that prolapse worsened their pain. CONCLUSION A higher proportion of participants than expected endorsed pelvic/low back pain. Among patients with pelvic pain, the majority experienced symptom onset with POP onset and a worsening of pain with POP. While roughly half of participants reported low back pain; a minority correlated this to their POP. These findings highlight a high incidence of pelvic pain, challenging the perception of POP as a painless condition.
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Affiliation(s)
- Katelyn Donaldson
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S, 176F Suite 10382, Birmingham, AL, 35233, USA.
| | - Julia Meilan
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Tiquez Rivers
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly Rutherford
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Kayla Shine
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Valentín Manríquez
- Division of Urogynecology, Department Obstetrics and Gynecology, Hospital Clínico Universidad de Chile (HCUCH, Santiago, Chile
| | | | - Autumn Edenfield
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Steven Swift
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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Lo TS, Harun F, Alzabedi A, Chiung HK, Jhang LS, Hsieh WC. Voiding Dysfunction in Patients With Advanced Pelvic Organ Prolapse and Bladder Outlet Obstruction Following Pelvic Reconstructive Surgery: Urodynamic Profile and Predictive Risk Factors. J Minim Invasive Gynecol 2024; 31:102-109. [PMID: 37952873 DOI: 10.1016/j.jmig.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/22/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
STUDY OBJECTIVE To determine the outcome of voiding function 1 year after pelvic reconstructive surgery (PRS) in women with bladder outlet obstruction (BOO). DESIGN Retrospective cohort study. SETTING Tertiary referral hospital. PATIENTS A total of 1894 women underwent PRS for advanced pelvic organ prolapse (POP) stages 3 to 4 with urodynamic findings of BOO. INTERVENTIONS PRS. MEASUREMENTS The primary outcome measured was the resumption of normal voiding function, defined clinically with multichannel urodynamic testing at 1 year postoperatively. The secondary outcomes were to identify the different risk factors for persistence voiding dysfunction (VD) 1 year after PRS. MAIN RESULTS A total of 431 women with Pelvic Organ Prolapse Quantification stages 3 and 4, urodynamic study of maximum urinary flow rate ≤15 mL/s, and detrusor pressure at maximum flow ≥20 cm H2O were included. Resumption of normal voiding function was found in 91% (n = 392 of 431), whereas 9% (n = 39 of 431) remained to have VD 1 year postoperatively. Those with persistent VD, 20.5% (n = 8 of 39) remained having urodynamic diagnosis of BOO. Univariate and multivariate logistic regression revealed factors associated with postoperative VD were pre-operative maximal cystometric capacity ≥500 mL and postvoid residual volume ≥200 mL. CONCLUSION VD may persist in women with BOO after PRS, particularly in those with preoperative maximal cystometric capacity of >500 mL and postvoid residual volume >200 mL.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan (Dr. Lo); Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan (Dr. Lo); Chang Gung University, School of Medicine, Taoyuan, Taiwan (Dr. Lo).
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah) Kuala Lumpur, Malaysia, (Dr. Harun)
| | - Aisha Alzabedi
- Women Health Center, International Medical Center Hospital, Jeddah, Saudi Arabia (Dr. Alzabedi)
| | - Huan-Ka Chiung
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
| | - Lan-Sin Jhang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (Drs. Lo, Chiung, Jhang, and Hsieh)
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Xie X, Shen J. Analysis of Risk Factors of Pelvic Organ Prolapse in Postmenopausal Women and Construction of Prediction Model. Altern Ther Health Med 2024; 30:265-269. [PMID: 37793331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background The incidence of Pelvic organ prolapse (POP) was as high as 50% in women, with the main symptoms of vaginal tissue prolapse, accompanied by urination, defecation, and sexual dysfunction, which affected patients' quality of life. POP is more prominent in postmenopausal women due to various factors. By constructing a model, we predict POP and expect to reduce the incidence of POP. Objective To explore the risk factors for POP in postmenopausal women and develop a predictive model that can identify high-risk individuals early so that targeted preventive measures can be taken to reduce the burden of POP. Methods Using retrospective studies, 290 menopausal women treated in the Department of Gynecology of the Ninth People's Hospital of Suzhou from January 2019 to December 2022 were selected as the study subjects. Women with menopause were divided into the POP group (62 cases) and a non-POP group (228 cases) according to whether or not POP occurred. Single factor analysis was performed on the two data groups. The risk factors of POP in menopausal women were screened by multivariate logistic regression analysis. Based on the screening results, a graph prediction model expressed as a nomogram is constructed. The model's effectiveness was analyzed by the goodness of fit test and receiver operating characteristic curve (ROC) curve. The decision curve was used to analyze the clinical effectiveness of the model. Results Multifactor logistic regression analysis showed that Older age (OR = 2.309, P = .007), more childbirth frequency (OR = 3.121, P = .002), low expression of estradiol (E2) (OR = 1.499, P = .023), low expression of serum 25-hydroxyvitamin D3[25-(OH)D3] (OR = 2.073, P = .011), and lower blood calcium (OR = 21.677, P = .014) were all risk factors for POP in menopausal women. Based on the above indicators, a risk prediction model is constructed. The model has been proved to have good recognition ability, areas under curve (AUC) = 0.887 (95%CI: 0.845-0.926), The best cutoff value is 0.37, The sensitivity and specificity were 0.885 and 0.840, respectively; The goodness of fit test showed that the predicted value of the model had no statistical significance with the actual value. The threshold probability is in the range of 1%~99%. The net benefit of menopausal women is higher than the other two extreme curves. It shows that the model is clinically effective. Conclusion Age, times of delivery, E2, 25-(OH)D3, and blood calcium are related to POP in menopausal women. A nomogram model based on these 5 indicators can effectively assess the risk of POP in postmenopausal women. The clinician can use this column chart to calculate the risk of POP occurrence for each patient and make clinical recommendations accordingly.
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Hegde A, Huebner M, Ibrahim S, Mastrolia SA, David-Montefiore E, Weintraub AY. Impact of childbirth on pelvic floor dysfunction in women who have undergone previous pelvic floor reconstructive surgery: systematic review and meta-analysis. Int Urogynecol J 2024; 35:3-17. [PMID: 37796329 DOI: 10.1007/s00192-023-05630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/27/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling. METHODS PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case-control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3. RESULTS Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures. CONCLUSION Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD.
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Affiliation(s)
- Aparna Hegde
- Department of Urogynecology, Cama Hospital, Grant Medical College, Mumbai, India.
| | - Markus Huebner
- Department of Obstetrics and Gynecology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Ntakwinja M, Werth A, Borazjani A, Iglesia C, Williams KJ, Mukwege D. Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo. Int Urogynecol J 2024; 35:103-108. [PMID: 37897521 DOI: 10.1007/s00192-023-05670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC. METHODS We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages. RESULTS A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment. CONCLUSIONS This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP.
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Affiliation(s)
- Mukanire Ntakwinja
- Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
| | - Adrienne Werth
- Global Innovations for Reproductive Health & Life, Chicago, IL, USA.
- Hartford Healthcare, Hartford, CT, USA.
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Chicago, IL, USA
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cheryl Iglesia
- Departments of Obstetrics & Gynecology and Urology, MedStar Heath, Georgetown University School of Medicine, Washington, DC, USA
| | | | - Denis Mukwege
- Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
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Lourenço DB, Santos HOD, Hirakawa EY, Rios LAS, Lemos GC, Bianco B, Carneiro A. Does vaginal surgery for correction of pelvic organ prolapse improve urinary function? A prospective cohort study. Int Urogynecol J 2024; 35:149-156. [PMID: 37999760 DOI: 10.1007/s00192-023-05683-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is caused by an imbalance in the stability of the pelvic organs, resulting in loss of support. The most common types of POP, anterior and apical, are associated with lower urinary tract symptoms (LUTS) such as bladder outlet obstruction and detrusor overactivity (DO). Vaginal surgery may improve LUTS and overall urinary symptoms. We assessed urodynamic (UD) parameters and urinary symptoms before and after vaginal surgery for POP correction. METHODS A prospective cohort of 59 women with symptomatic anterior and/or apical POP associated with urinary symptoms and with indications for vaginal surgery were included. POP surgeries included anterior colporrhaphy and vaginal hysterectomy with culdoplasty (VH) and with/without concomitant posterior colporrhaphy and mid-urethral sling (MUS). All participants underwent UD evaluation and answered urinary symptom questionnaires pre- and 3 months post-surgery. RESULTS Anterior colporrhaphy was performed in all patients: 45.7% with associated VH and 54.2% with concomitant MUS. Preoperative ICIQ-OAB score >8 points was significantly associated with DO (p<0.02) and decreased after surgery (9±4.3 to 3.2±3.0, p<0.001). All other questionnaires demonstrated improvements in urinary symptoms. Stress urinary incontinence rate decreased from 59.6% to 21% (p<0.001). Post-void residual (PVR) volume and Valsalva maneuver also decreased (p<0.001). CONCLUSIONS Pelvic organ prolapse surgery reduced the prevalence of urgency symptoms, and all questionnaires on urinary symptoms showed clinically significant improvement. Vaginal surgery for POP, even combined with MUS, significantly reduced PVR volume and improved urgency symptoms.
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Affiliation(s)
- Danilo B Lourenço
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Hugo O D Santos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Elizabeth Y Hirakawa
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Luis Augusto S Rios
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Gustavo C Lemos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Bianca Bianco
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil.
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, Sao Paulo, SP, CEP 05652-900, Brazil
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Watanabe S, Kinno K, Takeuchi Y, Sawada Y, Sekido N. Association between voiding lower urinary tract symptoms and findings on dynamic magnetic resonance imaging with regard to pelvic organs and their supportive structures. Low Urin Tract Symptoms 2024; 16:e12506. [PMID: 37866821 DOI: 10.1111/luts.12506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Pelvic organ prolapse (POP) causes voiding lower urinary tract symptoms (vLUTS). In the present study, we investigated the association between vLUTS and pelvic organ mobility (POM), including relevant supportive structures, on dynamic magnetic resonance imaging (dMRI). METHODS We included 118 patients who had POP of stage II or less before straining and stage III or more when straining during dMRI. The presence of vLUTS and overactive bladder (OAB) was determined by a voiding subscore of the International Prostate Symptom Score (vIPSS) ≥5 and the OAB symptom score, respectively. POM was measured by dMRI before and during straining, and patients with and without vLUTS as well as patients with and without vLUTS and/or OAB were compared. p < .05 was considered to be statistically significant. RESULTS According to vIPSS, 42 patients (35.6%) had vLUTS. On dMRI, patients with vLUTS showed a significantly more ventral position and/or movement of the bladder and cervix. Moreover, patients with vLUTS and OAB had significantly more ventral movement of the uterine cervix and a larger strain on imaginary uterosacral and cardinal ligaments than those without these symptoms. In addition, patients with vLUTS and OAB had significantly higher vIPSS than those with vLUTS alone. CONCLUSIONS vLUTS may be associated with the proximity of the bladder and cervix to the pubic bone and consequent compression of the urethra by the prolapsed organs. vLUTS with OAB might indicate more advanced lower urinary tract dysfunction than vLUTS alone.
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Affiliation(s)
- Shoutarou Watanabe
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - Kurenai Kinno
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
- Department of Urology, Yotsuya Medical Cube, Chiyoda City, Tokyo, Japan
| | - Yasuharu Takeuchi
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - Yoshitomo Sawada
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Meguro City, Tokyo, Japan
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Chang CH, Su TH, Lau HH. The changes in bladder function and symptoms after robot-assisted sacrocolpopexy and transvaginal mesh surgery for pelvic organ prolapse. Taiwan J Obstet Gynecol 2024; 63:68-72. [PMID: 38216272 DOI: 10.1016/j.tjog.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This study is aimed to compare the impact on bladder function and symptoms between robotic sacrocolpopexy (RSC) and transvaginal mesh surgery (TVM) in women with pelvic organ prolapse. MATERIALS AND METHODS This prospective controlled study enrolled patients who received RSC or TVM at our hospital between March 2020 and June 2022. We compared preoperative and postoperative bladder function between two groups by using a questionnaire of lower urinary tract symptom (LUTs) for subjective assessment and urodynamic study for objective assessment. RESULTS A total of 60 patients were enrolled, of whom 30 received RSC and 30 received TVM. In LUTs analysis, the RSC group had a higher risk of de novo stress urinary incontinence than the TVM group (33.3% vs. 3.3%, p = .007). Urodynamic studies showed that both groups had a deterioration in maximal urethral closure pressure postoperatively (RSC: 56.9 ± 17.1 vs. 44.2 ± 15.5 cmH2O; and TVM: 61.2 ± 29.4 vs. 47.6 ± 19.7 cmH2O, p < .01 and p = .03, respectively). The incidence of urodynamic stress incontinence was also significantly increased after RSC (33.3% vs. 76.7%, p = .01). The de novo urodynamic stress incontinence rate was 46.7% after RSC, which was not significantly different to the TVM group (26.7%, p = .16). In the TVM group, the incidence of voiding difficulty decreased after surgery (43.3% vs. 10.0%, p < .01), and urodynamic measurements revealed that the prevalence of urine retention decreased (43.3% vs. 16.7%, p < .01). In the RSC group, the incidence of incomplete emptying sensation decreased (36.7% vs. 13.3%, p = .04), and urodynamic measurements showed that none of the patients had bladder outlet obstruction, underactive detrusor, or urine retention after surgery. CONCLUSION RSC and TVM are both beneficial to improve voiding function in women with pelvic organ prolapse. However, a deterioration in urethral function was observed and the de novo SUI rate was higher in the RSC group than in the TVM group.
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Affiliation(s)
- Chia-Hua Chang
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Hsien Su
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Hui-Hsuan Lau
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
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Glass Clark S, Bretschneider CE, Bradley MS, Rhodes S, Shoag J, Sheyn D. Risk of postoperative mesh exposure following sacrocolpopexy with supracervical versus total concomitant laparoscopic hysterectomy. Int Urogynecol J 2024; 35:207-213. [PMID: 38060029 DOI: 10.1007/s00192-023-05658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/14/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The primary objective was to compare rates of mesh exposure in women undergoing minimally invasive sacrocolpopexy with concurrent supracervical vs total hysterectomy. We hypothesized there would be a lower risk of mesh exposure for supracervical hysterectomy. METHODS This was a retrospective cohort study using the Premier Healthcare Database. Women undergoing sacrocolpopexy with supracervical or total hysterectomy between 2010 and 2018 were identified using Current Procedural (CPT) codes. Complications were identified using CPT and diagnosis codes; reoperations were identified using CPT codes. Mesh exposures were measured over a 2-year period. A multivariable logistic regression was performed with a priori defined predictors of mesh exposure. RESULTS This study includes 17,111 women who underwent minimally invasive sacrocolpopexy with concomitant supracervical or total hysterectomy (6708 (39%) vs 10,403 (61%)). Women who underwent supracervical hysterectomy were older (age 60 ± 11 vs 53 ± 13, p < 0.01) and less likely to be obese (4% vs 7%, p < 0.01). Postoperative mesh exposures within 2 years were similar (supracervical n = 47, 0.7% vs total n = 65, 0.62%, p = 0.61). On logistic regression, obesity significantly reduced the odds of mesh exposure (OR 0.2, 95% CI 0.01, 0.8); concomitant slings increased odds (OR 1.91, 95% CI 1.28, 2.83). Supracervical hysterectomy was associated with higher rates of port site hernias (1.3% vs 0.65%, p < 0.01), but lower surgical site infections within 3 months (0.81% vs 1.2%, p = 0.03). Reoperation for recurrent prolapse within 24 months was similar (supracervical n = 94, 1.4% vs total n = 150, 1.4%, p = 0.88). CONCLUSIONS Postoperative mesh exposure rates do not significantly differ based on type of concomitant hysterectomy in this dataset.
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Affiliation(s)
- Stephanie Glass Clark
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA.
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Megan S Bradley
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals, Cleveland, OH, USA
| | - Jonathan Shoag
- Division of Urologic Oncology, Urology Institute, University Hospitals, Cleveland, OH, USA
| | - David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, OH, USA
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Vermeulen CKM, Tunnissen W, Coolen ALWM, Veen J, Dietz V, van Leijsen SAL, Bongers MY. Central Sensitisation Syndrome: A Frequent Finding in Women with Pelvic Floor Symptoms Without Evident Urogenital Prolapse. Int Urogynecol J 2024; 35:227-236. [PMID: 38165443 DOI: 10.1007/s00192-023-05697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Women with central sensitisation syndrome (CSS) experience poorer subjective post-operative outcomes even after successful pelvic floor reconstruction. This study tests the hypothesis that women with pelvic floor symptoms (PFS) without relevant pelvic organ prolapse (POP), are more likely to have CSS. METHODS A questionnaire was sent to women who participated in the POP-UP study in 2017. The POP-UP study evaluated POP in 247 women 16 years after laparoscopic or vaginal hysterectomy. POP-Q data and Pelvic Floor Distress Inventory (PFDI-20) results were used and supplemented with CSS-specific questionnaires. A Central Sensitisation Inventory (CSI) score above 40 implicates CSS. Women were divided into groups based on POP beyond the hymen in relation to the PFDI-20 score. Outcomes of women with PFS and without POP (called 'group 1') were compared with the rest of the cohort (groups 2-4; women without PFS and/or with POP). RESULTS A total of 136 women were included in the analysis. A CSI score above 40 was present in 16 out of 42 women of group 1 (37%) versus 11 out of 93 women of groups 2-4 (12%), p < 0.0001. Passive coping was more prevalent in group 1 (p = 0.039), and more deviations in somatisation, depression, anxiety and distress were found in group 1 (p values of < 0.0001, 0.018, 0.003 and 0.002 respectively). CONCLUSIONS This study suggests that CSS might be more prevalent in women with PFS without relevant POP. More awareness of CSS and valid individual counselling may overcome unnecessary surgery for POP and help in setting realistic expectations.
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Affiliation(s)
- Carolien K M Vermeulen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands.
- GROW, Research School of Oncology and Reproduction, University of Maastricht, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Willemijn Tunnissen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynecology and Obstetrics, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, The Netherlands
| | - Joggem Veen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Viviane Dietz
- Department of Gynecology and Obstetrics, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Sanne A L van Leijsen
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
| | - Marlies Y Bongers
- Department of Gynecology and Obstetrics, Máxima Medical Centre, De Run 4600, 5500 MB, Veldhoven, The Netherlands
- GROW, Research School of Oncology and Reproduction, University of Maastricht, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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Liedl B, Barba M, Wenk M. [Pelvic floor reconstruction-update 2024: prolapse-associated symptoms and their treatment]. Urologie 2024; 63:43-50. [PMID: 38153429 DOI: 10.1007/s00120-023-02247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
Pelvic organ prolapse (POP) and associated symptoms of urinary incontinence, fecal incontinence, obstructive micturition, defecation, and pain are frequent and a widespread disease with relevant reduction of quality of life and high costs. New insights into functional anatomy and pathophysiology of these pelvic floor dysfunctions let us recognize how ligamentous laxities/defects lead to these dysfunctions. Results of the PROpel study (ClinicalTrials.gov-Identifier: NCT00638235) are shown in which a detailed observation of symptoms (patient-related outcome measures) pre- and postoperatively was performed. Ligamentous vaginal repair of POP enables symptom cure in high percentages for urinary urge incontinence (up to 82%), nocturia (up to 92%), obstructive micturition (up to 87%), fecal incontinence (58-72%), obstructive defecation (71-84%), and pain (53-90%), if caused by POP. Women with POP‑Q stage 2 have similar symptom frequencies as women with POP‑Q stage 3-4, and also similar cure rates of their symptoms. If good anatomical prolapse repair (in responders) was achieved, the cure rates for obstructive micturition, urinary urgency incontinence, and nocturia were significantly higher than in those women with less effective surgical repair. In the future, pelvic floor surgery should have symptom cure as the primary objective and should lead to improved quality of life. The different, currently performed techniques for POP repair have to be investigated concerning this matter.
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Affiliation(s)
- B Liedl
- Zentrum für Rekonstruktive Urogenitalchirurgie, Urologische Klinik München-Planegg, Germeringer Str. 32, 82152, München-Planegg, Deutschland.
| | - M Barba
- Abteilung für Urologie, Kreiskrankenhaus Ebersberg, akad. Lehrkrankenhaus der technischen Universität München, Klinikum rechts der Isar, München, Deutschland
| | - M Wenk
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Deutschland
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Russell R, Rhodes S, Gupta A, Bretschneider CE, Ferrando CA, Hijaz A, Shoag J, Sheyn D. Comparison of Morbidity and Retreatment After Urethral Bulking or Midurethral Sling at the Time of Pelvic Organ Prolapse Repair. Obstet Gynecol 2023; 142:1468-1476. [PMID: 37917942 DOI: 10.1097/aog.0000000000005427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/11/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To compare postprocedure retreatment rates for stress incontinence in patients who underwent either midurethral sling or urethral bulking at the time of concomitant repair of pelvic organ prolapse (POP). METHODS This was a retrospective cohort study using data from the Premier Healthcare Database. Using Current Procedural Terminology codes, we identified patients who were undergoing POP repair and concomitant urethral bulking or midurethral sling between the years 2001 and 2018. Patients who underwent concomitant nongynecologic surgery, Burch urethropexy, or oncologic surgery, and those who did not undergo concomitant POP and anti-incontinence surgery, were excluded. Additional data collected included patient demographics, hospital characteristics, surgeon volume, and comorbidities. The primary outcome was a repeat anti-incontinence procedure at 2 years, and the secondary outcome was the composite complication rate. RESULTS Over the study period, 540 (0.59%) patients underwent urethral bulking, and 91,005 (99.41%) patients underwent midurethral sling. The rate of a second procedure within 2 years was higher for urethral bulking, compared with midurethral sling (9.07% vs 1.11%, P <.001); in the urethral bulking group, 4.81% underwent repeat urethral bulking and 4.81% underwent midurethral sling. In the midurethral sling group, 0.77% underwent repeat midurethral sling and 0.36% underwent urethral bulking. After adjusting for confounders, midurethral sling was associated with a decreased odds of a repeat anti-incontinence procedure at 2 years (adjusted odds ratio 0.11, 95% CI 0.08-0.16). The probability of any complication at 2 years was higher with urethral bulking (23.0% vs 15.0%, P <.001). CONCLUSION Urethral bulking at the time of POP repair is associated with a higher rate of repeat procedure and postoperative morbidity up to 2 years after surgery.
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Affiliation(s)
- Rebekah Russell
- Case Western Reserve University School of Medicine, University Hospitals Cleveland, the Urology Institute, University Hospitals Cleveland, and the Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio; the Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky; and the Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
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Deshpande RR, Foy OB, Mandelbaum RS, Roman LD, Dancz CE, Wright JD, Matsuo K. Reconstructive Surgery at Hysterectomy for Patients With Uterine Prolapse and Gynecologic Malignancy. Obstet Gynecol 2023; 142:1487-1490. [PMID: 37847908 DOI: 10.1097/aog.0000000000005405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/10/2023] [Indexed: 10/19/2023]
Abstract
In this cross-sectional study examining 211,708 patients with a diagnosis of uterine prolapse who underwent hysterectomy between 2016 and 2019 identified in the Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample, co-diagnosis of gynecologic malignancy was reported in 2,398 (1.1%) patients, and they were less likely to receive reconstructive surgery at hysterectomy (odds ratio [OR] 0.90, 95% CI 0.84-0.96). This absence of reconstructive surgery was most pronounced among patients with complete uterine prolapse and gynecologic malignancy (OR 0.68, 95% CI 0.57-0.81). The association was also consistent in coexisting gynecologic premalignancy (n=3,357 [1.6%]). In conclusion, this national-level assessment suggests that patients with uterine prolapse and coexisting gynecologic malignancy or premalignancy may be less likely to receive reconstructive surgery for pelvic floor dysfunction at hysterectomy.
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Affiliation(s)
- Rasika R Deshpande
- Division of Gynecologic Oncology, the Division of Reproductive Endocrinology & Infertility, and the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, the Keck School of Medicine, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York
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26
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Xiao L, Xiao H, Zhong Y, Luo Y, Luo H, Wang M. Association between functional constipation and vaginal wind in women at 6 weeks postpartum. Int Urogynecol J 2023; 34:2925-2932. [PMID: 37578617 PMCID: PMC10756862 DOI: 10.1007/s00192-023-05619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The pathogenesis of vaginal wind remains unclear. This study was aimed at assessing the association between functional constipation and vaginal wind in women at 6 weeks postpartum. METHODS This is a multicenter cross-sectional study. We collected data, such as baseline demographic, clinical characteristics, pelvic organ prolapse quantification score. and surface electromyography parameters of pelvic floor muscles, of women at 6 weeks postpartum who visited the postpartum rehabilitation clinic between May 2022 and September 2022. The cohort data were from women who visited the postpartum rehabilitation clinic of the First Affiliated Hospital of Gannan Medical University and the Women and Children's Health Care Hospital of Yudu County. Follow-up for the control and study cohorts was conducted until 6 weeks postpartum. RESULTS Among the 377 women, 101 (26.79%) reported vaginal wind. Multivariate regression analysis showed that postpartum women with functional constipation were at a higher risk for vaginal wind than women without functional constipation (odds ratio [OR], 2.41). The results remained stable across the propensity score analyses (OR, 1.86-2.30). In addition, we found age, body mass index, mode of delivery, changes in the anatomical location of Bp points, urinary incontinence, pelvic floor muscle strength, and birth weight of the neonate were not associated with increased odds of vaginal wind in women at 6 weeks postpartum. CONCLUSIONS Vaginal wind is common among women at 6 weeks postpartum and is associated with functional constipation. Functional constipation may serve as a reference for the pathogenesis, prevention, and treatment of vaginal wind.
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Affiliation(s)
- Li Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, No.128 Jinling Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou City, Jiangxi Province, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou City, Jiangxi Province, China
| | - Huilian Xiao
- Department of Pelvic Floor and Postpartum Rehabilitation, Maternal and Child Health Hospital of Yudu County, Ganzhou City, Jiangxi Province, China
| | - Yanbiao Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, No.128 Jinling Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou City, Jiangxi Province, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou City, Jiangxi Province, China
| | - Yun Luo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, No.128 Jinling Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou City, Jiangxi Province, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou City, Jiangxi Province, China
| | - Huachao Luo
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, No.128 Jinling Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou City, Jiangxi Province, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou City, Jiangxi Province, China
| | - Maoyuan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, No.128 Jinling Road, Zhanggong District, Ganzhou City, 341000, Jiangxi Province, China.
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou City, Jiangxi Province, China.
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou City, Jiangxi Province, China.
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Bauters E, Page AS, Cattani L, Housmans S, Van der Aa F, D'Hoore A, Deprest J. Safety and medium-term outcome of redo laparoscopic sacrocolpopexy: a matched case-control study. Int Urogynecol J 2023; 34:2799-2807. [PMID: 37632537 DOI: 10.1007/s00192-023-05631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/20/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION AND HYPOTHESIS In the case of recurrent apical prolapse following laparoscopic sacrocolpopexy (LSCP), one may consider a "redo" procedure. We hypothesized that redo LSCP may carry an increased complication risk and less favorable outcomes when compared with primary procedures. METHODS This is a single-center, matched case-control (1:4) study, comparing all 39 women who had a redo LSCP and 156 women who had a primary LSCP for symptomatic apical prolapse between 2002 and 2020 with a minimum follow-up of 12 months. Matching was based on proximity to the operation date. The primary outcome was the occurrence of intraoperative and early postoperative complications within 3 months. Secondary outcomes included subjective (Patient Global Impression of Change [PGIC] ≥4) and objective (Pelvic Organ Prolapse Quantification [POP-Q] stage <2) success rates, surgical variables, graft-related complications and reinterventions. RESULTS There was no difference in the rate of intraoperative and early postoperative complications (redo: 21.1% vs control: 29.8%, OR: 0.63, 95% CI 0.27-1.48). The conversion rate was higher in redo patients (redo: 10.3% vs control: 0.6, OR: 17.71, 95% CI 1.92-163.39). Early postoperative complications were comparable: they were mainly infectious and managed by antibiotics. At a comparable follow-up (redo: 81 months (IQR: 54) vs control: 71.5 months (IQR: 42); p=0.37), there were no differences in graft-related complications (redo: 17.9% vs control: 9.6%, p=0.14) and reinterventions for complications (redo: 12.8% vs control: 5.1%, p=0.14) or prolapse (redo: 15.4% vs control: 8.3%, p=0.18). Subjective (redo: 88.5% vs control: 80.2%, p=0.41) and objective (redo: 31.8% vs control: 24.7%, p=0.50) success rates were also comparable. CONCLUSIONS In our experience, redo LSCP is as safe and effective as a primary LSCP, but there is a higher risk of conversion.
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Affiliation(s)
- Emma Bauters
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ann-Sophie Page
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Laura Cattani
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Susanne Housmans
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium
- Department of Urology, University Hospitals KU Leuven, Leuven, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, University Hospitals KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.
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Kowalski JT, Barber MD, Klerkx WM, Grzybowska ME, Toozs-Hobson P, Rogers RG, Milani AL. International urogynecological consultation chapter 4.1: definition of outcomes for pelvic organ prolapse surgery. Int Urogynecol J 2023; 34:2689-2699. [PMID: 37819369 DOI: 10.1007/s00192-023-05660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript of Chapter 4 of the International Urogynecological Consultation (IUC) on Pelvic Organ Prolapse (POP) reviews the literature and makes recommendations on the definition of success in the surgical treatment of pelvic organ prolapse. METHODS An international group containing seven urogynecologists performed an exhaustive search of the literature using two PubMed searches and using PICO methodology. The first search was from 01/01/2012-06/12/2022. A second search from inception to 7/24/2022 was done to access older references. Publications were eliminated if not relevant to the clinical definition of surgical success for the treatment of POP. All abstracts were reviewed for inclusion and any disagreements were adjudicated by majority consensus of the writing group. The resulting list of articles were used to inform a comprehensive review and creation of the definition of success in the surgical treatment of POP. OUTCOMES The original search yielded 12,161 references of which 45 were used by the writing group. Ultimately, 68 references are included in the manuscript. For research purposes, surgical success should be primarily defined by the absence of bothersome patient bulge symptoms or retreatment for POP and a time frame of at least 12 months follow-up should be used. Secondary outcomes, including anatomic measures of POP and related pelvic floor symptoms, should not contribute to a definition of success or failure. For clinical practice, surgical success should primarily be defined as the absence of bothersome patient bulge symptoms. Surgeons may consider using PASS (patient acceptable symptom state) or patient goal attainment assessments, and patients should be followed for a minimum of at least one encounter at 6-12 weeks post-operatively. For surgeries involving mesh longer-term follow-up is recommended.
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Affiliation(s)
- Joseph T Kowalski
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Matthew D Barber
- Department of Ob/Gyn, Duke University Medical Center, Durham, NC, USA
| | | | - Magdalena E Grzybowska
- Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdańsk, Smoluchowskiego 17, 80-214, Gdańsk, Poland
| | | | | | - Alfredo L Milani
- Department of Obstetrics & Gynecology, Reinier de Graaf Hospital, 2625 AD, Delft, the Netherlands
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Mörlin V, Golmann D, Borgfeldt C, Bergman I. Antibiotic prophylaxis in posterior colporrhaphy does not reduce postoperative infection: a nationwide observational cohort study. Int Urogynecol J 2023; 34:2791-2797. [PMID: 37552239 DOI: 10.1007/s00192-023-05617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to explore if antibiotic prophylaxis prevents postoperative infection after a posterior colporrhaphy. METHODS In this register-based nationwide cohort study data were collected from the "The Swedish National Quality Register of Gynecological Surgery" (GynOp). Women 18 years or older who underwent a primary posterior colporrhaphy between 1 January 2015 and 31 December 2020 were included. Patients undergoing any concomitant prolapse procedure, mesh surgery, or incontinence procedure were excluded. The cohort was divided into two groups based on administration of antibiotic prophylaxis (n = 1,218) or not (n = 4,884). The primary outcome of this study was patient-reported infectious complication requiring antibiotic treatment. Secondary outcome measures included patient satisfaction and prolapse-related symptoms at 1 year postoperatively. RESULTS A total of 7,799 patients who underwent posterior colporrhaphy and met the inclusion criteria and did not meet the exclusion criteria were identified in the register database. Of these patients 6,102 answered the primary outcome question (79%). In the antibiotic prophylaxis group a total of 138 reported a postoperative infection (11%) and in the no antibiotic prophylaxis group the corresponding data were 520 (11%). There were no significant differences regarding either the primary or the secondary outcomes between the study groups. CONCLUSION In this nationwide Swedish register study antibiotic prophylaxis was not associated with a reduced risk of postoperative infection after a posterior colporrhaphy.
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Affiliation(s)
- Vilhelm Mörlin
- Department of Women's and Children's Health, Division of Obstetrics, Department of Pelvic Cancer, Theme Cancer, Karolinska Institutet and Gynecology, Karolinska University Hospital, Eugeniavägen 3, A5:01, Mottagning Gynekologisk Cancer, 171 76, Stockholm, Sweden.
| | - Denise Golmann
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Christer Borgfeldt
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Science Lund, Lund University, Lund, Sweden
| | - Ida Bergman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and the Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
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Anzböck T, Koensgen D. [Imaging of the pelvic floor : The gynaecological perspective]. Radiologie (Heidelb) 2023; 63:821-826. [PMID: 37789193 PMCID: PMC10600270 DOI: 10.1007/s00117-023-01215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Pelvic floor dysfunction is common in women. OBJECTIVES To describe the role of ultrasound in the urogynecological examination and imaging of the pelvic floor. MATERIALS AND METHODS Analysis and summary of current recommendations and literature on the role of pelvic floor ultrasound. RESULTS Pelvic floor ultrasound is a dynamic and real-time imaging modality. It is readily available, allows for a realistic assessment of anatomy and morphology, and poses minimal patient burden. CONCLUSIONS Pelvic floor ultrasound is of great value in preoperative diagnostics as well as in the postoperative management of complications.
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Affiliation(s)
- Teresa Anzböck
- Klinik für Gynäkologie und gynäkologische Onkologie, Sektion für Urogynäkologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Dominique Koensgen
- Klinik für Gynäkologie und gynäkologische Onkologie, Sektion für Urogynäkologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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Peinado Molina RA, Hernández Martínez A, Martínez Vázquez S, Martínez Galiano JM. Influence of pelvic floor disorders on quality of life in women. Front Public Health 2023; 11:1180907. [PMID: 37942254 PMCID: PMC10629477 DOI: 10.3389/fpubh.2023.1180907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
Objective To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions. Methods An observational study was conducted with women in Spain between 2021 and 2022. Information was collected using a self-developed questionnaire on sociodemographic data, employment, history and health status, lifestyle and habits, obstetric history, and health problems. The SF-12 questionnaire was used to assess quality of life. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor problems, and includes the POPDI-6 subscales for prolapse, CRADI- 8 for colorectal symptoms, and UDI-6 for urinary symptoms. Crude (MD) and adjusted mean differences (aMD) were estimated with their respective 95% confidence intervals (CI). Results Thousand four hundred and forty six women participated in the study with a mean age of 44.27 (SD = 14.68). A statistical association was observed between all the pelvic floor disorders and QoL, overall and in all its dimensions (p <0.001), in the bivariable analysis. The lowest scores were observed in the emotional component. After adjusting for confounding factors, the pelvic floor disorders in general (aMD -0.21, 95% CI: -0.23 to -0.20), the impact of uterine prolapse symptoms (aMD -0.20, 95% CI: -0.27 to -0.12), the colorectal-anal symptoms (aMD -0.15, 95% CI: -0.22 to -0.09), and urinary symptoms (aMD -0.07, 95% CI: -0.13 to -0.03) was negatively associated on the score on the SF-12 questionnaire (p <0.05). Conclusions Women who have a pelvic floor dysfunction, symptoms of pelvic organ prolapse, colorectal-anal symptoms, or urinary symptoms, have a worse perceived quality of life in all dimensions. Prolapse symptoms have the biggest impact, and the emotional component of QoL is the most affected sub-domains.
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Affiliation(s)
| | - Antonio Hernández Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla la Mancha, Ciudad Real, Spain
| | | | - Juan Miguel Martínez Galiano
- Department of Nursing, University of Jaén, Jaén, Spain
- Epidemiology and Public Health CIBER (CIBERESP), Madrid, Spain
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Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health 2023; 23:2005. [PMID: 37838661 PMCID: PMC10576367 DOI: 10.1186/s12889-023-16901-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions. OBJECTIVE Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women. MATERIAL AND METHODS This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated. RESULTS One thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia. CONCLUSIONS The prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.
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Affiliation(s)
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real, Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | - Julián Rodríguez-Almagro
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real, Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaen, Jaen, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Vereeck S, Pacquée S, De Wachter S, Jacquemyn Y, Neels H, Dietz HP. The effect of prolapse surgery on voiding function. Int Urogynecol J 2023; 34:2141-2146. [PMID: 37010545 DOI: 10.1007/s00192-023-05520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Of women with symptomatic prolapse, 13-39% experience voiding dysfunction (VD). The aim of our observational cohort study was to determine the effect of prolapse surgery on voiding function. METHODS Retrospective analysis of 392 women who underwent surgery between May 2005 and August 2020. All had a standardized interview, POP-Q, uroflowmetry and 3D/4D transperineal ultrasound (TPUS) pre-and postoperatively. Primary outcome was change in VD symptoms. Secondary outcomes were changes in maximum urinary flow rate (MFR) centile and post-void residual urine (PVR). Explanatory measures were change in pelvic organ descent as seen on POP-Q and TPUS. RESULTS Of 392 women, 81 were excluded due to missing data, leaving 311. Mean age and BMI were 58 years and 30 kg/m2, respectively. Procedures performed included anterior repair (n = 187, 60.1%), posterior repair (n = 245, 78.8%), vaginal hysterectomy (n = 85, 27.3%), sacrospinous colpopexy (n = 170, 54.7%) and mid-urethral sling (MUS) (n = 192, 61.7%). Mean follow-up was 7 (1-61) months. Pre-operatively, 135 (43.3%) women reported symptoms of VD. Postoperatively, this decreased to 69 (22.2%) (p < 0.001), and of those, 32 (10.3%) reported de novo VD. The difference remained significant after excluding concomitant MUS surgery (n = 119, p < 0.001). Postoperatively, there was a significant decrease in mean PVR (n = 311, p < 0.001). After excluding concomitant MUS surgery, there was a significant increase in mean MFR centile (p = 0.046). CONCLUSIONS Prolapse repair significantly reduces symptoms of VD and improves PVR and flowmetry.
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Affiliation(s)
- Sascha Vereeck
- Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA, Edegem, Belgium.
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
| | | | - Stefan De Wachter
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
- Department of Urology, Antwerp University Hospital UZA, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
| | - Hedwig Neels
- Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA, Edegem, Belgium
- MOVANT, Faculty of Rehabilitation Sciences and Physiotherapy, University of Antwerp, 2610, Antwerp, Belgium
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Tsui WL, Deng GH, Hsieh TC, Ding DC. Association between vaginal or cesarean delivery and later development of stress urinary incontinence or pelvic organ prolapse: A retrospective population-based cohort study. Int Urogynecol J 2023; 34:2041-2047. [PMID: 36917258 DOI: 10.1007/s00192-023-05504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/14/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Child delivery mode may be associated with pelvic floor disorders. We explored the association between different delivery modes and later development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in Taiwanese women. METHODS This was a retrospective population-based cohort study. Women who delivered babies between January 1, 2000, and December 31, 2018, were selected for this study. The study used Taiwan's National Health Insurance (NHI) Research Database. After propensity score matching, 51,587 women who underwent cesarean section (C/S) and 51,587 women who underwent vaginal delivery (VD) were recruited. Primary outcomes were the presence of SUI and POP after delivery. RESULTS The incidence of SUI (1.6/1000 person-years) and POP (1.5/1000 person-years) was higher in the VD group than in the C/S group (0.8 and 0.6 in 1000 person-years). VD was associated with an increased risk of SUI [hazard ratio (HR): 2.79, 95% confidence interval (CI): 2.45-3.17] and POP (HR: 1.96, 95% CI: 1.75-2.19) compared to C/S. We also found that age (HR: 1.06, 95% CI: 1.05-1.08 in SUI, HR: 1.08, 95% CI: 1.07-1.09 in POP) and Charlson Comorbidity Index (CCI) (HR: 1.28, 95% CI: 1.12-1.46 in SUI, HR: 1.27, 95% CI: 1.13-1.43 in POP) were associated with an increased risk of SUI and POP. The cumulative incidence of SUI and POP was higher in the VD group than in the C/S group (log-rank test, P < 0.05). CONCLUSIONS The current study was the largest retrospective cohort study regarding the influence of delivery mode on SUI and POP so far. VD was found to be associated with an increased risk of SUI and POP compared with C/S. Postpartum care for pelvic physical therapy should be provided particularly to women undergoing VD.
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Affiliation(s)
- Wing Lam Tsui
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, 970, Taiwan
| | - Guang-Hong Deng
- Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Tzu Chi University, Hualien, 970, Taiwan
| | - Tsung-Cheng Hsieh
- Tzu Chi University Research Center for Big Data Teaching, Research and Statistic Consultation, Tzu Chi University, Hualien, 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, 970, Taiwan.
- Institute of Medical Sciences, Tzu Chi University, Hualien, 970, Taiwan.
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Puranda JL, da Silva DF, Edwards CM, Nagpal TS, Souza SCS, Semeniuk K, McLean L, Adamo KB. Characteristics Associated with Pelvic Floor Disorders among Female Canadian Armed Forces Members. J Obstet Gynaecol Can 2023; 45:646-654. [PMID: 37268158 DOI: 10.1016/j.jogc.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent pelvic floor disorders (PFDs) among the female population. In the military environment, being a non-commissioned member (NCM), and physically demanding occupations are factors associated with higher PFD risk. This study seeks to characterize the profile of female Canadian Armed Forces (CAF) members reporting symptoms of UI and/or POP. METHODS Present CAF members (18-65 years) responded to an online survey. Only current members were included in the analysis. Symptoms of UI and POP were collected. Multivariate logistic regressions analyzed the relationships between PFD symptoms and associated characteristics. RESULTS 765 active members responded to female-specific questions. The prevalence of self-reported POP and UI symptoms were 14.5% and 57.0%, respectively, with 10.6% of respondents reporting both. Advanced age (adjusted odds ratio [aOR]: 1.062, CI 1.038-1.087), a body mass index (BMI) categorized as obese (aOR: 1.909, [1.183-3.081]), parity ≥1 (e.g., aOR for 1: 2.420, [1.352-4.334]) and NCMs (aOR: 1.662, [1.144-2.414]) were factors associated with urine leakage. Parity of ≥2 (aOR: 2.351, [1.370-4.037]) compared to nulliparous and having a perception of a physically demanding job (aOR: 1.933, [1.186-3.148]) were associated with experiencing POP symptoms. Parity of ≥2 increased the odds of reporting both PFD symptoms (aOR: 5.709, [2.650-12.297]). CONCLUSION Parity was associated with greater odds of experiencing symptoms of UI and POP. Higher age, higher BMI, and being an NCM were associated with more symptoms of UI, and the perception of having a physically demanding role increased the likelihood of reporting POP symptoms.
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Affiliation(s)
- Jessica L Puranda
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON
| | - Danilo F da Silva
- Sports Studies Department, Faculty of Arts and Science, Bishop's University, Sherbrooke, QC
| | - Chris M Edwards
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON
| | - Taniya S Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB
| | - Sara C S Souza
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON
| | - Linda McLean
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Science, University of Ottawa, Ottawa, ON.
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Qiao H, Zhou Q, Zhang H, Sun D, Li C. Analysis of clinical correlation between pelvic organ prolapse and HR-HPV infection. Eur J Obstet Gynecol Reprod Biol 2023; 288:170-174. [PMID: 37549508 DOI: 10.1016/j.ejogrb.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/11/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To explore the influence of pelvic organ prolapse (POP) on the risk of high-risk human papilloma virus (HR-HPV) infection. MATERIALS AND METHODS Retrospective analysis of the HR-HPV infection results of 1183 patients with POP who were treated at the First Affiliated Hospital of Chongqing Medical University, Liangping District People's Hospital affiliated to Chongqing Medical University, and the 13th People's Hospital of Chongqing between October 2018 and October 2021. Patients without POP who underwent HR-HPV examination at the same time were selected as the control group, and the HR-PV infection rate was compared between the two groups. Patients diagnosed with POP were stratified to analyse whether age, menopausal status, degree of POP, location of POP and duration of POP were associated with HR-HPV infection. RESULTS The rate of HR-HPV infection was lower for patients with POP compared with patients without POP over the same time period. The highest rate of infection was seen in patients aged 60-69 years (14.7%) and the lowest rate (7.5%) was seen in patients aged 50-59 years; differences between age groups were significant. The rate of HR-HPV infection in postmenopausal patients with POP was slightly higher than that in non-menopausal patients with POP, but the difference was not significant. No significant differences in the rate of HR-HPV infection were associated with location of POP, duration of POP or degree of POP. CONCLUSION POP does not increase the risk of HR-HPV infection.
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Affiliation(s)
- Hong Qiao
- Department of Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Zhou
- Department of Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - HuaYing Zhang
- Department of Gynaecology, Liangping Hospital, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - DaMin Sun
- Department of Gynaecology, 13(th) People's Hospital, Chongqing, China
| | - Cong Li
- Department of Gynaecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Cai L, Wu Y, Xu X, Cao J, Li D. Pelvic floor dysfunction in gynecologic cancer survivors. Eur J Obstet Gynecol Reprod Biol 2023; 288:108-113. [PMID: 37499277 DOI: 10.1016/j.ejogrb.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/06/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
Pelvic floor dysfunction (PFD) is a common complication in gynecologic cancer survivors (GCS) and is now a worldwide medical and public health problem because of its great impact on the quality of life of GCS. PFD after comprehensive gynecologic cancer treatment is mainly reflected in bladder function, rectal function, sexual dysfunction and pelvic organ prolapse (POP), of which different types of gynecologic cancer correspond to different disease incidence. The prevention strategies of PFD after comprehensive gynecologic cancer treatment mainly included surgical treatment, physical therapy and behavioral guidance, etc. At present, most of them still focus on physical therapy, mostly using Pelvic Floor Muscle Training (PFMT) and multi-modal PFMT treatment of biofeedback combined with electrical stimulation, which can reduce the possibility of PFD after surgery in GCS to some extent. This article reviews the clinical manifestations, causes and current research progress of prevention and treatment methods of PFD after comprehensive treatment for GCS.
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Affiliation(s)
- Linjuan Cai
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Yue Wu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Xuyao Xu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Jian Cao
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
| | - Dake Li
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
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Gökbel İ, Kinci MF, Akin Gökbel D, Sivaslioğlu AA. Anatomical and symptomatic mid-term outcomes of patients with isolated anterior compartment defect repair or stress urinary incontinence : Anatomical and symptomatic outcomes of anterior compartment repair or SUI. BMC Womens Health 2023; 23:443. [PMID: 37612672 PMCID: PMC10463472 DOI: 10.1186/s12905-023-02556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND An evaluation of preoperative and postoperative 12th month Pelvic Organ Prolapse Quantification (POP-Q) and Lower Urinary Tract Symptoms (LUTS) changes in patients operated for the diagnosis of isolated anterior compartment defect (ACD) or Stress Urinary Incontinence (SUI). METHOD Patients who were diagnosed with isolated ACD or SUI were retrospectively analyzed at urogynecology unit of our tertiary referral center. All pelvic examinations were performed by the same experienced urogynecologist. Pre-operative and post-operative 12th month POP-Q scores and the responses to a detailed LUTS questionnaire in the unit were assessed. RESULTS Of the 90 patients with isolated ACD or SUI, midurethral sling with mini-sling and retropubic transobturator tape methods was applied in 24, iliococcygeal fixation in 28, trapezoid repair in 9 patients, anterior bridge operation in 14, and plication of pubocervicovaginal fascia to the cervical ring in 15. We compared the POP-Q score and pre and post-operative 12th month LUTS. Between pre and post-operative 12th month, there was a statistically significant difference at Aa and Ba points (p < 0.00, 0.001). Comparative LUTS questionnaire showed statistically significant differences in stress urinary incontinence, frequency, urgency, abnormal emptying, nocturia, pelvic pain (p: <0.001, p < 0.001, p: <0.001, p:0.001, p:<0.001, p:0.003, respectively). CONCLUSION Anatomical and symptomatic recovery is achieved with appropriate surgical intervention in women with isolated ACD or SUI. When LUTS were evaluated in terms of symptomatic recovery, they were found to be related not only to symptoms involving the anterior compartment, but also to symptoms involving other compartments.
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Affiliation(s)
- İsmail Gökbel
- Obstetrics and Gynecology Department, Menteşe State Hospital, Muğla, Turkey
| | - Mehmet Ferdi Kinci
- Obstetrics and Gynecology Department, Muğla Sıtkı Koçman University Education and Research Hospital, Muğla, Turkey.
| | - Deniz Akin Gökbel
- Obstetrics and Gynecology Department, Muğla Sıtkı Koçman University Education and Research Hospital, Muğla, Turkey
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Muñiz KS, Grado L, Gomez M, Ortiz C, Cerna R, Brioso X, Carson KA, Chen CCG. Pelvic floor disorder assessment of knowledge and symptoms: an educational intervention for Spanish-speaking women (PAKS study). Int Urogynecol J 2023; 34:1789-1796. [PMID: 36735052 DOI: 10.1007/s00192-023-05459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/25/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Educational interventions have been effective in improving postpartum knowledge, performance of pelvic floor exercises, and bowel-specific quality-of-life. Our primary objective was to determine if a video-based educational intervention on pelvic floor disorders (PFDs) would increase Spanish-speaking women's knowledge of PFDs, and secondarily to assess if it would decrease pelvic floor symptoms. We hypothesized that Spanish-speaking women would improve their pelvic floor knowledge and symptoms post-intervention. METHODS Inclusion criteria included women age 18 years and older and self-reported as a predominantly Spanish-speaker or equally bilingual English- and Spanish-speaker. Changes in knowledge were assessed with the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). Changes in symptoms were assessed with the Pelvic Floor Distress Inventory-20 (PFDI-20). Linear regression assessed for independent effects. RESULTS One hundred and fourteen women were enrolled and 112 completed the pre- and post-intervention PIKQ. Mean (standard deviation [SD]) age was 50 (14) years. Immediate post-intervention scores showed significant improvement in knowledge. Total PIKQ score improved by 5.1 (4.7) points (p < 0.001). POP subscore improved by 2.7 (2.7) points (p<0.001) and UI subscore improved by 2.3 (2.5) points (p < 0.001). Improvement in knowledge continued after four weeks (p < 0.001). PFDI-20 prolapse (p=0.02), colorectal-anal (p < 0.001) and urinary (p = 0.01) scores significantly improved only for the most symptomatic women at baseline. Using linear regression, total PIKQ (p = 0.03) and total PFDI-20 scores (p = 0.04) were associated with predominantly Spanish-speakers versus fully bilingual. CONCLUSION Findings support the efficacy of a video-based educational intervention to improve knowledge of PFDs in Spanish-speaking women. The most symptomatic women benefitted from this intervention.
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Affiliation(s)
- Keila S Muñiz
- St. Joseph's Health Hospital, 104 Union Ave, Suite 804, Syracuse, NY, 13203, USA.
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Maria Gomez
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Rosa Cerna
- University of Maryland, College Park, MD, USA
| | - Xiomara Brioso
- Yale New Haven Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA
| | - Kathryn A Carson
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Division of Female Pelvic Medicine and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jayasinghe RT, Ruseckaite R, Dean J, Kartik A, Wickremasinghe AC, Daly O, O'Connell HE, Craig A, Duggan A, Vasiliadis D, Karantanis E, Gallagher E, Holme G, Keck J, Williams J, King J, Yin J, Short J, Sketcher-Baker K, Brennan P, Rayner S, Ahern S. Establishment and initial implementation of the Australasian Pelvic Floor Procedure Registry. Int Urogynecol J 2023; 34:1697-1704. [PMID: 36695860 PMCID: PMC10415488 DOI: 10.1007/s00192-022-05435-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/30/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are common pelvic floor disorders (PFDs). Owing to significant adverse events associated with mesh-related pelvic floor procedures (PFPs) in a proportion of the surgically treated population, and deficits in collection and reporting of these events, the Australian Government identified an urgent need for a tracking mechanism to improve safety and quality of care. The Australasian Pelvic Floor Procedure Registry (APFPR) was recently established following the 2018 Senate Committee Inquiry with the aim of tracking outcomes of PFP involving the use of devices and/or prostheses, with the objective of improving the health outcomes of women who undergo these procedures. This paper will describe the APFPR's aims, development, implementation and possible challenges on the way to its establishment. METHODS The APFPR has been developed and implemented in accordance with the national operating principles of clinical quality registries (CQRs). The minimum datasets (MDS) for the registry's database have been developed using a modified Delphi process, and data are primarily being collected from participating surgeons. Patient recruitment is based on an opt-out approach or a waiver of consent. Patient-reported outcome measures (PROMs) providing additional health and outcome information will be obtained from participating women to support safety monitoring of mesh-related adverse events. RESULTS Currently in the Australasian Pelvic Floor Procedure Registry (APFPR) there are 32 sites from various jurisdictions across Australia, that have obtained relevant ethics and governance approvals to start patient recruitment and data collection as of January 2023. Additionally, there are two sites that are awaiting governance review and five sites that are having documentation compiled for submission. Seventeen sites have commenced patient registration and have entered data into the database. Thus far, we have 308 patients registered in the APFPR database. The registry also published its first status report and a consumer-friendly public report in 2022. CONCLUSIONS The registry will act as a systematic tracking mechanism by collecting outcomes on PFP, especially those involving devices and/or prostheses to improve safety and quality of care.
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Affiliation(s)
- Randi T Jayasinghe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Joanne Dean
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Aruna Kartik
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Anagi C Wickremasinghe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Oliver Daly
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
- Department of Obstetrics and Gynaecology, Western Health, Melbourne, Victoria, Australia
| | - Helen E O'Connell
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
- Department of Surgery, University of Melbourne, Parkville, Australia
| | - Amanda Craig
- Department of Health and Aged Care, Therapeutic Goods Administration, Canberra, Australia
| | - Anne Duggan
- Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Dora Vasiliadis
- Consumer Representative, Australasian Pelvic Floor Procedure Registry, Melbourne, Australia
| | | | - Elizabeth Gallagher
- Calvary John James, Canberra Private and Canberra Hospital, Canberra, Australia
| | - Gwili Holme
- Commonwealth of Australia, Canberra, Australia
| | - James Keck
- St Vincent's Private Hospital Melbourne, Melbourne, Australia
| | | | | | - Jessica Yin
- Holywood Medical Centre (WA), Nedlands, Australia
| | - John Short
- Christchurch Women's Hospital & Southern Cross Hospital - Invercargill, Christchurch, New Zealand
| | | | - Pip Brennan
- Consumer Representative, Australasian Pelvic Floor Procedure Registry, Melbourne, Australia
| | | | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
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Moradinasab S, Iravani M, Mousavi P, Cheraghian B, Molavi S. Effect of cognitive-behavioral therapy on sexual self-esteem and sexual function of reproductive-aged women suffering from urinary incontinence. Int Urogynecol J 2023; 34:1753-1763. [PMID: 36715741 PMCID: PMC9885913 DOI: 10.1007/s00192-023-05460-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/24/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Patients with urinary incontinence may fear sexual activity due to the unpredictability of urine leakage during intercourse. Given the effective role of cognitive-behavioral therapy in correcting negative thoughts and attitudes, this study was aimed to investigate the effect of cognitive-behavioral therapy on sexual self-esteem and sexual function of reproductive-aged women suffering from urinary incontinence. METHODS This study was a randomized controlled clinical trial conducted on 84 reproductive-aged women (18 to 45 years old) with urinary incontinence who referred to Health Centers of Dezful, Iran. After random allocation, the participants were divided into two groups of intervention and control (n = 42). The intervention group attended eight 45-min sessions of cognitive-behavioral therapy, while the control group received only routine interventions. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Scale of Self-Esteem Index for Women-Short-form (SSEL-W-SF), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) were completed before, immediately after, and 4 weeks after the end of the intervention by patients in both groups. RESULTS The overall scores of sexual self-esteem and sexual function immediately and 4 weeks after the end of the intervention showed a statistically significant difference in the intervention group compared to the control group (p < 0.001). Also, the results showed that in women with urinary incontinence, an increase in the sexual self-esteem score is associated with an increase in the sexual function score (r = 0.9), p < 0.001). CONCLUSION Cognitive-behavioral therapy was found to increase sexual self-esteem and improve sexual function in reproductive-aged women suffering from urinary incontinence.
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Affiliation(s)
- Salimeh Moradinasab
- Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mina Iravani
- Reproductive Health Promotion Research Center, Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvaneh Mousavi
- Midwifery Department, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahman Cheraghian
- Department of Biostatistics and Epidemiology, School of Health, Alimentary Tract Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahla Molavi
- Health Psychology, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Kim Y, Rowley JE, Ortega MV, James KE, Von Bargen E. Incidence of de novo stress urinary incontinence following minimally invasive sacrocolpopexy. Int Urogynecol J 2023; 34:1599-1605. [PMID: 36645440 DOI: 10.1007/s00192-022-05434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the incidence and risk factors of postoperative de novo stress urinary incontinence (SUI) in stress-continent women following minimally invasive sacrocolpopexy without an anti-incontinence procedure. METHODS We completed a multicenter, retrospective cohort study of women undergoing laparoscopic sacrocolpopexy without concurrent anti-incontinence procedures from October 2006 through January 2021. RESULTS Of the 169 women who underwent minimally invasive sacrocolpopexy, 17.1% (n=30) developed de novo SUI, and 7.1% eventually underwent a midurethral sling placement. On logistic regression, BMI, preoperative urinary urgency, and history of transvaginal mesh repair were found to be significantly associated with and predictive of de novo SUI. When the concordance index (C-index) was calculated with the model published by Jelovsek et al. for women who developed de novo SUI within 12 months of the prolapse surgery, the current de novo SUI calculator was able to discriminate de novo SUI outcome (C-index = 0.71). CONCLUSIONS The incidence of de novo SUI after minimally invasive sacrocolpopexy without anti-incontinence procedure correlates directly with higher BMI, preoperative urinary urgency, and transvaginal mesh history for POP. Preoperative counseling for minimally invasive sacrocolpopexy should include discussing the risk of de novo SUI and preoperative factors that may increase this risk.
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Affiliation(s)
- Youngwu Kim
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Marcus V Ortega
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Kaitlyn E James
- Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Von Bargen
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
- Division of Female Pelvic Medicine and Reconstructive Surgery, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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Jansen SM, Pellino K, Zhou Q, Brown HW, Heisler CA. Fecal Incontinence and the Risk of Urinary Tract Infection in Patients Presenting for Urogynecological Consultation. Urogynecology (Phila) 2023; 29:641-645. [PMID: 37348087 PMCID: PMC10873920 DOI: 10.1097/spv.0000000000001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
IMPORTANCE Urinary tract infection (UTI) is common in urogynecology patients. Patients with fecal incontinence (FI) often attribute their UTIs to FI, but this association has not been evaluated. OBJECTIVES The objectives of this study were to compare the prevalence of UTI in urogynecology patients with and without FI and to characterize factors associated with UTI and recurrent UTI. STUDY DESIGN This retrospective cohort study included all new adult patients who presented to an academic female pelvic medicine and reconstructive surgery practice with FI from January 2014 through December 2017. Patients were age-matched to new adult patients with stage <2 pelvic organ prolapse without FI. All urine culture results from 1 year before and 1 year after the first visit were identified. Logistic regression identified factors associated with UTI. RESULTS Among 399 patients, 106 (27%) had a culture-confirmed UTI in the year before or after their first urogynecology visit; the prevalence of UTI was 23% (45/198) in patients with FI and 30% (61/201) in those without FI (P = 0.09). The rate of recurrent UTI was 11.5% overall and did not differ among those with and without FI. In multivariate models, variables that were statistically significantly associated with UTI included age, diabetes mellitus, anterior vaginal wall prolapse, and sexual activity. Fecal incontinence was not associated with any or recurrent UTI. CONCLUSIONS The prevalence of UTI and recurrent UTI was similar in urogynecology patients with and without FI. Variables that were associated with UTI risk included older age, sexual activity, diabetes mellitus, and anterior vaginal wall prolapse.
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Affiliation(s)
| | - Katherine Pellino
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - Qianqian Zhou
- University of Wisconsin School of Medicine and Public Health
| | - Heidi W. Brown
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christine A. Heisler
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Houshyar S, Saha T, Yin H, Zizhou R, Dekiwadia C, Pirogova E, Hill-Yardin EL, Yeung JM, Fox K, Cole I. Advanced flexible transvaginal mesh with high visibility under computerized tomography (CT) scan. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083162 DOI: 10.1109/embc40787.2023.10340322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pelvic floor disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are serious and very common. Surgery is commonly undertaken to restore the strength of the vaginal wall using transvaginal surgical mesh (TVM). However, up to 15% of TVM implants result in long-term complications, including pain, recurrent symptoms, and infection.Clinical Relevance- In this study, a new bioengineered TVM has been developed to address these issues. The TVM is visible using noninvasive imaging techniques such as computed tomography (CT); it has a highly similar structural profile to human tissue and potential to reduce pain and inflammation. These combined technological advances have the potential to revolutionize women's health.
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Crowder CA, Sayegh N, Guaderrama NM, Jeney SES, Buono K, Yao J, Whitcomb EL. Rectocele: Correlation Between Defecography and Physical Examination. Urogynecology (Phila) 2023; 29:617-624. [PMID: 36701286 DOI: 10.1097/spv.0000000000001330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE There is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse. OBJECTIVES The aim was to evaluate the association between rectocele on defecography and posterior vaginal wall prolapse (PVWP) on physical examination. The secondary objective was to describe radiologic and clinical predictors of surgical intervention and outcomes. STUDY DESIGN This was a retrospective review of patients enrolled in a large health maintenance organization who underwent defecography and were examined by a urogynecologist within 12 months. The electronic medical record was reviewed for demographic and clinical variables, including pelvic organ prolapse and defecatory symptoms, physical examination, and surgical intervention through 12 months after initial urogynecologic examination or 12 months after surgery if applicable. RESULTS One hundred eighty-six patients met inclusion criteria. Of those, 168 (90.3%) had a rectocele on defecography and 31 (16.6%) had PVWP at or beyond the hymen. Rectocele size on defecography was poorly correlated with PVWP stage (spearman ρ = 0.18). Forty patients underwent surgical intervention. Symptoms of splinting, digitation, and stool trapping were associated with surgical intervention (odds ratio, 4.24; 95% confidence interval, 1.59-11.34; P < 0.01) as was advanced PVWP stage ( P < 0.01), while rectocele presence and size on defecography were not. Large rectocele size on defecography was correlated with persistent postoperative defecatory symptoms ( P = 0.02). CONCLUSIONS We demonstrated a poor correlation between rectocele size on defecography and PVWP stage. Defecatory symptoms (splinting, digitation, stool trapping) and higher PVWP stage were associated with surgical intervention, while rectocele on defecography was not.
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Affiliation(s)
- Carly A Crowder
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, UC Irvine
| | | | | | - Sarah E S Jeney
- Division of Urogynecology, University of New Mexico, Department of Obstetrics and Gynecology, Albuquerque, NM
| | | | - Janis Yao
- Clinical Informatics and Research Databases, Southern California Permanente Medical Group, Pasadena CA
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Pavarini N, Valadares ALR, Varella GM, Brito LGO, Juliato CRT, Costa-Paiva L. Sexual function after energy-based treatments of women with urinary incontinence. A systematic review and meta-analysis. Int Urogynecol J 2023; 34:1139-1152. [PMID: 36680596 DOI: 10.1007/s00192-022-05419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) affects approximately 50% of adult women worldwide and is associated with declining sexual function (SF). Energy-based devices emerged as a minimally invasive alternative treatment. Nevertheless, their effect on sexuality is uncertain. We hypothesize that the UI energy treatment can lead to sexual function improvement. METHODS A search was performed in PubMed, Cochrane Library, Web of Science, Embase, and Scopus for randomized clinical trials (RCTs) and nonrandomized studies of intervention, which treated incontinent women using energy, with UI and sexual function (SF) as outcomes. Severe comorbidities, pelvic organ prolapse (POP)> grade 2, and use of medication to treat UI or that affects SF were excluded. Quality assessment and meta-analysis were performed. RESULTS From 322 articles, 11 RCTs were included for qualitative analysis. UI symptoms improved in all studies. Regarding SF, RCT with premenopausal women showed improvement in SF in the Er:Yag group (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 and Female Sexual Function Index). A prospective study showed improvement in SF independent of the grade of SUI. RF showed benefits for SF but was not superior to pelvic floor muscle training. One nonrandomized study of intervention with a High-Intensity Focused Electromagnetic Field showed significant improvement of SF in the Golombok Rust Inventory of Sexual Satisfaction total score, a decline in pain and dissatisfaction domains. Meta-analysis with 4 RCTs and 2 nonrandomized studies found no difference between groups (0.26 (95% CI -0.67 to 1.20, and -0.74 (95% CI -3.78 to 2.30) respectively). CONCLUSIONS This meta-analysis did not confirm that energy equipment improved the SF of women with UI.
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Affiliation(s)
- Nádia Pavarini
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana L R Valadares
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil.
| | - Glaucia M Varella
- School of Medical Science, University of Campinas (UNICAMP), Campinas, Brazil
| | - Luiz G O Brito
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Cássia R T Juliato
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil
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Banas J, Jankiewicz K, Rechberger T, Kołodyńska A, Bogusiewicz M. Outcome of transobturator sling for treatment of female stress urinary incontinence applied as a single procedure or concomitantly with pelvic organ prolapse surgery. Ann Agric Environ Med 2023; 30:190-194. [PMID: 36999874 DOI: 10.26444/aaem/162800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
INTRODUCTION AND OBJECTIVE The aim of the study was to check the safety and efficacy of transobturator tape (TOT) combined with various prolapse procedures. The results were compared with outcomes of sling performed as an alone surgery. Risk factors for TOT failure were also identified. MATERIAL AND METHODS The study comprised 219 patients with sling alone (Group SUI) and 221 after TOT combined with concomitant prolapse surgery (Group POP/SUI). Medical records were carefully reviewed to obtain demographic and clinical data, details of surgery, including intra-and postoperative complications. RESULTS Subjective cure rate was slightly, but statistically significantly, higher in POP/SUI group (89.6% vs 82.6%; ch2 = 4.44; p = 0.035). There was no significant difference in sling efficacy dependant of type of POP surgery. Post-operative urine retention was more frequent in POP/SUI group compared to SUI group (18.6% vs 3.2%; ch2 = 34.36; p < 0.001). Logistic regression showed that age, BMI and prolonged pos-operative urine retention are independent factors affecting TOT outcome. Age ≥65years and BMI ≥30kg,m2 more than doubled the risk of failure: OR 2.348, CI 95% (1.330-4.147); p = 0.003 and 2.030, (95% CI 1.148-3.587); p = 0.015; respectively. Interestingly, post-operative urine retention appeared to be a positive prognostic factor OR 0.145, (95% CI 0.019-1.097); p < 0.05. CONCLUSIONS Subjective efficacy of TOT used concomitantly with POP procedures is slightly higher than TOT alone. Better sling outcomes can be expected both for POP procedures involving both the anterior and posterior compartments. Age and obesity are independent factors of TOT failure, whereas prolonged post-operative urine retention is a positive predictive factor of TOT success.
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Affiliation(s)
- Joanna Banas
- 2nd Department of Gynaecology, Medical University, Lublin, Poland
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Agu I, Smith FK, Murarka S, Xu J, Siddiqui G, Orejuela F, Muir TW, Antosh DD. An evaluation of pelvic floor disorders in a public and private healthcare setting. Int Urogynecol J 2023; 34:693-699. [PMID: 35503122 DOI: 10.1007/s00192-022-05215-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objectives were to determine whether a difference exists in the duration of pelvic floor disorder (PFD) symptoms among patients presenting to urogynecologists in two healthcare systems: private and county; and to elucidate differences in baseline characteristics, type of PFDs, symptom severity and management, stratified by healthcare plans. METHODS A multi-center retrospective study was conducted including new patients presenting to three urogynecology clinics between March 2016 and May 2018: one private clinic (site A) and two public clinics in the same county healthcare system (sites B and C). Baseline data included age, race, BMI, parity, and comorbidities. Primary outcome was "time to presentation" defined as PFD duration in months. Secondary outcomes were symptom severity and PFD management, analyzed by healthcare setting and insurance type. RESULTS A total of 1,055 private and 439 public patients were included. Patients in the public setting were younger (54 vs 61 years, p<0.001), largely Hispanic (76% vs 14%, p<0.001), of higher parity (4 vs 3, p=0.001), and had more comorbidities, with a predominance of county-funded healthcare plans. There was no difference in duration of symptoms between the public and private groups respectively (54 vs 56 months, p=0.94). Patients in the public setting had more severe urinary incontinence (3 vs 2 pads/day, p<0.001) and prolapse (stages 3-4, 71% vs 61%, p=0.004); however, they had lower rates of surgical management for stress incontinence and prolapse. Differences in fecal incontinence could not be evaluated owing to small sample size. CONCLUSIONS Public patients presented younger with more severe symptoms but had lower rates of surgery for PFDs traditionally managed surgically.
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Affiliation(s)
- Ijeoma Agu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA.
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA.
| | - Fiona K Smith
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Shivani Murarka
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Jiaqiong Xu
- Center for Outcome Research, Houston Methodist Hospital Research Institute, Houston, TX, USA
| | - Gazala Siddiqui
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Francisco Orejuela
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Tristi W Muir
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Danielle D Antosh
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
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Larsudd-Kåverud J, Gyhagen J, Åkervall S, Molin M, Milsom I, Wagg A, Gyhagen M. The influence of pregnancy, parity, and mode of delivery on urinary incontinence and prolapse surgery-a national register study. Am J Obstet Gynecol 2023; 228:61.e1-61.e13. [PMID: 35932880 DOI: 10.1016/j.ajog.2022.07.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The long-term effects of vaginal delivery, parity, and pregnancy on the pelvic floor remain uncertain and controversial issues. In comparison with studies using self-reported symptoms, surgical register data may offer a more valid means for evaluating the relative influence of these risk factors. OBJECTIVE This study used data from 3 high-quality nationwide registers, namely the Swedish National Quality Register of Gynecological Surgery, the Swedish Medical Birth Register, and the Total Population Register, to evaluate the contribution of vaginal and cesarean delivery, parity, and factors not related to childbirth to the long-term risk for reconstructive urogenital surgery. STUDY DESIGN This was a register-based linkage study among women aged ≥45 years who underwent urinary incontinence or prolapse surgery from 2010 to 2017. This surgical cohort was divided into nulliparous women, women with ≥1 cesarean deliveries only, those with ≥1 vaginal deliveries, and according to the number of births. A corresponding reference group was constructed based on women born in 1960 from the Total Population Register (n=2,309,765). The Swedish Medical Birth Register was used to determine the rate of women with cesarean and vaginal delivery and their respective parity. Absolute and relative risk were presented per 1000 women with 95% confidence intervals. Pairwise differences were analyzed with Fisher exact tests and the Mann-Whitney U test for dichotomous and continuous variables. The trend between ≥3 ordered categories of dichotomous variables was analyzed with Mantel-Haenszel statistics. RESULTS A total of 39,617 women underwent prolapse surgery and 20,488 underwent incontinence surgery. Among women with prolapse surgery, 97.8% had ≥1 vaginal delivery, 0.4% had ≥1 cesarean delivery only, and 1.9% were nullipara. Corresponding figures for those with incontinence surgery were 93.1%, 2.6%, and 4.3%, respectively. Women with vaginal deliveries were overrepresented in the prolapse surgery (relative risk, 1.23; 95% confidence interval, 1.22-1.24; P<.001) and incontinence surgery groups (relative risk, 1.17; 95% confidence interval, 1.15-1.19; P<.001). Nulliparous and cesarean delivered women were underrepresented in the prolapse surgery (relative risk, 0.14; 95% confidence interval, 0.13-0.15 and relative risk 0.055; 95% confidence interval, 0.046-0.065; all P<.001) and incontinence surgery groups (relative risk, 0.31; 95% confidence interval, 0.29-0.33 and relative risk, 0.40; 95% confidence interval, 0.36-0.43). The absolute risk for prolapse surgery was lowest after cesarean delivery (0.09 per 1000 women; 95% confidence interval, 0.08-0.11) and differed by a factor of 23 (absolute risk, 2.11 per 1000 women; 95% confidence interval, 2.09-2.13) from that after vaginal birth. The absolute risk for prolapse and incontinence surgery increased consistently with parity after vaginal births. This trend was not observed after cesarean delivery, which is on par with that of nulliparous women. The first vaginal birth contributed the highest increase in the absolute risk for pelvic organ prolapse surgery (6-fold) and stress urinary incontinence surgery (3-fold). The second vaginal birth contributed the lowest increase in the absolute risk for pelvic organ prolapse surgery (∼1/3 of the first vaginal birth) and for stress urinary incontinence surgery (∼1/10 of the first vaginal birth). CONCLUSION Surgery for urinary incontinence and prolapse was almost exclusively related to vaginal parity. The risk for prolapse surgery increased consistently with parity after vaginal births but not after cesarean delivery, whereas the risk associated with cesarean delivery was on par with that of nulliparous women. Thus, cesarean delivery seems to offer protection from the need for pelvic organ prolapse and stress urinary incontinence surgery later in life.
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Affiliation(s)
- Jennie Larsudd-Kåverud
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Julia Gyhagen
- Department of Obstetrics and Gynecology, Södra Älvsborgs Hospital, Borås, Sweden
| | - Sigvard Åkervall
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mattias Molin
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Statistical Consultancy Group, Gothenburg, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adrian Wagg
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Gyhagen
- Gothenburg Continence Research Centre, Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Geriatrics, Dalen Hospital, Stockholm, Sweden.
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Kikuchi JY, Yanek LR, Handa VL, Chen CCG, Jacobs S, Blomquist J, Patterson D. Prolapse and mesh reoperations following sacrocolpopexy: comparing supracervical hysterectomy, total hysterectomy, and no hysterectomy. Int Urogynecol J 2023; 34:135-145. [PMID: 35689689 DOI: 10.1007/s00192-022-05263-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/22/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacrocolpopexy is effective for apical prolapse repair and is often performed with hysterectomy. It is unknown whether supracervical or total hysterectomy at time of sacrocolpopexy influences prolapse recurrence and mesh complications. The primary objective of this study is to compare reoperations for recurrent prolapse after sacrocolpopexy with either supracervical hysterectomy or total hysterectomy, or without concomitant hysterectomy. We also sought to compare these three groups for the incidence of mesh complications and describe cervical interventions following supracervical hysterectomy. METHODS A retrospective cohort study of sacrocolpopexy was performed using the MarketScan® Research Database. Women > 18 years who underwent sacrocolpopexy between 2010 to 2014 were identified. Utilizing diagnostic and procedural codes, reoperations for prolapse and mesh complications were identified. Women with < 2 years of follow-up were excluded. RESULTS From 2010 to 2014, 3463 women underwent sacrocolpopexy with at least 2 years of follow-up, 910 (26.3%) with supracervical hysterectomy, 1243 (35.9%) with total hysterectomy, and 1310 (37.8%) without hysterectomy. Reoperations for prolapse were similar after supracervical hysterectomy (1.5%), after total hysterectomy (1.1%, p = 0.40), and without hysterectomy (1.5%, p = 0.98). Mesh complications after sacrocolpopexy were similar after supracervical hysterectomy (1.8%), after total hysterectomy (1.5%, p = 0.68), and without hysterectomy (2.8%, p = 0.11). Following supracervical hysterectomy, 0.9% underwent cervical procedures. CONCLUSIONS When comparing supracervical and total hysterectomy at time of sacrocolpopexy, there were no significant differences in reoperations for recurrent prolapse, reoperations for mesh complications, or mesh complication diagnoses. This study shows that surgeons can be reassured on performing hysterectomy with sacrocolpopexy.
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Affiliation(s)
- Jacqueline Y Kikuchi
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA.
| | - Lisa R Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria L Handa
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA
| | - Stephanie Jacobs
- Department of Obstetrics and Gynecology, Greater Baltimore Medical Center, Towson, MD, USA
| | - Joan Blomquist
- Department of Obstetrics and Gynecology, Greater Baltimore Medical Center, Towson, MD, USA
| | - Danielle Patterson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, 301 Building, Suite 3200, Baltimore, MD, 21224, USA
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