The purpose of this study was to use the finite element analysis method to simulate sling surgeries for arcus tendineus fascia pelvis damage-induced stress urinary incontinence: tension-free vaginal tape and tension-free vaginal tape - obturator, to evaluate their therapeutic effects at different positions of the urethra, and to judge the occurrence of complications through the sling-urethra interaction force which is difficult to obtain clinically.

Pelvic geometric model was constructed based on the MRI of a woman without pelvic floor diseases. The constraints between arcus tendineus fascia pelvis and the lateral wall of the vagina were removed to simulate arcus tendineus fascia pelvis rupture. Gradient abdominal pressure was applied to the incontinence model, and tension-free vaginal tape and tension-free vaginal tape - obturator were placed at the proximal (30 %), mid-distal (60 %), and distal ends (80 %) of the urethra, respectively.

All three types of slings were able to return the parameters of the urethra and bladder to normal levels. High urethral pressure was observed with proximal placement. Distal placement led to a "knot" effect and sudden pressure spikes as abdominal pressure increased. Mid-distal placement resulted in the lowest urethral pressure. The pressure between tension-free vaginal tape and the urethra was generally greater than that between tension-free vaginal tape - obturator.

Placing slings at various positions within the urethra can all treat arcus tendineus fascia pelvis damage-induced stress urinary incontinence; the mid-distal tension-free vaginal tape - obturator should be considered the preferred treatment option.

Vaginal looseness is a common problem in women. However, many procedures are based on the principle of narrowing the distal 1/3 of the vagina. We aimed to describe a new technique for tightening the vagina from top to bottom.

Forty-four parous women complaining of wide vaginas were operated on according to three supportive levels of the vagina: Level I is sutured by uterosacral and cardinal ligament attachments to the proximal 2-3 cm of the vagina. Level II restraint is supported by the vesicovaginal and rectovaginal fascia. The level III segment is the region 2-3 cm above the hymeneal ring and is reinforced with the perineal membrane. The circumferential submucosal 30 mm polyglactin sutures were passed through and tied at each level. Postoperative pain was assessed with visual analog scale (VAS) 24 h later. Anatomical results were evaluated via comparisons with preoperative values of the genital hiatus (GH), total vaginal length (TVL), and proximal/mid/distal vaginal width at the 6-month visit. The functional results were compared with the preoperative values of the Female Sexual Function Index (FSFI-6). Additionally, patients' overall satisfaction was assessed with the Patient Global Impression of Improvement (PGI-I) questionnaire.

The patients' median age was 49 years (29-66 years). The mean duration of surgery was 38 min (31-56 min). The estimated blood loss was 35 ml (25-35 ml). No intraoperative complications were recorded. The mean VAS score was 2.7 (1.6-4.8). All patients stayed in the hospital for 1 night. A significant decrease in the dimensions of the vagina was noted (p < .05). There was no marked change in TVL (p = 0.53). When the preoperative total mean FSFI-6 score was 23.63 ± 6.84, it significantly increased to 27.11 ± 6.12, (p < .001). Thirty-seven of the 44 women (84%) responded "very much better" or "much better" on the PGI-I scale.

These findings support that Elçi technique is reliable for the treatment of vaginal laxity. It maintains normative dimensions of the vagina, with high FSFI-6 scores and patient satisfaction rates.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

To investigate the application of transperineal ultrasound (TPUS) and shear wave elastography (SWE) in the assessment of pelvic floor dysfunction (PFD) after total hysterectomy and to explore associated imaging indicators.

Forty-seven women who underwent total hysterectomy and 70 healthy women were prospectively enrolled in our study. We recorded relevant clinical information, including age, body mass index (BMI), and obstetric history. All participants underwent TPUS and SWE examination at rest, during contraction, and during the maximum Valsalva maneuver. The intra- and inter-observer repeatability of SWE measurements was assessed. And the comparison of the imaging parameters between the two groups was conducted. Further receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of TPUS and SWE in predicting PFD.

SWE used in this study to quantify LAM elasticity demonstrated satisfactory repeatability with all ICC values higher than 0.75. The incidence of PFD was significantly higher in the case group compared to the control group (57.45 % vs. 38.57 %, P = 0.045). The sagittal hiatal diameter (SHD) was higher while the thickness of the levator ani muscle (LAM) was lower in the case group compared to the normal group (P < 0.05), and the SHD showed a positive correlation with PFD while LAM showed a negative correlation. The elastic modulus values of Emax and Emean were significantly increased during contraction in the case group (P = 0.011 and P = 0.029). Further ROC analysis showed that TPUS alone and the combination of TPUS with SWE were both effective in diagnosing PFD than SWE alone (AUC = 0.946, 0.971 and 0.642 respectively).

Our research highlights the significance of the visual assessment of PFD using TPUS and SWE. A widened SHD, a thinned LAM and decreased compliance of LAM during contraction may be correlated with increased PFD.

Stress urinary incontinence (SUI) significantly impairs quality of life. This retrospective audit aimed to evaluate surgical treatment patterns and outcomes for SUI at a district general hospital between 2018 and 2023 and to compare them with national benchmarks from the third British Society of Urogynaecology (BSUG) report in 2020-21. Data from 99 patients were collected from the BSUG database and hospital electronic records, following clinical audit department approval. The mean age of patients undergoing surgery was 50 years. In 2018, mid-urethral tape was the most commonly performed procedure (46.2%); however, following the UK-wide suspension of vaginal mesh procedures that year, there was a notable shift towards alternative surgeries. Bladder neck injections (BNIs), colposuspension (open and laparoscopic), and autologous fascial sling (AFS) procedures all increased in frequency, mirroring national trends. BNIs became the predominant procedure, accounting for 76.8% of cases, with over 80% performed on an outpatient basis. Reported cure rates, when compared to national figures, were AFS (100% vs. 94%), laparoscopic colposuspension (71.4% vs. 84%), BNIs (66% vs. 60%), and open colposuspension (33.3% vs. 81%). Bladder injuries occurred in 17.3% of colposuspension cases, significantly higher than the national average of 2.7%. Additionally, prolonged catheterisation (>10 days) was noted in 29% of colposuspension cases, compared to 7.1% nationally. These elevated complication rates may reflect the procedural learning curve, as laparoscopic colposuspension was only recently introduced at the center. The audit highlights evolving surgical trends and outcomes in the management of SUI following the national mesh pause, with a shift toward non-mesh alternatives. Further audits with long-term follow-up and larger sample sizes are recommended to assess the safety, efficacy, and patient-reported outcomes of these procedures.

Background/Objectives: HINOTORI™ is a robotic-assisted surgical platform developed in Japan. It has been applied in urologic procedures such as robot-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN). This study aimed to evaluate the clinical performance of HINOTORI™ compared with the da Vinci® surgical system by analyzing outcomes of robot-assisted sacrocolpopexy (RSC) performed by a single skilled surgeon using a uniform surgical procedure. Methods: A total of 125 patients who underwent RSC for pelvic organ prolapse (POP) were analyzed. Surgical outcomes were compared between the HINOTORI™ (h-RSC group) and da Vinci® (d-RSC group) platforms. Evaluated parameters included operative time, robotic console time, anterior compartment dissection time, suture time per stitch, perioperative complications, hospital stay, and POP recurrence. Results: Operative and robotic console times were significantly longer in the h-RSC group (148 vs. 139 min, p < 0.005; 109 vs. 95 min, p < 0.001). Anterior compartment dissection time showed no significant difference (p = 0.58), but suture time per stitch was longer in the h-RSC group (76 vs. 60 s, p < 0.005), possibly due to limited suture-cutting functionality, requiring manual assistance. No significant differences were observed in perioperative complications, hospital stay, and POP recurrence. Conclusions: HINOTORI™ demonstrated surgical precision and safety comparable to the da Vinci® surgical system. It may serve as a viable alternative robotic platform, supporting broader adoption of robot-assisted surgical technologies.

To investigate the combined effect of transperineal ultrasound and Shear Wave Elastography (SWE) in the evaluation and monitoring of pelvic floor functions after total hysterectomy.

Fifty-two women who planned to undergo total hysterectomy from January 2019 to December 2022 in Nantong Third People's Hospital were selected, and the pelvic floor functions were assessed using transperineal ultrasound combined with SWE. The dynamic alterations in pelvic floor functions at different time points were compared after hysterectomy. The differences in pelvic floor parameters were compared between Transabdominal Total Hysterectomy (TAH) and Laparoscopic Total Hysterectomy (LTH).

The Posterior Urethravesical Angle at rest and Valsalve maneuver (R-PUA, V-PUA), antero-posterior diameter of the hiatus at rest and Valsalve maneuver (R-HAPD, V-HAPD), and elastic modulus of left and right puborectalis at rest (R-L-PRE, R-R-PRE), the Urethral Rotation Angle (URA)were obviously higher at 3 mon after surgery than before surgery and at 1-mon after surgery; the bladder neck-symphyseal distance at rest and Valsalve maneuver (R-BSD,V-BSD), and the difference in elasticity between the left and right puborectalis muscles (L-∆E, R-∆E) were markedly lower at 3 mon than before surgery and at 1 mon after surgery; V-BSD, L-∆E, R-∆E were obviously decreased and the Bladder Neck Descen (BND), URA, V-PUA were obviously increased in the TAH group in comparison with the LTH group.

Pelvic floor functions start to be weak at 3 months after total hysterectomy. TAH causes more significant damage to the structures and functions of the pelvic floor.

Numerous anatomical theories have been developed to explain women stress urinary incontinence (SUI) and improve its management. The transperineal ultrasound is an efficient and non-invasive exam that perfectly studies the bladder neck movement and the urethral anatomy. The measurement of the static portion of the distal urethral length, considered as the functional urethral length (FUL), and of the posterior urethral closure angle (PUCA) have not been studied before and could be of interest.

This prospective case control study compared incontinent and continent patients. Bladder neck descent, FUL and the PUCA were measured at rest and then during Valsalva maneuvers. The correlation between these perineal sonographic criteria and the severity of incontinence was then evaluated.

Fifty patients were included in the study. Bladder neck descent during Valsalva maneuvers was higher in the incontinence group (22.8mm versus 13.5mm, P=0.001). There was not any significant difference in the two groups concerning the FUL and PUCA. Bladder neck descent (ρ=0.36, P<0.05) and urethral funneling during Valsalva maneuvers (ρ=0.37, P<0.05) were significantly correlated to the severity of SUI whereas FUL and the PUCA were not. Bladder neck descent had the best area under the ROC curve (0.7685) for the diagnosis of SUI.

There was no significant correlation between the FUL or the PUCA and the severity of SUI. Bladder neck descent seemed to be the most reliable criteria for the diagnosis of SUI. Several factors may be responsible for a variation in the ultrasound measurements.

First, to assess whether levator ani deficiency (LAD) is associated with pelvic floor dysfunction 1 year postpartum, including urinary, vaginal and bowel symptoms; and second, to explore at what cut-off of LAD score such pelvic floor dysfunction arises.

Nested case-control study.

Örebro University Hospital, Örebro, Sweden.

Primiparous women 1 year after vaginal birth.

Three-dimensional endovaginal ultrasound assessment of the levator ani muscle; LAD score based on this ultrasound, and validated questions about pelvic floor dysfunction. Logistic regression models were used.

Symptoms of pelvic floor dysfunction associated with LAD.

Altogether 190 women were included, 103 of whom were symptomatic cases and 87 asymptomatic controls. 53% in the case group, and 58% in the control group had a LAD score of 0. A greater LAD score was significantly associated with urinary incontinence (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.00-1.22) and vaginal laxity (aOR 1.14, 95% CI 1.03-1.25). The risk of urinary incontinence was increased when the LAD cut-off score was set between ≥ 1 point and ≥ 4 points. The risk of vaginal laxity was increased when the cut-off was set between ≥ 8 and ≥ 14 points.

LAD was associated with both urinary incontinence and vaginal laxity. The risk of urinary incontinence increased already with minor LAD and defects of the most medial levator ani muscle portions normally supporting the midurethra may explain this increase.

Hysterectomy is the second most common surgery performed among women in the United States. The associations between hysterectomy and the risk of pelvic floor disorders remain unclear. The objective of this study is to systematically review the associations between hysterectomy and the likelihood of pelvic floor disorders.

A systematic search of Medline and Embase from inception to October 11, 2024, was performed without language restrictions. The systematic review was registered in The International Prospective Register of Systematic Reviews (CRD42023443210).

Studies included randomized controlled studies and nonrandomized comparative studies (that reported adjusted analyses) of adult female individuals aged ≥18 years old who underwent a hysterectomy through any route for benign indications. At least 1 year of follow-up after hysterectomy was required. Studies of individuals undergoing concomitant surgery for pelvic floor disorders were excluded.

Twelve investigators independently screened each abstract and potentially eligible full-text article in duplicate. Data extraction, risk of bias assessment, and strength of evidence grading were conducted using standard instruments. Meta-analyses were performed using random-effects models. Outcomes included pelvic organ prolapse, urinary incontinence (nonspecific, mixed, and stress), overactive bladder, voiding dysfunction, fecal incontinence, and defecatory dysfunction. Results were stratified by time since hysterectomy (≤10 years vs >10 years).

We included 60 studies (8 randomized controlled trials, 20 cohort studies, and 32 case-control studies) with 3,567,848 participants. In the first 10 years, hysterectomy was associated with higher likelihood of (nonspecific) urinary incontinence (effect size 1.29, 95% confidence interval 1.11-1.47; 25 studies), stress urinary incontinence (effect size, 1.31; 95% confidence interval, 1.06-1.56; 14 studies), overactive bladder (effect size, 1.41; 95% confidence interval, 1.25-1.58; 16 studies), and mixed urinary incontinence (effect size, 1.62; 95% confidence interval, 1.40-1.85; 3 studies). Beyond 10 years, hysterectomy was associated with higher likelihood of pelvic organ prolapse (effect size, 1.56; 95% confidence interval, 1.35-1.78; 6 studies) and stress urinary incontinence (effect size, 2.40; 95% confidence interval, 2.17-2.63; 5 studies).

Hysterectomy is associated with a statistically significant higher likelihood of urinary incontinence of all types within 10 years, as well as pelvic organ prolapse and stress urinary incontinence beyond 10 years after hysterectomy. It is important to discuss these risks at the time of counseling for hysterectomy with consideration of medical or nonhysterectomy treatment options if clinically acceptable.

Background and Objectives: This study aimed to evaluate the efficacy and safety of modified laparoscopic Burch intervention over a 24-month follow-up period. Materials and Methods: We performed a retrospective cohort evaluation including all eligible patients, 83 patients, who underwent modified laparoscopic Burch colposuspension for stress urinary incontinence (SUI). Primary outcomes included the presence or absence of SUI on follow-up and the success of index surgery based on responses to validated questionnaires of patient-reported outcomes. Results: Patient-reported outcomes indicated a progressive improvement in perceived well-being over time. At the 6-month follow-up, 50.6% of participants reported their condition as "greatly improved", increasing cumulatively to 66.7% by 24 months. The severity of urinary incontinence symptoms was markedly reduced following the intervention. The incidence of severe incontinence was notably low, with only 4.8% of patients affected at 6 months, remaining consistent at 5.1% at 24 months. This finding aligns with a high procedural success rate, as the vast majority of patients (≥94.9%) reported no severe symptoms across all follow-up intervals. Dryness, defined as the absence of urinary leakage, demonstrated an upward trend over time. At 6 months, 45.8% of patients reported complete dryness, with this figure rising to 55.1% at 12 months and 62.8% at 24 months. The Urogenital Distress Inventory-6 (UDI-6) served as a critical metric for evaluating the subjective burden of urinary symptoms. Across all follow-up intervals, over 97% of patients achieved scores below the clinically significant threshold (<33), indicating substantial symptom relief and enhanced quality of life. Conclusions: The modified laparoscopic Burch colposuspension demonstrated consistent efficacy, with significant improvements in urinary continence, symptom severity, and quality of life over the 24-month follow-up period.

In this editorial, we comment on an article by Wang et al. Recent literature shows an increase in research on pelvic organ prolapse (POP). Although the true incidence of POP remains uncertain, its impact on quality of life is substantial. Anatomical studies report high incidence rates, surpassing those observed in symptom-based surveys. Weakness of the endopelvic fascia is a primary anatomical risk factor for POP. Additionally, gestational diabetes mellitus (GDM) has emerged as a growing concern, as poor glycemic control increases complications for both mother and fetus. GDM and POP are interconnected, with factors like maternal obesity, macrosomia, and hormonal changes exacerbating pelvic floor dysfunction. Modifiable risk factors, such as obesity and chronic hyperglycemia, along with multiparity, instrumental deliveries, and obstetric trauma, further increase susceptibility. For patients with GDM, gynecological exams, Pelvic Organ Prolapse Quantification staging, and pelvic floor ultrasonography are valuable diagnostics, with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses. Imaging, though uncomfortable during pregnancy, is safe in the early postpartum period. This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.

To provide a brief anatomical pathogenesis of the Working Group SUI publication recommendations.

The anatomical science and surgical practice presented here formed the original basis for the MUS and other bladder dysfunctions, updated to 2024 with videos: https://atm.amegroups.org/issue/view/1400. Bladder control is binary, from outside the bladder, with ONLY two modes, EITHER closed (continence) OR open (micturition). The key concept for surgical repair of stress (SUI) and other types of urinary dysfunctions, is the role of three balanced oppositely-acting muscle forces which contract against PUL (pubourethral ligament) and USL (uterosacral ligaments) to close urethra, open it before evacuation and stretch vagina to prevent premature activation of micturition, perceived as "urge to go." Collagen-induced weakness in PUL or USL may cause dysfunction in all three of these activities, which can be improved or cured by collagen-creating ligament repair techniques (e.g., slings). It is important to diagnose Tethered Vagina Syndrome (TVS), iatrogenic scarring at bladder neck, much more frequent since large vaginal mesh implantation. TVS is often confused with SUI, as its cardinal symptom is massive urine loss with the "effort" of getting out of bed. Sling surgery worsens TVS as it adds more scar. Vaginal skin graft is required to restore elasticity and continence.

"Anatomical defects in binary control may cause SUI, retention or urge," and are potentially repairable. With regard to SUI, "a normal PUL does not lengthen during effort."

Background: The artificial urinary sphincter has been an effective treatment for stress urinary incontinence caused by intrinsic sphincter deficiency in women. However, the use of this device has been limited by the technical difficulties and risks associated with the open implantation procedure. Preliminary studies using robotic techniques have shown promising results, but only one small study has compared robotic to open procedures. This study aims to compare the outcomes of robotic and open artificial urinary sphincter implantation in women with stress urinary incontinence due to intrinsic sphincter deficiency in a large multicenter cohort. Methods: Data were collected retrospectively from female patients who underwent open or robot-assisted artificial urinary sphincter implantation from 2006 to 2020 at 12 urology departments. The primary outcome was the rate of complications within 30 days after surgery, graded using the Clavien-Dindo Classification. Perioperative and functional outcomes were compared between the two groups. Results: A total of 135 patients were included, with 71 in the robotic group and 64 in the open group. The open group had a higher rate of intraoperative complications (27.4% vs. 12.7%; p = 0.03) and postoperative complications (46.8% vs. 15.5%; p < 0.0001). More patients in the robotic group achieved full continence (83.3% vs. 62.3%; p = 0.01). The open group had higher explantation (27.4% vs. 1.4%; p < 0.0001) and revision rates (17.5% vs. 5.6%; p = 0.02). The estimated 1-year explantation-free survival rate was higher in the robotic group. (98.6% vs. 78.3%; p = 0.001). Conclusions: Robot-assisted implantation may reduce perioperative morbidity and improve functional outcomes compared to open implantation in women with stress urinary incontinence.

Transvaginal tape is currently a stress urinary incontinence (SUI) treatment with recommendation grade A in accordance with the 7th International Consultation on Incontinence. The main aim of the present study was to evaluate objective and subjective outcomes of tension-free vaginal tape (TVT) 20 years after our medical group started to use it. A second aim was to describe the voiding phase and the immediate, medium-term, and late complications of TVT procedures.

This is a retrospective cohort study that included patients diagnosed with SUI who received TVT treatment in a tertiary care hospital in Argentina from 1999 to 2003. Objective outcomes were recorded in a medical visit by means of urogynecological examination, which included a cough stress test with a comfortably full bladder and uroflowmetry. Subjective outcomes were assessed using quality-of-life questionnaires and questions addressed to the patient, regarding whether the patient felt cured and would recommend surgery.

A total of 74 patients with an average follow-up of 18 years were evaluated. Most of the patients evaluated (96.8%) were objectively continent in the long term, 95.3% reported feeling cured, and 97.6% would recommend surgery. The complications were similar to those reported in the literature. No cases of voiding disorder were found in the long-term follow-up.

Tension-free vaginal tape is a minimally invasive, safe, and effective surgical technique, with a high objective and subjective cure rate, a low rate of complications related to the mesh or aging, and good results in long-term follow-up.

The objective was to assess the sonographic tension-free vaginal tape-obturator (TVT-O) position and the outcome in Asian Chinese women.

A prospective cohort study of 254 patients who underwent TVT-O surgery between 2013 and 2022. The sonographic position of the TVT-O was recorded and correlated with the outcomes, including the subjective cure rates, Incontinence Impact Questionnaire 7 (IIQ-7), and retention of urine.

A total of 92.9% reported no stress urinary incontinence after the operation. The IIQ-7 score significantly improved after TVT-O surgery. 88.2% of patients had the TVT-O placed at 50-70% of the urethral length and half of the TVT-O were placed 3-5 mm from the urethra. The cure rate was higher when the tape was in the middle third of the urethra, but the tape position was not associated with postoperative retention of urine in our study.

Most TVT-Os can be placed in the target zone in a blind procedure in Asian Chinese women. The tape position was related to the outcomes. Early postoperative ultrasound of the tape position may predict the outcome of the surgery.

Stress urinary incontinence (SUI) is prevalent among women, often occurring alongside anterior vaginal wall prolapse. This study compares the efficacy and safety of an improved vaginal wall repair technique with pubocervical fascia fixation versus standard anterior colporrhaphy for treating SUI in women with anterior vaginal wall prolapse.

A single-centre, parallel-group, randomised controlled trial was conducted between September 2021 and June 2024. Women aged 40-70 years with symptomatic SUI and stage 2-3 anterior vaginal wall prolapse were randomised to either the improved repair group or the standard repair group. The primary outcome was patient-reported success at 12 months post-surgery, defined as 'very much improved' or 'much improved' on the Patient Global Impression of Improvement scale. Secondary outcomes included objective cure rates, quality of life scores, urodynamic parameters, anatomical outcomes, perioperative outcomes and adverse events.

A total of 102 women were randomised (51 in each group). At 12 months, the patient-reported success rate was significantly higher in the improved repair group (94.1% vs 78.4%, p = 0.019). The objective cure rate was also higher in the improved repair group (90.2% vs 74.5%, p = 0.038). Quality of life scores and urodynamic parameters showed greater improvements in the improved repair group. Anatomical success was achieved in 92.2% of the improved repair group compared with 80.4% in the standard repair group (p = 0.048). The improved repair technique was associated with longer operative time but lower estimated blood loss, shorter hospital stay and quicker return to normal activities. The overall complication rate was lower in the improved repair group (11.8% vs 23.5%, p = 0.043).

The improved vaginal wall repair with pubocervical fascia fixation demonstrates superior outcomes compared with standard anterior colporrhaphy, with higher patient-reported success rates, improved quality of life and fewer complications.

Serious concerns have been raised over the safety of vaginal mesh tapes for stress urinary incontinence (SUI). Autologous rectus fascial sling and the more recent 'sling on a string' through a laparotomy are gaining popularity as native tissue options for SUI. We describe a novel technique of laparoscopic mid-urethral autologous rectus fascial sling for SUI. Ten patients underwent this new technique safely. At 12 months, all patients reported cure of SUI with normal voiding. The advantages of this technique include the minimal access approach, introduction of the sutures under laparoscopic guidance, and avoidance of over-tightening of the sling.

Background/Objectives: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. Methods: We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. Results: Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, p < 0.001). The result was more favorable after periurethral bulking than the midurethral sling (p < 0.001). Conclusions: This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence.

The primary objective of this study was to evaluate the impact of vaginal uterosacral plication on urge symptoms and quality of life in a cohort of patients with uterosacral ligament insufficiency and urge symptoms.

A total of 40 female patients were included in the study, and their posterior fornix was supported with gauze to simulate the surgical procedure. Uterosacral plication was applied to patients who experienced a decrease in urinary incontinence, nocturia, a sense of urgency, and a decrease in urge urinary incontinence symptoms or complete recovery. Images of the bladder, bladder neck, urethra, and symphysis pubis were obtained preoperatively and 1 year postoperatively. POP-Q staging was also performed, and patients completed the Overactive Bladder Evaluation Form (OAB-V8) and the Incontinence Impact Questionnaire Short Form (ICIQ-SF).

Results from the OAB-V8 questionnaire showed that postoperative nocturia scores improved by 72.1% compared to preoperative scores, and the need to urinate at night and waking up scores improved by 68.3%. The mean bladder neck thickness and the mean detrusor thickness were significantly decreased from 10 to 9.2 (p < 0.0001) and from 8.7 to 6.4 (p < 0.0001), respectively. The ICIQ-SF questionnaire scores showed a 68.4% improvement in urinary incontinence affecting daily life after the operation.

This study adds to the clinical evidence that uterosacral ligament support improves symptoms of overactive bladder syndromes, including urgency and nocturia. The use of pelvic floor ultrasound and the apical tamponade test is important in patient selection for the correct indication.

The study aimed to determine whether pelvic floor muscle (PFM) function before surgery may correlate with the success of surgical interventions for treating stress urinary incontinence (SUI). Our hypothesis was that addressing identified variables in preoperative rehabilitation could potentially improve surgical outcomes.

This prospective observational study was conducted at a single center and enrolled women qualified to mid-urethral tape insertion for SUI between 2020 and 2022. Digital palpation and manometry (Peritron™ 9300 V) were used to evaluate PFM function. The following parameters were acquired: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), the area under the curve during a 10-second MVC, moreover the ability to perform correct PFM contraction, reflexive PFM contraction during cough and relaxation were assessed. All measurements were performed before the surgical treatment and during follow-up assessments at 1, 3, and 6 months postoperatively. The primary endpoint of the study was defined as objective cure, characterized by a negative cough stress test (CST), along with a subjective assessment based on the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7).

The study involved 57 eligible female participants, all of whom completed the 6-month follow-up. Objective cure was observed in 75.44% of cases, while subjective cure was reported in 33%. There was no association between PFM parameters and surgical outcomes.

The success of surgical treatment of SUI 6 months postsurgery is not related to preoperative pelvic floor muscle function.

The closure of the urethra under the condition of stress is the result of a reflex contraction of the urethral rhabdosphincter and pelvic floor muscles. This is likely induced by activity of the abdominal muscles due to a sudden increase in abdominal pressure. This reflex contraction with an increase of urethral pressure occurs a few milliseconds before an increase in intraabdominal pressure. The urethral pressure increase during stress is only possible with fixation of the urethra by the pubourethral ligaments (PUL), facilitating urethral kinking. The highest and most important increase in pressure and resistance occurs in the distal urethra due to this kinking of the urethra.

To evaluate the surgical outcomes and predictors of failure of Single Incision Mini Sling (Ophira) in women with urodynamic stress incontinence.

Records of 115 women underwent anti-incontinence procedure using Ophira Mini Sling from June 2019 to September 2020 reviewed. Subjective evaluation was assessed using validated IIQ-7, UDI-6, POPDI-6 and PISQ-12 questionnaires. Multichannel urodynamics, 1-h pad test and 72-h voiding diary was performed as objective evaluation. Primary outcome was the objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was to identify risk factors associated with failure for Ophira.

Total of 108 women were evaluated. The objective cure rate was 91.7% with subjective cure rate of 86.1%. Comparison of clinical outcome shows significant improvement of USI post-operatively (p < 0.001) and reflected in 1-h pad test (p < 0.001). Improvement in all subjective evaluation parameters is seen except for POPDI-6. Failure of Ophira correlate significantly in women age >66 years, presence of asthma, pre-operative Intrinsic Sphincter Deficiency (ISD), and Maximum Urethral Closure Pressure (MUCP) value < 40 cmH20.

Ophira Single Incision Mini Sling is safe and effective treatment option for USI, showing high objective and subjective cure rates with low incidence of complications. Non-modifiable risks of age ≥66 years, asthma status, pre-operative intrinsic sphincteric deficiency and low maximal urethral closure pressure were the factors of failure for Ophira.

Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). This study aimed to compare single-incision midurethral sling (SIMS) and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results.

This is a prospective randomized study.

A university tertiary hospital.

Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study.

Patients were treated with SIMS and LBC operations.

Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire form, Female Sexual Function Index and Prolapse Quality of Life Questionnaire form, postoperative day 1 visual analog scale score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, whereas the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs 85%, p = .633) or subjective success (85% vs 75%, p = .695) between the 2 groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, although this improvement was significant in the SIMS group, it was not significant in the LBC group. In addition, surgery time, catheterization time, and hospitalization time were shorter in the SIMS group than in the LBC group. The visual analog scale score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of preoperative and postoperative complications.

This preliminary study is the first randomized study that compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.

This study is aimed at developing and validating a new integral parameter, the Biomechanical Integrity score (BI-score) of the female pelvic floor for stress urinary incontinence conditions.

A total of 130 subjects were included in the observational cohort study; 70 subjects had normal pelvic floor conditions, and 60 subjects had stress urinary incontinence (SUI). A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t test, correlation) to identify the VTI parameters sensitive to the pelvic SUI conditions.

Twenty-seven parameters were identified as statistically sensitive to SUI development. They were subdivided into five groups to characterize tissue elasticity (group 1), pelvic support (group 2), pelvic muscle contraction (group 3), involuntary muscle relaxation (group 4), and pelvic muscle mobility (group 5). Every parameter was transformed to its standard deviation units using the dataset for normal pelvic conditions, similar to the T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups 1-5 and to the BI-score in standard deviation units. The p value for the BI-score has p = 4.0 × 10-28 for SUI versus normal conditions.

Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the SUI BI-score in future research and clinical applications.

Pelvic floor muscle training (PFMT) has emerged as a potential intervention to improve post-total hysterectomy (TH) sexual function. Electromyographic (EMG) biofeedback is an adjunct that may improve outcomes.

In this study we aimed to compare the EMG biofeedback-assisted PFMT and PFMT alone for improving sexual function in women after TH.

For this prospective study we enrolled women undergoing TH in our hospital between January 2022 and April 2023. Participants were divided according to the treatment they selected: EMG biofeedback-assisted PFMT or PFMT alone.

The primary study outcome was change in patient sexual function evaluated by use of the Female Sexual Function Index. Secondary outcomes were changes in anxiety and depression evaluated with the Hospital Anxiety and Depression Scale score and pelvic floor muscle strength was evaluated with the Glazer assessment performed from before to after treatment.

A total of 73 patients were included, with 38 patients treated with Electromyographic biofeedback-assisted pelvic floor muscle training. After treatment, sexual function was significantly improved compared to baseline in all patients (all P < .001). Compared to patients with pelvic floor muscle training, the changes in total Female Sexual Function Index scores from before to after treatment in patients with Electromyographic biofeedback-assisted pelvic floor muscle training were significantly higher (all P < .05). There were no significant differences between the 2 groups in the changes in the Glazer score and Hospital Anxiety and Depression Scale scores from before to after treatment (both P > .05).

The results demonstrate that Electromyographic biofeedback-assisted pelvic floor muscle training may be used to improve the sexual function of patients following TH.

This study is limited by its single-center design, small sample size, lack of randomization, and absence of estrogen monitoring in enrolled participants.

Electromyographic biofeedback-assisted pelvic floor muscle training appears to be more effective than pelvic floor muscle training alone in improving sexual function among patients after total hysterectomy.

Pelvic organ prolapse (POP) significantly affects women's quality of life, occurring in 20-30% of females aged over 20 globally. With aging populations, demand for pelvic reconstructive surgery is rising. Patients seek anatomical restoration while preserving uterus and sexual function. Sacrohysteropexy is the gold standard for apical prolapse, but carries risks. Lateral suspension, offers safer apical and anterior correction especially for obese, sexually active women. Our prospective study compares laparoscopic sacrohysteropexy and lateral suspension objectively and subjectively.

The study included patients who had laparoscopic lateral suspension (n = 22) or laparoscopic sacrohysteropexy (n = 22) for symptomatic stage 2 apical prolapse. Groups randomized with using block design. Anatomical cure was based on measurements taken by the same physician, unaware of intervention, before and at 12 months using POP-Q score. Pelvic floor ultrasound also used for objective rates. Subjective comparison used Prolapse Quality of Life (P-QoL), Pelvic Organ Prolapse-Symptom Score (POP-SS), Female Sexual Function Index (FSFI), Visual Analog Score (VAS), and Michigan Incontinence Severity Index (M-ISI).

Age, BMI, parity, menopause, sexual activity, complications, showed no significant difference between groups (p > 0.05). Surgical procedure duration significantly varied between groups lateral suspension group was shorter. There was no significant difference in post operative complications. No significant differences in posterior/enterocele stages.) Anterior staging showed no significant difference in sacrouteropexy (p = 0.130), but significant difference in lateral suspension group (p < 0.001). No significant differences in pre-op and post-op PQOL, POP-SS, FSFI, and M-ISI scores between the two groups.

Both methods effectively managed apical prolapse with similar outcomes. Objective measurements showed lateral suspension's superiority in reducing bladder descent.

The study was aimed at systematically analyzing the research status and trends of pelvic organ prolapse (POP) using bibliometrics.

We retrieved documents published between 1975 and 2022 from the Web of Science Core Collection (WoSCC) database, and manually selected them for bibliometric analyses of country, institution, journal, highly locally cited documents and research trends based on co-citation clustering and keywords using the R Bibliometricx package and CiteSpace software.

A total of 5,703 publications were included. Although the number of annual publications on POP increased, the trend of annual publication reached an obvious plateau in the first half of the 2010s. The USA, China, the UK, the University of Michigan, the University of Pittsburgh, and the University of Sydney were the top three countries and institutions with the most publications respectively. International Urogynecology Journal, American Journal of Obstetrics and Gynecology, and Obstetrics and Gynecology were the journals with the most extensive academic influence on the field of POP research. The international cooperation was lacking and the highly cited documents focused on high-level, evidence-based studies. Epidemiological studies and surgical treatment have achieved a plateau or decline. Recent studies have focused on conservative treatment, physical therapy, and minimally invasive surgery. In addition to evidence-based medicine studies, tissue engineering is the future direction of POP.

This study used bibliometric analyses to provide insights into the status and potential research directions of POP. More high-quality, evidence-based medicine studies and in-depth tissue engineering research should be propelled forward.

Single-incision slings (SIS) have emerged as a less invasive alternative to conventional slings for stress urinary incontinence (SUI) treatment. However, long-term efficacy and safety results remain uncertain owing to a lack of studies.

A retrospective review of 155 patients treated with Altis® for SUI between February 2012 and June 2017, held in 2022, as a continuation of a prospective study in which all patients (197) were reviewed for 2 years after surgery (1, 6, 12, and 24 months). Preoperative demographic data, comorbidities, and pressure-flow studies were also recorded. Continence status and satisfaction rates were assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) and the Patient Global Impression of Improvement (PGI-I) respectively. The assessment in the 2022 retrospective review was performed via a telephone survey.

Mean follow-up time after surgery was 85.3 months (82.5-88.1). In 2022, complete continence was present in 75.4% of the patients. The presence of urinary urgency conditioned the ICIQ-SF score (10.9 vs 1.7 points, p < 0.01), with the ICIQ-SF = 0 in 84.5% of the patients with no associated urgency. Satisfaction assessed by the PGI-I was high, with 84.6% of the patients showing improvement. De novo urgency was present in 37,9% of the patients by 2022. Urinary tract infections were the most frequent complication (9.7%), with only 5 documented cases of mesh erosion.

Altis® SIS is a safe and effective device for SUI treatment, with satisfaction rates comparable with those of the conventional slings. Persistence or development of urinary urgency influences the results.

Urethral function declines by roughly 15% per decade and profoundly contributes to the pathogenesis of urinary incontinence. Individuals with poor urethral function are more likely to fail surgical management for stress incontinence that focus on improving urethral support. The reduced number of intramuscular nerves and the morphologic changes in muscle and connective tissue collectively impact urethral function as women age. Imaging technologies like MRI and ultrasound have advanced our understanding of these changes. However, substantial knowledge gaps remain. Addressing these gaps can be crucial for developing better prevention and treatment strategies, ultimately enhancing the quality of life for aging women.

Pelvic organ prolapse (POP) and associated symptoms of urinary incontinence, fecal incontinence, obstructive micturition, defecation, and pain are frequent and a widespread disease with relevant reduction of quality of life and high costs. New insights into functional anatomy and pathophysiology of these pelvic floor dysfunctions let us recognize how ligamentous laxities/defects lead to these dysfunctions. Results of the PROpel study (ClinicalTrials.gov-Identifier: NCT00638235) are shown in which a detailed observation of symptoms (patient-related outcome measures) pre- and postoperatively was performed. Ligamentous vaginal repair of POP enables symptom cure in high percentages for urinary urge incontinence (up to 82%), nocturia (up to 92%), obstructive micturition (up to 87%), fecal incontinence (58-72%), obstructive defecation (71-84%), and pain (53-90%), if caused by POP. Women with POP‑Q stage 2 have similar symptom frequencies as women with POP‑Q stage 3-4, and also similar cure rates of their symptoms. If good anatomical prolapse repair (in responders) was achieved, the cure rates for obstructive micturition, urinary urgency incontinence, and nocturia were significantly higher than in those women with less effective surgical repair. In the future, pelvic floor surgery should have symptom cure as the primary objective and should lead to improved quality of life. The different, currently performed techniques for POP repair have to be investigated concerning this matter.

Stress urinary incontinence is common among women, and surgical interventions have significantly improved patients' symptoms. The long-term effectiveness of these surgeries is increasingly drawing attention, yet it remains sparsely documented in the literature.

To compare the long-term effectiveness and safety of retropubic tension-free vaginal tape (TVT-RP), tension-free vaginal tape-obturator (TVT-O), transobturator tape (TOT), single-incision sling (SIS), Burch colposuspension, and pubovaginal sling (PVS).

A comprehensive and systematic literature review was conducted in PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov from inception to May 2023. Selected trials were evaluated for potential bias using the Cochrane tool. Treatment modalities were compared using network meta-analysis to assess objective success rate, subjective success rate, and complications as outcomes.

A total of 37 studies involving 5720 patients were included. No significant statistical differences were found among the interventions regarding objective success rate. PVS had the highest surface under the cumulative ranking curve SUCRA value (93.1). For subjective success rate, TVT-RP, TVT-O, and PVS demonstrated superiority over SIS, with PVS having the highest SUCRA value (80.1). SIS had lower overall complication and pain rates compared to other methods, with statistical significance. There were no differences in reoperation rate, exposure rate, and urinary tract infection occurrence among the surgical approaches.

In terms of long-term effectiveness and safety, TVT-RP and TVT-O appear to be the preferred options for patients opting for synthetic slings, while for patients seeking nonsynthetic slings, PVS may represent the optimal choice.

This study aims to provide an in-depth analysis of patient preferences and clinical outcomes associated with two surgical techniques for treating stress urinary incontinence (SUI): the transobturator suburethral sling (TOT) procedure and the pubourethral ligament plication (PUL) procedure. We evaluated the rates of postoperative complications, the duration of each procedure, hemoglobin loss, and days of hospitalization.

This prospective study included 80 patients who underwent surgery for SUI: 40 patients for the TOT procedure and 40 patients for the PUL procedure. Clinical data on patient characteristics, treatment efficacy, and post-surgical outcomes were analyzed to assess patient preferences and real-world clinical effectiveness.

Regarding patient preferences, those who underwent TOT surgery were more likely to be older, had a higher average number of pregnancies, and were more often postmenopausal, in contrast to those who underwent PUL surgery (p < 0.001 for each comparison). TOT patients had a hospital stay on average of 1.02 days, while PUL patients benefited from ambulatory stays only. In addition, the TOT group had a significantly longer average operating time (16.80 min) compared to the PUL group (9.90 min, p < 0.001). The study revealed notable outcomes in both groups, with high cure rates for both TOT (N1 = 33, 82.5%) and PUL (N2 = 28, 70%) procedures. Specifically, 76.25% of the patients (61 out of 80) were cured after the procedures. Chronic pelvic pain was present in 3.75% of all patients and was notably only observed in the TOT group, with 3 (7.5%) cases being noted. Similarly, vaginal erosion was experienced by 5% of all patients, with 10% of patients in the TOT group and none in the PUL group being affected. Dyspareunia occurred in 2.5% of all patients, with there being two (5%) cases in the TOT group and none in the PUL group.

This study highlights that while the PUL procedure achieves cure rates comparable to TOT, it offers a less invasive option with shorter operating times and no hospitalization required. These findings suggest that PUL could be a viable alternative for stress urinary incontinence (SUI) treatment, especially in contexts where avoiding mesh use is preferred. This adds significant value to patient-centered care in SUI management, offering tailored treatment options based on patient characteristics, preferences, and risk profiles.

Stress urinary incontinence presents a condition not only found in female elderlies, but also in young athletes participating in high-impact sports such as volleyball or trampolining. Repeated jumps appear to be a predisposing factor. Yet the pathophysiology remains incompletely elucidated to date; especially with regard to the influence of the surrounding buttock tissues including gluteus maximus. The present study assessed the morpho-mechanical link between gluteus maximus and the pelvic floor female bodies. 25 pelves obtained from Thiel embalmed females were studied in a supine position. Strands of tissues connecting gluteus maximus with the pelvic floor obtained from 20 sides were assessed mechanically. Plastinates were evaluated to verify the dissection findings. In total, 49 hemipelves were included for data acquisition. The fascia of gluteus maximus yielded connections to the subcutaneous tissues, the fascia of the external anal sphincter and that of obturator internus and to the fascia of the urogenital diaphragm. The connection between gluteus maximus and the urogenital diaphragm withstood an average force of 23.6 ± 17.3 N. Cramér φ analyses demonstrated that the connections of the fasciae connecting gluteus maximus with its surroundings were consistent in the horizontal and sagittal planes, respectively. In conclusion, gluteus maximus is morphologically densely linked to the pelvic floor via strands of connective tissues investing the adjacent muscles. Though gluteus maximus has also been reported to facilitate urinary continence, the here presented morpho-mechanical link suggests that it may also have the potential to contribute to urinary stress incontinence. Future research combining clinical imaging with in-situ testing may help substantiate the potential influence from a clinical perspective.

When a disorder causes the absence of a healthy, full-size vagina, various neovaginal creation methods are available. Sometimes dilation or stretching of the vaginal cavity is sufficient, but intestinal or dermal flap tissue is generally required. However, different inherent tissue properties cause complications. Therefore, a lost body part should be replaced with a similar material. The use of organ-specific acellular vaginal tissue carries great potential, as its similar architecture and matrix composition make it suitable for vaginal regeneration.

The authors developed an optimized protocol for decellularization of healthy human vaginal tissue. Resected colpectomy tissue from 12 healthy transgender patients was used. Successful decellularization was confirmed by applying acellular criteria from in-vivo remodeling reports. Suitability as a tissue-mimicking scaffold for vaginal reconstruction was determined by visible structural features, biocompatibility during stretching, and the presence of visible collagen, elastin, laminin, and fibronectin.

Histological examination confirmed the preservation of structural features, and minimal cellular residue was seen during fluorescence microscopy, DNA and RNA quantification, and fragment length examination. Biomechanical testing showed decreased peak load (55%, P <0.05), strain at rupture (23%, P <0.01), and ultimate tensile stress (55%, P <0.05) after decellularization, while the elastic modulus (68%) did not decrease significantly. Fluorescence microscopy revealed preserved Fibronectin-I/II/III and Laminin-I/II, while Collagen-I and Ficolin-2B were decreased but mostly retained.

The absence of cellular residue, moderately altered biomechanical extracellular matrix properties, and mostly preserved structural proteins appear to make our decellularized human vaginal matrix a suitable tissue-mimicking scaffold for vagina transplantation when tissue survival through vascularization and innervation are accomplished in the future.

Stress urinary incontinence (SUI) is a common condition that requires proper evaluation to select a personalized therapy. Vaginal Tactile Imaging (VTI) is a novel method to assess the biomechanical parameters of the pelvic floor.

Women with SUI were enrolled in this cross-sectional study. Participants completed the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire and the Patient Global Impression of Severity Question (PGI-S) and underwent a VTI examination. Based on the MESA and PGI-S questionnaires, participants were divided into mild, moderate, and severe SUI groups. Fifty-two biomechanical parameters of the pelvic floor were measured by VTI and compared between the groups (mild vs. moderate and severe). SUI Score and Index were calculated from the MESA questionnaire. Pearson correlation was used to determine the strength of association between selected VTI parameters and the MESA SUI Index and MESA SUI Score.

Thirty-one women were enrolled into the study. Significant differences were observed in the VTI parameters 16, 22-24, 38, 39 when the difference between mild and severe subgroups of SUI based on the PGI-S score was examined. Parameter 16 refers to the maximum gradient at the perineal body, parameter 22-24 refers to the pressure response of the tissues behind the vaginal walls, and parameter 38, 39 refers the maximum pressure change and value on the right side at voluntary muscle contraction. VTI parameter 49, describing the displacement of the maximum pressure peak in the anterior compartment, showed a significant difference between the mild SUI and the moderate-severe SUI according to the MESA SUI score (mean ± SD 14.06 ± 5.16 vs. 7.54 ± 7.46, P = 0.04). The MESA SUI Index and SUI Score displayed a positive correlation concerning VTI parameters 4 (the maximum value of the posterior gradient) and 27 (the displacement of the maximum pressure peak in the anterior compartment) (VTI4 vs. MESA SUI Index r = 0.373, P = 0.039; VTI4 vs. MESA SUI Score r = 0.376, P = 0.037; VTI27 vs. MESA SUI Index r = 0.366, P = 0.043; VTI27 vs. MESA SUI Score r = 0.363, P = 0.044).

Female pelvic floor biomechanical parameters, as measured by VTI, correlate significantly with the severity of SUI and may help guide therapeutic decisions.

The proper placement of a midurethral sling (MUS) is the key factor for a successful surgical outcome.

This study aimed to evaluate the relationship of perineal ultrasonographic measures of the tape location with subjective and objective outcomes after MUS surgery at midterm follow-up of women.

The tape percentile (TP; total urethral length/bladder neck tape distance×100) and urethra tape distance (UTD; the shortest distance from the longitudinal smooth muscle complex of the urethra to the midpoint of the tape) were correlated with midterm surgical success. Patient satisfaction measured with the visual analog scale (VAS) was considered as the primary outcome. The presence of stress urinary incontinence on direct questioning, the Urinary Distress Inventory 6 (UDI-6) scores, findings of the cough stress test, free uroflowmetry, postvoid residual volume, and single-cycle voiding ambulatory urodynamic monitoring (AUM) were the other outcomes.

Seventy-eight women were evaluated at a mean follow-up of 4.4 ±3.3 years. Women who were highly satisfied (VAS ≥ 8) had a significantly higher TP (64.7% vs 50.8%, P < 0.001) and lower UTD (3.6 vs 4.5 mm, P = 0.018). Irritative, stress, and obstructive scores at UDI-6 increased as the tape was located closer to the bladder neck (P < 0.001, P < 0.001 and P = 0.044, respectively), and stress symptoms decreased with a tape closer to the urethra (P < 0.001). Women with detrusor overactivity at AUM were found to have a lower TP (P < 0.001).

The perineal ultrasonographic evaluation of tape location with UTD and TP seems to be well correlated with the women's midterm MUS surgical outcomes.

Stress urinary incontinence (SUI) is a common condition that affect 30-40% of women in their lifetime. Midurethral slings (MUS) either suprapubic or transobturator can be safely used in the surgical treatment of SUI. The aim of this study was to collect clinical long-term data regarding safety and performance of transobturator sling with an additional tape fixation in women with urinary incontinence. This prospective longitudinal study was conducted on a group of 2086 female patients diagnosed with stress urinary incontinence. Follow up visits where scheduled 6 weeks, 6 and 12 months after surgery followed by annual checking when possible. Patients underwent transobturator sling procedure from 01.01.2011 to 31.12.2021. All patients had a monofilament tape inserted at the mid-urethra using outside-in technique (TOT) with 2 absorbable sutures parallel to the urethra. Success of surgery was defined as lack of any leakage during cough stress test whereas the subjective cure rate was determined by Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF). 87% of patients who were operated at least 10 years before assessment reported ICIQ -SF < 6. Main postoperative complications were storage symptoms - de novo urgency and voiding difficulties. TOT is safe and highly effective surgical treatment for (SUI) in a long-term observation.

Uterine prolapse (UP) seriously affects the quality of life and physical and mental health of elderly women, which can easily be caused by ligament injury or intra-abdominal pressure (IAP) increasing. The objective of this manuscript was to study the influence of IAP and ligament injury on uterus and its surrounding ligaments using the finite element method. First, the three-dimensional (3D) models of retroverted uterus and its surrounding ligaments were established, and loads and constraints were set in ABAQUS software, then the stress and deformation of uterine ligaments and uterine displacement were calculated. The study found that the uterine displacement and the stress and deformation of the ligaments increased when IAP and ligament injury increased alone or simultaneously. Then, the stress and sensitivity of the ligaments to the changes of IAP or ligament injury were in the order of uterosacral ligament (USL), broad ligament (BL), cardinal ligament (CL) and round ligament (RL), while the deformation and sensitivity the changes of the ligaments were in the order of BL > RL > USL > CL. Moreover, the ligament injury had a greater influence on the uterus and uterine ligaments than IAP. The results of this study can provide guidance for optimization of surgical scheme of uterus prolapsed in clinic and exploration of pathogenesis.

Pelvic organ prolapse (POP) is a concerning gynecological benign illness in middle-aged and senior women. Its etiology is complex, the incidence rate is high, symptoms are clinically subjective, and its influence tends to be polarized. At present, for those who need medical treatment, whether surgical or non-surgical, complications cannot be ignored, and treatment effect needs to be optimized. However, there is a lack of accurate molecular biological interventions for the prevention, diagnosis, progression delay, and treatment of POP. Here, we reviewed the current state of understanding of the molecular mechanisms and factors associated with POP etiology. These factors include cyclins, matrix metal peptidases/tissue inhibitors of metalloproteinases, microRNAs, homeobox A11, transforming growth factor β1, insulin-like growth factor 1, fibulin 5, lysyl oxidase-like 1, oxidative stress, inflammatory response, estrogen, and other potential biomarkers associated with POP. In addition, relevant molecular targets that may be used to intervene in POP are summarized. The aim of this review was to provide more information to identify accurate potential biomarkers and/or molecular targets for the prevention, diagnosis, progression delay, and treatment of POP, with the goal of improving medical treatment for patients at-risk for POP or having POP. Continued research is needed to identify additional details of currently accepted molecular mechanisms and to identify additional mechanisms that contribute to POP.