Current Trends in Urogynecology: Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 June 2024 | Viewed by 11741

Special Issue Editor

II Department of Gynecology, Medical University of Lublin, Lublin, Poland
Interests: orogynecological surgery; LUTS; pharmacological treatment
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Special Issue Information

Dear Colleagues,

The female pelvic floor is one of the most complex anatomical and functional areas of the human body due to many, often relatively poorly recognized, factors influencing its functioning. Regardless of anatomical compartments (anterior, middle, and posterior), all pelvic floor components act in unison to maintain optimal bladder, bowel, and sexual functions. As such, any kind of pelvic floor disorder (anatomical or functional) represents a significant physical, social, and economic problem that often poses a challenge to the various specialists dealing with them. It is commonly accepted that the complexity of the factors contributing to a patient’s symptoms does not always correspond to physical examination findings, and this phenomenon could only be explained by various co-existing occult conditions that are often underdiagnosed and underestimated. By expanding our diagnostic and imaging knowledge, we can better serve our patients and help them to safely return to their normal lives.

This Special Issue of JCM aims to focus on diagnostic and therapeutic modalities and risk factors, as well as on prognostic implications in patients with symptomatic pelvic organ prolapse and lower urinary tract symptoms, especially overactive bladder and various clinical types of urinary incontinence, also including modern management of urogenital fistulas. Moreover, new methods of pelvic floor imaging will also be discussed in this Special Issue, since their implementation into clinical practice can substantially enhance our skills in the diagnosis and management of pelvic floor disorders.

I am confident that this Special Issue concerning the frontiers of our specialty will keep us up to date with the latest advances in urogynecology, thanks to the contributions of renowned international experts.

Prof. Dr. Tomasz Rechberger
Guest Editor

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Keywords

  • urogynecological surgery (uterovaginal prolapse, urinary incontinence, fistulas)
  • OAB
  • pharmacology
  • physiotherapy
  • LUTS

Published Papers (10 papers)

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Research

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16 pages, 5070 KiB  
Article
Trends in Urogynecology—Transvaginal Mesh Surgery in Germany
J. Clin. Med. 2024, 13(4), 987; https://doi.org/10.3390/jcm13040987 - 08 Feb 2024
Viewed by 399
Abstract
Background: Pelvic organ prolapse constitutes a prevalent condition associated with a considerable impact on the quality of life. The utilization of transvaginal mesh surgery for managing POP has been a subject of extensive debate. Globally, trends in TVM surgery experienced significant shifts subsequent [...] Read more.
Background: Pelvic organ prolapse constitutes a prevalent condition associated with a considerable impact on the quality of life. The utilization of transvaginal mesh surgery for managing POP has been a subject of extensive debate. Globally, trends in TVM surgery experienced significant shifts subsequent to warnings issued by the FDA. Methods: This study aims to explore temporal patterns in transvaginal mesh surgery in the German healthcare system. A comprehensive analysis was conducted on in-patient data from the German Federal Statistical Office spanning 2006 to 2021. A total of 1,150,811 operations, each associated with specific codes, were incorporated into the study. Linear regression analysis was employed to delineate discernible trends. Results: The trends in transvaginal mesh surgery within the anterior compartment exhibited relative stability (p = 0.147); however, a significant decline was noted in all other compartments (posterior: p < 0.001, enterocele surgery: p < 0.001). A subtle increasing trend was observed for uterine-preserving transvaginal mesh surgery (p = 0.045). Conclusion: Surgical trends over the specified timeframe demonstrate how POP management has evolved globally. Notably, despite observed fluctuations, transvaginal mesh surgery remains a viable option, particularly for specific cases with a high risk of relapse and contraindications to alternative surgical approaches. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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12 pages, 1083 KiB  
Article
Mobile Application Based Pelvic Floor Muscle Training for Treatment of Stress Urinary Incontinence: An Assessor-Blind, Randomized, Controlled Trial
J. Clin. Med. 2023, 12(22), 7003; https://doi.org/10.3390/jcm12227003 - 09 Nov 2023
Viewed by 712
Abstract
A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to [...] Read more.
A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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14 pages, 2229 KiB  
Article
The Use of Capacitive and Resistive Energy Transfer in Postpartum Pain Management in Women after Perineal Trauma
J. Clin. Med. 2023, 12(18), 6077; https://doi.org/10.3390/jcm12186077 - 20 Sep 2023
Viewed by 1090
Abstract
Perineal pain occurs in 97% of women with episiotomy or first- and second-degree perineal tears on the first day after delivery. The study aimed to assess the impact of capacitive and resistive energy transfer (TECAR) on perineal pain and discomfort in the first [...] Read more.
Perineal pain occurs in 97% of women with episiotomy or first- and second-degree perineal tears on the first day after delivery. The study aimed to assess the impact of capacitive and resistive energy transfer (TECAR) on perineal pain and discomfort in the first two postpartum days. The prospective randomized double-blind study was performed with the pain and discomfort assessment using the Visual Analogue Scale at baseline and after both TECAR interventions. Characteristics data, delivery information, and the number of painkillers taken were collected. The assumed significance level was α < 0.05. The study included 121 women with a mean age of 30.7 ± 4.2 years and a median BMI of 26.1 kg/m2 (24.1; 28.9). Pain reduction at rest, when walking, and discomfort reduction when walking were significantly higher in the TECAR group compared to the sham group (p < 0.05). After the first TECAR intervention, significant reduction in all measured parameters was observed in the study group (p < 0.03), whereas in the control group, it was observed in pain and discomfort while sitting (p < 0.04). The amount of ibuprofen taken on the second day was significantly reduced in the study group compared to the first day (p = 0.004). TECAR has been shown to provide more immediate and significant reduction in perineal pain and discomfort. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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8 pages, 586 KiB  
Article
Relationship between Q-Tip Test and Urethral Hypermobility on Perineal Ultrasound
J. Clin. Med. 2023, 12(14), 4863; https://doi.org/10.3390/jcm12144863 - 24 Jul 2023
Viewed by 1686
Abstract
Background: The aim of this study was to assess the correlation between the overall rest–stress distance measured by transperineal ultrasound (TPUS) and Q-tip test angle in women with urodynamic stress incontinence (USI), and determine a cut-off value of rest–stress distance for predicting urethral [...] Read more.
Background: The aim of this study was to assess the correlation between the overall rest–stress distance measured by transperineal ultrasound (TPUS) and Q-tip test angle in women with urodynamic stress incontinence (USI), and determine a cut-off value of rest–stress distance for predicting urethral hypermobility (UH). Methods: Women with USI scheduled for mid-urethral sling surgery were retrospectively recruited. UH was defined as a Q-tip angle more than or equal to 30 degrees. Ultrasonic measurement of the overall rest–stress distance was defined as the linear distance of bladder-neck position change from resting status to maximal strain. Results: Among the 132 enrolled women, the Pearson correlation coefficient between the overall rest–stress distance in TPUS and Q-tip test angle was 0.9104 (95% CI, 0.8758–0.9357, p < 0.001). In receiver-operating-characteristic-curve analysis, a rest–stress distance of more than 13.3 mm was an optimal cut-off value to predict UH (sensitivity = 76.47%, specificity = 93.3%; area = 0.937, 95% confidence interval: 0.881–0.972). Conclusions: The overall rest–stress distance in TPUS correlated well with the Q-tip test angle, indicating that it can be an alternative method for the assessment of USI. A rest–stress distance of more than 13.3 mm was an optimal cut-off value to predict UH in women with USI. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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9 pages, 730 KiB  
Article
Rate of Postoperative Urinary Retention after Anterior Compartment Prolapse Surgery: A Randomized Controlled Trial Comparing Early versus Conventional Transurethral Catheter Removal
J. Clin. Med. 2023, 12(10), 3436; https://doi.org/10.3390/jcm12103436 - 12 May 2023
Viewed by 2426
Abstract
Background: Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior [...] Read more.
Background: Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior compartment prolapse-related surgeries. As we know, postoperative urinary retention (POUR) is one of the most common complications following pelvic floor surgery. To prevent this complication, indwelling bladder catheterization is routinely applied. In contrast, to minimize risk of infection and the patient’s discomfort, the catheter should be removed as soon as possible. However, there is a lack of clarity regarding the optimal timing for catheter removal. Therefore, the aim of this trial is to compare the rate of POUR after anterior prolapse surgery between early transurethral catheter removal (24 h postoperatively) and our standard practice (on postoperative day 3). Methods: We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed, and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction. Analysis was performed according to the intention to treat principle. The calculated sample size was 68 patients (34 patients in each group) for a 95% confidence interval, 80% power, 5% probability of type I error, and 10% data loss. Discussion: This study demonstrated that early catheter removal was comparable in POUR rate to conventional treatment with shorter hospitalization among patients undergoing anterior compartment prolapse surgery. Additionally, we observed no re-hospitalization owing to POUR. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse-related surgery. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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10 pages, 486 KiB  
Article
Lower Urinary Tract Symptoms and Overactive Bladder in a Large Cohort of Older Poles—A Representative Tele-Survey
J. Clin. Med. 2023, 12(8), 2859; https://doi.org/10.3390/jcm12082859 - 13 Apr 2023
Viewed by 1415
Abstract
Background: A reliable reference of population-based parameters for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) is lacking for the elderly. Thus, the objective of this study was to estimate the prevalence, bother, effect on quality of life, and treatment-related behavior for [...] Read more.
Background: A reliable reference of population-based parameters for lower urinary tract symptoms (LUTS) and overactive bladder (OAB) is lacking for the elderly. Thus, the objective of this study was to estimate the prevalence, bother, effect on quality of life, and treatment-related behavior for LUTS and OAB in a large population-level cohort of Polish adults aged ≥ 65 years. Methods: We used data from the telephone LUTS POLAND survey. Respondents were categorized by sex, age, and residence. All LUTS and OAB were assessed with validated questionnaires and a standard protocol based on the International Continence Society definitions. Results: The mean (standard deviation) age of 2402 participants (60.4% women) was 72.5 (6.7) years. The prevalence of LUTS was 79.5% (men: 76.6%; women: 81.4%), and the prevalence of OAB was 51.4% (men: 49.4%; women: 52.8%). The prevalence of both conditions increased with age. The most prevalent symptom was nocturia. LUTS and OAB were often bothersome, and almost half of participants who reported LUTS or OAB had decreased quality of life related to their urinary functioning. Nevertheless, only one third of participants sought treatment for their bladder problems, and most of these participants received treatment. We did not observe differences between urban and rural areas in all analyzed population-level parameters. Conclusions: LUTS and OAB were prevalent conditions with significant bother and negative effects on quality of life among Polish adults aged ≥ 65 years. Nevertheless, most affected respondents had not sought treatment. Thus, for older persons, there is a need to increase public awareness about LUTS and OAB, and the negative effects of LUTS and OAB on healthy aging. In addition, greater government and healthcare system resources are needed to better manage LUTS and OAB in older patients. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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Review

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16 pages, 1385 KiB  
Review
Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update
J. Clin. Med. 2024, 13(5), 1377; https://doi.org/10.3390/jcm13051377 - 28 Feb 2024
Viewed by 245
Abstract
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed [...] Read more.
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords “incontinence” and “bulking” or “laser”. Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types—the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser—deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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19 pages, 502 KiB  
Review
Perioperative Factors Affecting the Healing of Rectovaginal Fistula
J. Clin. Med. 2023, 12(19), 6421; https://doi.org/10.3390/jcm12196421 - 09 Oct 2023
Viewed by 856
Abstract
Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment [...] Read more.
Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment effectiveness depends on the etiology of fistula, the age of the patients, the presence of comorbidities, the type of surgery and many other factors. Considering the low efficiency of treatment and the high risk of recurrence, the question of possible methods to improve the results occurs. In our review, we analyzed both modifiable and non-modifiable factors which may influence the treatment, healing rate and future fate of the patients. Taking into account all analyzed risk factors, including age, comorbidities, smoking status, microbiology, medications, stoma and stool features, we are aware that rectovaginal fistula’s treatment must be individualized and holistic. In cases of poorly healing RVF, the drainage of feces, the use of antibiotic prophylaxis or the implementation of estrogen therapy may be useful. Moreover, microbiome research in women with RVF and towards estrogen therapy should be performed in order to create treatment algorithms in women with fistulae. Those interventions, in our opinion, may significantly improve the outcome of the patients. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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17 pages, 2409 KiB  
Review
Cycle Biodynamics of Women’s Microbiome in the Urinary and Reproductive Systems
J. Clin. Med. 2023, 12(12), 4003; https://doi.org/10.3390/jcm12124003 - 12 Jun 2023
Cited by 2 | Viewed by 1704
Abstract
The genitourinary microbiome plays a crucial role in the establishment and maintenance of urinary and reproductive health in women throughout their lives. Particularly during the reproductive stage, resident microorganisms contribute to implantation and protect against perinatal complications, including preterm birth, stillbirth, and low [...] Read more.
The genitourinary microbiome plays a crucial role in the establishment and maintenance of urinary and reproductive health in women throughout their lives. Particularly during the reproductive stage, resident microorganisms contribute to implantation and protect against perinatal complications, including preterm birth, stillbirth, and low birth weight, while also serving as the first line of defense against pathogens that can cause infections, such as urinary tract infections and bacterial vaginosis. This review aimed to elucidate the relationship between a healthy microbiome environment and women’s overall health. We examine the variability and dynamics of the microbiome during different developmental stages, ranging from the prepubertal to the postmenopausal stage. Furthermore, we explore the significance of a healthy microbiota in successful implantation and pregnancy development and investigate potential differences between women experiencing infertility. In addition, we analyze the local and systemic inflammatory responses associated with the establishment of a dysbiotic state and compare it to a condition where a healthy microbiome was established. Lastly, we present the most recent evidence regarding preventive measures, such as dietary interventions and the use of probiotics to promote and maintain a healthy microbiome, thereby ensuring comprehensive women’s health. By highlighting the importance of the genitourinary microbiome in reproductive health, this review aimed to enhance this microbiome’s visibility and significance in the field. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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Other

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7 pages, 519 KiB  
Brief Report
Percutaneous Tibial Nerve Stimulation in the Treatment of Refractory Idiopathic Overactive Bladder Syndrome: A Retrospective Cohort Study
J. Clin. Med. 2023, 12(21), 6783; https://doi.org/10.3390/jcm12216783 - 26 Oct 2023
Viewed by 626
Abstract
Background: Overactive bladder (OAB) is a syndrome defined as urinary urgency, accompanied by increased frequency and nocturia with or without urge incontinence, in the absence of urinary tract infection or other obvious pathology. The standard therapies are anticholinergic agents, selective beta-3 adrenoreceptor agonists, [...] Read more.
Background: Overactive bladder (OAB) is a syndrome defined as urinary urgency, accompanied by increased frequency and nocturia with or without urge incontinence, in the absence of urinary tract infection or other obvious pathology. The standard therapies are anticholinergic agents, selective beta-3 adrenoreceptor agonists, or intradetrusor injections of botulinum toxin (BTX-A). For patients with contraindications for BTX-A or drug therapies, percutaneous tibial nerve stimulation (PTNS) may be used. PTNS shows fewer side effects than anticholinergic drugs and costs less than BTX-A. The primary outcome of this study was to assess the efficacy of PTNS in women with refractory OAB. Methods: Women with refractory OAB undergoing PTNS at our tertiary referral center from 2017 to 2019 were included. The validated German Female Pelvic Floor Questionnaire and a micturition protocol were filled out before and after PTNS. PTNS was applied weekly for 12 weeks. Results: Improvements in OAB symptoms were seen in daily micturition frequency, urgency, and urgency incontinence from pre- to post-PTNS (p < 0.006). Impairments to quality of daily life were significantly (p < 0.0002) less severe after PTNS. There was a significant reduction in daytime voiding frequency from a median of nine to five (p < 0.0001). Conclusions: Substantial reductions in OAB symptoms, daily micturition frequency, urgency, and urgency incontinence were found in patients with refractory OAB after PTNS. Full article
(This article belongs to the Special Issue Current Trends in Urogynecology: Part II)
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