Long-term mesh complications and reoperation after laparoscopic mesh sacrohysteropexy: a cross-sectional study
ConclusionsLaparoscopic mesh sacrohysteropexy has a low incidence of reoperation for mesh complications and apical prolapse, and a high rate of patient-reported improvement in prolapse symptoms. With appropriate clinical governance measures, the procedure offers an alternative to vaginal hysterectomy with apical suspension. However, long-term comparative studies are still required. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - July 3, 2020 Category: OBGYN Source Type: research

A one-stop perineal clinic: our eleven-year experience
ConclusionWe describe a dedicated, one-stop perineal clinic model for antenatal and postnatal women for management of perineal and pelvic floor disorders. This comprehensive and novel data will enable clinicians to better counsel women regarding of outcomes after OASI and focus training to minimize risks of morbidities. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - July 2, 2020 Category: OBGYN Source Type: research

Complications and re-operations after tension-free vaginal tape operation in women with stress urinary incontinence
ConclusionThis study demonstrated high safety and efficacy of the TVT operation with only minor short-term complications and few long-term re-operations. The ICIQ-UI SF improved significantly postoperatively and was not statistically significantly affected by the occurrence of complications. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - July 2, 2020 Category: OBGYN Source Type: research

Vaginal hysterectomy with anterior and posterior repair for pelvic organ prolapse under local anesthesia: results of a pilot study
ConclusionsLocal anesthesia for patients undergoing VH and PFR has been shown to be a viable alternative to regional anesthesia, offering reduced postoperative pain and less opioid use for the first 8  h. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - July 2, 2020 Category: OBGYN Source Type: research

Is antibiotic prophylaxis necessary in mid-urethral sling surgery?
ConclusionsAntibiotic prophylaxis resulted in fewer women developing postoperative infections or prolonged postoperative pain after MUS surgery, but did not offer protection against tape exposure. The differences in cure rates were small and probably without clinical relevance. If a small increase in surgical site infections is accepted, the routine use of antibiotic prophylaxis can probably be omitted. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - July 2, 2020 Category: OBGYN Source Type: research

Health-related quality of life in parous women with pelvic organ prolapse and/or urinary incontinence in Bangladesh
AbstractIntroduction and hypothesisWe assessed the association of pelvic organ prolapse (POP) and urinary incontinence (UI), alone and in combination (POP-UI), and related factors with health-related quality of life (HRQOL) in parous women in Bangladesh.MethodsThe study included 357 parous women: 107 with POP alone, 124 with POP-UI, and 126 with UI alone. Data were collected on sociodemographic characteristics, comorbidities, symptom duration, UI severity and type, POP stage, and the 12-item Short-Form Health Survey (SF-12).ResultsThe median scores of the SF-12 Physical and Mental Component Summary (PCS and MCS) were 29.1 ...
Source: International Urogynecology Journal - July 1, 2020 Category: OBGYN Source Type: research

Age-associated impairments in tissue strength and immune response in a rat vaginal injury model
ConclusionsIn this rat model, age impaired vaginal wound healing, which was reflected in the altered inflammatory response to injury and reduced tissue strength. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 20, 2020 Category: OBGYN Source Type: research

The use of tomographic ultrasound imaging on three-dimensional translabial ultrasound: a diagnostic sign for urethral diverticulum
The objective was to apply tomographic ultrasound imaging (TUI) to diagnose urethral diverticulum (UD) and summarize the specific imaging findings.MethodsThis was a retrospective analysis of 42 women with a paraurethral cyst. All women underwent a clinical interview, three-dimensional pelvic floor ultrasound and a transvaginal cystectomy between May 2016 and March 2019. UD was defined on TUI if a tract connecting the paraurethral cyst to the urethral lumen was shown in the urethral rhabdosphincter circular muscle in the pelvic floor axial plane. All patients ’ demographics, history, clinical evaluation and surgical o...
Source: International Urogynecology Journal - June 20, 2020 Category: OBGYN Source Type: research

Variables associated with an inability to learn clean intermittent self-catheterization after urogynecologic surgery
AbstractIntroduction and hypothesisPost-operative urinary retention is a common problem affecting close to half of all women undergoing pelvic reconstructive surgery. This was an exploratory analysis that was aimed at identifying factors associated with an inability to learn clean intermittent self-catheterization (CISC) after a failed post-operative retrograde voiding trial (RGVT).MethodsWe performed a retrospective case –control study of women who underwent pelvic organ prolapse or urinary incontinence surgery within a single division from 2016 to 2018. We compared women who could learn CISC with those unable to le...
Source: International Urogynecology Journal - June 20, 2020 Category: OBGYN Source Type: research

Bowel preparation prior to minimally invasive sacrocolpopexy: a randomized controlled trial
ConclusionsAlthough there was no difference in ITT analysis, women who underwent a bowel preparation prior to MIS demonstrated benefit to post-operative defecatory function with a corresponding improvement in surgeon ’s perception of case complexity. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 20, 2020 Category: OBGYN Source Type: research

Long-term mesh erosion rate following abdominal robotic reconstructive pelvic floor surgery: a prospective study and overview of the literature
ConclusionsThe long-term rate of mesh erosion following an abdominally placed synthetic graft is low. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 20, 2020 Category: OBGYN Source Type: research

Laparoscopic repair of female genitourinary fistulae: 10-year single-center experience
ConclusionsLaparoscopic repair of VVF, VUF, and UVF is a feasible procedure with a high success rate and low morbidity. LESS repair of VVF and VUF has a comparable success rate to conventional laparoscopy, but with a shorter hospital stay and fewer analgesic requirements. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 20, 2020 Category: OBGYN Source Type: research

Temporal decline in the improved detection rates following OASIS workshops
ConclusionsAttending an OASIS workshop increases the detection rate in the year following the workshop but declines gradually. To maximize its benefits, the workshop must be repeated periodically. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 19, 2020 Category: OBGYN Source Type: research

A biomechanically based concept for a stronger obstetric anal sphincter repair
ConclusionsWe have analyzed causes of sphincter repair failure, introduced a graft method, preferably autologous, for the prevention thereof and supported ultrasound assessment, rather than the absence of fecal incontinence as the criterion for success of EAS repair. Although based on well-established biomechanical principles, our proposal at this stage remains unproven. Our hope is that these concepts will be challenged, clarified, and tested, preferably in a randomized controlled trial. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 18, 2020 Category: OBGYN Source Type: research

Obstructive patterns in videourodynamic studies predict responses of female dysfunctional voiding treated with or without urethral botulinum toxin injection: a long-term follow-up study
We report long-term changes in VUDS profiles of women with dysfunctional voiding and investigate potential predictors for treatment response.MethodsWomen with dysfunctional voiding and available VUDS data between November 1997 and June 2018 were enrolled for retrospective analysis. The patients were all treated with medication first. In refractory patients, urethral botulinum toxin was provided as an additional option. The primary outcome was the change of VUDS parameters between baseline and follow-up studies. The secondary outcomes were baseline parameters and clinical factors that were associated with the BOOI response ...
Source: International Urogynecology Journal - June 18, 2020 Category: OBGYN Source Type: research

Update in native tissue vaginal vault prolapse repair
AbstractThe lifetime risk of women for undergoing surgery for pelvic organ prolapse (POP) is estimated to be 11 –19%, and 30% of these women will require subsequent reoperation over time. Following hysterectomy, 3.6 per 1,000 person-years need surgical correction of prolapse, and in two-thirds of these cases multi-compartment prolapse is present. In the last decades, vaginally synthetic meshes were widely u sed in pelvic reconstructive surgery. However, after the decision of the Food and Drug Administration in 2019 to stop selling all surgical mesh devices for transvaginal prolapse repair, native tissue (NT) vaginal ...
Source: International Urogynecology Journal - June 18, 2020 Category: OBGYN Source Type: research

Urethral diverticulum with giant calculus: an unusual cause of prolonged lower urinary tract symptoms
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 18, 2020 Category: OBGYN Source Type: research

The effect of advisory documents on mid-urethral sling case acquisition to the British Society Urogynaecology (BSUG) database in England
AbstractIntroduction and hypothesisMany advisory documents have recommended uploading of all mid-urethral sling (MUS) cases onto the British Society of Urogynaecology (BSUG) or British Association of Urological Surgeons (BAUS) database. The aim of this study was to determine whether these documents have resulted in an increase in database case acquisition for MUS surgery.MethodWe determined the number of cases uploaded onto the BSUG and BAUS databases and cases acquired by Hospital Episode Statistics (HES) over the period January 2011 –March 2017 for the 6 months prior to each document and 6 months afterwards.Results...
Source: International Urogynecology Journal - June 17, 2020 Category: OBGYN Source Type: research

Total colpocleisis technique in huge neglected ulcerated uterovaginal prolapse
ConclusionsTotal colpocleisis is an excellent surgical option in women with multiple, large cervicovaginal ulcers and multiple comorbidities with no desire for penetrative vaginal function. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 17, 2020 Category: OBGYN Source Type: research

Commentary: effect of darifenacin on fecal incontinence in women with double incontinence
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 17, 2020 Category: OBGYN Source Type: research

Prolapse repair in the elderly patient: contemporary trends and 30-day perioperative complications
AbstractIntroduction and hypothesisPelvic organ prolapse is common and increases with age. Although conservative options exist for management, surgery remains a mainstay of treatment. Understanding how surgical repair affects the elderly is increasingly important as the population ages. We set out to describe current treatment patterns for prolapse repair in the elderly. Our main goal was to compare perioperative morbidity and mortality for elderly patients who undergo surgical repair of pelvic organ prolapse with colpocleisis, vaginal repair or sacrocolpopexy.MethodsWomen 75  years and older who underwent prolapse re...
Source: International Urogynecology Journal - June 16, 2020 Category: OBGYN Source Type: research

Outcome of anal symptoms and anorectal function following two obstetric anal sphincter injuries (OASIS) —a nested case-controlled study
ConclusionsWe have demonstrated that women with recurrent OASI do not have significant anorectal symptoms compared to those with one OASI 12  weeks after delivery, but worse anal sphincter function and integrity. Therefore, on long-term follow-up, symptoms may possibly develop. This information will be useful when counselling women in a subsequent pregnancy. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 16, 2020 Category: OBGYN Source Type: research

Evaluation of the ACS NSQIP surgical risk calculator in patients undergoing pelvic organ prolapse surgery
ConclusionsThe NSQIP surgical risk calculator displayed poor predictive ability in our cohort of patients undergoing surgery for pelvic organ prolapse, suggesting that this tool might have limited clinical applicability to individual patients in this population. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 16, 2020 Category: OBGYN Source Type: research

Commentary on “Percutaneous tibial nerve stimulation maintenance therapy for overactive bladder in women: long-term success rates and adherence”
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 16, 2020 Category: OBGYN Source Type: research

Effect of darifenacin on fecal incontinence in women with double incontinence
AbstractIntroduction and hypothesisTo evaluate change in fecal incontinence symptom severity after 8  weeks of darifenacin therapy in patients with double incontinence-urgency urinary incontinence (UUI) and fecal incontinence. Important secondary outcomes included fecal incontinence symptom distress and impact on quality of life, fecal incontinence episodes, global impression of improvement and ov eractive bladder symptom distress and impact.MethodsProspective open-label cohort study of women presenting primarily with UUI, diagnosed with double incontinence and electing antimuscarinic therapy for UUI. Women ≥ 18&nb...
Source: International Urogynecology Journal - June 15, 2020 Category: OBGYN Source Type: research

A commentary on “Apical suspension is underutilized for repair of stage IV pelvic organ prolapse: an analysis of national practice patterns in the United States”
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 15, 2020 Category: OBGYN Source Type: research

The effect of replacing vacuum with forceps in operative vaginal delivery: an observational study
ConclusionsA change in obstetric practice resulting in the conversion of primary VD to primary FD would be expected to substantially increase the likelihood of pelvic floor trauma. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 13, 2020 Category: OBGYN Source Type: research

Complex extensive urethral diverticulum on pelvic floor ultrasound and MRI
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 13, 2020 Category: OBGYN Source Type: research

Predictors of delayed postoperative urinary retention after female pelvic reconstructive surgery
AbstractIntroduction and hypothesisRisk factors can be used to determine what patients will develop delayed postoperative urinary retention after female pelvic reconstructive surgery.MethodsA case-control study was performed including all female pelvic reconstructive surgeries necessitating a voiding trial. All patients passed their previous voiding trial. Cases had an acute encounter for urinary retention. Controls did not have acute postoperative urinary retention. Cases and controls were stratified based on procedure. Demographics, medical/surgical histories, voiding symptoms, urodynamic testing, and intraoperative data...
Source: International Urogynecology Journal - June 12, 2020 Category: OBGYN Source Type: research

Stress urinary incontinence after transvaginal mesh surgery for anterior and apical prolapse: preoperative risk factors
AbstractIntroduction and hypothesisDebate persists over whether surgery to correct pelvic organ prolapse (POP) should be combined with midurethral sling (MUS) insertion. The aim of this study was to evaluate the incidence of stress urinary incontinence (SUI) up to 12  months after transvaginal mesh surgery, with or without MUS, and to identify risk factors for postoperative SUI.MethodsThis retrospective single-center study included patients who underwent transvaginal mesh surgery with Uphold ™ between October 2010 and December 2017. The primary outcome was the prevalence of SUI at 12 months postoperatively....
Source: International Urogynecology Journal - June 12, 2020 Category: OBGYN Source Type: research

Response re: Letter to the editor: selective episiotomy versus no episiotomy for severe perineal trauma: systematic review and meta-analysis
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 11, 2020 Category: OBGYN Source Type: research

Is vaginal flatus related to pelvic floor functional anatomy?
ConclusionsVaginal flatus is a prevalent and bothersome condition affecting one-third of our study population. The condition is associated with pelvic floor functional anatomy. A higher resting tone may confer a higher resistance against which trapped air is expelled during physical activities. Younger age was moderately correlated with symptom bother. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 11, 2020 Category: OBGYN Source Type: research

Biofeedback versus electrical stimulation for sexual dysfunction: a randomized clinical trial
ConclusionsBoth biofeedback and electrical stimulation increased the Female Sexual Function Index score. However, to improve sexual function, women undergoing biofeedback seem to benefit more than those receiving electrical stimulation. We recommend considering the prescription of biofeedback for the treatment of sexual dysfunction because of its efficacy, lack of adverse effects, and easy application. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 11, 2020 Category: OBGYN Source Type: research

Circumferential urethral diverticulum: a surgical conundrum
ConclusionThis video highlights the steps required to successfully excise a complex circumferential diverticulum that extends over the dorsal midurethra and has a communication with the urethral lumen. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 11, 2020 Category: OBGYN Source Type: research

Long-term safety and efficacy of laparoscopically placed mesh for apical prolapse
ConclusionsThis study shows excellent long-term results from LSC and LSH with comprehensive follow-up, demonstrating a very low and acceptable level of intraoperative, short- and long-term complications. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 10, 2020 Category: OBGYN Source Type: research

Intrapartum risk factors for postpartum urinary retention: a case-control study
ConclusionNo single factor predicted development of postpartum urinary retention; however, a higher index of suspicion after vaginal delivery is warranted for nulliparous women, ≥ 2nd-degree obstetrical laceration, and if intermittent catheterization during labor was required. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 10, 2020 Category: OBGYN Source Type: research

Author reply to the commentary on: Is endoanal, introital or transperineal ultrasound diagnosis of sphincter defects more strongly associated with anal incontinence?
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 9, 2020 Category: OBGYN Source Type: research

Response to letter to the editor
(Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 9, 2020 Category: OBGYN Source Type: research

Urinary incontinence in female university students
ConclusionWe demonstrated that UI is a common condition among female university students. The identification of the associated risk factors will help to further raise the knowledge and awareness of the problem, and preventive strategies may be proposed to young women to improve the quality of life and psychological well-being. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 8, 2020 Category: OBGYN Source Type: research

Apical suspension is underutilized for repair of stage IV pelvic organ prolapse: an analysis of national practice patterns in the United States
AbstractIntroduction and hypothesisSupport of the vaginal apex is paramount for a durable repair of pelvic organ prolapse (POP). Our aim is to assess national utilization of apical suspension procedures for the surgical treatment of complete POP. We hypothesize that there might be a high rate of apical suspension with advanced prolapse.MethodsThe 2006 –2016 National Surgical Quality Improvement Program database was queried for a primary postoperative diagnosis of complete POP. The primary outcome was type of repair. Secondary outcomes included patient characteristics associated with apical suspension or colpocleisis....
Source: International Urogynecology Journal - June 8, 2020 Category: OBGYN Source Type: research

Voided volume for postoperative voiding assessment following prolapse and urinary incontinence surgery
ConclusionSpontaneous voiding trial based on a minimum voided volume of 150  ml is a safe and reliable alternative to the retrograde fill method after female pelvic floor procedures. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 6, 2020 Category: OBGYN Source Type: research

Validation of the Malay version of the p-QOL questionnaire
This study aimed to translate and validate the P-QOL questionnaire in the Malay language.MethodsThe P-QOL questionnaire was translated into the Malay language and subsequently back-translated to English. Test-retest reliability and internal consistency were tested. All patients who visited the gynecology outpatient clinic of UKMMC, UMMC and IIUM between January 2016 and May 2017 completed the P-QOL questionnaires and were assessed for POP-Q staging.ResultsOne hundred twenty patients with symptomatic pelvic organ prolapse and 180 asymptomatic patients were included. The Cronbach ’s alpha for each domain was> 0.70, ...
Source: International Urogynecology Journal - June 6, 2020 Category: OBGYN Source Type: research

The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes: a systematic review and meta-analysis
ConclusionAntenatal PFME may be effective at shortening the second stage of labour and reducing severe perineal trauma. These findings need to be interpreted considering the included studies ’ risk of bias. More high-quality RCTs are needed. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 6, 2020 Category: OBGYN Source Type: research

Female buccal mucosa graft urethroplasty: a new modified ventral onlay “AZ” technique
ConclusionFemale urethroplasty provides high cure rates and should be performed in case of recurrent FUS. The early and medium-term results of our modified new technique indicated that it might be used as a simple alternative to current techniques. In all of our patients, it significantly increased the flow rate and reduced PVR without any significant complications. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 4, 2020 Category: OBGYN Source Type: research

Pelvic floor morphology in the standing position using upright computed tomography: age and sex differences
This study was aimed at comparing pelvic floor parameters between the standing and supine positions using upright computed tomography (CT) and evaluating the effects of sex and age in normal healthy volunteers.MethodsIn total, 139 volunteers (70 men, mean 46.7  years; 69 women, mean 47.3 years) underwent both upright CT in the standing position and conventional CT in the supine position. The distances from the bladder neck to the pubococcygeal line (PCL) and anorectal junction (ARJ), defined as the posterior aspect of the puborectalis muscle, to PCL wer e measured. The length, width, and area of the levator hiatu...
Source: International Urogynecology Journal - June 4, 2020 Category: OBGYN Source Type: research

Lumbosacral discitis as a rare complication of laparoscopic sacrocolpopexy
ConclusionFrequency of postoperative discitis has been increased by the widespread use of a laparoscopic approach. In order to reduce the complication rate, surgical technique allowing the needle to penetrate only the depth of the anterior longitudinal ligament and usage of monofilament suture for mesh attachment is recommended. In treatment, removal of the sacral mesh, and even extensive tissue debridement, may be necessary. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 4, 2020 Category: OBGYN Source Type: research

Long-term follow-up of native tissue anterior vaginal wall repair: does the POP-Q stage really reflect patients ’ satisfaction rate?
ConclusionDespite having a low objective success rate, patients ’ satisfaction with AC is very high. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 3, 2020 Category: OBGYN Source Type: research

Trans-obturator cystocele repair of level 2 paravaginal defect
ConclusionWe believe that the trans-obturator cystocele repair procedure offers several advantages over existing paravaginal defect repair alternatives. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 3, 2020 Category: OBGYN Source Type: research

Surgical traps in laparoscopic sacrocolpopexy for vaginal vault prolapse
ConclusionKnowing how to avoid these surgical traps will help trainee urogynecologic surgeons to perform laparoscopic sacrocolpopexy for vaginal vault prolapse. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 3, 2020 Category: OBGYN Source Type: research

Video and review of the surgical management of recurrent urethral diverticulum
ConclusionsMobilizing and repositioning a Martius labial fat pad is a feasible technique for complex recurrent urethral diverticulum repairs. The graft alone without meticulous urethral repair will not prevent diverticulum recurrence, fistula formation or stress urinary incontinence. This procedure requires experienced surgeons to minimize surgical complications and optimize outcome. (Source: International Urogynecology Journal)
Source: International Urogynecology Journal - June 3, 2020 Category: OBGYN Source Type: research