{"title":"The Relationship Between the Distance of Common Iliac Artery Bifurcation to the Sacral Promontory and Sacropelvic Parameters: Implications for Sacropexy Operations.","authors":"Onur Bektaş, Kıvılcım Bektaş","doi":"10.1007/s00192-025-06176-0","DOIUrl":"https://doi.org/10.1007/s00192-025-06176-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This study is aimed at assessing how sacropelvic parameters influence the spatial proximity between the sacral promontory and the aorta-common iliac artery bifurcation, which is of particular relevance in gynecological surgeries involving the presacral region.</p><p><strong>Methods: </strong>Abdominal computed tomography (CT) scans of 223 female patients, obtained for various unrelated clinical indications, were retrospectively evaluated. The distance between the aorta-common iliac artery bifurcation and the sacral promontory (aBPD), as well as sacropelvic parameters, were measured on these CT images. The relationship between aBPD and both demographic variables and sacropelvic parameters was analyzed.</p><p><strong>Results: </strong>The average distance (aBPD) was measured as 40.81 mm, with the bifurcation most frequently located at the L4 vertebral body level. Statistical analyses revealed that the aBPD had a negative correlation with age (p < 0.001) and hypertension (p = 0.026), while showing a positive correlation with BMI (p = 0.008), diagonal conjugate (DC) (p = 0.029), and pelvic thickness (PTH) (p = 0.031).</p><p><strong>Conclusions: </strong>A shorter aBPD was identified in patients with hypertension, low BMI, shorter PTH, shorter DC, and advanced age. These findings underscore the importance of considering individual anatomical variations during surgical risk assessment. Recognizing such factors may help to reduce the risk of vascular injury and enhance the safety and effectiveness of sacropexy procedures.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary on \"Effect of Preoperative Tamsulosin on Postoperative Urinary Retention Prevention after Sling Placement: A Randomized Controlled Trial\".","authors":"Alexandre Fornari","doi":"10.1007/s00192-025-06218-7","DOIUrl":"https://doi.org/10.1007/s00192-025-06218-7","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher P Chung, Wilma I Larsen, Thomas J Kuehl
{"title":"Magnetic Resonance Imaging Evaluation of Pregnancy and Aging on External Anal Sphincter Volume in Squirrel Monkeys.","authors":"Christopher P Chung, Wilma I Larsen, Thomas J Kuehl","doi":"10.1007/s00192-025-06189-9","DOIUrl":"https://doi.org/10.1007/s00192-025-06189-9","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Both humans and squirrel monkeys are susceptible to pelvic floor injury and prolapse from pregnancy, delivery, and aging. The mechanisms for external anal sphincter (EAS) injury in squirrel monkeys have not been evaluated in detail. This study evaluates a method for measuring EAS volume using magnetic resonance imaging (MRI) in squirrel monkeys and demonstrates the feasibility of serial measurements.</p><p><strong>Methods: </strong>Using a previously described procedure, MRI was performed on 10 squirrel monkeys prior to euthanasia. After euthanasia, tissue blocks of EAS were cryo-sectioned and stained with succinic dehydrogenase to identify EAS striated muscle fibers. EAS volumes from both MRI and histological measurements were calculated using image analysis software. MRI measurements were obtained by two independent investigators. A cohort of four monkeys, each having five pregnancies and 11 MRI studies over a 5-year span, was used to evaluate EAS volume changes serially within females.</p><p><strong>Results: </strong>Volumes measured by MRI for each squirrel monkey were similar for the two researchers (Cronbach alpha of 0.97 with 95% lower confidence limit of 0.92), and they were statistically consistent with the volumes obtained from analysis of histology (linear regression with R-squared of 0.97 and p < 0.0001). This validated technique was used to measure EAS volumes in four breeding females and demonstrated sufficient power to detect a decrease (p < 0.00001) from 32.1 ± 3.2 mm<sup>3</sup> (mean ± SE) prior to the first pregnancy to 10.7 ± 1.5 mm<sup>3</sup> after five pregnancies in 5 years.</p><p><strong>Conclusion: </strong>Magnetic resonance imaging is a valid technique for measuring EAS volume changes in squirrel monkeys with sufficient sensitivity to detect EAS volume changes such that effects of aging and serial pregnancies can be evaluated.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qi Wang, Xiaoxiang Jiang, Stefano Manodoro, Chaoqin Lin
{"title":"Outcomes of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for Uterosacral Ligament Suspension in Apical Compartment Prolapse: A Systematic Review.","authors":"Qi Wang, Xiaoxiang Jiang, Stefano Manodoro, Chaoqin Lin","doi":"10.1007/s00192-025-06195-x","DOIUrl":"https://doi.org/10.1007/s00192-025-06195-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This systematic review is aimed at assessing the efficacy and safety of transvaginal natural orifice transluminal endoscopic surgery-uterosacral ligament suspension (vNOTES-USLS) based on current evidence.</p><p><strong>Methods: </strong>A comprehensive search of PubMed and Web of Science was conducted for studies published up to 31 December 2024. Original studies on vNOTES-USLS were included, whereas reviews, abstracts, and publications not in the English language were excluded. No restrictions were placed on sample size or publication date.</p><p><strong>Results: </strong>Nine studies with 336 patients met the criteria, including 1 randomized controlled trial, 3 prospective, and 5 retrospective studies. Operative time ranged from 17.4 ± 6.4 to 29.7 ± 8.2 minutes. Hemoglobin reduction varied between 1.12 ± 0.83 and 1.80 ± 1.57 g/dl. Hospital stays ranged from 1.0 ± 0.5 to 3.7 ± 1.1 days. Intraoperative complications occurred in 2.1% (7 out of 336), with bladder injury being the most common (3 cases). One patient required conversion to vaginal USLS, but no laparotomy conversions were reported. Ureteral kinking occurred in 1 case (0.3%) and was resolved intraoperatively. Postoperative complications were reported in 7.4% (25 out of 336), with urinary tract infection being the most frequent (10 cases). Over 1-37 months of follow-up, 1 patient required reoperation for anterior prolapse recurrence.</p><p><strong>Conclusion: </strong>vNOTES-USLS appears to be a promising option for apical prolapse, with favorable short-term outcomes. However, small sample sizes, short follow-ups, and study design variations limit current evidence. Larger prospective studies with longer follow-ups and direct comparisons with established procedures are needed to assess long-term safety and effectiveness.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rima Anggrena Dasrilsyah, Reut Rotem, Bobby O'Leary, Claudine Domoney, Barry O'Reilly
{"title":"Female Orgasmic Disorder: How Far We Have [Not] Come?","authors":"Rima Anggrena Dasrilsyah, Reut Rotem, Bobby O'Leary, Claudine Domoney, Barry O'Reilly","doi":"10.1007/s00192-025-06206-x","DOIUrl":"https://doi.org/10.1007/s00192-025-06206-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The female orgasm is a complex physiological and psychological response essential for sexual well-being and overall health. Historically misinterpreted, its significance is now better understood through modern research integrating neurobiological, hormonal, and psychological factors. Female orgasmic disorder (FOD), characterized by persistent difficulty in achieving orgasm, significantly affects emotional and relational well-being. This review summarizes current knowledge on the female orgasm, its dysfunction, and treatment modalities.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using MEDLINE/PubMed and Google Scholar, focusing on studies published between 2000 and 2024. Keywords included \"female orgasmic disorder,\" \"female orgasm,\" \"anorgasmia,\" and \"female sexual dysfunction.\" After screening abstracts and full texts, 20 articles were included, supplemented by additional sources through reference review.</p><p><strong>Results: </strong>The female orgasm involves interplay between anatomical structures such as the clitoris, vagina, and pelvic floor muscles, as well as neural pathways and hormonal interactions. FOD is classified as primary (lifelong) or secondary (acquired) and is influenced by psychosocial, relational, and medical factors. Treatment options include cognitive-behavioral therapy, directed masturbation, pelvic floor muscle training, pharmacological interventions such as sildenafil, bupropion, or hormonal therapy, mechanical devices, and emerging regenerative therapies such as platelet-rich plasma and stem cell treatments.</p><p><strong>Conclusions: </strong>Understanding the female orgasm and its dysfunction is essential for improving sexual health care. A biopsychosocial approach that integrates personalized, patient-centered treatments can enhance outcomes. Future research should focus on refining therapeutic strategies and expanding knowledge on novel interventions.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"\"The Problem of Recurrent Anterior Wall Prolapse after Supracervical Hysterectomy with Sacrocolpopexy\".","authors":"Kaven Baessler","doi":"10.1007/s00192-025-06224-9","DOIUrl":"https://doi.org/10.1007/s00192-025-06224-9","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Detection of Age-Related Pelvic Floor Fragility in Female Patients Using Magnetic Resonance Imaging.","authors":"Itsuko Okuda, Naoki Yoshioka, Keiichi Akita, Masahiro Jinzaki","doi":"10.1007/s00192-025-06200-3","DOIUrl":"https://doi.org/10.1007/s00192-025-06200-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>As aging societies become increasingly widespread worldwide, the prevalence of pelvic floor (PF) disorders is also increasing, particularly among older women. We hypothesized that PF fragility associated with aging could be detected by examining its configurations and the condition of the levator ani muscle. Therefore, in the present study, we aimed to establish a method for detecting age-related PF fragilities by analyzing PF configuration and levator ani muscle thickness using magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>In total, 328 healthy female participants aged 20-91 years were enrolled in this study. T2-weighted coronal MR images of the pelvis were used to classify PF configuration into four types: wing, shallow-V, deep-V, and cup. The correlation between age and levator ani muscle thickness was analyzed for each classification.</p><p><strong>Results: </strong>PF configuration was observed to transition from wing to shallow-V, deep-V, and finally to cup type with age. Additionally, a strong negative correlation was identified between age and levator ani muscle thickness (r = -0.75, P < 0.001). Levator ani muscle thickness decreased progressively in the following order: wing, shallow-V, deep-V, and cup.</p><p><strong>Conclusions: </strong>This MRI-based visual classification method provides a simple and practical approach to evaluate age-related PF changes. Visually assessing PF configuration facilitates the detection of structural decline associated with aging.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Complex Reconstructive Approach to Iatrogenic Vaginal Scarring and Resultant Urethral Intercourse.","authors":"Janice Wong, Alejandro Gomez-Viso, Cassandra Kisby","doi":"10.1007/s00192-025-06214-x","DOIUrl":"https://doi.org/10.1007/s00192-025-06214-x","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This video aims to: 1) Review vaginal septa; 2) Present a case of iatrogenic vaginal scarring leading to unknowing engagement in urethral intercourse; and 3) Demonstrate a multi-component reconstructive procedure to restore vaginal patency and urethral continence.</p><p><strong>Methods: </strong>This is a stepwise demonstration of surgical techniques with video narration. IRB approval was not required.</p><p><strong>Results: </strong>Vaginal septa are congenital anomalies that may present as transverse, longitudinal, and oblique septa Miller et al (Clin Obstet Gynecol 51:223-36, 1); Skinner and Quint (J Minim Invasive Gynecol 24: 909-14, 2). Concomitant anal, renal, or ureteral anatomic differences may be present, and additional imaging should be considered Lecka-Ambroziak et al (J Clin Med 12:7284, 3); Murphy et al (Curr Opin Obstet Gynecol 35: 328-36, 4); Kang et al (Medicine (Baltimore) 97:e12822, 5). This video presents the case of a 20-year-old female with a history of a vaginal septum resection followed by multiple surgeries resulting in a bladder injury and vaginal scarring. Subsequently, she developed chronic urinary leakage and dyspareunia. Examination revealed a urethra splayed from the meatus to the bladder trigone and vaginal obliteration. This video details an extensive reconstructive procedure, emphasizing the use of an autologous sling, Martius flap, and biologic graft. Ultimately, successful genitourinary reconstruction restored this patient's sexual function and urinary continence.</p><p><strong>Conclusions: </strong>Accurate diagnosis of congenital anomalies and referral to appropriate care are essential to ensure positive outcomes. Urogynecologists are well-equipped to perform these multi-component procedures.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Automated Evaluation of Female Pelvic Organ Descent on Transperineal Ultrasound: Model Development and Validation.","authors":"Shuangyu Wu, Jiawei Wu, Yuteng Xu, Jiantao Tan, Ruixuan Wang, Xinling Zhang","doi":"10.1007/s00192-025-06211-0","DOIUrl":"https://doi.org/10.1007/s00192-025-06211-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Transperineal ultrasound (TPUS) is a widely used tool for evaluating female pelvic organ prolapse (POP), but its accurate interpretation relies on experience, causing diagnostic variability. This study aims to develop and validate a multi-task deep learning model to automate POP assessment using TPUS images.</p><p><strong>Methods: </strong>TPUS images from 1340 female patients (January-June 2023) were evaluated by two experienced physicians. The presence and severity of cystocele, uterine prolapse, rectocele, and excessive mobility of perineal body (EMoPB) were documented. After preprocessing, 1072 images were used for training and 268 for validation. The model used ResNet34 as the feature extractor and four parallel fully connected layers to predict the conditions. Model performance was assessed using confusion matrix and area under the curve (AUC). Gradient-weighted class activation mapping (Grad-CAM) visualized the model's focus areas.</p><p><strong>Results: </strong>The model demonstrated strong diagnostic performance, with accuracies and AUC values as follows: cystocele, 0.869 (95% CI, 0.824-0.905) and 0.947 (95% CI, 0.930-0.962); uterine prolapse, 0.799 (95% CI, 0.746-0.842) and 0.931 (95% CI, 0.911-0.948); rectocele, 0.978 (95% CI, 0.952-0.990) and 0.892 (95% CI, 0.849-0.927); and EMoPB, 0.869 (95% CI, 0.824-0.905) and 0.942 (95% CI, 0.907-0.967). Grad-CAM heatmaps revealed that the model's focus areas were consistent with those observed by human experts.</p><p><strong>Conclusions: </strong>This study presents a multi-task deep learning model for automated POP assessment using TPUS images, showing promising efficacy and potential to benefit a broader population of women.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on \"Cause of Non‑specific Low Back Pain in Women: Pelvic Floor Muscle Weakness\".","authors":"Jie Hao","doi":"10.1007/s00192-025-06220-z","DOIUrl":"https://doi.org/10.1007/s00192-025-06220-z","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}