International Urogynecology Journal最新文献

{"title":"Perioperative Interventions to Facilitate Day-Case Vaginal Surgery for Pelvic Organ Prolapse: A Systematic Review.","authors":"Thomas Curtis, Yashna Mirchandani, Grace Stott, Charlotte Chant, Thomas Giles Gray","doi":"10.1007/s00192-026-06880-5","DOIUrl":"https://doi.org/10.1007/s00192-026-06880-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Multiple studies report good outcomes when performing day-case native tissue vaginal surgery for pelvic organ prolapse (POP). Despite this, consensus on optimal perioperative strategies to safely achieve same-day discharge (SDD) remain unclear and no complete protocol has been tested in a high-quality prospective study.</p><p><strong>Methods: </strong>MedLine, PubMed, Scopus and Web of Science databases were searched from inception to May 2025 to identify English-language studies investigating perioperative interventions that facilitate day-case vaginal POP surgery. The primary outcome was successful SDD with secondary outcomes of patient satisfaction and rates of complications. Risk of bias and certainty of evidence were assessed using established tools (RoB2, ROBINS-I, MINORS, GRADE).</p><p><strong>Results: </strong>Searches identified 2345 studies, from which 30 studies (six RCTs, ten cohort, two case-control, 12 single-arm) met inclusion criteria. Early removal (2-6 h postoperatively) of vaginal packs and urinary catheters did not increase complication rates compared with removal on postoperative day one. Omission of vaginal packing was associated with improved SDD rates and had no adverse impact on complications. Enhanced recovery protocols were consistently associated with substantial improvements in SDD. No anaesthetic approach demonstrated clear superiority. Most patients, including older women, are suitable candidates for day-case surgery, though comorbidities and surgical complexity reduce the probability of SDD.</p><p><strong>Conclusion: </strong>Day-case vaginal POP surgery is safe and achievable. Enhanced recovery principles, omission of routine vaginal packing and early catheter removal are all evidence-based interventions that would support its implementation. These findings should be incorporated into a comprehensive protocol and evaluated through a high-quality, prospective randomised trial.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919672","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":"Mucosa-Sparing Trans-Vestibular Surgical Approach for Excision of an Anterior Urethral Leiomyoma: A Case Report and Review of the Literature.","authors":"Maysoon Alhaizan, Zhuoran Chen","doi":"10.1007/s00192-026-06868-1","DOIUrl":"https://doi.org/10.1007/s00192-026-06868-1","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Urethral leiomyomas are rare benign smooth-muscle tumors. Approximately 40 well-documented cases have been reported, most arising from the posterior urethral wall where exposure is relatively straightforward. Anterior wall lesions pose surgical difficulty because of proximity to the external urinary sphincter, periurethral fascia, and vestibular mucosa, all of which must be preserved to avoid urethrovaginal fistula and stress urinary incontinence. We hypothesized that a mucosa-sparing trans-vestibular approach would allow safe excision with preservation of urethral integrity and continence.</p><p><strong>Methods: </strong>A 39-year-old para-1 woman presented with a 6-month history of a tender peri-meatal urethral mass and intermittent post-coital spotting. Examination revealed a 3 cm anterior urethral mass distorting the external urethral meatus. Pelvic MRI demonstrated a 2.7 cm well-circumscribed anterior distal urethral mass with apparent urethral wall involvement. Examination under anesthesia, cystourethroscopy, and core biopsy confirmed leiomyoma. The lesion was excised via a mucosa-sparing trans-vestibular approach with intraoperative catheter palpation, capsular dissection, layered urethral reconstruction, and mid-urethral sphincter re-approximation.</p><p><strong>Results: </strong>A 3 cm anterior urethral leiomyoma with focal urethral communication was excised. Blood loss was minimal; there were no intraoperative complications. A transurethral catheter was maintained for 21 days. Micturating cystourethrogram confirmed an intact urethra without fistula; the patient was continent. Histopathology confirmed benign leiomyoma (SMA-positive, desmin-positive, MIB-1 < 1%).</p><p><strong>Conclusions: </strong>Anterior urethral leiomyomas are an important differential in women with a peri-meatal mass. The mucosa-sparing trans-vestibular technique provides excellent anterior urethral exposure while preserving vestibular mucosa and periurethral fascia, thereby reducing the risk of urethrovaginal fistula and postoperative incontinence.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912003","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":"Anxiety in Women Receiving Clinician-Managed Pessary Care for Pelvic Organ Prolapse.","authors":"Lara M Kruyt, J Marinus van der Ploeg, Anuschka S Niemeijer, Robert A Hakvoort","doi":"10.1007/s00192-026-06874-3","DOIUrl":"https://doi.org/10.1007/s00192-026-06874-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vaginal pessaries are an effective nonsurgical treatment for pelvic organ prolapse, but routine pessary care can be associated with pain. Anxiety is known to influence pain perception in clinical procedures but its role in pessary care has not been studied. We hypothesised that anticipatory anxiety is present in women receiving continuous, non-self-managed pessary care and is associated with procedural pain.</p><p><strong>Methods: </strong>In this prospective observational cohort study, women with pelvic organ prolapse receiving continuous clinician-managed pessary care in a tertiary urogynaecology unit were included. Pain during pessary removal and insertion was assessed using the Numeric Rating Scale (NRS). Anticipatory anxiety regarding future pessary care was evaluated 4-6 weeks later using an adapted version of Corah's Dental Anxiety Scale. Logistic regression was performed to identify factors associated with moderate to high anxiety.</p><p><strong>Results: </strong>A total of 150 women were included, of whom 128 (85%) completed the anxiety questionnaire. Median age was 70 years (range 46-86). Moderate to high anticipatory anxiety was reported by 28% of women. Higher pain scores during previous pessary removal or insertion and care provided by a male gynaecologist were independently associated with increased anticipatory anxiety.</p><p><strong>Conclusions: </strong>Clinically relevant anticipatory anxiety is common in women receiving clinician-managed pessary care and is associated with procedural pain and physician gender. These findings highlight the importance of addressing both physical discomfort and psychological distress in routine pessary care to optimise patient experience.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911988","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":"Pelvic Floor-Related and Genitourinary Outcomes Associated with Menstrual Cup Use: A Scoping Review.","authors":"María Ángeles Sirvent-Pinar, Eleuterio A Sánchez-Romero, Arturo Garcia-Garcia, Erika Meléndez-Oliva","doi":"10.1007/s00192-026-06881-4","DOIUrl":"https://doi.org/10.1007/s00192-026-06881-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Menstrual cups are increasingly used as sustainable and cost-effective menstrual hygiene products, but their effects on pelvic floor function and genitourinary health remain unclear. We aimed to map evidence on pelvic floor-related symptoms and clinically relevant genitourinary outcomes associated with menstrual cup use.</p><p><strong>Methods: </strong>We conducted a scoping review following PRISMA-ScR and Joanna Briggs Institute guidance. Six databases were searched from inception to March 2026. Eligible studies included women or menstruating individuals using menstrual cups who reported pelvic floor-related symptoms or clinically relevant genitourinary outcomes. Two reviewers independently screened studies, extracted data, and assessed methodological quality.</p><p><strong>Results: </strong>Ten studies were included: one randomized controlled trial, one cross-sectional study, one prospective case series, and seven case reports. Evidence was synthesized into two conceptually distinct domains: functional pelvic floor and lower urinary tract outcomes and structural genitourinary complications. Reported functional outcomes included pain-related symptoms, initial vaginal discomfort, pelvic floor symptom burden, and exploratory changes in pelvic floor muscle parameters. The evidence was heterogeneous and insufficient to establish causality or clinically meaningful pelvic floor dysfunction. Rare structural complications consisted mainly of reversible ureteral obstruction or hydronephrosis reported in isolated cases, with resolution after cup removal.</p><p><strong>Conclusions: </strong>Current evidence does not support clinically established pelvic floor dysfunction attributable to menstrual cup use. The literature primarily identifies rare reversible mechanical complications and important knowledge gaps. Well-designed prospective studies using standardized objective pelvic floor assessments are needed.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905778","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":"Robotic-Assisted Early Repair of Vesicovaginal Fistula in a Colon Cancer Patient: A Case Report and Surgical Technique Video.","authors":"Dhruvi S Patel, Stephanie Bernard, Fernando Cabrera, Joel Cardenas Goicoechea","doi":"10.1007/s00192-026-06884-1","DOIUrl":"https://doi.org/10.1007/s00192-026-06884-1","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>To demonstrate the feasibility and technical approach of early robotic-assisted vesicovaginal fistula (VVF) repair in a patient with newly diagnosed colon cancer requiring timely initiation of chemotherapy following surgical resection.</p><p><strong>Methods: </strong>A stepwise robotic-assisted transperitoneal extravesical VVF repair was performed at a tertiary-care academic medical center through multidisciplinary collaboration between the Departments of Obstetrics and Gynecology and Urology. The procedure was conducted 6 weeks after the patient's initial oncologic surgery and included identification and excision of the fistula tract, dissection of the vesicovaginal space, layered closure of the bladder and vagina and interposition of an omental flap.</p><p><strong>Results: </strong>The surgery was completed robotically without intraoperative complications. Operative time was 4 h and 8 min with an estimated blood loss of 200 mL. The patient was discharged on postoperative day 3 in stable condition. Follow-up cystoscopic evaluation confirmed successful fistula closure without recurrence, allowing initiation of adjuvant chemotherapy.</p><p><strong>Conclusion: </strong>Early robotic-assisted VVF repair was technically feasible and resulted in successful fistula closure in this carefully selected patient requiring timely continuation of oncologic treatment. The repair incorporated careful patient selection, excision of devitalized tissue, tension-free multilayer closure and vascularized omental interposition, with no recurrence at 2 years. This case highlights the potential role of a multidisciplinary robotic approach in selected patients, while larger studies are needed to better define its safety, reproducibility and optimal indications.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886931","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":"Music as a Nonpharmacological Adjunct for Reducing Pain, Anxiety, and Physiological Stress During Cystoscopy: A Systematic Review and Meta-Analysis.","authors":"Mohamed Abo Zeid, Michael Gerges, Kareem Khalefa, Amira A Aboali, Ahmed Talkhan, Lamees Taman, Amr M Abou Elezz","doi":"10.1007/s00192-026-06828-9","DOIUrl":"https://doi.org/10.1007/s00192-026-06828-9","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Cystoscopy is a commonly performed invasive urological procedure often associated with pain and anxiety, negatively affecting patient compliance and satisfaction. Music has been proposed as a simple, low-cost, nonpharmacological intervention to reduce procedural discomfort and stress. This systematic review and meta-analysis evaluated the effectiveness of music during cystoscopy.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines, PubMed, Scopus, Web of Science, and the Cochrane Library were searched through 5 January 2026. Randomized controlled trials (RCTs) including male patients undergoing cystoscopy and comparing music with a placebo were eligible. Primary outcomes were changes in pain and anxiety scores; secondary outcomes were heart rate and systolic blood pressure. Data were pooled using a random-effects model, and study quality was assessed using the Cochrane Risk-of-Bias 2 tool.</p><p><strong>Results: </strong>Thirteen RCTs comprising 1,347 participants were included. Music significantly reduced pain (MD = -1.39, 95% CI -1.87 to -0.91), anxiety (MD = -7.35, 95% CI -12.16 to -2.56), and heart rate (MD = -3.31, 95% CI -4.47 to -2.15) compared with control. No significant reduction was observed in systolic blood pressure (MD = -1.27, 95% CI -4.08 to 1.53). Subgroup analysis showed consistent reductions in pain and heart rate for both rigid and flexible cystoscopy. Anxiety reduction was significant in flexible cystoscopy but not in rigid procedures.</p><p><strong>Conclusion: </strong>Music is a safe, inexpensive adjunct that effectively reduces pain, anxiety, and heart rate during cystoscopy and may enhance patient comfort and procedural tolerance.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886717","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":"Hysterectomy with Minimally Invasive Sacrocolpopexy Versus Native Tissue Repair for Primary Uterovaginal Prolapse: A Systematic Review and Meta-Analysis.","authors":"Joseph A Huffman, Sarah Ashmore, Shihyun Kim, Dheera Samdariya, Pranadeep Reddy, Mackenzie Wood, Kaidi Kang, Jacqueline Zillioux, Cara L Grimes, Ankita Gupta, Amy Sisson, Catherine A Matthews","doi":"10.1007/s00192-026-06863-6","DOIUrl":"https://doi.org/10.1007/s00192-026-06863-6","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Sacrocolpopexy (SCP) is regarded as the gold-standard apical suspension procedure for vaginal vault prolapse; however, systematic reviews informing this reputation have largely included post-hysterectomy populations. Comparative evidence for primary uterovaginal prolapse (U-POP) remains limited. We aimed to evaluate failure and retreatment rates after hysterectomy with minimally invasive SCP compared with vaginal hysterectomy and native tissue repair (TVH + NTR).</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA guidelines (PROSPERO CRD420251171050) as part of the 2026 U-POP Global Consensus Conference. MEDLINE and Embase were searched through October 31, 2025. Eligible studies included randomized trials and comparative cohort studies (≥ 30 participants) evaluating hysterectomy with minimally invasive SCP for primary U-POP, with or without a comparator group undergoing TVH + NTR. Outcomes included retreatment and failure. Pooled proportions of outcomes were estimated and between-group differences were evaluated using mixed-effects meta-regression. Study quality was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.</p><p><strong>Results: </strong>Of 5262 abstracts and 189 full texts screened, 24 studies met inclusion criteria: 6329 patients underwent hysterectomy with SCP and 681 underwent TVH + NTR. Compared with TVH + NTR, hysterectomy with SCP demonstrated significantly lower retreatment rates (1.59% vs 10.23%, p < 0.0001), subjective failure (5.09% vs 17.55%, p = 0.002), objective failure (6.80% vs 18.16%, p = 0.002), and composite failure (9.23% vs 18.19%, p = 0.005). Certainty of evidence was moderate to low.</p><p><strong>Conclusions: </strong>For women undergoing surgery for U-POP, hysterectomy with minimally invasive SCP is associated with significantly lower failure and retreatment rates compared with TVH + NTR and thus may be preferred for patients at higher risk of recurrence.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887527","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":"Obstetric Factors Associated with Pelvic Floor Disorders and Surgery 30 Years After Childbirth: A Prospective Cohort Study.","authors":"Ingrid Volløyhaug, Martina Belluardo, Rune Svenningsen, Kjell Åsmund Salvesen, Erling Belaska, Maria Øyasæter Nyhus","doi":"10.1007/s00192-026-06872-5","DOIUrl":"https://doi.org/10.1007/s00192-026-06872-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>We aimed to compare symptoms of pelvic floor disorders (PFDs) and surgery risk by mode of delivery 30 years after first childbirth and assess symptom changes over time. We also examined associations between PFDs and pelvic floor muscle injuries.</p><p><strong>Methods: </strong>Prospective cohort study in 2024 of women with first childbirth at Trondheim University Hospital, Norway in 1990-97. They responded to the pelvic floor distress inventory (PFDI-20) in 2013 and 2024. Ultrasound assessed pelvic floor muscle trauma in 2013-14. Outcomes included symptoms and surgery for PFDs and hysterectomy.</p><p><strong>Results: </strong>Sixty percent of women (965/1606) responded 30.6 years after childbirth, with mean age 58.2 years; 140 (14.5%) had cesarean delivery, 414 (42.9%) normal vaginal delivery, 217 (22.5%) forceps, and 179 (18.5%) vacuum delivery. Cesarean delivery had lower mean PFDI-20 scores than normal vaginal delivery (28.9 vs 38.6), and no women in the cesarean group had PFD surgery. Forceps increased the risk for PFD surgery or hysterectomy (aOR 1.59 vs normal delivery; 1.68 vs vacuum). PFDI-20 score increased from 24.5 in 2013 to 37.9 in 2024, similarly for all delivery groups. Anal sphincter defects were associated with higher colorectal-anal and prolapse symptom scores and prolapse surgery (aOR 6.6), and levator ani injury with higher prolapse symptom scores and prolapse surgery (aOR 15.0).</p><p><strong>Conclusions: </strong>Thirty years after first childbirth, cesarean delivery was associated with lower symptom scores and no PFD surgery. Symptoms increased over time for all delivery methods. Forceps delivery increased surgery risk by 60% compared to normal vaginal and vacuum delivery, likely mediated by pelvic floor muscle injuries.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880117","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":"Comparative Efficacy of Tadalafil and Amitriptyline in Female Interstitial Cystitis/Bladder Pain Syndrome: Double-Blind Randomized Trial.","authors":"Noran N Makled, Mirhan N Makled, Tamer E Helmy, Mahmoud R El-Kenawy, Ahmed S El-Hefnawy","doi":"10.1007/s00192-026-06536-4","DOIUrl":"10.1007/s00192-026-06536-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating disorder of unclear etiology that impairs quality of life; physically, emotionally, and sexually. Up till now, no standard effective therapy has existed. Phosphodiesterase-5 inhibitors are vasodilatory and anti-inflammatory. We studied the efficacy and safety of tadalafil, amitriptyline, and their combination in female IC/BPS patients.</p><p><strong>Methods: </strong>In this study, 132 female patients were randomized into three groups. Assessments were performed at baseline and at 4, 8, and 12 weeks using voiding diary, uroflowmetry, the visual analog scale (VAS), the Interstitial Cystitis Symptom Index (ICSI), and the Interstitial Cystitis Problem Index (ICPI). Global Response Assessment (GRA) and correlations between VAS and voided volume were analyzed at the end. Statistical analysis was performed using the Kruskal-Wallis test.</p><p><strong>Results: </strong>Tadalafil and combination improved daytime voids more than amitriptyline (tadalafil vs amitriptyline p = 0.0005, amitriptyline vs combination p < 0.0001, tadalafil vs combination p = 0.0009). Night-time voids improved notably in tadalafil and combination vs amitriptyline (p < 0.0001). Maximum urinary flow rate (Qmax) increased in combination and tadalafil vs amitriptyline (p = 0.0004) and (p = 0.0294) respectively. Voided volume was higher in combination vs amitriptyline (p = 0.0041). ICSI, ICPI, and VAS scores decreased in all groups (p < 0.0001). Ninety-two patients achieved a GRA score of 7. VAS correlated with voided volume in the tadalafil group (r = -0.60). Amenorrhea was the most bothering adverse event among the patients in the tadalafil group.</p><p><strong>Conclusions: </strong>Tadalafil, alone or combined with low-dose amitriptyline, is a safe and effective treatment for female IC/BPS. The combination had comparable or superior efficacy to tadalafil using a lower amitriptyline dose while reducing adverse events.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"3021-3031"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837761","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":"Multimodal Prediction Model for Postoperative Voiding Dysfunction After Pelvic Organ Prolapse Surgery.","authors":"Apisith Saraluck, Orawee Chinthakanan, Rujira Wattanayingcharoenchai, Jittima Manonai, Komkrit Aimjirakul","doi":"10.1007/s00192-026-06655-y","DOIUrl":"10.1007/s00192-026-06655-y","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Postoperative voiding dysfunction remains a clinically important complication after advanced pelvic organ prolapse (POP) surgery. We hypothesized that preoperative urodynamic parameters provide incremental predictive value beyond clinical characteristics and uroflowmetry.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 283 women undergoing advanced POP surgery. Multivariable logistic regression models were constructed sequentially using clinical variables, uroflowmetry, and urodynamic parameters. Model performance was evaluated by discrimination, calibration, bootstrap internal validation, and decision-curve analysis.</p><p><strong>Results: </strong>Postoperative voiding dysfunction at 6 months occurred in 56 out of 283 patients (19.8%). Complete data for model comparison were available in 271 patients. Discrimination improved stepwise across models: clinical variables alone (areas under the curve [AUC] 0.68), plus uroflowmetry (AUC 0.72), plus urodynamics (AUC 0.78), and the combined model (AUC 0.82). Bootstrap validation demonstrated stable performance with good calibration (optimism-corrected slope 0.80; mean absolute error 0.036). Decision-curve analysis showed greater net clinical benefit for models incorporating urodynamic parameters.</p><p><strong>Conclusions: </strong>Preoperative urodynamic parameters substantially improve the prediction of postoperative voiding dysfunction after POP surgery. A multimodal model integrating clinical, functional, and physiological assessments provides the most accurate risk estimation and supports individualized perioperative management.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"3043-3051"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941302","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}