European journal of obstetrics, gynecology, and reproductive biology最新文献

{"title":"Gasless transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for sacrospinous fixation: An anatomical study","authors":"Gautier Chene ,&nbsp;Emanuele Cerruto ,&nbsp;Stephanie Moret ,&nbsp;Erdogan Nohuz","doi":"10.1016/j.ejogrb.2025.114897","DOIUrl":"10.1016/j.ejogrb.2025.114897","url":null,"abstract":"<div><h3>Objective</h3><div>Minimally invasive sacrospinous fixation is the gold standard procedure for management of apical pelvic organ prolapse. However, as it is a blind and palpatory technique, there may be a relevant risk of neurovascular injury due to the proximity of neurovascular structures. The vNOTES (transvaginal Natural Orifice Transluminal Endoscopic Surgery) approach is a surgical technique that appears promising in the management of pelvic organ prolapse. We propose an anatomical study concerning the vNOTES anterior sacrospinous fixation.</div></div><div><h3>Study design</h3><div>Bilateral gasless vNOTES anterior sacrospinous fixation was performed in two female cadavers without any synthetic mesh.</div></div><div><h3>Results</h3><div>Identification of ischial spine and sacrospinous ligament as well as feasibility of gasless vNOTES sacrospinous fixation were always possible on both sides.</div></div><div><h3>Conclusions</h3><div>The vNOTES sacrospinous fixation may be relevant and could be an advantage in terms of safety and better placement of the suture on the sacrospinous ligament thanks to endoscopic vision.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114897"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint hypermobility syndrome for the urogynaecologist – A narrative review","authors":"Islam Abaza,&nbsp;Miriam Tadros,&nbsp;Bernadette Lemmon,&nbsp;Alka Bhide,&nbsp;Ruwan Fernando,&nbsp;Vik Khullar","doi":"10.1016/j.ejogrb.2026.114943","DOIUrl":"10.1016/j.ejogrb.2026.114943","url":null,"abstract":"<div><h3>Purpose of this review</h3><div>Joint Hypermobility Syndrome (JHS), also referred to as hypermobile Ehlers–Danlos Syndrome (hEDS), is increasingly recognised as a significant contributor to gynaecological, pelvic floor and lower urinary tract symptoms. This review aims to highlight the current evidence on the relationship between JHS and key urogynaecological conditions, with particular attention to recent developments in epidemiology, clinical presentation, and management.</div></div><div><h3>Recent findings</h3><div>Emerging research demonstrates a strong association between JHS and pelvic organ prolapse (POP), with meta-analytic data showing more than a twofold increased risk. Large cohort studies highlight substantial symptom burden, including high rates of stress and urgency incontinence, bladder pain, pelvic floor dysfunction and sexual difficulties. Recent work also reveals distinct challenges in perioperative care, such as dysautonomia-related anaesthetic risks, tissue fragility, impaired wound healing and higher rates of surgical complications in some series. Studies document higher prevalence of urinary incontinence, bladder diverticula, recurrent urinary infections and voiding dysfunction linked to increased bladder capacity and elevated residual volumes.</div></div><div><h3>Summary</h3><div>Women with JHS experience a wide and often severe spectrum of urogynaecological symptoms that significantly affect quality of life. Although management generally mirrors standard care pathways, the unique connective-tissue and systemic features of JHS necessitate tailored assessment and multidisciplinary involvement. Further high-quality research is required to develop specific management algorithms and clarify the role of conservative versus surgical treatments in this complex clinical population.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114943"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training and assessment of competencies in hysteroscopy – A systematic review","authors":"Karen Høgh Abrahamsen ,&nbsp;Martine Siw Nielsen ,&nbsp;Nicolaj Bruun Brandt ,&nbsp;Anders Bo Nielsen ,&nbsp;Lars Konge ,&nbsp;Margit Dueholm ,&nbsp;Pernille Ravn","doi":"10.1016/j.ejogrb.2025.114890","DOIUrl":"10.1016/j.ejogrb.2025.114890","url":null,"abstract":"<div><h3>Objective</h3><div>Hysteroscopy is a core gynecological competence, acquired by training. Simulation training offers safe competence acquisition, but requires resource-efficient, clinically transferable approaches. Current hysteroscopic training curricula lack standardized assessment and validated pass-fail criteria. This review synthesizes evidence to inform optimized training and robust competency assessment.</div></div><div><h3>Methods</h3><div>Five databases were systematically searched on June 2nd 2025. Studies assessing hysteroscopy training and skills assessment were included without restrictions on population, study design, or publication year. Data extraction was performed using Covidence. Outcomes were evaluated with Kirkpatrick’s levels and quality assessment was evaluated with the Medical Education Research Study Quality Instrument (MERSQI).</div></div><div><h3>Results</h3><div>A total of 39 studies, 36 prospective cohort studies (92 %) and 3 RCTs (8 %), met the inclusion criteria. Studies used animal (13 %), inanimate (33 %), virtual reality (39 %), and combinations of models (15 %). Training approaches varied, with numbers-based training being most common (74 %). Outcomes were primarily evaluated with pre-post testing (41 %) and self-assessment (28 %). All studies reported improved performance, especially in novices, with either pre- and posttests or questionnaires. Study quality varied, with a mean MERSQI of 11.3 (range 5–16, of possible 5–18). Only one RCT showed clinical transferability.</div></div><div><h3>Conclusion</h3><div>Simulation-based training enhances hysteroscopic competencies. Despite methodological variability, evidence supports structured curricula combining theory, hands-on training, and pass-fail-based progression. A combination of virtual reality with tactile feedback seems optimal. Overall evidence failed to establish optimized training and robust competency assessment. Future research should include high-quality studies, patient-level outcomes, and updated validity frameworks to decide how to optimize training effectively.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114890"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, awareness and practices regarding human papillomavirus vaccine amongst secondary school girls and mothers in North India","authors":"A. Anand ,&nbsp;Y.M. Mala ,&nbsp;S. Tyagi ,&nbsp;P. Sharma","doi":"10.1016/j.ejogrb.2026.114945","DOIUrl":"10.1016/j.ejogrb.2026.114945","url":null,"abstract":"<div><h3>Background</h3><div>Lack of awareness about cervical cancer, its aetiology and preventive measures are barriers to disease control.</div></div><div><h3>Objectives</h3><div>To study the knowledge, attitudes and practices of adolescent girls and their mothers regarding cervical cancer, human papillomavirus (HPV) vaccine, and preventive strategies.</div></div><div><h3>Design</h3><div>A quasi-experimental study<!--> <!-->amongst girls aged 15–18 years and their mothers. In total, 110 girls and 100 mothers, who gave their consent, were given a pre-intervention questionnaire to assess baseline knowledge and attitudes towards cervical cancer, HPV vaccine, and preventive strategies. Printed educational material was provided. A post-intervention survey was undertaken after a minimum gap of 2 weeks.</div></div><div><h3>Results</h3><div>Ninety-one girls and 82 mothers with a diverse demographic profile completed the study. Pre-intervention findings revealed notable baseline awareness of cervical cancer, albeit with limited understanding of associated symptoms and preventive measures, including HPV vaccination. Post-intervention, knowledge regarding the symptoms of cervical cancer increased significantly among girls (<em>p</em> = 0.000), and awareness of early detection of cervical cancer increased significantly among mothers (<em>p</em> = 0.002). Knowledge about Pap smear tests increased among girls (<em>p</em> = 0.000). An increase in vaccination was seen in girls at the end of the study, but the difference was not significant (pre-intervention 23.1 %, post-intervention 31.9 %; <em>p</em> = 0.045).</div></div><div><h3>Conclusion</h3><div>Significant improvements were observed in adolescent girls and mothers regarding awareness of symptoms and early detection of cervical cancer.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114945"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends over years and maternal characteristics associated with use of recommended drugs during pregnancy: A cross-sectional study in France","authors":"Margaux Louchet ,&nbsp;Mathis Collier ,&nbsp;Jean-Marc Treluyer ,&nbsp;Jeanne Sibiude ,&nbsp;Laurent Chouchana","doi":"10.1016/j.ejogrb.2025.114903","DOIUrl":"10.1016/j.ejogrb.2025.114903","url":null,"abstract":"<div><h3>Aim</h3><div>Pregnant women require different nutritional intake such as folic acid, iron and cholecalciferol, and specific vaccination to prevent fetal abnormalities and improve outcomes. This study aims to analyze usage trends for these recommended drugs over the last decade, and to identify maternal factors associated with their use.</div></div><div><h3>Methods</h3><div>The nationwide cross-sectional study is based on data from the French National Health Data System (SNDS) including pregnancies from 2012 to 2022. Folic acid, iron, cholecalciferol, and influenza vaccination use were analyzed according to the relevant periods based on WHO and French guidelines. Multivariable logistic regression assessed maternal characteristics associated with drug use.</div></div><div><h3>Results</h3><div>Analyzing 8,979,173 pregnancies, the study found that 46.0% of pregnancies used folic acid during the periconceptional period, rising from 33.8% in 2012 to 52.6% in 2022. Women with chronic disease and higher financial resources were more likely to use it. 64.1% used iron during pregnancy with exposure increasing with age. 35.5% used cholecalciferol, with higher socioeconomic status associated with increased use. Only 5.1% were vaccinated against influenza, with the rate increasing until 2020, before declining. Vaccination was positively associated with maternal age, the presence of a chronic disease, and higher financial resources.</div></div><div><h3>Conclusion</h3><div>This study revealed increasing trends of use in recommended drugs during pregnancy over the last decade in France, although overall prevalence remains not optimal, and concerning for influenza vaccination. The identified risk factors for non-use include young maternal age, low income, and deprived areas, emphasizing the need for targeted interventions to improve maternal health outcomes.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114903"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145911023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal ultrasound-based follow up of non-surgically treated endometriosis using #Enzian classification","authors":"Sara Valeriani ,&nbsp;Aikaterini Selntigia ,&nbsp;Consuelo Russo ,&nbsp;Myriam Adele Traulo ,&nbsp;Elvira Nocita ,&nbsp;Federica Iacobini ,&nbsp;Daniele Farsetti ,&nbsp;Giorgia Soreca ,&nbsp;Caterina Exacoustos","doi":"10.1016/j.ejogrb.2025.114923","DOIUrl":"10.1016/j.ejogrb.2025.114923","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare clinical and ultrasound outcomes over 24 months in premenopausal women with ultrasound-diagnosed endometriosis/adenomyosis, never treated surgically, and managed with or without hormonal therapy. We specifically assessed ultrasonographically disease progression progression, symptom control, and lesion dynamics using the compartment-based #Enzian classification.</div></div><div><h3>Materials and methods</h3><div>This single-center retrospective study included patients with endometriosis/adenomyosis who underwent transvaginal ultrasound (TVUS) and clinical assessment at baseline, 12, and 24 months. All lesions were classified according to #Enzian compartments. Patients were divided into Group A, receiving continuous hormonal therapy, and Group B managed without hormonal treatment.</div></div><div><h3>Results</h3><div>A total of 125 patients were included (Group A: n = 95; Group B: n = 30). In Group A, endometrioma prevalence declined from 87.4 % at baseline to 66.3 % at 24 months (p = 0.001), with O2 lesions decreasing from 45.3 % to 6.3 % and O1 lesions increasing from 42.1 % to 60.0 %, reflecting lesion shrinkage. Group B showed no significant changes in the O compartment (p = 0.7). FA (adenomyosis) lesions remained stable in Group A (p = 0.3) but increased from 53.0 % to 73.0 % in Group B over 24 months (p = 0.01). Compartments A, B, and C of deep endometriosis showed no significant changes in either group. Symptom prevalence decreased significantly in Group A compared with Group B.</div></div><div><h3>Conclusions</h3><div>#Enzian-based ultrasound provides a standardized approach for non-invasive longitudinal monitoring of endometriosis/adenomyosis. Hormonal therapy mainly improved symptoms, with significant lesion changes limited to O compartment, supporting its use ad a conservative management strategy while reserving surgery for selected cases.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114923"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical distribution of ovarian and deep endometriosis using a multimodal diagnostic approach applying the updated international definition: A prospective observational study","authors":"Shay M. Freger ,&nbsp;Melissa Marien ,&nbsp;Ido Mick ,&nbsp;Mathew Leonardi","doi":"10.1016/j.ejogrb.2026.114947","DOIUrl":"10.1016/j.ejogrb.2026.114947","url":null,"abstract":"<div><h3>Objective</h3><div>To (1) determine how application of the updated international definition of deep endometriosis (DE) alters apparent disease prevalence across pelvic sites, and (2) characterize the distribution of endometriosis phenotypes, including ovarian (OE), DE, and superficial (SE) disease, using a standardized multimodal approach integrating transvaginal ultrasound (TVS), surgical, and histopathologic findings.</div></div><div><h3>Study design</h3><div>Prospective observational study conducted at a tertiary endometriosis center between November 2021 and January 2023.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing laparoscopy for chronic pelvic pain or infertility underwent systematic TVS and intraoperative assessment performed by a single fellowship-trained operator. Lesions were classified as DE if confirmed by at least two of three modalities. Prevalence estimates under the updated definition were compared descriptively with those using the previous &gt; 5 mm criterion.</div></div><div><h3>Results</h3><div>Among 131 participants, OE were present in 45.4 % (59/130; excluding one participant with prior bilateral oophorectomy) and DE in 64.1 % (84/131). Among individuals with DE, the uterosacral ligaments were the most frequently involved site (52.7 %), followed by bowel (18.3 %), pararectal spaces (16.8 %), posterior vaginal fornix (12.2 %), and parametrium (6.1 %). Under the updated definition, DE prevalence increased from 22.9 % to 52.7 % at the uterosacral ligaments and from 10.7 % to 16.8 % at the pararectal spaces compared with the prior &gt; 5 mm threshold. Isolated SE was found in 32.8 % (43/131) of participants, while OE and DE coexisted in over 90 % of cases with endometrioma.</div></div><div><h3>Conclusions</h3><div>The application of the updated DE definition substantially increases the reported prevalence across key posterior pelvic sites by reclassifying lesions previously categorized as superficial. Comprehensive multimodal assessment further delineates the distribution and overlaps of endometriosis phenotypes, providing a reproducible framework for future multicenter and outcome-based validation.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114947"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of predictive models for endometrial outcomes in patients with intrauterine adhesions post-hysteroscopic adhesiolysis: evaluating endometrial vascularization through narrow-band imaging hysteroscopy and Doppler ultrasound","authors":"Jiezhuang Huang ,&nbsp;Yanlan Huang ,&nbsp;Shengcai Chen ,&nbsp;Qing Ye ,&nbsp;Shuang Liang ,&nbsp;Caini Wei ,&nbsp;Zhifu Zhi","doi":"10.1016/j.ejogrb.2026.114951","DOIUrl":"10.1016/j.ejogrb.2026.114951","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the potential of narrow-band imaging (NBI) hysteroscopy and 2-Dimensional (2-D) ultrasound in predicting re-adhesion for patients with intrauterine adhesions (IUAs) following transcervical resection of adhesions (TCRA).</div></div><div><h3>Design</h3><div>Retrospective study.</div></div><div><h3>Patients</h3><div>We included 56 patients diagnosed with IUAs who underwent TCRA with NBI hysteroscopy at the First Affiliated Hospital of Guangxi medical university from June 2020 to February 2023.</div></div><div><h3>Interventions</h3><div>Participants were divided into two groups based on their endometrial recovery during a three-month follow-up after TCRA: a recovery group (n = 42) and a poor recovery group (n = 14). Both univariable and multivariable logistic regression analyses were conducted to identify independent factors impacting postoperative outcomes. Subsequently, nomogram prediction models were constructed and internally validated using the identified independent factors in conjunction with the classifications established by the European Society of Gynecological Endoscopy (ESGE) and the American Fertility Society (AFS).</div></div><div><h3>Main outcome measures</h3><div>Endometrial restoration within the 3-month follow-up after TCRA.</div></div><div><h3>Results</h3><div>A higher endometrial microvascular index assessed by NBI hysteroscopy and enhanced endometrial blood flow in zone 3, as measured by 2-D Doppler ultrasound, were identified as independent protective factors for postoperative endometrial recovery. The identified factors, when combined with ESGE or AFS classifications, were utilized to build nomogram prediction models, referred to as the NUE and NUA models, respectively. The NUE model (AUC = 0.935, 95% CI: 0.865–1.000) and the NUA model (AUC = 0.939, 95% CI: 0.876–1.000) demonstrated superior discrimination compared to the ESGE (AUC = 0.651, 95% CI: 0.490–0.813) and AFS classifications (AUC = 0.736, 95% CI: 0.578–0.893) alone. The calibration curve indicated that the NUA model exhibited greater consistency between predicted and actual outcomes than the NUE model.</div></div><div><h3>Conclusion</h3><div>Endometrial vascularity is a critical factor for postoperative endometrial recovery in IUAs patients following TCRA. NBI hysteroscopy and Doppler ultrasound provide significant advantages in evaluating endometrial blood vessels, thereby facilitating accurate predictions of endometrial outcomes.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114951"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation of pelvic floor muscle for women with urinary incontinence post hysterectomy: A randomized controlled trial","authors":"Marwa S. Abd Elhady ,&nbsp;Niven R. Basyouni ,&nbsp;Salam Bani Hani ,&nbsp;Hala N. El Galada","doi":"10.1016/j.ejogrb.2025.114908","DOIUrl":"10.1016/j.ejogrb.2025.114908","url":null,"abstract":"<div><h3>Objective</h3><div>Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions among women that can impact all aspects of quality of life. This study aims to compare active training (birth ball) and passive training (biofeedback) on pelvic floor muscle strength and urinary incontinence among post-hysterectomy women.</div></div><div><h3>Methods</h3><div>A Randomized Controlled Trial design was carried out that recruited a purposive sample of 40 women who were allocated randomly into two groups, 20 participants for each group. The intervention group received training in PFM by using biofeedback, while the control group demonstrated active PFM training using a birth ball. Data collected using a basic data structured interview schedule, the Protection, Amount, Frequency, Adjustment, Body Image (PRAFAB) questionnaire, and the Pelvic floor muscles strength test (Manometric Assisted Biofeedback-MBF).</div></div><div><h3>Findings</h3><div>Following 6 weeks and 3 months of interventions, there was a statistically significant difference in the two groups concerning pelvic floor muscle strength. Regarding the degree of urinary incontinence, a statistically significant difference was found between the two study groups after 6 weeks and 3 months following the intervention, with p-values of 0.048 and 0.024, respectively. In favor of the control group, where most participants (75 %) had mild urinary incontinence compared to only 50 % of the intervention group.</div></div><div><h3>Conclusion</h3><div>The study found that pelvic floor exercises improved strength and reduced incontinence, with active birth ball training yielding better outcomes and lower recurrence than passive biofeedback.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114908"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic indocyanine green-guided sentinel lymph node mapping in early-stage cervical cancer: The fluorescent robotic indocyanine endoscopic node detection series (FRIENDS)","authors":"Rahul Chatterjee ,&nbsp;Marielle Nobbenhuis ,&nbsp;Jenneke Kasius ,&nbsp;Manou Kaur ,&nbsp;Katherine Vroobel ,&nbsp;Ayoma Attygalle ,&nbsp;Thomas Edward James Ind","doi":"10.1016/j.ejogrb.2025.114927","DOIUrl":"10.1016/j.ejogrb.2025.114927","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the implementation of robotic indocyanine green (ICG)–guided sentinel lymph node (SLN) mapping for nodal staging in early-stage cervical cancer and to report mapping outcomes, anatomical distribution of SLNs, and perioperative morbidity.</div></div><div><h3>Methods</h3><div>This single-centre cohort study included women with presumed early-stage cervical cancer who underwent robotic ICG-guided SLN mapping between 2015 and 2025. SLN mapping was performed with or without pelvic lymphadenectomy according to a side-specific algorithm. Institutional practice evolved over time from routine SLN mapping with lymphadenectomy to selective SLN-only staging. Outcomes included SLN detection rates, anatomical distribution of SLNs, nodal metastases, and postoperative morbidity.</div></div><div><h3>Results</h3><div>A total of 161 women underwent robotic SLN mapping. SLN detection was achieved in all patients, with bilateral mapping in 145 (90.1 %). Sixteen women (9.9 %) had nodal metastases; all metastatic disease was identified within sentinel lymph nodes. SLNs were most frequently located in the obturator and external iliac regions, with occasional upper pelvic and <em>para</em>-aortic drainage when lymphatic channels extended cranially. Lymphoedema occurred in 18 women (11.2 %) and was observed only in those who underwent pelvic lymphadenectomy.</div></div><div><h3>Conclusions</h3><div>This study describes long-term, real-world implementation of robotic ICG-guided SLN mapping in early-stage cervical cancer. The findings demonstrate consistent SLN detection, characteristic patterns of lymphatic drainage, and a lower observed incidence of lymphoedema when lymphadenectomy is avoided, supporting the role of SLN-guided nodal staging within contemporary, algorithm-based surgical practice.</div></div>","PeriodicalId":11975,"journal":{"name":"European journal of obstetrics, gynecology, and reproductive biology","volume":"318 ","pages":"Article 114927"},"PeriodicalIF":1.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}