International Urogynecology Journal最新文献

{"title":"Applicability of Deep Learning to Dynamically Identify the Different Organs of the Pelvic Floor in the Midsagittal Plane.","authors":"José Antonio García-Mejido, David Solis-Martín, Marina Martín-Morán, Cristina Fernández-Conde, Fernando Fernández-Palacín, José Antonio Sainz-Bueno","doi":"10.1007/s00192-024-05841-0","DOIUrl":"10.1007/s00192-024-05841-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The objective was to create and validate the usefulness of a convolutional neural network (CNN) for identifying different organs of the pelvic floor in the midsagittal plane via dynamic ultrasound.</p><p><strong>Methods: </strong>This observational and prospective study included 110 patients. Transperineal ultrasound scans were performed by an expert sonographer of the pelvic floor. A video of each patient was made that captured the midsagittal plane of the pelvic floor at rest and the change in the pelvic structures during the Valsalva maneuver. After saving the captured videos, we manually labeled the different organs in each video. Three different architectures were tested-UNet, FPN, and LinkNet-to determine which CNN model best recognized anatomical structures. The best model was trained with the 86 cases for the number of epochs determined by the stop criterion via cross-validation. The Dice Similarity Index (DSI) was used for CNN validation.</p><p><strong>Results: </strong>Eighty-six patients were included to train the CNN and 24 to test the CNN. After applying the trained CNN to the 24 test videos, we did not observe any failed segmentation. In fact, we obtained a DSI of 0.79 (95% CI: 0.73 - 0.82) as the median of the 24 test videos. When we studied the organs independently, we observed differences in the DSI of each organ. The poorest DSIs were obtained in the bladder (0.71 [95% CI: 0.70 - 0.73]) and uterus (0.70 [95% CI: 0.68 - 0.74]), whereas the highest DSIs were obtained in the anus (0.81 [95% CI: 0.80 - 0.86]) and levator ani muscle (0.83 [95% CI: 0.82 - 0.83]).</p><p><strong>Conclusions: </strong>Our results show that it is possible to apply deep learning using a trained CNN to identify different pelvic floor organs in the midsagittal plane via dynamic ultrasound.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2285-2293"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Urinary Incontinence with Sensory-Motor Performance in Women with Multiple Sclerosis.","authors":"Fatih Özden, Mehmet Özkeskin, Zübeyir Sarı, Ece Ekici, Nur Yüceyar","doi":"10.1007/s00192-024-05854-9","DOIUrl":"10.1007/s00192-024-05854-9","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The relationship between somatosensory and motor components of urinary incontinence in individuals with MS has not been extensively addressed. The study was aimed at investigating the association of urinary incontinence severity with motor and sensory performance in women with multiple sclerosis (MS).</p><p><strong>Methods: </strong>A cross-sectional single-center prospective study was conducted in 337 women with MS. The severity of MS symptoms was assessed using the SymptoMScreen questionnaire. The urinary incontinence status of the participants was evaluated using the Urinary Incontinence Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Physical performance was considered with the Timed Up and Go (TUG) test and the 5-Times Sit-to-Stand (5TSTS) test. In addition, the sensory performance of the individuals with MS was queried using the Somatosensory Amplification Scale (SSAS) and Sensory Sensitivity Scale (SeSS).</p><p><strong>Results: </strong>The UDI-6 (r=0.685, p<0.05) and IIQ-7 (r=0.759, p<0.05) correlated highly with SymptoMScreen. Among the physical performance measures, TUG (r=0.012, p<0.05) and 5TSTS (r=0.096, p<0.05) were weakly associated with UDI-6, but not statistically significantly. Similarly, there was a low correlation between IIQ-7 and TUG (r=-0.005, p<0.05) and 5TSTS (r=0.068, p<0.05). UDI-6 (0.360, p<0.05) and IIQ-7 (0.378, p<0.05) correlated moderately with SASS. On the other hand, SeSS had a low correlation coefficient with UDI-6 (0.305, p<0.05) and IIQ-7 (0.272, p<0.05).</p><p><strong>Conclusions: </strong>The results revealed that sensory performance was more associated with urinary incontinence in women with MS than physical performance. The urinary incontinence severity was also related to MS symptoms (bladder control, walking, spasticity, stiffness cognitive function). Future studies should consider the potential impact of sensory performance on urinary incontinence and focus on explaining the mechanism behind this relationship.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2305-2311"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554753","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":"Evaluation of Videos Related to Vaginal Cone Usage on YouTube as an Online Information Source.","authors":"Bengisu Tufekci, Ozlem Basgut, Omer Bayrak, Aliye Bulut","doi":"10.1007/s00192-024-05932-y","DOIUrl":"10.1007/s00192-024-05932-y","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The aim of this study is to examine the quality and content characteristics of educational videos on the use of vaginal cones published on YouTube.</p><p><strong>Methods: </strong>Video searches were conducted on the YouTube website using the keyword \"usage of vaginal cones\". A total of 52 videos were included in the current study. Modified DISCERN (mDISCERN) and Journal of the American Medical Association (JAMA) scales were used to evaluate the reliability of the videos, and the Global Quality Scale (GQS) was used for quality and usefulness.</p><p><strong>Results: </strong>As a result of the content analysis conducted, it was observed that 29 videos were classified as having \"poor content\" and 23 as \"rich content.\" When we examined the sources of the videos (n = 52), it was found that the majority (58%, n = 30) were produced by nonhealth care sources (medical companies and nonhealth professionals). With statistical significance in mDISCERN and GQS (p = 0.014, p = 0.036), physiotherapists were found to have the highest average scores (4.11 ± 1.05, 3.44 ± 0.73) whereas doctors ranked second in the average standard deviation (3.09 ± 1.04, 2.82 ± 0.98). In JAMA, medical companies were found to have the highest average score with statistical significance (p = 0.015) at 3.4 ± 0.74, followed by doctors at 3 ± 1, and physiotherapists at 2.89 ± 0.78 when averages were analyzed.</p><p><strong>Conclusion: </strong>It is clearly evident that there is a need for higher quality and more reliable vaginal cone content database on YouTube. It is important for patients to be guided by health care professionals and informed about quality content criteria in order to access quality, reliable, and useful information.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2403-2411"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307666","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":"Adherence to Non-Antibiotic Prophylactic Regimens in Women with Recurrent Urinary Tract Infections.","authors":"Sarah Ashmore, Julia Geynisman-Tan, Eseohi Ehimiaghe, Morgan Cheeks, Rebecca Arteaga, Prottusha Sarkar, Deepanjana Das","doi":"10.1007/s00192-024-05928-8","DOIUrl":"10.1007/s00192-024-05928-8","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Non-antibiotic regimens such as methenamine hippurate, D-mannose, and vaginal estrogen are often prescribed as prevention for recurrent urinary tract infections (rUTIs). The objective of our study was to describe adherence rates in women prescribed non-antibiotic prophylaxis for rUTI and to explore factors associated with adherence.</p><p><strong>Methods: </strong>This was an ambispective cohort study describing and comparing adherence to non-antibiotic prophylactic regimens for rUTIs. Adult women who sought care from a Urogynecology clinic at a tertiary care center for rUTIs or frequent UTIs between January 2020 and December 2021 were included if they were prescribed a non-antibiotic prophylactic regimen. The Medication Adherence Questionnaire (MAQ) was administered to all eligible patients prospectively and then their charts were reviewed retrospectively for demographic and clinical factors. A score of 0 on the MAQ defined medication adherence. Any score ≥ 1 defined medication non-adherence.</p><p><strong>Results: </strong>A total of 90 patients met the inclusion criteria and completed the MAQ, with 33 (37%) in the adherent group and 57 (63%) in the non-adherent group. Mean age was 64.7 (± 14.7) years. Vaginal estrogen (81.1%) was the most commonly prescribed prophylactic regimen, followed by methenamine hippurate (26.7%). 73.3% of patients met criteria for rUTI at the index visit as per the American Urogynecologic Society best-practice statement. No demographic or clinical factors were associated with adherence to non-antibiotic prophylactic regimens.</p><p><strong>Conclusions: </strong>Non-antibiotic prophylactic rUTI regimens are commonly prescribed; however, adherence remains low at 37%. There were no predictors associated with patient compliance. Clinicians should therefore inquire about adherence prior to escalating treatment.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2395-2401"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307665","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":"Long-Term Self-Management of Vaginal Cube Pessaries Can Improve Sexual Life in Patients with Pelvic Organ Prolapse, Results from a Secondary Analysis.","authors":"Zoltan Nemeth, Peter Vida, Predrag Markovic, Peter Gubas, Kalman Kovacs, Balint Farkas","doi":"10.1007/s00192-024-05882-5","DOIUrl":"10.1007/s00192-024-05882-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing.</p><p><strong>Methods: </strong>We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I).</p><p><strong>Results: </strong>Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as \"better\" or \"much better\" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as \"better\" or \"much better\" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive.</p><p><strong>Conclusions: </strong>The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2329-2334"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Vaginal Laxity Associated with Vaginal Parity and Mode of Delivery?","authors":"Susana Mustafa-Mikhail, Moshe Gillor, Yara Nakhleh Francis, Hans Peter Dietz","doi":"10.1007/s00192-024-05849-6","DOIUrl":"10.1007/s00192-024-05849-6","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vaginal laxity (VL) is a common symptom of pelvic floor dysfunction. Although VL has become a frequent topic for research in the last decade, its pathogenesis is still not well understood. The objective was to determine whether vaginal parity or mode of delivery is associated with vaginal laxity.</p><p><strong>Methods: </strong>This was a retrospective observational study involving women seen in a tertiary urogynecology clinic between May 2016 and November 2018 with symptoms of pelvic floor dysfunction. Patients underwent a standardized interview, clinical examination (POP-Q), and four-dimensional (4D) pelvic floor ultrasound (PFUS). Data regarding vaginal parity and the mode of delivery were based on patient-reported information. Archived 4D-PFUS volumes were analyzed offline to evaluate levator hiatal area on Valsalva.</p><p><strong>Results: </strong>Data from 1,051 patients were analyzed. VL was reported by 236 women (23%) who were younger on average (mean age 54 vs 59 years, p < 0.001) and less likely to be menopausal (530 out of 815 [65.0%] vs.129 out of 236 [54.7%]), p = 0.004]. Symptoms of prolapse were much more common in the VL group (214 out of 236 [91%] vs 316 out of 815 [39%], p =  < 0.001) and on imaging mean levator hiatal area (HA) on Valsalva was larger (31 vs 26 cm², p = 0.01). Vaginal parity was associated with VL symptoms (235 out of 236 [99%] vs 767 out of 815 [94%], p = 0.008), but neither VL prevalence nor bother increased with higher parity. Women who delivered vaginally were three times more likely to complain of VL than those who delivered only by cesarean section.</p><p><strong>Conclusions: </strong>Vaginal laxity was found to be more prevalent in vaginally parous women. This effect seems to be largely attributable to the first delivery. Instrumental delivery was not shown to increase association with VL compared with normal vaginal delivery.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2323-2328"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Device-Related Reoperations 8 Years Following Sacral Neuromodulation Implantation in Older Women.","authors":"C Emi Bretschneider, David Sheyn, Nicola Lanki, Lena Volpe, Ankita Gupta","doi":"10.1007/s00192-024-05891-4","DOIUrl":"10.1007/s00192-024-05891-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The objective was to describe long-term device-related reoperations at 8 years following sacral neuromodulation (SNM) in women older than 65 years for the indications of overactive bladder (OAB), fecal incontinence (FI), and/or idiopathic urinary retention (UR).</p><p><strong>Methods: </strong>The 2010-2019 Medicare 100% Outpatient Limited Dataset was used to identify women aged 65 years and older who underwent SNM to treat OAB, FI, and/or UR. The primary study outcome was any device-related reoperation within 8 years following initial implantable pulse generator (IPG) implantation defined as: IPG revision or removal; IPG replacement; or neuro-electrode revision or removal. Kaplan-Meier survival analysis was also performed to evaluate time to adverse event.</p><p><strong>Results: </strong>The cohort included 32,454 women with a mean age of 74 years. The most common indication for SNM was OAB (71%) followed by UI and FI (13%) and FI only (8%). Staged SNM procedures were performed more frequently (60%) than percutaneous nerve evaluation/full implants. The overall rate of device-related reoperations was 24% over 8 years: 12% of patients underwent removal or revision of the neuro-electrode, 11% underwent removal or revision of the IPG, and 13% underwent replacement of the IPG. The mean follow-up was 3.9 ± 2.4 years. The cumulative incidence of any device-related reoperations was 9.4% at 1 year, 20% at 3 years, and 43% at 8 years.</p><p><strong>Conclusions: </strong>In the 8 years following SNM implantation, the rate of device-related reoperation among female Medicare beneficiaries was 43%, and staged implants were associated with a 17% lower likelihood of undergoing any device-related reoperations.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2349-2355"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916681","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 \"Long-Term Outcomes of Diastasis Recti Abdominis on Postpartum Women: A Retrospective Cohort Study\".","authors":"Fátima Faní Fitz","doi":"10.1007/s00192-024-05973-3","DOIUrl":"10.1007/s00192-024-05973-3","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2437"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567501","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 Making of Confident Surgeons: Why and How?","authors":"Roxana Geoffrion, Terry Lee","doi":"10.1007/s00192-024-05987-x","DOIUrl":"10.1007/s00192-024-05987-x","url":null,"abstract":"<p><p>Low self-confidence in surgical residents can be associated with poor self-efficacy and perceptions of sub-optimal preparedness for practice at graduation. The influence of social and biologic determinants of confidence deserves further study. Through a randomized controlled trial of procedure-specific didactic and low fidelity simulation training for vaginal surgery, we showed positive correlations between self-confidence and objective performance in the real operating room for three different surgical procedures and through validated scales. This demonstrates an accurate ability of novice surgeons to self-monitor in a high-stakes environment. Our trial results (described in full elsewhere), combined with our multiple one-on-one teaching interactions with surgical trainees through the trial, incentivized us to evaluate self-confidence in view of optimizing it through directed training and feedback. The current opinion piece summarizes our main findings for surgical educators and emphasizes their role engaging with trainees at extremes of confidence.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2281-2284"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619864","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":"Use of the Martius Flap for Tethered Vagina Syndrome After a Single-Incision Mini-Sling Procedure.","authors":"Mahmut Kuntay Kokanalı, Melike Doganay","doi":"10.1007/s00192-024-05979-x","DOIUrl":"10.1007/s00192-024-05979-x","url":null,"abstract":"<p><p>Tethered vagina syndrome is an iatrogenic, but poorly defined condition that usually develops after surgical procedures performed on the anterior vaginal wall. Loss of elasticity as a result of scarring in the bladder neck-urethra is blamed for its pathogenesis. Patients often present with typical, massive uncontrollable urine loss and have specific examination findings. Having awareness about the diagnosis is important for its management. Surgical restoration and maintenance of bladder neck elasticity are essential for treatment. In our case, we presented the surgical approach we applied to tethered vagina syndrome that developed after the single-incision mini-sling operation. We demonstrated the surgical technique of Martius flap transposition and showed that this flap can be used to maintain the elasticity of the bladder neck area of the vagina.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"2431-2433"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619978","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}