Gynecology and pelvic medicine最新文献

{"title":"Laparoscopic temporary uterine artery occlusion combined with <i>en bloc</i> lesion resection for type III cesarean scar pregnancy: surgical technique.","authors":"Ping Cheng, Shuang Liu, Qinwen Shen","doi":"10.21037/gpm-25-30","DOIUrl":"10.21037/gpm-25-30","url":null,"abstract":"<p><p>This article presents a refined laparoscopic surgical technique for the management of type IIIb cesarean scar pregnancy (CSP), as classified by Ban <i>et al.</i>'s 2023 criteria [residual myometrial thickness <3 mm, maximum sac diameter (MSD) ≥3 cm, bladder protrusion], in a 35-year-old female with vaginal bleeding and a history of two cesarean sections. The core protocol integrates temporary bilateral uterine artery occlusion (simple ligation of the main trunk with No. 1 absorbable Vicryl suture at 2 cm from the uterine wall) immediately before resection, adhesiolysis, <i>en bloc</i> excision of the ectopic mass with a 0.3 cm safe margin, and multilayer anatomical uterine repair. This technique addresses the key clinical challenge of massive intraoperative bleeding in highly vascular type IIIb CSP, with innovations in precise timing of occlusion and reversible minimally invasive ligation. Perioperative outcomes demonstrated excellent hemostasis (total blood loss 100 mL), complete lesion removal confirmed by frozen section, and intact uterine anatomy post-surgery. The study emphasizes the technique's value in hemorrhage control, anatomical restoration, and fertility preservation for patients with large type IIIb CSP (66 mm in this case). We provide a detailed step-by-step surgical guide, clarify patient selection criteria and contraindications, and discuss the technique's advantages, limitations, and potential to revise the standard of care for type III CSP. Postoperative 18-month follow-up showed successful natural conception and uncomplicated second-trimester pregnancy, validating its long-term fertility benefits.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"16"},"PeriodicalIF":0.4,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forty-month durable partial response with well-tolerated olaparib maintenance in a 92-year-old patient with <i>BRCA2</i>-mutated uterine serous carcinoma: a case report.","authors":"Xiaojuan Lin, Rui Li, Chuntang Sun, Mengpei Zhang, Jiacen Wan, Qingli Li","doi":"10.21037/gpm-2025-1-80","DOIUrl":"10.21037/gpm-2025-1-80","url":null,"abstract":"<p><strong>Background: </strong>Treatment selection for very elderly patients with endometrial cancer (EC) is frequently constrained by multimorbidity and frailty, increasing the risk of undertreatment and compromised outcomes. With the incorporation of molecular profiling into clinical practice, a subset of ECs has been recognized to exhibit homologous recombination deficiency (HRD), providing a rationale for the use of poly(ADP-ribose) polymerase (PARP) inhibitors. However, evidence for PARP inhibitor maintenance in EC remains limited, particularly in nonagenarians.</p><p><strong>Case description: </strong>A 92-year-old woman at first-time diagnosis of International Federation of Gynecology and Obstetrics (FIGO) stage IVB uterine serous carcinoma (USC) harboring a somatic <i>BRCA2</i> mutation received initial treatment consisting of suboptimal cytoreductive surgery followed by first-line carboplatin monotherapy, achieving a partial response (PR). Given the moderate renal impairment of the patient and her advanced age with anticipated vulnerability to treatment-related adverse events (TRAEs), maintenance olaparib was initiated at a reduced dose (150 mg twice daily) rather than the standard 300 mg twice daily. Under olaparib maintenance, the patient achieved a durable PR by serial imaging that has been maintained for 40 months until the latest follow-up (March 2026, 46 months after initial diagnosis), with serum cancer antigen 125 (CA-125) levels remaining consistently low and stable. The treatment was well tolerated; TRAEs were grade 1 or lower and were manageable with supportive care.</p><p><strong>Conclusions: </strong>This case illustrates that reduced-dose olaparib maintenance may be feasible and well-tolerated in very elderly patients with advanced, <i>BRCA</i>-mutated USC. It also highlights the potential clinical value of molecular profiling to enable individualized treatment strategies in this high-risk population.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"17"},"PeriodicalIF":0.4,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal associations between plasma proteins and premature ovarian failure through multi-omics Mendelian randomization analyses.","authors":"Caixia Wang, Meng Cheng","doi":"10.21037/gpm-2025-1-68","DOIUrl":"10.21037/gpm-2025-1-68","url":null,"abstract":"<p><strong>Background: </strong>Premature ovarian failure (POF), an endocrine disorder with ovarian dysfunction before age 40 years, severely affects fertility and health. This study aims to elucidate the genetic association of POF through plasma protein profiling to identify potential therapeutic targets.</p><p><strong>Methods: </strong>Using genetic instruments derived from the UKB-PPP and eQTLGen, two-sample Mendelian randomization (MR) analysis was conducted to systematically identify significant causal associations between plasma proteins and POF at both the gene expression and protein levels. Additional analytical approaches, including summary-data-based MR (SMR), heterogeneity in dependent instruments (HEIDI) testing, Bayesian co-localization, and a series of sensitivity analyses, were also employed to further validate the robustness of the findings. Subsequently, mediation analysis was performed to explore potential pathways through which plasma proteins may influence POF via immune or metabolic intermediaries. Finally, a phenome-wide MR analysis (MR-PheWAS) was conducted to assess the potential pleiotropic effects of the identified proteins.</p><p><strong>Results: </strong>Our analysis identified 96 proteins exhibiting causal relationship with POF. Notably, C-C motif chemokine 23 (CCL23) and tumor necrosis factor receptor superfamily member 14 (TNFRSF14) emerged as protective factors. Validation through SMR and HEIDI tests confirmed significant associations for 58 proteins. Bayesian colocalization further provided moderate evidence of colocalization for CCL23 [posterior probability for H4 (PP.H4) =72.1%] and TNFRSF14 (PP.H4 =54.9%). Additionally, mediation analysis revealed that immune cell traits and metabolic factors play crucial roles in POF development. MR-PheWAS demonstrated that CCL23 and TNFRSF14 are associated with various phenotypes, suggesting their broader implications beyond POF.</p><p><strong>Conclusions: </strong>This study identifies CCL23 and TNFRSF14 as putative causal mediators of POF, revealing their potential as dual therapeutic targets and providing novel insights into the underlying mechanisms of POF.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"12"},"PeriodicalIF":0.4,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the knowledge landscape of lymph node metastasis in ovarian cancer: a bibliometric and collaboration network analysis.","authors":"Chunru Chen, Xiaohua Cheng, Yingjie Zhang, Chenyang Cui, Yanan Peng, Juan Wang, Wenting Li, Fuxia Li","doi":"10.21037/gpm-25-47","DOIUrl":"10.21037/gpm-25-47","url":null,"abstract":"<p><strong>Background: </strong>Lymph node metastasis (LNM) is a critical pathway for the spread of ovarian cancer, significantly influencing staging, treatment decisions, and patient prognosis. Despite increasing clinical attention to ovarian cancer LNM, no bibliometric study has summarized the evolution of this research area. This study uses bibliometric methods to analyze global research trends, core themes, and future directions in ovarian cancer LNM.</p><p><strong>Methods: </strong>We retrieved and screened English-language publications on ovarian cancer LNM from the Web of Science Core Collection (WoSCC), covering the period from January 1, 2010, to May 31, 2025. The search utilized core subject headings related to ovarian cancer and lymphatic metastasis. Bibliometric analysis and visualization were conducted using tools such as VOSviewer and CiteSpace.</p><p><strong>Results: </strong>A total of 845 publications were identified, showing steady growth, peaking between 2017 and 2019. Collaboration network analysis revealed extensive international partnerships, with China being the central collaborative hub. China emerged as the leading contributor in publication volume. Key analyses identified influential institutions, core authors, and high-activity journals. Co-citation analysis further mapped the field's foundational knowledge clusters. The research focus evolved distinctly from surgical staging towards investigating molecular mechanisms, with the tumor immune microenvironment standing out as a current and central research focus.</p><p><strong>Conclusions: </strong>Research on ovarian cancer LNM has substantially evolved, progressing from descriptive clinical assessments to molecular and personalized approaches. However, unresolved issues remain regarding the underlying mechanisms and optimal surgical management. Continued multidisciplinary research, focusing on molecular biology and individualized treatment strategies, represents a promising path forward.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"11"},"PeriodicalIF":0.4,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant transformation of abdominal wall endometriosis: a case report and literature review.","authors":"Mengsi Liu, Sikai Chen, Shanshan Lu, Xiaoyang Shi, Honglan Zhu","doi":"10.21037/gpm-2025-1-57","DOIUrl":"https://doi.org/10.21037/gpm-2025-1-57","url":null,"abstract":"<p><strong>Background: </strong>Abdominal wall endometriosis (AWE) is a relatively rare subtype of endometriosis that has the potential for malignant transformation. It typically presents with nonspecific clinical symptoms, such as abdominal pain and palpable masses. Diagnosis primarily relies on multimodal imaging combined with histopathological examination. The main treatment strategies include carboplatin- and paclitaxel-based combination chemotherapy, resection of the abdominal wall mass, and hysterectomy with bilateral salpingo-oophorectomy. The uniqueness of this article lies in the patient experimentally receiving treatment with bevacizumab and sintilimab, while not undergoing hysterectomy with bilateral salpingo-oophorectomy.</p><p><strong>Case description: </strong>This article presents the case of a 48-year-old G2P1 female, with no family history of gynecological cancer, who presented with a progressively enlarging abdominal mass over 1 month at her prior cesarean section scar site, two decades post-procedure. Computed tomography (CT) revealed multiple cystic hypodense lesions within the bilateral rectus abdominis muscles, measuring up to 11.03 cm × 7.64 cm. Her tumor markers were elevated [cancer antigen 125 (CA125): 98.6 U/mL; human epididymis protein 4 (HE4): 74.9 pmol/L]. Histopathological analysis confirmed malignant transformation of AWE into clear cell carcinoma. The patient underwent radical resection of a 15 cm × 15 cm infiltrative mass with 5 mm margins, followed by mesh hernioplasty and abdominal wall reconstruction. Postoperatively, the patient received 6 cycles of 21 days of chemotherapy comprising albumin-bound paclitaxel (300 mg), carboplatin (600 mg), bevacizumab (500 mg), and sintilimab (200 mg). However, pulmonary metastasis was detected 13 months after the completion of adjuvant chemotherapy.</p><p><strong>Conclusions: </strong>This patient was not diagnosed with clear cell carcinoma of the abdominal wall prior to the initial surgery; therefore, hysterectomy and bilateral salpingo-oophorectomy were not performed. Our case highlights the need for increased vigilance toward malignant transformation of AWE, as well as may provide references for the treatment and follow-up of similar cases.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"40"},"PeriodicalIF":0.4,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptomatic prepubertal obstructed hemivagina and ipsilateral renal anomaly (OHVIRA)-spectrum anomalies: two case reports with individualized management and no recurrence during follow-up.","authors":"Fan Li, Heng Zhang, Ping Wang, Yueyue Chen, Ling Mei, Tao Wang, Xiaoyu Niu, Tao Cui","doi":"10.21037/gpm-25-51","DOIUrl":"10.21037/gpm-25-51","url":null,"abstract":"<p><strong>Background: </strong>Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a congenital anomaly characterized by uterus didelphys, obstructed hemivagina, and an ipsilateral renal anomaly, most commonly renal agenesis. Most patients become symptomatic after menarche and require surgical treatment. In prepubertal girls, asymptomatic fluid collections are often managed conservatively, whereas symptomatic cases have often prompted concern for ectopic ureter-related urinary accumulation requiring intervention. We report two early-childhood cases to show that integrated assessment of imaging, fluid analysis, and follow-up findings can help clarify the cause of symptomatic fluid collection and thereby guide management.</p><p><strong>Case description: </strong>Two early-childhood girls with left renal agenesis presented with abnormal genital findings, including a protruding vaginal mass in one case and persistent vaginal discharge in the other. In the first case, imaging revealed a vaginal/paravaginal cystic lesion without definite uterine anomaly, suggesting an OHVIRA-like developmental anomaly rather than classic OHVIRA. Vaginoscopic aspiration was performed; symptoms resolved, and no recurrence was observed during follow-up. In the second case, imaging demonstrated uterine didelphys, obstructed hemivagina, and fluid distension of the left uterine cavity, cervix, and vagina, consistent with OHVIRA. The patient underwent vaginoscopy-guided partial septectomy with no recurrence during follow-up, and fluid analysis supported infected retained secretions rather than ectopic ureter-related urinary accumulation as the likely cause of the early presentation.</p><p><strong>Conclusions: </strong>Symptomatic prepubertal OHVIRA is uncommon and may present with abnormal vaginal discharge. Such cases are not always caused by ectopic ureter-related urinary accumulation; infection may also underlie retained fluid. Integrated assessment can help clarify fluid origin and support individualized management.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"18"},"PeriodicalIF":0.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of results from KEYNOTE-826 and its impact within the East Asian population with real-world applications.","authors":"Christopher M Mayer, Charles A Leath","doi":"10.21037/gpm-2025-1-75","DOIUrl":"10.21037/gpm-2025-1-75","url":null,"abstract":"","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"21"},"PeriodicalIF":0.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine fibroids reduce the sensitivity of ultrasound to detect endometrioid and serous endometrial cancer: a retrospective cohort study.","authors":"Anna J Najor, Tori B Aspir, Alexander J Fife, Udele J Tagoe, Nada M Hussein, Sheila T Moran, Kelsea R Grant, Sara S Isani, Matthew W Cowan, Nicole S Nevadunsky, Ohad D Rotenberg, Ken Y Lin","doi":"10.21037/gpm-25-34","DOIUrl":"10.21037/gpm-25-34","url":null,"abstract":"<p><strong>Background: </strong>Transvaginal ultrasound (TVUS) is a guideline-approved stand-alone method to assess the risk of endometrial cancer (EC) for an episode of postmenopausal bleeding (PMB). However, the studies informing this guideline did not assess non-endometrioid histology which have a lower prevalence of abnormally thickened endometrium (EM), or account for uterine fibroids which may disproportionately obscure non-endometrioid histology. This study aims to assess whether fibroids reduce the sensitivity of TVUS for endometrioid and serous EC.</p><p><strong>Methods: </strong>This study is a retrospective cohort of pathology-confirmed endometrioid and serous EC of diagnosed between January 2012 and October 2022 at Montefiore Medical Center, an urban academic hospital system. Univariate analysis was completed with Fisher's exact tests for categorical data and Student's <i>t</i>-test for continuous variables. Multivariate logistic regression was used to model dichotomous outcomes.</p><p><strong>Results: </strong>Of 330 people who met eligibility criteria, 41% of the cohort had serous histology, and 25% had stage III-IV cancer. Large fibroid burden was present in 52% of serous EC <i>vs.</i> 29% of endometrioid EC, and in 55% of Black people <i>vs.</i> 26% of White people. Those with larger fibroid burden had EM visualized 15.9% less (73.8% <i>vs.</i> 89.7%, P<0.001), identification of thickened EM 3.6% less (87.5% <i>vs.</i> 91.1%, P=0.40). They had identification of any TVUS feature suspicious for malignancy 10.9% less (86.1% <i>vs.</i> 97.0%, P<0.001), and identification of focal TVUS features suspicious for malignancy 14.6% less (48.1% <i>vs.</i> 62.7%, P=0.01). Non-visualized EM (16.2% of TVUSs) was associated with total fibroid diameter >5 centimeters [adjusted odds ratio (aOR) 0.99, 95% confidence interval (CI): 0.36-1.61, P=0.002] and inversely associated with body mass index (BMI) ≥35 kg/m2 (aOR -1.15, 95% CI: -2.06 to -0.25, P=0.01). Larger fibroid burden reduced the sensitivity of TVUS to detect any feature suspicious for malignancy 3.2% more for serous than endometrioid histology (P=0.02).</p><p><strong>Conclusions: </strong>Uterine fibroid burden is associated with lower sensitivity of TVUS to detect features of EC, especially for serous than endometrioid histology. This highlights an important limitation to guidelines for the evaluation of PMB.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"13"},"PeriodicalIF":0.4,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated right ventricular apical hypoplasia with atrial fibrillation in a young female at her third trimester: a case report.","authors":"Xiaoping Liu, Chuan Liu, Qiang Yao, Weiwei Sun","doi":"10.21037/gpm-25-27","DOIUrl":"10.21037/gpm-25-27","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy represents a significant life event for most women, inducing extensive physiological adaptations. Consequently, it poses additional risks for women with congenital heart disease (CHD), a leading cause of maternal mortality. Isolated right ventricular apical hypoplasia (IRVAH) is a poorly characterized CHD subset, with pregnancy outcomes remaining unreported. Our case of a primigravida with IRVAH underscores the need for heightened monitoring in this population.</p><p><strong>Case description: </strong>We present a 28-year-old primigravida at 28 gestational weeks referred for structural right heart failure and paroxysmal atrial fibrillation (AF) with no palpitations and dyspnea. Diagnostic evaluation revealed IRVAH on echocardiography, characterized by preserved left ventricular function, severe tricuspid regurgitation, and right ventricular dilation, alongside electrocardiography showing AF; cardiac magnetic resonance imaging (MRI) subsequently confirmed apical right ventricular hypoplasia with no associated structural anomalies. Management was guided by multidisciplinary consensus, initiating stabilization with oral metoprolol (12.5 mg per dose, twice daily) for resting heart rate control (target heart rate <110 bpm). Pregnancy prolongation strategies included weekly fetal growth scans, daily maternal oxygen saturation (SpO₂)/blood pressure (BP) monitoring, and steroid coverage at 30 weeks for fetal lung maturation. Due to maternal AF recurrence despite therapy, fetal growth restriction (<10^th percentile), and the need to avoid hemodynamic stress from labor, an elective cesarean delivery was scheduled at 32 weeks. A preterm infant (1,580 g, Apgar scores 9/10) was delivered via cesarean section under spinal-epidural anesthesia and transferred to the neonatal intensive care unit (NICU) for recovery. Postoperative AF in the mother was successfully controlled with increased oral metoprolol (25 mg per dose, twice daily). At the 1-, 3-, and 6-month follow-ups, maternal cardiac function remained at New York Heart Association (NYHA) class I, and no developmental delays were observed in the infant.</p><p><strong>Conclusions: </strong>This case demonstrates the critical value of multidisciplinary team collaboration in managing pregnancy complicated by IRVAH, underscoring the need for individualized monitoring and intervention strategies. These findings may serve as a reference for the clinical management of similar cases in the future.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"19"},"PeriodicalIF":0.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is occult stress urinary incontinence truly \"occult\"?","authors":"Xingqi Wang, Ling Li, Zhenhua Gao, Daoming Tian, Yuan Li, Jiangna Gu, Hongcheng Li, Qian Luo, Jihong Shen","doi":"10.21037/gpm-25-49","DOIUrl":"10.21037/gpm-25-49","url":null,"abstract":"<p><p>Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) frequently coexist due to shared pathophysiological mechanisms. In some cases, SUI becomes evident only after the reduction of prolapse, a condition referred to as occult stress urinary incontinence (OSUI). Conventional understanding attributes OSUI to urethral obstruction caused by mechanical kinking or compression from the descending bladder base. This perception has led to ongoing controversy regarding the necessity of concomitant anti-incontinence procedures during POP repair. However, is this conventional interpretation accurate? This review challenges the traditional concept and argues that OSUI is not truly \"occult\". Instead, it results from alterations in the biomechanics of urinary control following apical suspension surgery, which often fails to restore physiological function or ensure the integrity of urinary control structures. Through an analysis of different surgical approaches-including posterior, anterior, lateral, and mesh-based suspensions-this article suggests that postoperative SUI may often be attributable to uncorrected support deficits, such as levator ani fissure enlargement, perineal body laceration, and inadequate vaginal wall support. The review emphasizes that apical suspension alone merely repositions the cervix horizontally without addressing underlying functional defects, thereby predisposing patients to OSUI. Consequently, physiological reconstruction, rather than mere anatomical correction, is proposed as a potentially important biomechanical strategy for reducing the risk of OSUI.</p>","PeriodicalId":92781,"journal":{"name":"Gynecology and pelvic medicine","volume":"9 ","pages":"14"},"PeriodicalIF":0.4,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}