Journal of minimally invasive gynecology最新文献

{"title":"Female sexual function, dysfunction, and treatment: A biopsychosocial multidisciplinary approach.","authors":"Anna Myers, Jean Marino, Karen Connor, Erika Kelley, Sheryl A Kingsberg, Rachel Pope","doi":"10.1016/j.jmig.2025.07.019","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.019","url":null,"abstract":"<p><strong>Objective: </strong>Female sexual function is a multi-dimensional, complex, often understated aspect of health that encompasses desire, arousal, and orgasm. Physiological, psychological, and emotional factors impact sexual satisfaction. This article presents an expert-guided summary of the physiology and pathology of female sexual dysfunction and management of female sexual dysfunction from a multidisciplinary team lens.</p><p><strong>Data sources: </strong>Key peer-reviewed articles, summary articles and books, and consensus guidelines on identification and management of female sexual dysfunction identified via a multi-modal search.</p><p><strong>Methods of study selection: </strong>The multidisciplinary team iteratively selected key peer-reviewed articles, summary articles and books, and consensus guidelines on identification and management of female sexual dysfunction, with a particular focus on implications for minimally invasive gynecology.</p><p><strong>Tabulation, integration, and results: </strong>In recent years, advancements in minimally invasive gynecology have provided practitioners with innovative techniques to address physical issues often affecting female sexual function.</p><p><strong>Conclusion: </strong>The identification and management of female sexual dysfunction often requires a multidisciplinary approach, as physiological contributing factors rarely are the sole direct cause of dysfunction. The authors, who are part of a multidisciplinary sexual health division at a metropolitan teaching hospital, discuss normal female sexual function, dysfunction, implications of age and surgical changes, and treatment options through the biopsychosocial model.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In the Shadow of Adhesions: Risk Factors and Mental Health in Asherman Syndrome.","authors":"Linda Boon, Miriam M F Hanstede, Karlijn J van Stralen","doi":"10.1016/j.jmig.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.06.008","url":null,"abstract":"<p><strong>Study objective: </strong>To determine the prevalence and risk factors for psychological distress in women treated for Asherman Syndrome (AS) and explore its implications for surgical management and patient-centered care.</p><p><strong>Design: </strong>Cross-sectional cohort study among women treated for AS.</p><p><strong>Setting: </strong>University-affiliated hospital in the Netherlands.</p><p><strong>Patients: </strong>Of 108 invited women diagnosed with AS, 98 (91%) completed an online questionnaire. Among them, 82 non-pregnant women (84%) and 16 pregnant women (16%) with AS were included in the analysis.</p><p><strong>Interventions: </strong>Psychological distress was assessed using the Symptom Questionnaire-48 (SQ-48) and the Hospital Anxiety and Depression Scale (HADS).</p><p><strong>Measurements and main results: </strong>Descriptive statistics and linear regression analyses were performed to identify risk factors. Clinical and demographic data were retrieved from patient records. Among non-pregnant women (n=82, 84%), 6% reported moderate and 10% severe depression, while 24% had moderate and 23% severe anxiety. The SQ-48 indicated clinical anxiety in 42%, hostility in 38%, cognitive problems in 31%, and reduced vitality in 51%. Treatment duration >2 years increased anxiety risk 16-fold (OR 16, 95% CI 1.3-195), while ≥6 hysteroscopies increased cognitive problems risk 14-fold (OR 14, 95% CI 2.0-97). A history of psychological treatment increased risks for anxiety (OR 6, 95% CI 1.4-21.0; OR 20, 95% CI 2.4-173.9) and cognitive problems (OR 11, 95% CI 1.3-94.5). Among pregnant women with AS, hostility scores were significantly lower than in non pregnant AS patients (p = .017, 95% CI).</p><p><strong>Conclusion: </strong>Psychological distress is highly prevalent in non pregnant AS patients, particularly those undergoing prolonged treatment or multiple hysteroscopies. Gynecologic surgeons should recognize the psychological burden in this population, as it may affect treatment adherence, recovery, and patient satisfaction. Routine psychological screening, collaboration with mental health professionals, and counseling should be considered to optimize surgical outcomes and patient well-being.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of ArtiSential and Conventional Laparoscopic Instruments in Hysterectomy for Gynecologic Cancers: A Hybrid Observational Study on Surgical Outcomes, Pain Control, and Oncologic Safety.","authors":"Seongyun Lim, Young Eun Chung, Jun-Hyeong Seo, Chel-Hun Choi, Kazuyoshi Kato, Yi-Liang Lee, Yu-Li Chen, Yooyoung Lee","doi":"10.1016/j.jmig.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.021","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical and oncologic outcomes of gynecologic cancer surgeries performed using multi-joint laparoscopic instruments (ArtiSential) compared to conventional instruments, focusing on hysterectomy.</p><p><strong>Design: </strong>A hybrid observational study combining prospective data for the ArtiSential group (n = 44) and retrospective data for the conventional group (n = 136).</p><p><strong>Setting: </strong>International multicenter study conducted in Korea, Taiwan, and Japan.</p><p><strong>Participants: </strong>180 patients who underwent hysterectomy for gynecological cancers.</p><p><strong>Interventions: </strong>Laparoscopic hysterectomy using either ArtiSential or conventional laparoscopic instruments.</p><p><strong>Results: </strong>No significant differences were observed in operative time (100.1 min vs. 99.7 min, p = .95) or estimated blood loss (111.6 mL vs. 125.0 mL, p = .39) between the ArtiSential and conventional groups. The ArtiSential group showed numerical reduction in moderate-to-severe postoperative pain without statistical significance in total group (6.8% vs. 18.4%, p = .09), but a statistically significant reduction in uterine cancer patients (3.6% vs. 21.4%, p = .04). Complication rates were generally lower in the ArtiSential group across all cancer types, although not statistically significant. In radical hysterectomy, the ArtiSential group demonstrated shorter operative times (109.2 min vs. 135.9 min, p = .14) and reduced estimated blood loss (150.0 mL vs. 162.9 mL, p = .75). Multivariate Cox analysis revealed that FIGO stage, operative time, and estimated blood loss significantly affected progression-free survival in uterine cancer, while ArtiSential use did not (p = .47) CONCLUSIONS: ArtiSential instruments appear to be feasible for gynecological cancer surgeries, offering potential benefits such as reduced postoperative pain and fewer complications but without statistical significance. While these findings highlight the utility of ArtiSential in complex pelvic surgeries, further prospective multicenter studies with larger cohorts and longer follow-up periods are required to confirm oncologic safety and long-term complication.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-centre study assessing the diagnostic accuracy of ultrasonographic features of the uterosacral ligaments in patients with and without endometriosis.","authors":"Diego Raimondo, Linda Bertoldo, Matteo Giorgi, Lucia Lazzeri, Roberto Palermo, Simona Del Forno, Daniele Neola, Gabriele Centini, Errico Zupi, Maria Giovanna Vastarella, Lucia De Meis, Luigi Cobellis, Antonio Raffone, Renato Seracchioli","doi":"10.1016/j.jmig.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.010","url":null,"abstract":"<p><strong>Objective: </strong>To assess the diagnostic accuracy of different ultrasonographic features of USLs affected by endometriosis.</p><p><strong>Design: </strong>Multicentric, observational, prospective, diagnostic study.</p><p><strong>Setting: </strong>Two tertiary care clinics.</p><p><strong>Participants: </strong>All consecutive symptomatic patients aged between 18 and 50 years with an ultrasonographic diagnosis of endometriosis and submitted to surgery from January 2023 to July 2023.</p><p><strong>Interventions: </strong>The preoperative ultrasonographic features of the USLs were compared between those affected by USLs endometriosis and those not affected, as confirmed by pathological examination. Diagnostic accuracy metrics-including sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC)-were calculated for the following ultrasound features of the USLs: optimal anteroposterior diameter cut-off (in millimeters), echogenicity, peritoneal surface characteristics, tenderness upon targeted probe pressure, and presence of contiguous endometriotic lesions.</p><p><strong>Results: </strong>Eighty-five women were enrolled. The anteroposterior diameter of the USLs affected by endometriosis was significantly higher than that of unaffected USLs [mean (±SD): 5.0 (±2.5) mm vs 3.3 (±1.6) mm, p<.001]. USLs affected by endometriosis showed more frequently a hypoechoic or inhomogeneous echogenicity (p<.001), an irregular peritoneal surface (p<.001), tenderness upon target vaginal probe pressure (p<.001), and an association with rectal endometriosis lesions contiguous to the USLs (p=.004). The best USLs antero-posterior diameter cut-off value to predict USLs endometriosis involvement was 4.2 mm, with sensitivity, specificity, and AUC of 57.3%, 86.3%, and 0.72, respectively. The AUC was low for all the ultrasound features considered individually. The combination of each ultrasound feature along with the most accurate USL anteroposterior diameter cut-off value showed a moderate accuracy to diagnose USL endometriosis involvement.</p><p><strong>Conclusion: </strong>The combination of an anteroposterior thickness of USLs > 4.2 mm with at least one of the above-mentioned ultrasound features suggestive of endometriosis may have a moderate diagnostic accuracy for diagnosing USLs endometriosis involvement at ultrasound.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Outcomes of Ureteral and Bladder Injury Intra-Operatively Repaired During Open and Minimally Invasive Hysterectomy from 2013-2023: A National Matched Cohort Study.","authors":"Mark N Alshak, Isabella Florissi, Craig Cronin, Logan Galansky, Andrew J Cohen","doi":"10.1016/j.jmig.2025.07.022","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.022","url":null,"abstract":"<p><strong>Study objective: </strong>Ureteral injury (UI) and bladder injury (BI) can occur during hysterectomy. Over the past 10 years, minimally invasive hysterectomies (MIH) have become more common. We sought to compare incidence of UI and BI during MIH and open hysterectomy (OH) and complications over the past 10 years.</p><p><strong>Design: </strong>A retrospective cohort study was conducted using TriNetX research network.</p><p><strong>Setting: </strong>Large medical claims database of healthcare organizations in the United States.</p><p><strong>Patients: </strong>Patients >18 years old who underwent MIH (laparoscopic or robotic assisted) or OH from 2013-2023. Simultaneous pelvic exenerations, recurrent gynecologic tumor debulking, or previous UI or BI were excluded. Propensity score matching adjusted for differences in pre-operative comorbidities. UI or BI was identified using ICD and CPT codes.</p><p><strong>Interventions: </strong>Minimally invasive and open hysterectomy.</p><p><strong>Main results: </strong>211,637 patients underwent MIH while 54,705 underwent OH. Incidence of UI during MIH was 0.95% while incidence of UI during OH was 0.57% (p<0.01). UI in the MIH cohort increased over time (2013-2018: 0.76%; 2019-2023: 1.1%; p<0.01). The highest incidence of UI was in 2023 (1.3%). Incidence of UI in OH did not change significantly. Patients who had UI were more likely to have infectious complications, readmissions, and ureteral strictures. BI in our MIH and OH cohorts was 0.24% and 0.81%, respectively (p<0.01). Patients who suffered BI were more likely to have UTI, readmission, and VVF or UVF. BI during MIH decreased from 2013-2018 (0.29%) to 2018-2023 (0.22%) (p<0.01) but did not change for OH.</p><p><strong>Conclusions: </strong>In our large national database study, we found that MIH patients were more likely to suffer UI, but less likely to have BI than OH patients. The incidence of UI during MIH is increasing with time. The short and long-term sequela is significant with increased rates of readmission, infections, ureteral strictures, and fistulas.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Targeted Endometriosis Treatment On Patients with Central Sensitization: Systematic Review and Meta Analysis.","authors":"Adriana Gomez-Llerena, Pallavi Shekawat, Aishwarya Pradeep, Victoria L Clifton, Sherif A El Nashar, Aakriti R Carrubba","doi":"10.1016/j.jmig.2025.07.020","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.020","url":null,"abstract":"<p><strong>Objective: </strong>Central sensitization (CSS), a condition where the central nervous system amplifies pain signals, may impact response to treatment of chronic pain conditions. The objective of this study is to determine if CSS affects outcomes after medical or surgical treatment for women with endometriosis via a systematic review and meta-analysis.</p><p><strong>Data sources: </strong>A systematic literature search using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, Science Citation Index Expanded, and Emerging Sources Citation Index was conducted without language or date restrictions. The search strategy utilized MeSH and EMTREE terms to capture concepts related to central sensitization, endometriosis, and associated symptoms like dysmenorrhea. Interventions in the reviewed studies included medical treatment or surgery.</p><p><strong>Methods of study selection: </strong>Studies reporting on endometriosis outcomes in women with and wihout CSS were included in the review. We excluded studies which primarily focused on non-endometriosis pelvic pain syndromes. A total of 1821 abstracts were identified, and 259 full texts were reviewed for eligibility. Five studies met inclusion criteria encompassing a total of 1271 patients. Data for meta-analysis was not available for one study and another study was excluded as it was the only one describing medical treatment. The Newcastle-Ottawa scale was used to assess quality and risk of bias. Results were sythesized using random effect meta-anlayses to estimate the pooled risk ratio (RR) and 95% confience using the DerSimmonian and Laird methods.</p><p><strong>Tabulation, integration, and results: </strong>The percentage of patients with CSS ranged from 28.3%% to 80.2%. Patients with CSS have smaller changes in pain scores after endometriosis surgery (RR 0.79, confidence interval 0.73 - 0.86) and significantly higher persistent pain (RR 2.27, confidence interval 1.40 - 3.68).</p><p><strong>Conclusion: </strong>Higher baseline catastrophization is associated with worse outcomes in women undergoing treatment for endometriosis. This is important to consider during counseling and decision-making.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Path Toward Earlier Recognition of Endometriosis: Can AI Bridge the Diagnostic Gap?","authors":"Aline Talhouk","doi":"10.1016/j.jmig.2025.07.016","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.016","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding \"Risk Factors and Prediction Nomogram of Local Regeneration After Ultrasound-Guided Microwave Ablation of Uterine Fibroids\".","authors":"Likun Wang","doi":"10.1016/j.jmig.2025.06.024","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.06.024","url":null,"abstract":"<p><p>The median follow-up time in this study [1] was 13 months (interquartile range, 8-22), reflecting significant variability in follow-up duration, with the minimum period recorded at 8 months and the maximum extending to 22 months. This variability may result in an incomplete understanding of the long-term effects of the treatment, as a shorter followup period might not adequately capture the full spectrum of outcome events, particularly those occurring later. This limitation may lead to a lack of recognition of the actual risk associated with local regeneration, which might only become evident following a prolonged observation period. Secondly, the study [1] describes that \"For patients with fertility desires, the ablative margins were kept ≥5 mm away from the endometrium and serosa.\" In this context, it is plausible that the ablative margins, rather than fertility desires per se, play a more direct role in influencing local regeneration. A conservative ablation range (ablative margins ≥5 mm) may allow for the preservation of adjacent healthy tissue but could also leave behind residual uterine fibroid cells, thereby increasing the likelihood of incomplete ablation and subsequent local regeneration. Thirdly, hormone levels are a critical risk factor for local regeneration. The development and persistence of uterine fibroids may be influenced by estrogen, alongside ovarian steroid secretion [2,3], which also impacts their growth. However, the investigation does not provide details concerning hormone concentrations. A plausible hypothesis is that patients undergoing local regeneration may exhibit higher estrogen levels compared to those in the non-local regeneration group, potentially enhancing the likelihood and intensity of local regeneration.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Hidden Behind the Cecum: When Acute Pain Reveals a Retrocecal Ovary\".","authors":"Shweta Kanyal, Olivia Casas Diaz, Courtney Poston, Katrin Arnolds","doi":"10.1016/j.jmig.2025.07.015","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.015","url":null,"abstract":"","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onabotulinumtoxin A Injections for patients with pelvic floor dysfunction.","authors":"Gabrielle T Whitmore, Jenny Tam, Megan Orlando","doi":"10.1016/j.jmig.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.jmig.2025.07.005","url":null,"abstract":"<p><strong>Objective: </strong>To review the current literature surrounding onabotulinum toxin A injections for patients with pelvic floor dysfunction and to demonstrate how to perform these injections.</p><p><strong>Setting: </strong>Academic tertiary care hospital PARTICIPANTS: It is estimated that about 50-90% of patients with chronic pelvic pain have pain that originates from myofascial sources, including the pelvic floor muscles. In patients with pelvic floor dysfunction, management consists of pelvic floor physical therapy with the addition of pelvic floor trigger point injections with a local anesthetic as needed. We offer onabotulinum toxin A to individuals who require long-term repeat trigger point injections, have barriers to accessing monthly injections, or show no durable improvement.</p><p><strong>Intervention: </strong>We demonstrate a comprehensive pelvic floor exam and techniques for administration of onabotulinum toxin A into pelvic floor muscles in individuals with pelvic floor dysfunction, as well as a demonstration on a live patient. We perform an exam while the patient is awake, either in clinic or at the time of the procedure, and examine the pubococcygeus, iliococcygeus, and obturator internus muscles to assess for hypertonicity and tenderness to palpation. Once sedation is initiated, 200 units of onabotulinum toxin A is then reconstituted with 20 mL of normal saline. The pudendal nerve kit allows for 1cm depth of penetration with the needle. Approximately 1-2 mL of onabotulinumtoxin A are injected sequentially in multiple locations along the above-mentioned pelvic floor muscles. Medication effects may last up to 3-6 months, with a reduction in pain scores starting at 6 weeks and lasting through 12 weeks based on published literature. Adverse effects may include constipation, urinary incontinence, urinary tract infections, fecal incontinence, or urinary retention.</p><p><strong>Conclusions: </strong>Onabotulinumtoxin A may be helpful in patients with refractory pelvic floor dysfunction. We demonstrate how to perform these injections with a safe and reproducible technique.</p>","PeriodicalId":16397,"journal":{"name":"Journal of minimally invasive gynecology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}