International Urogynecology Journal最新文献

{"title":"Adaptations for Urogynecologic Surgery in Limited-Resource Settings: How to Do More with Less.","authors":"Hnin Yee Kyaw, Catherine Matthews, Hannah G Krause, Marvin Mwesigwa, Judith T W Goh","doi":"10.1007/s00192-025-06137-7","DOIUrl":"https://doi.org/10.1007/s00192-025-06137-7","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Pelvic floor disorders affect up to 50% of women in limited-resource settings (LRS) but are severely under-treated. Historically, attention has focused on urogenital fistulae, but pelvic organ prolapse (POP) is emerging as a growing issue, especially for women engaged in manual labor. Women in these regions often endure their conditions in silence owing to social stigma and mental health impacts, compounded by health care access barriers. Delivery of urogynecological services in LRS requires adaptable surgical models and skills because of limited tools and equipment. Diagnostic treatment approaches must be tailored to the unique challenges of these settings.</p><p><strong>Methods: </strong>This article presents a practical guide to managing vesicovaginal fistulae, chronic fourth-degree tears, and POP based on limited evidence and expert experience in LRS. Key diagnostic tools, surgical techniques, and case management strategies are outlined, addressing challenges such as resource scarcity and patient follow-up in LRS.</p><p><strong>Results: </strong>The article emphasizes the importance of precise diagnosis with limited access to diagnostic testing, adaptable surgical interventions, and postoperative care, offering sustainable solutions that maximize patient outcomes despite restrictions in equipment availability. Cases are presented to illustrate practical diagnostic and surgical approaches to urinary leakage, fecal incontinence, and POP.</p><p><strong>Conclusions: </strong>The article underscores the need for an adaptable care model that prioritizes cost-effective, reproducible methods while considering patients' long-term health and social well-being.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995984","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":"Association of Bladder Pain Syndrome/Interstitial Cystitis with Hyperlipidemia: A Case‒Control Study.","authors":"Zhong-Yun Zhang, Zhao Zhang, Ming Ling, Bo-Wen Shi, Zheng-Wang Zhang","doi":"10.1007/s00192-025-06149-3","DOIUrl":"https://doi.org/10.1007/s00192-025-06149-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Metabolic factors have been proposed to be related to the bladder pain syndrome/interstitial cystitis (BPS/IC) pathogenesis. Herein, we investigated the association between metabolic factors, especially blood lipids, and BPS/IC.</p><p><strong>Methods: </strong>The present study adopted a case‒control design, comparing several metabolic indicators in 106 women with BPS/IC versus 164 women without BPS/IC, all of whom were diagnosed at the Hospital between January 2013 and December 2022. The case-control odds ratio (OR) and 95% confidence interval (CI) for metabolic indicators were estimated using logistic regression. The associations between indicators and BPS/IC classifications were assessed using ordinal multinominal logistic regression.</p><p><strong>Results: </strong>The propensity score-matching method was used to eliminate bias from age and body mass index (BMI), and the BPS/IC group had a greater hypercholesterolemia prevalence than the control group (16.3% vs 7.1%, p = 0.046), with an OR > 2.4 (p < 0.05). Ordinal multinomial logistic regression between indicators and BPS/IC classifications showed that age and triglycerides correlated with the BPS/IC lesion grade. However, when the data were corrected for age and BMI, triglycerides still correlated with lesion grade.</p><p><strong>Conclusions: </strong>The BPS/IC group had a greater hypercholesterolemia prevalence than the control group. Hypercholesterolemia may be a risk factor. Cystoscopic lesion grade correlated with age and triglyceride level. These results indicate a potential association between hyperlipidemia and the BPS/IC pathogenesis.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966020","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: Facts, Fallacies, and Why a Unified Theory of Hiatal Failure is Needed.","authors":"John O L DeLancey, James A Ashton-Miller, Jennifer LaCross, Fernanda Pipitone, Payton Schmidt, Luyun Chen","doi":"10.1007/s00192-025-06153-7","DOIUrl":"https://doi.org/10.1007/s00192-025-06153-7","url":null,"abstract":"<p><p>An enlarged urogenital hiatus is as important as apical support or fascial attachment failures in the development of prolapse and is strongly related to operative failure, yet we lack a conceptual model for factors responsible for hiatal failure. For a conceptual model to be valid, it cannot be proven false by empirical observation. We present six clinical observations with which future model development must be consistent. (1) Perineal body damage alone does not explain an enlarged urogenital hiatus. Three women have complete 4th degree lacerations but small hiatuses. (2) Levator damage is not a sole causal factor. One woman has bilateral levator avulsion but a normal hiatus, while another has intact muscles and an enlarged hiatus. (3) Hiatal assessment during straining is incomplete. Two women with similar straining urogenital hiatuses of 6-7 cm have respective 1.5 cm and 7 cm resting hiatuses. (4) Urogenital hiatus measurements during straining are confounded by Valsalva effort strength. Urogenital hiatus size increases by 30%, 51%, and 181% in one woman depending on straining strength. (5) Hiatal closure during pelvic muscle contraction differs widely. One woman can close her hiatus from 3.5 cm to 1.5 cm, while another shows no reduction despite evidence of contraction. (6) Prolapse/hiatus interactions occur with advancing age. One woman experiences progressive hiatal enlargement over 31 years. Our clinical observations reveal the complexity of the multiple factors involved in hiatal failure and support the need for a unified disease model consistent with these factors on which to base future research.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994929","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 \"Development and Validation of Risk Assessment Model for Pelvic Organ Prolapse Based on a Retrospective Study with Machine Learning Algorithms\".","authors":"Triwiyanto Triwiyanto","doi":"10.1007/s00192-025-06164-4","DOIUrl":"https://doi.org/10.1007/s00192-025-06164-4","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010298","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 \"Global Prevalence of Overactive Bladder: A Systematic Review and Meta-analysis\".","authors":"Shubham Kumar, Rachana Mehta, Ranjana Sah","doi":"10.1007/s00192-025-06165-3","DOIUrl":"https://doi.org/10.1007/s00192-025-06165-3","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004862","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":"Impact of Vaginal Hysterectomy on Quality of Life, Body Image, and Sexual Function in Women with Pelvic Organ Prolapse: A Study of Rural Women in a Low-Resource Setting.","authors":"Aslihan Yurtkal, Mujde Canday","doi":"10.1007/s00192-025-06156-4","DOIUrl":"https://doi.org/10.1007/s00192-025-06156-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>This study examines the repercussions of vaginal hysterectomy and apical suspension for prolapse, when used as a surgical remedy for pelvic organ prolapse (POP), with regard to sexual function, body image, and the overarching quality of life (QoL) in women living in low- to middle-income rural areas.</p><p><strong>Methods: </strong>We conducted a longitudinal assessment involving 108 sexually active women with a diagnosis of stage 3 or higher POP undergoing vaginal hysterectomy and apical suspension for prolapse. Evaluations were performed preoperatively and at 6 months postoperatively. Participants underwent qualitative in-depth interviews and completed the 36-item Short Form Health Survey (SF-36), Body Image Scale (BIS), and Female Sexual Function Index (FSFI). We calculated aggregate and domain-specific scores from these instruments and utilized the Wilcoxon signed-rank test to discern pre- to post-surgical changes.</p><p><strong>Results: </strong>Data from a total of 108 women were analyzed. The mean age of participants was 56.65 ± 10.03 years. Post-hysterectomy outcomes showed a statistically significant enhancement in sexual function, evidenced by increased scores on the FSFI from 13.42 ± 4.87 preoperatively to 27.99 ± 4.88 postoperatively (p < 0.001). Notable improvements were similarly recorded on the BIS and SF-36 subscales (p < 0.001). Qualitative analyses suggested that these positive changes in sexual function might be directly attributable to the alleviation of POP-related symptoms.</p><p><strong>Conclusions: </strong>Pelvic floor dysfunction presents a multifaceted health concern with both functional and anatomical repercussions for affected individuals. This investigation highlights the association between pelvic reconstructive procedures and improvement in women's QoL in an understudied population.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989792","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 Antibiotics for Disturbed Bladder Microbiome Disorders.","authors":"Yasir Bukhari, Ryan Chow, Alexander Jie Xiang, Nucelio Lemos","doi":"10.1007/s00192-025-06145-7","DOIUrl":"https://doi.org/10.1007/s00192-025-06145-7","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>In recent years, there has been significant progress in understanding bladder disorders and their connection to the bladder microbiome. Emerging evidence suggests that the bladder microbiome, which is unique to each individual, plays a pivotal role in maintaining bladder health. Disruptions to the normal microbiome composition have been associated with various pathological conditions such as recurrent urinary tract infections, interstitial cystitis, and chronic recalcitrant cystitis.</p><p><strong>Methods: </strong>We completed a focused literature review to collect studies that evaluated the use of antibiotics for long-term treatment (more than 28 days) of infectious/inflammatory disturbed bladder microbiome DBM disorders.  RESULTS: This article reviews current literature on the composition of the bladder microbiome, describes the disorders associated with DBM, explores the utility of long-term antibiotics in managing DBM, and foresees future venues for DBM disorders research.</p><p><strong>Conclusion: </strong>This review has demonstrated encouraging outcomes regarding the use of long-term antibiotics in managing infectious disorders of DBM, such as recurrent urinary tract infections and chronic recalcitrant cystitis, while no benefit was seen in interstitial cystitis patients. The studies showed that long-term cephalexin, fluoroquinolones, and fosfomycin are well-tolerated and effective options, with cephalexin being favored given its low side-effect profile.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004298","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":"Rate of Urine Culture Contamination with Different Methods of Urine Specimen Collection.","authors":"Sarah Ashmore, Jinxuan Shi, Tara Samsel, Margaret G Mueller, Juraj Letko, Kimberly Kenton","doi":"10.1007/s00192-025-06068-3","DOIUrl":"10.1007/s00192-025-06068-3","url":null,"abstract":"<p><strong>Background: </strong>Midstream urine (MSU) samples are commonly collected at the time of patient evaluation despite known high rates of contamination.</p><p><strong>Objective: </strong>The primary objective of this study was to evaluate the rate of mixed flora results in urine specimens obtained by MSU compared to straight catheterization urine (SCU).</p><p><strong>Study design: </strong>This was a quality improvement project evaluating urine culture results of women who provided either an MSU or SCU sample for analysis. Adult women seen within urogynecology clinics at a tertiary care center between April and August 2023 who had urine cultures performed for any indication were included. Mixed flora was defined as the presence of ≥ 2 non-uropathogens or 1 uropathogen in low quantity (at least 10 times fewer) compared to the concentration of nonsignificant organisms.</p><p><strong>Results: </strong>Three hundred forty women provided a urine specimen during the study period. SCU collection was performed for 171 (50.3%) women while 169 (49.7%) provided an MSU sample. Overall, 18.8% of urine cultures were reported as mixed flora (33.1% in MSU and 4.7% in SCU, p < 0.001). Mixed flora was more common with MSU specimens (87.5%, p < 0.001) and associated with a higher BMI compared to positive or negative cultures (mixed flora 29.8 kg/m² ± 16.3, positive or negative cultures 27.8 kg/m² ± 7.0, p = 0.04). MSU samples had increased odds of urine contamination compared to SCU collection (7.40 aOR, 95% CI 3.01-18.24).</p><p><strong>Conclusion: </strong>The prevalence of mixed flora was reduced significantly when SCU samples were obtained. Clinicians should consider performing SCU collection when a urine specimen is required for patient evaluation.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1029-1035"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189163","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":"Enhancing Mesh-Tissue Integration in Menopausal Models Using a Platelet-Rich Plasma-Decellularized Amnion Scaffold Sandwich: A Study on Mesh Contraction, Inflammatory Infiltrate, IL-17, CD31, and Collagen Deposition.","authors":"Alfa Putri Meutia, Pribakti Budinurdjaja, Amir Fauzi, Arief Boediono, Suskhan Djusad, Joedo Prihartono, Puspita Eka Wuyung, Andon Hestiantoro, Budi Iman Santoso","doi":"10.1007/s00192-025-06084-3","DOIUrl":"10.1007/s00192-025-06084-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Mesh-augmented surgery in urogynecology involves the use of surgical mesh to support and reinforce weakened pelvic tissue. Although it can be effective, there are potential complications, including mesh extrusion and dyspareunia related to excessive inflammatory response. One possible approach to preventing excessive inflammation and promoting mesh-tissue integration is to utilize a mesh sandwiched between two layers of platelet-rich plasma-decellularized amnion scaffold (PRP-DAS).</p><p><strong>Methods: </strong>This experimental study was performed on 24 menopausal rabbit models. The treatment group consisted of a polypropylene (PP) mesh coated with PRP-DAS on both sides, whereas the control group included a PP mesh without PRP-DAS. Mesh-tissue integration was evaluated through macroscopic, histological, and immunohistochemical analyses. Macroscopic assessment focused on mesh extrusion and contraction, whereas histology and immunohistochemistry were done by assessing inflammatory response (inflammatory infiltrates [ININ] and interleukin-17 [IL-17] expression), neovascularization (angiogenesis score and cluster of differentiation 31/CD31 expression) and collagen deposition using image J on days 14, 28, and 90 following mesh implantation. Data were analyzed using one-way ANOVA followed by Tukey post hoc test.</p><p><strong>Results: </strong>Results demonstrated that no mesh extrusion was found in either group; however, mesh contraction was significantly lower in the PRP-DAS group than in controls. On days 28 and 90, ININ was significantly lower (p < 0.01; p = 0.011) and IL-17 expression was markedly elevated (p < 0.01) in the PRP-DAS group compared with the controls. Moreover, collagen deposition was significantly higher (p < 0.01) in the PRP-DAS group by day 90.</p><p><strong>Conclusion: </strong>The PRP-DAS sandwich prevents excessive inflammatory response and enhanced mesh-tissue integration in the menopausal rabbit model.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1045-1052"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556914","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":"Effect of Preoperative Tamsulosin on Postoperative Urinary Retention Prevention After Sling Placement: A Randomized Controlled Trial.","authors":"Angela Leffelman, Henry Chill, Claudia Paya-Ten, Alireza Hadizadeh, Jungeun Lee, Cecilia Chang, Ghazaleh Rostaminia","doi":"10.1007/s00192-025-06120-2","DOIUrl":"10.1007/s00192-025-06120-2","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>The objective of this study was to evaluate whether preoperative administration of tamsulosin would decrease the frequency of postoperative urinary retention (POUR) after mid-urethral sling (MUS) placement METHODS: This was a prospective randomized, double-blinded, placebo-controlled trial of patients with SUI who underwent elective MUS placement at a single institution. Patients scheduled to undergo MUS placement consented, were enrolled, and were randomized to receive either a single tablet of tamsulosin 0.4 mg or placebo in the preoperative holding area on the day of their surgery. We then evaluated the rate of POUR after administration of tamsulosin compared with placebo using appropriate statistical methods. Sample size was calculated to include 160 patients.</p><p><strong>Results: </strong>A total of 161 patients (81 placebo, 80 tamsulosin) were analyzed. The incidence of POUR was similar between the tamsulosin and placebo groups (17.7% vs 19.8%, p = 0.7420). Secondary outcomes, including unplanned admissions, urinary-tract infections (UTIs), and hypotension, did not differ significantly between groups. A subgroup analysis of patients undergoing MUS without concomitant prolapse surgery suggested a trend toward lower POUR rates in the tamsulosin group (7.5% vs 16.7%, p = 0.142), although this was not statistically significant.</p><p><strong>Conclusion: </strong>These results suggest that single-dose preoperative tamsulosin might not have an effect on postoperative urinary retention after MUS placement, with or without concomitant reconstructive pelvic surgery.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1085-1093"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001096","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}