International Urogynecology Journal最新文献

{"title":"Comment on \"Short-Term Complications of Concomitant Pelvic Organ Prolapse and Rectal Prolapse Repair: A Systematic Review and Meta-Analysis\".","authors":"Shubham Kumar, Nosaibah Razaqi, Rachana Mehta, Ranjana Sah","doi":"10.1007/s00192-025-06066-5","DOIUrl":"10.1007/s00192-025-06066-5","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005138","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":"Beyond the Visible: The Relationship Between Social Appearance Anxiety, Hopelessness, and Depression in Women with Urinary Incontinence.","authors":"Serap Canlı, Yeşim Çetinkaya Şen, İlknur Münevver Gönenç, Ayfer Tezel","doi":"10.1007/s00192-025-06050-z","DOIUrl":"https://doi.org/10.1007/s00192-025-06050-z","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to examine the relationship between the severity of urinary incontinence and levels of social appearance anxiety, hopelessness, and depression in women.</p><p><strong>Methods: </strong>A total of 393 women participated in this descriptive and correlational study. Data were collected using the Introductory Information Form, Incontinence Severity Index (ISI), Social Appearance Anxiety Scale (SAAS), Beck Hopelessness Scale (BHS), and Beck Depression Inventory (BDI).</p><p><strong>Results: </strong>Of the participants, 46.3% reported moderate social appearance anxiety, while 25.2% had severe depression. The mean BHS score was 8.80 ± 5.63. No significant correlation was found between the severity of incontinence and social appearance anxiety (p > 0.05). A strong positive correlation was observed between the BDI and BHS scores (p < 0.001). A one-unit increase in age was associated with a 0.172 (B) increase in incontinence severity, and a one-unit increase in BDI score was linked to a 0.137 (B) increase in incontinence severity.</p><p><strong>Conclusions: </strong>The results suggest that increasing age is associated with greater severity of urinary incontinence. Higher incontinence severity is also correlated with higher levels of hopelessness and depression. The psychological impact of urinary incontinence on women's mental health should be addressed, and referrals to psychiatric care should be considered when necessary for a comprehensive treatment approach.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004900","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":"Fistulae Secondary to Vaginal Pessary Use for Pelvic Organ Prolapse: A Systematic Review.","authors":"Thomas James Curtis, Charlotte Chant, Stuart Quek, Ilias Giarenis, Thomas Giles Gray","doi":"10.1007/s00192-024-06035-4","DOIUrl":"https://doi.org/10.1007/s00192-024-06035-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Urogenital and rectovaginal fistulae are rare complications of pessary use for pelvic organ prolapse (POP). This systematic review investigates the prevalence of these complications in patients using pessary for POP, potential risk factors and approaches to their investigation and management.</p><p><strong>Methods: </strong>All studies in English reporting urogenital or rectovaginal fistulae secondary to pessaries for POP were eligible for inclusion. AMED, CINAHL, MedLine, Scopus and Web of Science databases were searched from inception to March 2024. Risk of bias was assessed using validated tools: Murad et al.'s tool for case series/reports and ROBINS-I for non-randomised studies. Quantitative synthesis of descriptive statistics and narrative summary were performed.</p><p><strong>Results: </strong>Two retrospective studies and 60 case series/reports were included, describing 76 fistulae (34 urogenital, 42 rectovaginal). The retrospective studies estimated the prevalence of fistulae to be 3%. Of reported fistulae, 45% occurred with Gellhorn, 16% with ring, 11% with shelf and 9% with cube pessaries. Fifty percent were associated with neglected pessary care. Conservative management resulted in size reduction or resolution in 69% of fistulae: this approach should be considered. Vaginal (88%) and abdominal (100%) vesicovaginal fistula repairs were successful. Diverting ostomies were popular for rectovaginal fistulae but often resulted in permanent stoma without reducing mortality, recurrence or repair failure. Colpocleisis represents an effective procedure for managing co-existing POP.</p><p><strong>Conclusions: </strong>The prevalence of fistulae from pessary use is likely < 1% but may rise to 3% with risk factors present, including Gellhorn pessaries and neglected care. Both conservative and surgical management are viable treatment options.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005241","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":"Bothersome Pelvic Floor Dysfunction and Quality of Life During Pregnancy and Postpartum in Primiparous Women.","authors":"Sofia Nestor, Jan Brynhildsen, Ayako Hiyoshi, Markus Harry Jansson","doi":"10.1007/s00192-024-06038-1","DOIUrl":"https://doi.org/10.1007/s00192-024-06038-1","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This is a prospective cohort study based on the hypothesis that pregnancy and childbirth are associated with the occurrence of bothersome pelvic floor dysfunction (PFD), which impairs health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>Primiparous women completed a questionnaire including questions about bothersome PFD and HRQoL in early pregnancy, late pregnancy, 8 weeks postpartum, and 12 months postpartum. HRQoL was measured using the Incontinence Impact Questionnaire, Short Form (IIQ-7). The association between bothersome urinary incontinence (UI) 1 year postpartum and maternal and delivery characteristics was examined using generalized linear models.</p><p><strong>Results: </strong>The study sample comprised 851 women. The prevalence of bothersome UI increased from 0.7% in early pregnancy to 8.1% at 1 year postpartum. At 1 year postpartum, 22.8% of the women reported PFD with impairment in HRQoL, with a median IIQ-7 score of 14.3. Bothersome UI in late pregnancy (adjusted RR 4.51, 95% CI 1.43-14.26) and 8 weeks postpartum (adjusted RR 10.17, 95% CI 5.45-18.98) were associated with bothersome UI 1 year postpartum.</p><p><strong>Conclusions: </strong>Most women were not bothered by UI during pregnancy and up to 1 year postpartum and did not report PFD with impairment in HRQoL. Most women who reported PFD with impairment in HRQoL had low IIQ-7 scores, but a few women reported substantial restriction in lifestyle. Bothersome UI in late pregnancy and 8 weeks postpartum was predictive of bothersome UI 1 year postpartum. This indicates the importance of the early identification of these women to provide appropriate counseling and treatment.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005043","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":"Three-dimensional Analysis of the Distribution of Smooth and Skeletal Muscle Tissue Around the Female Urethra.","authors":"Tong Liu, Satoru Muro, Suthasinee Tharnmanularp, Keiichi Akita","doi":"10.1007/s00192-025-06045-w","DOIUrl":"https://doi.org/10.1007/s00192-025-06045-w","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The urethra is surrounded by layers of smooth muscle, including inner longitudinal and outer circler muscles, as well as the skeletal muscle of the external urethral sphincter. However, the extent of these muscles and their relationship with the levator ani (LA) remain unclear. This study aimed to clarify the composition of muscle layers around the female urethra and their three-dimensional arrangements.</p><p><strong>Methods: </strong>Pelvises from five female cadavers were collected for histological analysis. The surrounding urethral tissue was serially sectioned and stained with Elastica van Gieson stain to identify the connective and muscular tissues. Immunohistological staining with an anti-smooth muscle antibody was performed to confirm the distribution of the smooth and skeletal muscles. Thereafter, muscle layers were three-dimensionally reconstructed on the basis of serial histological sections.</p><p><strong>Results: </strong>The female urethra was surrounded by four muscle layers arranged from inner to outer layers in the following order: longitudinal smooth muscle, circular smooth muscle, the external urethral sphincter (EUS), and an outermost smooth muscle layer. These muscles surrounded the urethra and partially extended anteriorly. Moreover, smooth muscle fibers extending from the vagina were found between the LA and EUS.</p><p><strong>Conclusions: </strong>This study clarified the distribution of muscle tissue surrounding the female urethra, showing that the EUS is connected to the LA through the outermost smooth muscle layer. Thus, urination control likely involves both the urethral muscle layers and the pelvic floor muscles.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005262","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":"Educational and Resource Needs of Pelvic Health Physiotherapists: Context Matters.","authors":"Corlia Brandt","doi":"10.1007/s00192-024-06036-3","DOIUrl":"https://doi.org/10.1007/s00192-024-06036-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Evidence on health system challenges mostly relate to high-income countries. Lack of context-specific knowledge, educational opportunities, and access to resources among pelvic health care providers could be barriers to effective implementation of pelvic health services in South Africa. The aim of this study was to determine the patient and therapist profile, and the educational and resource needs of pelvic health physiotherapists in South Africa.</p><p><strong>Methods: </strong>Ninety-five pelvic health physiotherapists, recruited over 6 months, participated in a cross-sectional study during 2022-2023. Participants completed a REDCap survey covering the stipulated domains. Frequencies, percentages, and Chi-squared tests were used for data analysis.</p><p><strong>Results: </strong>The majority were employed in the private sector (n = 72; 75.8%) and had undergraduate training in pelvic health (n = 86; 89.5%); mostly in pre- and postnatal care (n = 69; 72.6%). Urinary incontinence was the most frequently seen condition (n = 81; 85.3%). Conditions were seen very seldom (n = 46; 48.4%) and most participants treated < 5 patients per month (n = 75; 78.9%), did not have patient educational material available (n = 58; 61.1%), preferred hard-copy formats (63.8%, n = 60), whereas 94.7% (n = 90) felt that there is a lack of patient resources. Participants (n = 66; 69.5%) indicated a need for educational opportunities for clinicians.</p><p><strong>Conclusions: </strong>This study highlights the contextualising of educational and resource needs in mid- to low-income countries, such as South Africa, which might be contrary to common beliefs and practices.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005139","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 Association Between Levator Ani Integrity and Postpartum Ano-Rectal Dysfunction: A Systematic Review.","authors":"Adéla Samešová, Rafaël Kiebooms, Laura Cattani, Bram Packet, Helena Williams, Lucie Hájková Hympánová, Ladislav Krofta, Jan Deprest","doi":"10.1007/s00192-024-06034-5","DOIUrl":"https://doi.org/10.1007/s00192-024-06034-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Pregnancy and delivery are commonly associated with ano-rectal dysfunction. In addition, vaginal delivery may impact both the structure and functionality of the pelvic floor. Herein, we systematically reviewed the literature for the potential association between levator ani muscle (LAM) avulsion and ano-rectal function after childbirth.</p><p><strong>Methods: </strong>We systematically searched the PubMed, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL (Cochrane), Clinicaltrials.gov, and ICTRP databases from inception. We selected studies reporting on the anatomy of the LAM and ano-rectal function within 24 months after childbirth, the former determined by imaging and the latter measured through validated questionnaires or ano-rectal manometry. Meta-analyses were used to pool data from studies reporting on the association between LAM avulsion and ano-rectal function, with subgroup analysis according to the presence or absence of anal sphincter trauma. Summary odds ratio (OR) and mean difference (MD) are reported with 95% confidence intervals.</p><p><strong>Results: </strong>From the 7,621 studies identified, 11 were included, reporting on 2,146 women. Ten studies used transperineal ultrasound (TPUS) and one study used magnetic resonance imaging (MRI) for LAM assessment. Ano-rectal function was assessed through validated questionnaires in all but one study, in which ano-rectal manometry was used. There was no evidence for an association between LAM avulsion and symptoms of incontinence (OR 1.75 [0.74, 4.12]; MD 0.13 [-0.58, 0.85]), including in the subgroup of patients with concomitant anal sphincter injury (OR 1.83 [0.71, 4.71]).</p><p><strong>Conclusions: </strong>We did not identify an association between LAM avulsion and ano-rectal dysfunction following vaginal childbirth.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005332","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 Learning Curve in Urogynecology and Functional Urology: A Systematic Review.","authors":"Hanieh Salehi-Pourmehr, Fateme Tahmasbi, Shima Hosseinpour, Ozra Nouri, Behzad Lotfi, Pedram Iranmanesh, Fariba Pashazadeh, Sakineh Hajebrahimi","doi":"10.1007/s00192-024-06016-7","DOIUrl":"https://doi.org/10.1007/s00192-024-06016-7","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>When adopting new methods, surgeons may experience a period of complexity and longer operation times because of their inexperience. This period is known as the \"learning curve.\" This study was aimed at systematically reviewing the current literature on functional urology learning curves.</p><p><strong>Methods: </strong>A comprehensive search was conducted across multiple databases from inception to July 2023 with no language restrictions. All original studies on urogynecological and functional urological procedures, including cross-sectional, cohort, and clinical trials, were eligible for inclusion. Relevant data were extracted, and methodological quality was appraised using standardized Joanna Briggs Institute critical appraisal tools. To quantitatively investigate learning curves, a mixed-effects generalized linear regression analysis was conducted on studies employing cumulative summation methods.</p><p><strong>Results: </strong>From the 7,104 records, 68 studies met the inclusion criteria. The majority of studies were observational and the most common outcome measures were surgical duration, blood loss, and hospital stay. The learning curves varied by procedure type-for incontinence surgeries, 15-80 cases were required; for pelvic organ prolapse surgeries, 18-47 cases; for laparoscopic procedures, 10-105 cases; and for robotic procedures, 5-84 cases. The analysis showed that the number of cases required to surpass the learning curve decreased over time, likely reflecting technological advancements and increased surgical experience.</p><p><strong>Conclusion: </strong>The learning curve for surgical procedures varies significantly. It varies between 5 cases for robotic supratrigonal cystectomy to 75 cases for robot-assisted ventral mesh rectopexy or robotic sacrocolpopexy surgery in 84 cases. These variable learning curves highlight the need for structured training programs and ongoing assessment.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005340","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":"Assessment of Different Pubococcygeal Lines for the Quantitative Diagnosis of Pelvic Organ Prolapse Using Magnetic Resonance Defecography.","authors":"Min Li, Sumei Wang, Tongtong Liu, Xiao Liu","doi":"10.1007/s00192-024-06021-w","DOIUrl":"https://doi.org/10.1007/s00192-024-06021-w","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The objective was to elucidate the clinical utility of two reference lines, the pubosacrococcygeal joint line (PCL_jnt) and pubococcygeal joint line (PCL_cc), in the quantitative diagnosis of pelvic organ prolapse (POP) and pelvic floor laxity.</p><p><strong>Methods: </strong>A retrospective analysis of magnetic resonance defecography (MRD) in patients with stage II or above POP was conducted. POP and pelvic floor relaxation were quantitatively assessed using both PCL_jnt and PCL_cc as reference lines. Further research, point-to-point correlation analysis was performed between the pelvic organ prolapse quantification (POP-Q) system and MRD to investigate the discrepancies between the two reference lines.</p><p><strong>Results: </strong>There was no significant statistical difference in the degree of cystocele and H line between the PCL_jnt and PCL_cc groups (p > 0.05). Nevertheless, significant differences in the degree of uterine prolapse and M-line between the two groups were observed (p = 0.00). Both the PCL_jnt and PCL_cc reference lines demonstrated better correlation with POP-Q, and the PCL_cc exhibited slightly higher correlation coefficients than the PCL_jnt.</p><p><strong>Conclusions: </strong>The results revealed significant moderate correlations between both reference lines and key POP-Q landmarks. Both PCL_jnt and PCL_cc can be utilized for interpreting MRD images and diagnosing POP for anterior wall and uterine prolapse.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004881","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":"Cardiometabolic Index and Stress Urinary Incontinence in US Women: The Mediating Role of the Triglyceride Glucose Index.","authors":"Qian Yang, Yue Cao","doi":"10.1007/s00192-025-06044-x","DOIUrl":"https://doi.org/10.1007/s00192-025-06044-x","url":null,"abstract":"<p><strong>Background: </strong>Stress urinary incontinence (SUI) is a prevalent condition among women, significantly impairing their quality of life. Emerging evidence suggests that metabolic dysfunction may play a role in the development of SUI, although the underlying mechanisms remain unclear. This study aims to examine the association between the cardiometabolic index (CMI), a novel marker of metabolic health, and the risk of SUI in women.</p><p><strong>Methods: </strong>Cross-sectional data from the 2001-2020 NHANES were analyzed. Weighted multivariable logistic regression models assessed the relationship between CMI and SUI risk, while restricted cubic spline (RCS) models examined potential nonlinear associations. Subgroup analyses and interaction tests were performed to explore how specific characteristics influenced the CMI-SUI relationship. Mediation analysis was performed to evaluate whether the triglyceride glucose (TyG) index mediated the CMI-SUI association. Sensitivity analyses using propensity score matching (PSM) ensured the robustness of the findings.</p><p><strong>Results: </strong>Higher CMI was significantly associated with increased SUI risk in women (P < 0.001). RCS analysis revealed a nonlinear relationship, with a threshold at 1.64. Below this point, reducing CMI was significantly associated with a lower risk of SUI (overall P < 0.001, linear P < 0.001). Subgroup and interaction analyses showed stronger associations among women under 65 years, those with higher education, those without a history of hypertension or diabetes, and women taking oral contraceptives (P for interaction < 0.05). Mediation analysis showed that the TyG index completely mediated the relationship between CMI and SUI, accounting for 97.67% of the total effect. Sensitivity analyses using PSM confirmed the robustness of these results.</p><p><strong>Conclusion: </strong>This study highlights that a higher CMI is associated with an increased risk of SUI in women, and this relationship may be largely mediated by the TyG index.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983506","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}