International Urogynecology Journal最新文献

{"title":"A Graph Attention Network-Based Multimodal Auxiliary Intelligent Grading Model for Uterine Prolapse Severity.","authors":"Bo Zheng, Shifan Wu, Weiwei Liang, Maonian Wu, Shaojun Zhu, Cheng Qian, Yan Yin","doi":"10.1007/s00192-026-06603-w","DOIUrl":"https://doi.org/10.1007/s00192-026-06603-w","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Uterine prolapse affects women's quality of life. Traditional diagnosis relies on subjective experience with limited accuracy (ACC). Fusing multimodal data (clinical features of uterine prolapse and pelvic floor magnetic resonance imaging [MRI]) is anticipated to improve grading ACC, but existing methods generally lack effective cross-modal fusion strategies. This study hypothesizes that the proposed Multimodal Aggregation Graph Attention Network (MAGANet) achieves objective and efficient uterine prolapse grading auxiliary diagnosis via multimodal data fusion.</p><p><strong>Methods: </strong>Clinical features and pelvic floor MRI data of 564 patients (March 2019 to April 2023) were retrospectively collected. MAGANet consists of modules for clinical feature data extraction, fused MRI feature extraction, sequential MRI feature extraction, graph representation construction, graph-representation fusion, and model output. It extracts deep features from structured clinical data, fused MRI, and MRI sequences to build a multimodal shared feature space and graph structure, which are fused via a Multi-level Gated Graph Attention Network for grading results. Key metrics were ACC, precision, macro-averaged F1 Score (macro-F1), kappa, area under the curve (AUC), sensitivity, and specificity.</p><p><strong>Results: </strong>On the independent test set, MAGANet outperformed single-modal models and various fusion methods, achieving ACC 0.935, precision 0.868, macro-F1 0.908, kappa 0.803, AUC 0.980, sensitivity 0.962, and specificity 0.650.</p><p><strong>Conclusions: </strong>MAGANet effectively integrates multimodal data, yielding excellent grading performance. It provides an objective, efficient clinical diagnostic tool and new insights for multimodal intelligent diagnosis in this field.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728886","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":"Methodological Considerations in Cross-Cultural Adaptation: Comments on the Iranian Prolapse and Incontinence Knowledge Questionnaire Validation Study.","authors":"Fatih Özden","doi":"10.1007/s00192-026-06627-2","DOIUrl":"https://doi.org/10.1007/s00192-026-06627-2","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728904","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":"Circulating Neutrophils Exhibit an Altered Immune Response in Chronic LUTS: An Image-Based Deep Learning Analysis.","authors":"Catherine C Y Chieng, Alia Khoru Azamira, Natasha S Y Liou, Qingyang Kong, Artur Yakimovich, Rajvinder Khasriya, Harry Horsley","doi":"10.1007/s00192-026-06625-4","DOIUrl":"https://doi.org/10.1007/s00192-026-06625-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Chronic lower urinary tract symptoms (LUTS) are characterised by persistent symptoms and elevated urinary leukocyte counts. Much evidence supports an infective aetiology in chronic LUTS, often coined chronic UTI, due to the poor performance of current gold standard tests to detect refractory forms of infection. Hence, we hypothesised that neutrophils from chronic LUTS patients may exhibit an aberrant response which prevents complete disease resolution.</p><p><strong>Methods: </strong>Freshly isolated circulating neutrophils from seven healthy women (control neutrophils) and four patients (patient neutrophils) were stimulated with commensal E. coli or pathogenic E. coli in artificial urine or pooled urine from controls (control urine) and patients (patient urine). Live imaging was performed at 37 °C for 15 h. Image sequences were analysed to assess neutrophil viability counts, morphometrics, cell activity and bacterial growth.</p><p><strong>Results: </strong>Neutrophils from both cohorts were able to recognise a commensal E. coli from a pathogenic strain, with cell death occurring faster when stimulated with the latter. However, when stimulated with the same bacterial strain in control urine, patient neutrophils showed a higher level of activity and a delayed rate of death. Without bacterial stimulation, patient neutrophils died faster in patient urine. The delayed response and the shorter survival without bacteria exhibited by patient neutrophils may have implications in chronic LUTS patients, where their neutrophils are unable to effectively clear bacteria or survive for an adequate duration to exert their functions.</p><p><strong>Conclusions: </strong>Temporal differences in neutrophil response towards bacteria and dysregulation in neutrophil maturation or activation may lead to symptom persistence in chronic LUTS.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716710","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":"Multi-parametric Quantitative MRI to Evaluate the Value of Pelvic Floor Muscle Dysfunction in POP Patients.","authors":"XiaoYing Wang, Wei Guo, Meng Wang, BaoGen Zhao, HongLiang Hu, Lu Zhang, Yong Wang, Li Zhang","doi":"10.1007/s00192-026-06652-1","DOIUrl":"https://doi.org/10.1007/s00192-026-06652-1","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the application value of multiparameter quantitative MRI in evaluating pelvic floor muscle function in POP patients.</p><p><strong>Methods: </strong>Sixty-nine POP patients and 32 healthy controls (HC) were prospectively enrolled and categorized into POP _I-II (n = 32) and POP _III-IV (n = 37) groups based on POP-Q. All participants underwent conventional pelvic floor MRI, Q-Dixon, and T1-mapping. The PDFF and native T1 values of pelvic floor muscles were measured. Between-group differences in PDFF and T1 values were compared.</p><p><strong>Results: </strong>No significant differences were found in the PDFF and native T1 values of the bilateral OIM, OEM, PEC, and COC muscles (P > 0.05). The PDFF of the levator ani muscle (LAM) was significantly higher in the POP _III-IV group than in the POP _I-II and HC groups (P < 0.001). The PDFF of the coccygeus muscle (COC) was higher in both POP groups than in HCs (P < 0.001). Native T1 values of LAM and COC were lower in both POP groups compared to HCs (P < 0.001). Combined PDFF and T1 values of LAM and COC showed good diagnostic performance for POP severity (AUCs 0.826 and 0.841). Interobserver agreement was excellent (ICC 0.807-0.920).</p><p><strong>Conclusion: </strong>PDFF and native T1 values are valuable biomarkers for assessing pelvic floor muscle dysfunction and stratifying disease severity in patients with POP.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716699","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 AI-Generated Patient Education Materials for Bladder Training and Pelvic Floor Muscle Therapy: Comparison with an International Society Leaflet.","authors":"Mustafa Onur Kamani","doi":"10.1007/s00192-026-06660-1","DOIUrl":"https://doi.org/10.1007/s00192-026-06660-1","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>High-quality patient education materials are essential in urogynecology. We hypothesized that patient handouts generated by different large language models (LLMs) would vary in quality and readability and would differ from an established society-produced leaflet.</p><p><strong>Methods: </strong>Twelve leaflets on bladder training and pelvic floor muscle therapy from six origins: GPT-4, Gemini-2.5 Pro, Sonnet-4, Llama-4, Perplexity, and The International Urogynecological Association (IUGA), were produced or obtained and standardized into plain text. Three blinded reviewers assessed completeness, information quality (DISCERN), and the Patient Education Materials Assessment Tool (PEMAT-A: actionability; PEMAT-U: understandability). The statistical plan included ordinary least squares fixed-effects per metric with type II analysis of variance for source effects; estimated marginal means with Holm-adjusted pairwise comparisons; a crossed mixed-effects model for topic groups; and inter-rater reliability was measured. Readability and text analyses used standard indices.</p><p><strong>Results: </strong>Origins varied in completeness (p < 0.001), DISCERN (p < 0.001), and PEMAT-A (p = 0.0018); PEMAT-U showed a trend (p = 0.063). Llama-4 scored significantly lower on completeness and DISCERN, and lower than GPT-4, IUGA, and Perplexity on PEMAT-A; Sonnet4 outperformed Llama-4 on PEMAT-U. No single origin dominated all metrics. Readability varied greatly: GPT-4 had an average Flesch-Kincaid grade level ≈ 6.6, Gemini ≈ 7.4; Sonnet4 ≈ 15; Llama-4 ≈ 17. IUGA leaflets were the longest, with grade levels around 9-10. Bladder-training materials were modestly more complete than pelvic muscle materials (p = 0.045). Inter-rater reliability was high (ICC ≥ 0.87).</p><p><strong>Conclusions: </strong>Patient education quality varies substantially across AI tools and compared with society materials. AI-generated content can meet readability targets but requires expert review to ensure completeness and reliability before clinical use.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716674","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 \"Letter to the Editor: Urodynamic and Quality-of-Life Outcomes After Endometrial Cancer Treatment: A Prospective Cohort Study\".","authors":"Dominik Habes, Munachiso Iheme Ndukwe, Jiri Spacek","doi":"10.1007/s00192-026-06661-0","DOIUrl":"https://doi.org/10.1007/s00192-026-06661-0","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716708","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":"Obituary: Professor Paul Riss (1948 -2026).","authors":"Peter L Dwyer","doi":"10.1007/s00192-026-06672-x","DOIUrl":"https://doi.org/10.1007/s00192-026-06672-x","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716706","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":"Patient Factors Associated with Presacral Space Depth: A Pelvic MRI Study.","authors":"Krystine Gulbrand, Amanda Chapa, Mariana Masteling, Jordan Swensson, Anne Sammarco, Ramzy Burns, Douglass Hale, John D E Lancey, Jennifer Hamner","doi":"10.1007/s00192-026-06645-0","DOIUrl":"https://doi.org/10.1007/s00192-026-06645-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Sacrocolpopexy is the most durable surgical repair for advanced pelvic organ prolapse, but dissection of the presacral space can be technically challenging. Variation in presacral space depth may affect surgical exposure and operative risk. Limited data exist regarding patient-specific factors associated with variation in presacral anatomy and presacral space depth. We hypothesized that body mass index (BMI) would not meaningfully predict variation in presacral space depth.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated presacral anatomic measurements using pelvic magnetic resonance imaging (MRI) in women. Presacral anatomic measurements, including presacral depth, anterior longitudinal ligament thickness, and sacral vertebral dimensions, were obtained between L5 and S3 using a standardized midsagittal MRI technique. Patient demographics, clinical characteristics, and medical history were collected. Descriptive statistics, correlation analyses, and effect sizes were calculated.</p><p><strong>Results: </strong>A total of 209 pelvic MRIs were reviewed, of which 167 had complete data. BMI demonstrated only weak correlations with presacral space depth. A history of hysterectomy was associated with increased presacral depth at S1 compared with women with an intact uterus (24% increase; p = 0.01). Postmenopausal status and exogenous estrogen use were associated with increased L5-S1 disc space height (p = 0.03 and p = 0.02, respectively). Presacral space depth was significantly shallower at the sacral promontory than at more caudal levels, while anterior longitudinal ligament thickness was greatest at the promontory. Presacral depth was also moderately correlated with sacral vertebral body height.</p><p><strong>Conclusions: </strong>Presacral space depth was not associated with BMI but was modestly increased in women with a history of hysterectomy. These findings suggest that prior pelvic surgery, rather than BMI, may influence presacral anatomy and could be relevant for surgical planning.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698475","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":"Psychometric Assessment of a New Pain-Specific Patient-Reported Outcome Measure for Pelvic Floor Surgery Using Exploratory Factor Analysis.","authors":"Sheymonti S Hoque, Susannah Ahern, Helen E O'Connell, Rasa Ruseckaite","doi":"10.1007/s00192-026-06620-9","DOIUrl":"https://doi.org/10.1007/s00192-026-06620-9","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Pelvic floor procedures are associated with pain in some women, adversely affecting health-related quality of life (HRQoL). Current patient-reported outcome measures (PROMs) are inadequate for assessing pain following pelvic floor procedures. A new 16-item pain-specific PROM, the Pelvic Floor Procedure Pain Questionnaire (PPPQ), was developed to address this gap. This study aimed to undertake a psychometric assessment of the PPPQ through field testing and to understand its latent structure.</p><p><strong>Methods: </strong>The PPPQ was administered online to 103 adult women from pelvic mesh support groups who underwent pelvic floor surgery. Exploratory factor analysis (EFA) using principal axis factoring and Promax rotation was conducted to assess the PROM's psychometric properties (i.e. structural validity, internal consistency), refine items, and explore the relationship between items.</p><p><strong>Results: </strong>Most commonly, participants were aged 60-69 years (n = 46, 44.7%) and from the United Kingdom (n = 48, 46.6%). EFA identified a 3-factor model comprising: (1) HRQoL disruptions from post-pelvic floor procedure pain, (2) characteristics and management of post-pelvic floor procedure pain, and (3) pain avoidance behaviours, resulting in a refined 11-item PPPQ. The PPPQ and its items demonstrated acceptable internal consistency (Cronbach's α > 0.70), with items clustering into expected pain-related themes confirming structural validity.</p><p><strong>Conclusions: </strong>Study findings suggest that the revised, 11-item PPPQ has good reliability (internal consistency) and structural validity. While the psychometric evaluation demonstrates its suitability in assessing pain post-pelvic floor surgery, additional psychometric testing is needed. Full development of the PROM could offer deeper insights into pain and help monitor health outcomes in this population.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698490","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":"Urogenital Hiatus Closure System: A Framework for Understanding how Muscle, Motor Control, and Fascial Connections Interact in Normal and Failed Closure.","authors":"John O L DeLancey, James A Ashton-Miller, Jennifer LaCross, Payton Schmidt, Mariana Masteling, Fernanda Pipitone, Christopher X Hong, Luyun Chen","doi":"10.1007/s00192-026-06641-4","DOIUrl":"https://doi.org/10.1007/s00192-026-06641-4","url":null,"abstract":"<p><p>Failure of the urogenital hiatus to remain closed in women is a major contributor to prolapse operation failure and development of prolapse after childbirth. This article presents a conceptual framework, the Urogenital Hiatus Closure System (UHCS), that explains how anatomic and neuromuscular elements interact to maintain, or fail to maintain, hiatal closure. Clinical observations demonstrate that no single structure reliably predicts hiatus size; instead, hiatal behavior results from the integrated functional components. The UHCS has three primary elements: the levator ani muscle, neuromotor control, and Level III connective tissues of the perineal complex-each of which can be injured, partially compensated, or overloaded. These structures form a neuromechanically integrated unit in which the medial levator ani, the perineal membrane and its central connection, and the afferent-efferent control loops work to provide resting tone, active contraction, resistance to dilation, and spatial alignment. A principle of the model is redundancy: failure in one component may not enlarge the hiatus, but combinations of failures exceed compensatory capacity and result in failure. It links Level III mechanics to Level I-II support by demonstrating how an open hiatus increases forces on apical and paravaginal tissues, driving a feed-forward cycle of prolapse dilation and muscle elongation. Conceptually, the UHCS is an interacting triad influenced by functional modifiers-loading conditions, prolapse effects, muscle length, motor activation, and connective-tissue properties-that determine hiatus size. This systems-based approach can guide classification of failure patterns to inform biomechanical, anatomical, and therapeutic research.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690037","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}