To complete the psychometric validation and scale derivation of the International Consultation on Incontinence Questionnaire-Underactive Bladder (ICIQ-UAB).

The developmental ICIQ-UAB was administered within a Phase II randomised controlled trial of a drug for the treatment of underactive bladder at baseline and follow-up 4 weeks after the start of trial medication treatment. Descriptive analyses and exploratory factor analyses (EFAs) informed the derivation of scored domains for symptoms, health-related quality of life (HRQoL), and associated bother items. The reliability was assessed by Cronbach's α, while validity was assessed via the correlation with other concurrently administered PROMs at baseline. Responsiveness was evaluated using the change in mean scores from baseline to follow-up.

A total of 132 male and female patients with the symptomatic and urodynamic characteristics of detrusor underactivity were enrolled in the analysis. Descriptive analyses and EFAs informed scored domains for 11 symptom items with associated bother, and 7 HRQoL items with associated bother. A further 8 unscored symptom items and one overall HRQL item were retained for their clinical utility. Sensitivity of the ICIQ-UAB to the severity of the condition was supported (known groups validity), and correlations with concurrent PROMs were as expected, showing evidence of construct validity. All domains demonstrated reliability (Cronbach's α ≥ 0.88). Limited evidence for responsiveness was found, which was likely due to insufficient efficacy of trial medication treatment over administration time-points.

The two scored domains and associated bother for the ICIQ-UAB have been shown to be reliable, valid and sensitive to the severity of the condition. The instrument can be recommended to researchers and clinicians for the comprehensive assessment of symptoms and their impact on HRQoL on patients with suspected UAB.

We present results of a two-arm pilot study assessing the feasibility of conducting a double-blind randomized controlled trial (RCT) to evaluate the efficacy of sacral neuromodulation (SNM) in patients with multiple sclerosis (MS) suffering from neurogenic lower urinary tract dysfunction (NLUTD).

Eligible subjects with refractory NLUTD and EDSS < 5 underwent SNM test phase. Those showing more than a 50% improvement of bladder variables, received implantable pulse generators (IPG) and were randomized to either treatment group (IPG ON) or to sham group (IPG OFF) for 1 month. During second month, all patients had the IPG ON until the end of the trial. The primary endpoints were trial feasibility, recruitment potential, and response rate at the end of SNM test phase. Secondary endpoint was safety. Changes in key bladder diary-derived variables and patient reported outcomes were recorded as well.

Thirty-two patients were screened, 17 were eligible and 13 were included in the SNM test phase. Eleven were considered responders and were implanted with IPG. Subsequently, six patients were randomized to the treatment group and five to the sham group. No serious adverse events were reported. In the intervention phase, both objective and subjective improvements were seen in the treatment group, while the symptoms in the sham group remained mostly unchanged. At study completion, six patients reported being completely satisfied, three were mostly satisfied, and two were indifferent to the treatment.

This pilot trial demonstrated feasibility of double-blind RCT assessing safety and efficacy of SNM in MS patients.

ClinicalTrials. gov NCT05380856.

Some postmenopausal women suffer from genital and urinary symptoms, while others do not. Therefore, the hypoestrogenic status cannot entirely explain the occurrence of the genitourinary syndrome in menopause (GSM). Differences in the urinary microbiome might play a role in bladder function and vulnerability to urinary symptoms. This study aimed to compare characterization urinary microbiome in postmenopausal women who experienced GSM with urinary symptoms with that in those without urinary symptoms. Forty participants were screened for genital symptoms of GSM and then divided into the urinary symptoms group and the non-urinary symptoms group on the basis of a validated questionnaire. 16 S rRNA gene sequencing was performed to investigate microbial diversity. The alpha diversity was used to evaluate the species richness and evenness, while the beta diversity was used to estimate the differences in the urinary microbiome between the groups. Differential abundance analysis was used to investigate biomarkers in the groups by linear discriminant analysis effect size. The relationship between the urinary microbiome and urinary symptoms was assessed using Spearman's correlation analysis. The characteristics of the participants were not different between the groups. Gardnerella was found in 22.2% (4/18) and 11.1% (2/18) of participants in the urinary symptoms group and in the non-urinary symptoms group, respectively (p > 0.05). Alpha diversity was less in the urinary symptoms group than in the non-urinary symptoms group, but this was not significant. Beta diversity of the urinary microbiome was not significantly different between the two groups. A differential abundance analysis showed that the genus Prevotella was significantly dominant in postmenopausal women with GSM who reported urinary symptoms. Prevotella was marginally correlated with voiding symptoms (r2 = 0.44; p = 0.01). The bladder or urinary microbiome is closely related to urinary symptoms of GSM. Species richness and diversity are not significantly different between postmenopausal women with GSM with and without urinary symptoms. Prevotella is dominant in symptomatic women and slightly correlated with voiding symptoms.

Lower urinary tract symptoms (LUTSs) are increasingly reported more frequently in females, negatively impacting their lives. This study identified the prevalence of urinary symptoms among females in eastern Uttar Pradesh using the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) questionnaire.

This research aimed to determine the prevalence of LUTS in females in eastern Uttar Pradesh.

The study involved a one-step sampling approach for surveying adolescents and young girls (11-24 years) in eastern Uttar Pradesh from different primary and secondary schools and colleges. The ICIQ-FLUTS questionnaire was used to evaluate LUTS over the last 4 weeks. Scores ranged from 0 to 48, and SPSS version 25.0 was used for descriptive statistics and Chi-square tests to analyze symptom prevalence and categorical relationships.

According to our study, nocturia and urgency were more prevalent in all age groups, affecting 66.1% to 72.3% and 69.7% to 68.9%, respectively. Urge urinary incontinence varies from 25.0% in early adolescence to 24.6% in late adolescence. Urban areas residents reported more urgency (65.3%) and bladder pain (42.8%), while rural areas residents had higher incidences of frequent incontinence (49.6%) and nocturia (77.4%). In addition, Hindus had the most frequent levels of LUTS, especially for urgency (60.7%) and nocturia (70.3%).

The study highlights the high prevalence of LUTS among adolescents and young females and differences in LUTS among different demographics in Eastern Uttar Pradesh. Symptoms increase as age progresses. The urban population showed higher LUTS rates than rural areas, and religious affiliation also impacts symptom prevalence.

Pelvic floor muscle training (PFMT), compared to no treatment, is effective for treating urinary incontinence (UI) in women. Feedback and biofeedback are additional resources that give women more information about their pelvic floor muscle contraction. The extra information could improve training performance by increasing capability or motivation for PFMT. The Committee on Conservative Management from the 7th International Consultation on Incontinence states that the benefit of adding biofeedback to PFMT is unclear. This review is an update of a Cochrane review last published in 2011.

The primary objective was to assess the effects of PFMT with feedback or biofeedback, or both, for UI in women. We considered the following research questions. Are there differences in the effects of PFMT with feedback, biofeedback, or both versus PFMT without these adjuncts in the management of stress, urgency or mixed UI in women? Are there differences in the effects of feedback versus biofeedback as adjuncts to PFMT for women with UI? Are there differences in the effects of different types of biofeedback?

We searched the Cochrane Incontinence Specialised Register (searched 27 September 2023), which includes searches of CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP as well as handsearching of journals and conference proceedings, and the reference lists of relevant articles.

We included only randomised controlled trials (RCTs), cluster-RCTs and quasi-RCTs in women with UI. We excluded studies that recruited women with neurological conditions, who were pregnant or less than six months postpartum. Eligible studies made one of the following comparisons: PFMT plus feedback versus PFMT alone, PFMT plus biofeedback versus PFMT alone, PFMT plus feedback or biofeedback versus PFMT alone, PFMT plus feedback versus PFMT plus biofeedback, and one type of biofeedback versus another.

Two review authors independently assessed studies for eligibility, extracted data onto a prepiloted form, and assessed risk of bias using RoB 1. We used the GRADE approach to assess the certainty of evidence in each comparison by outcome. Our primary outcome was lower urinary tract symptom-specific quality of life. We pooled data using a standardised mean difference (SMD). Secondary outcomes were leakage episodes in 24 hours (mean difference (MD)), leakage severity (MD), subjective cure or improvement (odds ratio (OR)), satisfaction (OR), and adverse events (descriptive summary).

We included 41 completed studies with 3483 women. Most (33 studies, 3031 women) investigated the effect of PFMT with biofeedback versus PFMT alone. Eleven studies were at low risk of bias overall, 27 at unclear risk of bias, and three at high risk. Only one study reported leakage severity, with no usable data. Comparison 1. PFMT with feedback versus PFMT alone: one eligible study reported no outcome of interest. Comparison 2. PFMT with biofeedback versus PFMT alone: there was little or no difference in incontinence quality of life (SMD 0.07 lower, 95% confidence interval (CI) 0.18 lower to 0.05 higher; 11 studies, 1169 women; high-certainty evidence). Women randomised to biofeedback had 0.29 fewer leakage episodes in 24 hours versus PFMT alone (MD 0.29 lower, 95% CI 0.42 lower to 0.16 lower; 12 studies, 932 women; moderate-certainty evidence), but this slight reduction in leakage episodes may not be clinically important. Women in biofeedback arms report that there is probably little to no difference in cure or improvement (OR 1.26, 95% CI 1.00 to 1.58; 14 studies, 1383 women; moderate-certainty evidence) but may report greater satisfaction with treatment outcomes (OR 2.41, 95% CI 1.56 to 3.7; 6 studies, 390 women; low-certainty evidence). None of these outcomes were blinded. Eight studies (711 women) assessed severe adverse events but reported that there were no events. Comparison 3. PFMT with feedback or biofeedback versus PFMT alone: a single study contributed very-low certainty evidence regarding leakage episodes in 24 hours, subjective cure or improvement, and satisfaction. Comparison 4. PFMT with feedback versus PFMT with biofeedback: the evidence is very uncertain about any difference in effect between biofeedback versus feedback for incontinence-related quality of life. Not only is the evidence certainty very low, the confidence interval is very wide and there could be a more than small effect in favour of biofeedack or feedback (SMD 0.14 lower, 95% CI 0.56 lower to 0.28 higher; 2 studies, 91 women; very-low certainty evidence). There may be fewer leakage episodes in 24 hours for women receiving biofeedback verus feedback but the difference may not be clinically important and the evidence certainty is low (MD 0.28 lower, 95% CI 0.62 lower to 0.07 higher; 2 studies, 120 women; low-certainty evidence). There were no data for subjective cure, improvement or satisfaction. One study measured adverse events and none were reported. Comparison 5. PFMT with biofeedback versus PFMT with another type of biofeedback: five studies assessed this comparison, with individual studies contributing data for separate outcomes. There was low- or very-low certainty evidence about the benefits of one type of biofeedback versus another for leakage episodes in 24 hours or subjective cure or improvement, respectively. One study reported adverse events from two of nine women receiving electromyography biofeedback versus six of 10 receiving pressure biofeedback.

PFMT with biofeedback results in little to no difference in incontinence quality of life. The addition of biofeedback to PFMT likely results in a small unimportant difference in leakage episodes in 24 hours, and likely little to no difference in patient-reported cure or improvement. Satisfaction may increase slightly for PFMT with biofeedback, based on low-certainty evidence. Five of the 33 studies in this comparison collected information about adverse events, and four reported none in either group. Adverse events reported by women using biofeedback seemed related to using a vaginal or rectal device (e.g. discomfort with device in place, vaginal discharge). The other comparisons had few, small studies, and low- to very low-certainty evidence for all outcomes. None of the studies reported any severe adverse events.

To improve understanding of genitourinary symptoms (GUS) in women with breast cancer (BC).

Women with BC completed a survey assessing the type, severity, and impact of GUS experienced, and perceptions of treatment options.

Surveys were completed by 506 women: median age 60 years (range 30 - 83). The majority reported: being sexually active (52%); currently taking endocrine therapy (58%); and having early-stage BC (84%). 69% had GUS, with some changing (5%) or stopping (4%) endocrine therapy as a result. Vaginal dryness was the most common symptom (62%), followed by pain during penetration (41%) and itch (33%). Only 44% recalled being warned by their cancer doctor that BC treatment can cause GUS, and 38% reported never being asked about GUS. Being uncomfortable talking to a male healthcare professional was a moderate or major barrier to accessing advice and treatment for GUS in 28% of respondents. A minority reported using vaginal: lubricants (40%); moisturisers (25%); or oestrogens (16%). Amongst those using vaginal oestrogens, 45% found they helped "quite a bit" or "very much". The most frequently reported moderate to major barrier to using vaginal oestrogens was product information warning against use in women with BC.

Although GUS are very common in women with BC, the majority of women in our study do not recall being warned or asked about these symptoms. Healthcare professionals should initiate conversations about GUS and treatment options with women with BC to help reduce the impact of these symptoms.

Gender-affirming hormone therapy (GAHT) includes estrogen preparations and androgen inhibitors for transgender women, and testosterone preparations for transgender men. The aim of the study was to investigate possible effects of GAHT on lower urinary tract symptoms (LUTS) and sexual function among transgender individuals.

Fifty-one transgender men and 47 transgender women were prospectively recruited. Four validated female questionnaires (Bristol Female Lower Urinary Tract Symptoms [BFLUTS] questionnaire, the Medical, Epidemiologic, and Social aspects of Aging [MESA] questionnaire, Urgency, the Severity and Impact Questionnaire [USIQ], and the Female Sexual Function Index [FSFI]) and two validated male questionnaires (International Prostate Symptom Score [IPSS], and the International Index of Erectile Function [IIEF]) were used to assess LUTS and sexual function among transgender men and women, respectively, before and during GAHT. Follow-up was performed over a period of 3-12 months.

Thirty-four transgender men (mean age 24.4 ± 7.6 years) and 31 transgender women (mean age 29 ± 8.7 years) completed all questionnaires, before and during GAHT. Testosterone treatment was associated with a statistically significant improvement in sexual desire among transgender men, as reflected in the FSFI questionnaire (4.5 ± 1.2 vs. 3.6 ± 1.3, P = 0.002). None of the three LUTS questionnaires showed statistically significant changes during the treatment with testosterone preparations. Estrogen treatment was associated with a statistically significant decrease in erectile function among transgender women, as reflected by the IIEF questionnaire (9.0 ± 7.2 vs. 14.1 ± 11.1, P = 0.012). No significant changes were found in LUTS during the treatment with estrogen preparations, except for a slight worsening of nocturia (2.1 ± 1.8 vs. 1.1 ± 1.4, P = 0.009).

GAHT was not found to be associated with significant LUTS in both transgender men and women. Nevertheless, some effects on sexual function were observed, mainly a decrease in erectile function among transgender women and an increase in sexual desire among transgender men.

Lower Urinary Tract Symptoms (LUTS) are defined by their distressing effect on patients' day-to-day life. Given the pressures on secondary care resources, LUTS may be overlooked or inadequately assessed and therefore patients may be burdened for an extended period before treatment.

In a debate held at the International Consultation on Incontinence Research Society (ICI-RS) meeting in Bristol in June 2024, we considered how new technologies might contribute to an expedited, dignified and effective investigation of LUTS.

We describe three broad areas where technology has a role to play: streamlining of existing investigations through mobile and miniaturized technology; entirely new investigations made possible by the technology; and advanced analytics to provide better insights from the data available.

We describe key research questions that will signpost us toward answering the question raised in the title.

Wolfram syndrome (WFS1-Spectrum Disorder) is an ultra-rare monogenic form of progressive neurodegeneration and diabetes mellitus. In common with most rare diseases, there are no therapies to slow or stop disease progression. Sodium valproate, an anticonvulsant with neuroprotective properties, is anticipated to mediate its effect via alteration of cell cycle kinetics, increases in p21cip1 expression levels and reduction in apoptosis and increase in Wolframin protein expression. To date, there have been no multicentre randomised controlled trials investigating the efficacy of treatments for neurodegeneration in patients with Wolfram syndrome.

TREATWOLFRAM is an international, multicentre, double-blind, placebo-controlled, randomised clinical trial designed to investigate whether 36-month treatment with up to 40 mg/kg/day of sodium valproate will slow the rate of loss of visual acuity as a biomarker for neurodegeneration in patients with Wolfram syndrome. Patients who satisfied the eligibility criteria were randomly assigned (2:1) to receive two times per day oral gastro-resistant sodium valproate tablets up to a maximum dose of 800 mg 12 hourly or sodium valproate-matched placebo. Using hierarchical repeated measures analyses with a 5% significance level, 80% power and accounting for an estimated 15% missing data rate, a sample size of 70 was set. The primary outcome measure, visual acuity, will be centrally reviewed and analysed on an intention-to-treat population.

The protocol was approved by the National Research Ethics Service (West of Scotland; 18/WS/0020) and by the Medicines and Healthcare products Regulatory Agency. Recruitment into TREATWOLFRAM started in January 2019 and ended in November 2021. The treatment follow-up of TREATWOLFRAM participants is ongoing and due to finish in November 2024. Updates on trial progress are disseminated via Wolfram Syndrome UK quarterly newsletters and at family conferences for patient support groups. The findings of this trial will be disseminated through peer-reviewed publications and international presentations.

NCT03717909.

Bladder health in high school and collegiate females is not well understood.

The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes.

English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake.

One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes ( P < 0.01) versus more stress fractures in athletes ( P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids ( P = 0.03).

Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.

To examine (i) if depression and anxiety are prospectively associated with subsequent lower urinary tract symptoms (LUTS) and (ii) if LUTS are prospectively associated with subsequent depression.

The study is based on data from parous middle-aged women from the Avon Longitudinal Study of Parents and Children. LUTS were assessed using the Bristol Female LUTS Questionnaire and the International Consultation on Incontinence Questionnaire on Female LUTS. Depression was assessed using the Edinburgh Postnatal Depression Scale and anxiety was assessed using the Crown Crisp Experiential Index. We used multivariable logistic regression to examine (i) associations between depression and anxiety at baseline in 2002-04 and subsequent LUTS at follow-up in 2011-2012 (n = 5291) and (ii) associations between LUTS at baseline in 2002-04 and subsequent depression at follow-up in 2010-11 (n = 6147). Analyses were adjusted for age, socioeconomic factors, stressful life events, social support, smoking, weekly alcohol consumption, BMI, physical activity, obstetric/reproductive factors, and menopausal status.

We found evidence of prospective associations between depression and subsequent mixed urinary incontinence [odds ratio = 1.97, 95 % confidence interval = 1.16, 3.33], any urinary incontinence [1.68 (1.21, 2.31)], and urgency [1.90 (1.28, 2.83)]. Anxiety was only associated with subsequent nocturia [1.84 (1.04, 3.26)]. Only stress urinary incontinence was associated with subsequent depression [1.37 (1.03, 1.83)].

We find evidence that mental health problems could be contributing factors, as well as consequences, of LUTS. Research is needed to determine if these observed associations are causal and to identify underlying mechanisms.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women of reproductive age worldwide, and its related features like obesity, mental health issues and hyperandrogenism may contribute to inadequately investigated health problems such as sexual dysfunction (SD) and lower urinary tract symptoms (LUTS). Therefore, this study examined the impact of PCOS on sexual function (SF) and lower urinary tract in Syrian women by recruiting a total of 178 women of reproductive age, of whom 88 were diagnosed with PCOS according to the Rotterdam criteria and 90 without PCOS were considered as the control group. Female sexual function index (FSFI) and Bristol Female Lower Urinary Tract Symptom Questionnaire (BFLUTS) were used to assess SF and LUTS respectively. PCOS group had higher SD prevalence compared to control group (65.9% vs 48.9%, p = 0.016), and BMI showed an inverse correlation with the total FSFI score in PCOS group (p = 0.027, r = -0.235). Furthermore, PCOS group exhibited significantly lower scores in orgasm and satisfaction subdomains. Additionally, PCOS patients had significantly higher total BFLUTS score compared to control group (median 8 vs 5, p = 0.025). Thus, PCOS may be related to SD and LUTS, highlighting the importance of evaluating SF and urinary symptoms in PCOS patients.

Pelvic floor muscle training (PFMT) is a recommended treatment for female stress, urgency, and mixed urinary incontinence. Training varies in exercise type (pelvic floor muscles contracting with and without other muscles), dose, and delivery (e.g. amount and type of supervision).

To assess the effects of alternative approaches (exercise type, dose, and delivery) to pelvic floor muscle training (PFMT) in the management of urinary incontinence (stress, urgency, and mixed) in women.

We searched the Cochrane Incontinence Specialised Register (searched 27 September 2023; which contains CENTRAL, MEDLINE, ClinicalTrials.gov, and World Health Organization ICTRP), handsearched journals and conference proceedings, and reviewed reference lists of relevant articles.

Randomised, quasi-randomised, or cluster-randomised trials in female stress, urge, or mixed urinary incontinence where one trial arm included PFMT and another was an alternative approach to PFMT type, dose, or intervention delivery. We excluded studies with participants with neurological conditions or pregnant or recently postpartum.

Two review authors independently assessed trials for eligibility and methodological quality using the Cochrane RoB 1 tool. We extracted and cross-checked data and resolved disagreements by discussion. Data processing was as described in the Cochrane Handbook for Systematic Reviews of Interventions (Version 6). Synthesis was completed in intervention subgroups.

This is a review update. The analysis included 63 trials with 4920 women; the previous version included 21 trials with 1490 women. Samples sizes ranged from 11 to 362. Overall, study participants were mid-age (45 to 65 years) parous women with stress or stress-predominant mixed urinary incontinence (46 trials), who had no prior incontinence treatment or pelvic surgery, or appreciable pelvic floor dysfunction. Trials were conducted in countries around the world, mostly in middle- or high-income settings (53 trials). All trials had one or more arms using 'direct' PFMT, defined as repeated, isolated, voluntary pelvic floor muscle contractions. Trials were categorised as comparisons of exercise type (27 trials, 3 subgroups), dose (11 trials, 5 subgroups, 1 with no data), and delivery (25 trials, 5 subgroups). Incontinence quality of life data are reported here as the primary outcome. Adverse event data were summarised narratively. Comparison 1: exercise type Co-ordinated training (body movements with concurrent pelvic floor muscle contraction) versus direct PFMT Co-ordinated training may slightly improve quality of life (standardised mean difference (SMD) -0.22, 95% confidence interval (CI) -0.44 to -0.01; I2 = 81%; 8 trials, 356 women; low-certainty evidence). Indirect training (exercises that are not contractions of the pelvic floor muscles) versus direct PFMT Direct PFMT may moderately improve quality of life (SMD 0.70, 95% CI 0.38 to 1.02; I2 = 78%; 4 trials, 170 women; low-certainty evidence). Indirect training combined with direct PFMT versus direct PFMT Combining indirect training with direct PFMT may make little to no difference in quality of life (SMD -0.08, 95% CI -0.26 to 0.10; I2 = 33; 7 trials, 482 women; low-certainty evidence). Comparison 2: exercise dose PFMT with resistance device versus PFMT without resistance device PFMT without a resistance device may slightly improve incontinence quality of life, but the evidence is very uncertain (SMD 0.22, 95% CI -0.04 to 0.48; I2 = 32%; 3 trials, 227 women; very low-certainty evidence). Maximal pelvic floor muscle contractions versus submaximal pelvic floor muscle contractions No data reported. PFMT more days per week versus PFMT fewer days per week PFMT more days per week may greatly improve incontinence quality of life (SMD -1.60, 95% CI -2.15 to -1.05; 1 trial, 68 women; low-certainty evidence). PFMT in upright body positions versus PFMT when lying down No data reported. Comparison 3: exercise intervention delivery PFMT supervised in clinic versus PFMT at home Clinic supervision may slightly improve incontinence quality of life, but the evidence is very uncertain (SMD -0.30, 95% CI -0.65 to 0.05; I2 = 89%; 3 trials, 137 women; very low-certainty evidence). More clinician contact for PFMT supervision versus less clinician contact No usable data reported. Individual supervision of PFMT versus group supervision Individually supervised PFMT probably results in little to no difference in quality of life (SMD -0.18, 95% CI -0.35 to -0.01; I2 = 0%; 5 trials, 544 women; moderate-certainty evidence). PFMT supervised in clinic versus supervision using e-health (mobile app communication with clinicians) Clinic supervision may make little to no difference in incontinence quality of life, but the evidence is very uncertain (SMD -0.11, 95% CI -0.41 to 0.19; 1 trial, 173 women; very low-certainty evidence). PFMT instruction delivered via e-health versus written instruction E-health delivery may slightly improve quality of life (SMD -0.21, 95% CI -0.43 to 0.01; I2 = 25%; 3 studies, 318 women; low-certainty evidence). Adverse events Nine trials collected adverse event data; 66/1083 (6%) women had an adverse event. Almost all events were associated with use of an intravaginal or intrarectal training device. The adverse events were vaginal discharge, spotting, or discomfort. Limitations in the evidence Four main factors influenced our certainty in the evidence: 44 trials were at unclear or high risk of selection bias; data were sparse in some subgroups with few trials, trials that did not measure outcomes of interest, or did not report usable data; results were inconsistent; and many trials were small (imprecise).

Although there is low- to moderate-certainty evidence that some approaches to PFMT are better than others, for some there was little or no difference. The 7th International Consultation on Incontinence recommends PFMT as first-line therapy for women with urinary incontinence. Direct PFMT (sets of repeated, isolated, voluntary pelvic floor muscle contractions) may result in a small improvement in incontinence quality of life compared to indirect training. In terms of improved quality of life, PFMT can be supervised individually or in a group because it probably makes little to no difference in achieving this outcome. Many comparisons had low- or very low-certainty evidence, often because there was only one trial or several small trials with methodological limitations. More, better designed and reported trials, directly comparing PFMT approaches are needed, especially trials investigating exercise dose.

The proliferation of several robotic platforms presents an opportunity to pinpoint the most suitable system for specific procedures and patient profiles. This study aims to explore differences in complications and functional outcomes among patients undergoing deep endometriosis excision with the da Vinci surgical system compared to the Hugo™ RAS system.

This is a retrospective, multicenter cohort study. Patients were categorized based on the surgical system used: the Da Vinci system and the Hugo™ RAS system. Perioperative complications, functional outcomes (via validated questionnaire: BFLUTS, KESS, GIQLI), and pain symptoms both before and after surgery were compared between the two groups.

A total of six postoperative complications were reported: four in the Da Vinci system group (20%) and two in the Hugo™ RAS system group (12.5%). No difference in the mean operative time (p = 0.647), median estimated blood loss (p = 0.179), and hospital stay (p < 0.0001) was found between the two groups. A significant difference was reported in questionnaire score changes and dyspareunia severity in the da Vinci system arm.

Both robotic systems offer comparable performances in terms of intraoperative complications, although there was a higher incidence of postoperative complications in patients who underwent surgery with the Da Vinci system. Moreover, there was an improvement in dyspareunia, urinary, and gastrointestinal function in the same group.

To evaluate complication rate and functional outcomes of nerve-sparing parametrectomy for deep endometriosis in relation to the extension of the surgical procedure, based on recognizable anatomical landmarks.

This was a prospective single-center study including all patients undergoing parametrectomy for deep endometriosis from September 2020 to June 2023 at our tertiary center. Dorsolateral parametrectomies were divided into parametrectomies medial to the presacral fascia and cranial to the medial rectal artery (superficial parametrectomy), and parametrectomies in which one of the two landmarks was overcome during the surgical procedure, leading to the excision of tissue lateral to the presacral fascia (deep parametrectomy type 1, or DP1) or caudal to the medial rectal artery (DP2). Finally, we used the hypogastric fascia as landmark to define type 3 deep parametrectomy (DP3), when the procedure was deeply lateral to the fascia.

Bladder voiding deficit occurred in 9.7% of cases, with higher rates in DP2 (20.8%) and DP3 (30%) groups. Regarding postoperative gastrointestinal function, our data showed a significant improvement over time in all groups, with the exception of DP2; instead an improvement in postoperative bladder function was only shown in DP3. Parametrectomy was not associated with a simultaneous improvement in sexual function expressed with the female sexual function index, in any of the four groups.

Our classification constitutes a concrete approach for comparing, in a standardized way, the complications and functional outcomes of parametrectomy, which, even if carried out by expert surgeons, demonstrates a non-negligible rate of bladder voiding deficit.

Existing questionnaires provide limited information on the nature, severity and context surrounding lower urinary tract symptoms (LUTS) experienced during running, jogging and brisk walking. The aims of this study were to develop a theoretical model of the experience of LUTS by females participating in gait-based exercise activities and to use this model to generate a questionnaire to evaluate the presence, symptoms and bother associated with LUTS experienced by females during gait-based activities.

A theoretical model was developed through a review of the literature and refined through a focus group consultation including pelvic health physiotherapists, females who experienced leakage during exercise and academic researchers who studied female LUTS. A draft questionnaire was developed using key constructs identified in the model by the focus group. A new expert panel was recruited, which included physiotherapists, women with self-reported gait-induced LUTS and urogynecologists. This panel followed a DELPHI process to evaluate the relevance and completeness of the constructs within the questionnaire.

Two rounds of consultation were required to reach consensus on the completeness of included constructs as well as the inclusion and wording of questions. The resulting questionnaire contains questions related to five key constructs: physical activity characteristics, symptoms of urgency, urgency urinary incontinence, stress urinary incontinence experienced during exercise and management/mitigation strategies adopted by respondents.

The content validity of the brisk walking- and running-induced lower urinary tracts symptoms questionnaire has been established. The next steps are to ensure that the questionnaire has adequate comprehensibility, followed by adequate measurement properties.

After curatively intended rectal cancer (RC) surgery, new follow-up strategies are warranted, seeking more individualised care and targeting health-related quality of life (HRQoL) and functional outcomes. The FURCA trial aimed to investigate the effect of patient-led follow-up on HRQoL and symptom burden 3 years after surgery.

RC patients from four Danish centres were randomised 1:1 to intervention (patient-led follow-up with patient education and self-referral to a specialist nurse) or control (standard follow-up with five routine doctor visits). Patients in both groups had a computed tomography (CT) at 1 and 3 years. The primary outcome (HRQoL) was assessed by the Functional Assessment of Cancer Therapy - colorectal (FACT-C) score (Ward et al. in Qual Life Res. 8(3):181-95, 18). Secondary outcomes were functional measures, patient involvement and satisfaction and cancer recurrence at 3 years.

From Feb 2016 to Aug 2018, 336 patients were included of whom 248 completed 3 years of follow-up. Between-group differences were found neither for the primary endpoint, nor for functional outcomes. The recurrence rate did not differ between the groups. Patient involvement and satisfaction were higher in the intervention group with statistical significance in almost half of the items.

We found no effect on HRQoL and symptom burden from patient-led follow-up, although it may improve patient-perceived involvement and satisfaction.

The findings in this study suggest that patient-led follow-up is a more tailored approach to meet cancer survivors' needs and might improve their ability to cope with survivorship.

R97-A6511-14-S23.

To investigate how reproductive history was associated with urinary incontinence in midlife.

A follow-up study.

Denmark.

A total of 39 977 mothers who participated in the Maternal Follow up (2013-2014) in the Danish National Birth Cohort. National registries provided their reproductive history.

How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression.

Self-reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence.

At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10-1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35-0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86-0.98). Compared with no tear/first-degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86-0.97) whereas third/fourth-degree tears were associated with more (OR 1.14, 95% CI 1.04-1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence.

Vaginal birth was associated with a higher risk of long-term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.

To investigate long-term and patient-reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes.

We conducted a retrospective analysis at a tertiary referral centre (2010-2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient-reported outcome measures in UGF repair was also performed.

The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7) for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR) ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross-study comparisons.

Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula.

The Overactive Bladder Symptom Score (OABSS) measures all overactive bladder (OAB) symptoms with graded answers, evaluates urgency symptoms, and reveals the subjective bladder control. However, the Turkish version and the cutoff value of the questionnaire have not yet been studied.

The aims of this study were to determine the psychometric properties of the 7-item OABSS and to estimate the cutoff value of the scale.

This was an observational study. The internal consistency (Cronbach α) and test-retest reliability were analyzed, and exploratory factor analysis was performed. For the criterion validity, the correlations between the OABSS, the Overactive Bladder Questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, and outcomes of a bladder diary were used. The cutoff value of the OABSS was analyzed by the receiver operating characteristics curve analysis.

Participants with (n = 49) and without (n = 38) OAB were included. The internal consistency was very strong (Cronbach α = 0.95). The test-retest reliability was very strong (intraclass correlation coefficients = 0.93-0.95, P = 0.001). The percentage of explanation of the total variance was calculated as 78%. There was a strong to very strong correlation between the OABSS and the Overactive Bladder Questionnaire and Bristol Female Lower Urinary Tract Symptoms scores and outcomes of the bladder diary. The cutoff value for the OABSS was determined as 10.5.

The Turkish OABSS was found to be a valid and reliable scale to determine OAB symptoms and severity. Those who score more than 10.5 on the questionnaire can be considered as at risk of OAB syndrome.

Female urethral strictures are a rare condition that significantly impacts patients' quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center.

We conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009-2023. We assessed objective (retreatment-free survival, ΔQmax) and subjective outcomes (validated patient-reported outcomes).

Of 12 women, 83% and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25% and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm. At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate (ΔQmax) was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction.

Buccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.

and hypothesis.We evaluated different bladder parameters using Transperineal Ultrasound (TPUS) in patients with apical pelvic organ prolapse undergoing lateral suspension or sacropexy.

We included 73 cases with 37 cases in lateral suspension (LS) group and 36 cases in sacropexy group. We enrolled cases with apical prolapse stage 2 or higher according to Pelvic Organ Prolapse Quantification system (POP-Q). Evaluation done of all cases using TPUS preoperatively and at 6, 12 and 18 months follow-up visits.

In LS group we found significant differences postoperatively in bladder neck height (Dy distance) at Valsalva and rest (P value < 0.001 in both) and in β angle at Valsalva and rest (P value < 0.001 in both). There was significant improvement in PVR (P value < 0.001). In sacropexy group we found no significant differences postoperatively in bladder neck height at Valsalva (P value 0.07) or in β angle at Valsalva (P value 0.097). There was significant improvement in PVR (P value 0.006). In between the 2 groups, there was better improvement in LS group than sacropexy group in bladder neck height at rest (P value 0.001) and in β angle both at Valsalva and rest (P value < 0.001 & 0.002 respectively). There was no significant difference in PVR, bladder wall thickness or bladder neck funnelling.

LS and sacropexy showed good postoperative improvement in some bladder parameters using TPUS with better improvement in bladder neck height in LS.

Clinical trial ID: NCT03772691.

We aimed to investigate the diagnostic value of International Prostate Symptom Score voiding symptom score (IPSS-VS) and Bristol Female Lower Urinary Tract Symptoms-short form voiding score (BFLUTS-VS) in female patients with urodynamically diagnosed voiding dysfunction.

The medical records of female patients who underwent urodynamic examination between May 2007 and November 2021 for lower urinary tract complaints were retrospectively evaluated. A total of 1858 female patients were included in the study. Patients investigated between 2007 and 2014 were asked to fill the IPSS, and patients investigated after 2015 were asked to fill the BFLUTS-SF.

The mean age of the patients was 49.06 ± 0.33 in the IPSS group and 50.02 ± 0.47 in the BFLUTS group. On the pressure flow study, voiding dysfunction was found in 14.8% (n = 95) in the IPSS group and 15.1% (n = 183) in the BFLUTS group. The area under curve value was found to be 0.58 for IPSS and 0.64 for BFLUTS. Threshold values were found as >9 for IPSS-VS and >4 for BFLUTS-VS. The sensitivity, specificity, false negative, and false positive rates for IPSS-VS were 33.3%, 78.8%, 66.7%, and 21.2%, respectively. The same parameters were 45.5%, 78.9%, 54.5%, and 21.1% for BFLUTS-VS, respectively.

The diagnostic performance of both the questionnaires was found to be low for diagnosing voiding dysfunction in female patients according to our data. Therefore, the assessment of the voiding phase in women should not solely rely on the current questionnaires. However, further studies using questionnaires including all voiding symptoms are required.

The burden and high prevalence of overactive bladder (OAB) underline the urgent need for effective treatment. This study provides an initial look at an alternative approach to behavioral therapy for overactive bladder (OAB) that is delivered as an app on a smartphone.

This study aimed to investigate feasibility, acceptability, and preliminary efficacy of a digital therapeutic for OAB.

This was a multicentered prospective pilot study. We used a convenience sample (N = 30) from waiting lists of women referred for incontinence, excluding urinary tract infections, urinary retention, bladder pain syndrome, pelvic cancer, current pregnancy, kidney disease, dementia, stroke, and prior neuromodulation. The intervention, a smartphone app, provided an 8-week program with weekly modules combining evidence-based knowledge videos and skill-building exercises that incorporated behavioral therapy, cognitive behavioral therapy, pelvic muscle training, and general health information. Combined scores on the International Consultation on Incontinence Questionnaire was the primary outcome measure. Secondary outcomes included improvement in quality of life, based on International Consultation on Incontinence Questionnaire, a 72-hour urinary diary, and Patient Global Impression of Improvement. We evaluated usability with the Mobile Application Rating Scale. Statistical tests included Shapiro-Wilk tests and paired-sample t tests.

Overall, 100% of participants reported a reduction in their OAB symptoms and 82% reported an improvement in quality of life. There was a significant improvement in diary parameters, including frequency (10.19-6.71 a day: SD, 1.25; P = 0.017) and incontinence (10-3.57: SD, 4.58). Participants rated the app highly on functionality, and 70% would recommend it. Patient Global Impression of Improvement improved for 72% of participants.

This study supports the application of a digital platform to over-come the real-world barriers for first-line treatment for OAB and offers information to inform further evaluation of the safety and efficacy of the NUIG OAB App.

The genitourinary syndrome of menopause (GSM), apart from symptoms related to vulvovaginal atrophy (VVA), also consists of lower urinary tract symptoms (LUTS). Based on the common embryological origin of the genital and lower urinary system, the presence of estrogen receptors, and the high prevalence of VVA and LUTS in the menopausal population, the two conditions can coexist. This study is aimed at investigating the prevalence and risk factors of LUTS in a sample of Greek peri- and postmenopausal women.

Four hundred and fifty (450) women, aged 40-70 years, attending three outpatient gynecology clinics for routine examination, completed a structured interview and responded to a validated questionnaire (International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms, ICIQ-FLUTS).

Urinary urgency or frequency affected 51.6% and dysuria 43.6% of the participants. Mild urgency or frequency was described by 25.6%, moderate by 14.4%, and severe by 11.6% of the women. Mild dysuria was reported by 26.26%, moderate by 5.8%, and severe by 11.6%. Age, weight, BMI, and number of pregnancies and abortions correlated with a higher ICIQ-FLUTS score. Women with moderate/severe symptoms of VVA, such as irritation, a burning sensation, and pruritus of the vulva or vagina, had a higher ICIQ-FLUTS score than women without such symptoms (beta coefficient 2.42, CI 1.204, 3.635, p < 0.001).

Lower urinary tract symptoms are very common among peri- and postmenopausal women and are linked to symptoms of VVA. Our data support the need for prompt evaluation of women transitioning to menopause, as these symptoms compromise the quality of life.

Urinary tract infection (UTI) is one of the most common human infections. Evidence suggests that there might be a genetic predisposition to UTI. Previous small candidate gene studies have suggested that common variants in genes involved in the immune response to UTI could increase susceptibility to the development of recurrent UTI (rUTI). The objective was to conduct a gene association study to replicate previous gene association studies identifying single nucleotide polymorphisms (SNPs) putatively associated with rUTI in adult women.

Women with a history of rUTI and healthy controls were recruited (n = 1,008) from gynaecology outpatient clinics. Participants completed a signed consent form and questionnaire for phenotyping. DNA was extracted from blood or saliva samples for each participant. Putative associated SNPs were identified from a comprehensive systematic review of prior gene association studies. Primers for each selected SNP were designed, and genotyping was conducted using a competitive polymerase chain reaction (PCR) method. The Chi-squared test was used to assess the association between each variant and rUTI. Genotyping quality was assessed by checking for deviation from Hardy-Weinberg equilibrium.

We found no association between SNPs tested in the VDR (p = 0.16, p = 0.09, p = 0.36), CXCR1 (p = 0.09), CXCR2 (p = 0.39), PSCA (p = 0.74) genes, and rUTI in adult women.

To our knowledge, this is the largest study to date, finding no significant associations. Previously reported positive associations may have been due to type 1 error, or genotyping errors. Future studies should adjust for confounders and employ adequate sample sizes. A greater understanding of the genetic components associated with rUTI may influence future treatment guidelines and screening for susceptible patients.

The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife.

Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013-2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression.

At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight.

Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk.

Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling.

Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling.

The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population.

NCT05880862. Registered on 30 May 2023.

Little is known about the challenges faced by women with a neuromuscular disease (NMD) when having to go to the toilet in other places than home; a topic that is highly important for participation and bladder health.

The aim was to investigate whether women with NMD have problems in going to the toilet when not at home, the problems' impact on their social activities, education, and working life, which strategies they use to manage the problems, and the prevalence of lower urinary tract symptoms (LUTS).

A national survey containing questions on type of NMD, mobility, impacts on social activities, education, working life, and bladder health was developed by women with NMD and researchers. LUTS were assessed by the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS). Female patients≥12 years (n = 1617) registered at the Danish National Rehabilitation Centre for Neuromuscular Diseases were invited.

692 women (43%) accepted the invitation; 21% were non-ambulant. 25% of respondents avoided going to the toilet when not at home. One third of respondents experienced that problems in going to the toilet impacted their social life. 43% of respondents refrained from drinking to avoid voiding when not at home, 61% had a low frequency of urinating, 17% had experienced urinary tract infections, and 35% had experienced urine incontinence. Problems were seldom discussed with professionals, only 5% of participants had been referred to neuro-urological evaluation.

The results highlight the difficulties in urinating faced by women with NMD when not at home and how these difficulties impact functioning, participation, and bladder health. The study illustrates a lack of awareness of the problems in the neuro-urological clinic. It is necessary to address this in clinical practice to provide supportive treatment and solutions that will enable participation for women with NMD.

Surgical management of bowel endometriosis is still controversial. Recently, many authors have pointed out the potential benefits of preserving the superior rectal artery, thus ensuring better perfusion of the anastomosis. The aim of this study was to evaluate the complication rate and functional outcomes of a bowel resection technique for deep endometriosis (DE) involving a nerve- and vascular-sparing approach.

A single-center retrospective study was conducted by enrolling patients who underwent segmental resection of the rectus sigmoid for DE in our department between September 2019 and April 2022. Intraoperative and postoperative complications were recorded for each woman, and functional outcomes relating to the pelvic organs were assessed using validated questionnaires (Knowles-Eccersley-Scott-Symptom [KESS] questionnaire and Gastro-Intestinal Quality of Life Index [GIQLI] for bowel function, Bristol Female Lower Urinary Tract Symptoms [BFLUTS] for urinary function, and Female Sexual Function Index [FSFI] for sexual function). These were evaluated preoperatively and postoperatively after 6 months from surgery.

Sixty-one patients were enrolled. No patients had Clavien-Dindo grade 3 or 4 complications, there were no rectovaginal fistulas or ureteral lesions, and in no cases was it necessary to reoperate. Temporary bladder voiding deficits were reported in 8.2% of patients, which were treated with self-catheterizations, always resolving within 45 days of surgery. Gastrointestinal function evaluated by KESS and GIQLI improved significantly after surgery, whereas sexual function appeared to worsen, although without reaching the level of statistically significant validity.

Our vascular- and nerve-sparing segmental bowel resection technique for DE had a low intraoperative and postoperative complication rate and produced an improvement in gastrointestinal function after surgery.

Background and Objectives: Endometriosis is a chronic and recurrent disease defined as the presence and proliferation of endometrial glands and stroma outside the uterine cavity. It affects up to 6-10% of women of reproductive age and can be classified into superficial, ovarian, and deep infiltrating endometriosis (DIE). Deep infiltrating endometriosis can be associated with pain symptoms and pelvic floor muscle hypertone. Moreover, it may be responsible of bowel, urinary, and sexual dysfunctions with impairment of women's quality of life. Few studies have investigated the role of physiotherapy in women with DIE. Here, we aimed first to evaluate the effects of pelvic floor physiotherapy (PFP) on urinary, bowel, and sexual functions. Secondly, we aimed to evaluate the effects of ultrasound visual feedback during PFP on pelvic floor and subjective modifications in the frequency of sexual intercourse. Materials and Methods: This randomized controlled trial was conducted between June 2018 and December 2019 at our tertiary center. Nulliparous women with DIE and superficial dyspareunia were enrolled. At first examination, levator hiatal area (LHA) assessed with 3D/4D transperineal ultrasound, pain symptoms, urinary, bowel, and sexual functions were evaluated. Then, women were randomly assigned to no intervention (control group) or treatment with five individual sessions of PFP (experimental group), and after four months women underwent a second examination. Urinary, bowel, and sexual functions were assessed with validated questionnaires at first and second examinations. In particular, the Bristol Female Lower Urinary Tract Symptoms questionnaire was used to evaluate urinary symptoms, the Knowles-Eccersley-Scott-Symptom questionnaire to assess the presence of constipation, and the Female Sexual Function Index to investigate sexual function. Study outcomes were the comparisons among groups in terms of differences in actual changes in median of questionnaire scores between first and second examinations. Results: Thirty women (17 in the experimental group and 13 in the control group) completed the study. No significant differences were found between the two groups regarding urinary, bowel, and sexual functions, although women in the experimental group showed a tendency towards an improvement in constipation symptoms. Conclusion: In women with DIE, PFP does not appear to affect urinary, bowel, and sexual functions. Therefore, despite the improvement in superficial dyspareunia, chronic pelvic pain, and PFM relaxation with high treatment satisfaction, women should be informed about the unclear impact of PFP on urinary, bowel, and sexual functions. Larger studies are necessary to further investigate the impact of PFP on these functions.

Despite the increasing utilization of sphincter and/or organ-preservation treatment strategies, many patients with low-lying rectal cancers require abdominoperineal resection (APR), leading to permanent ostomy. Here, we aimed to characterize overall, sexual-, and bladder-related patient-reported quality of life (QOL) for individuals with low rectal cancers. We additionally aimed to explore potential differences in patient-reported outcomes between patients with and without a permanent ostomy.

We distributed a comprehensive survey consisting of various patient-reported outcome measures, including the FACT-G7 survey, ICIQ MLUTS/FLUTS, IIEF-5/FSFI, and a specific questionnaire for ostomy patients. Descriptive statistics and univariate comparisons were used to compared demographics, treatments, and QOL scores between patients with and without a permanent ostomy.

Of the 204 patients contacted, 124 (60.8%) returned completed surveys; 22 (18%) of these had a permanent ostomy at the time of survey completion. There were 25 patients with low rectal tumors (≤5 cm from the anal verge) who did not have an ostomy at the time of survey completion, of whom 13 (52%) were managed with a non-operative approach. FACTG7 scores were numerically lower (median 20.5 vs. 22, p = 0.12) for individuals with an ostomy. Sexual function measures IIEF and FSFI were also lower (worse) for individuals with ostomies, but the results were not significantly different. MLUTS and FLUTS scores were both higher in individuals with ostomies (median 11 vs. 5, p = 0.06 and median 17 vs. 5.5, p = 0.01, respectively), suggesting worse urinary function. Patient-reported ostomy-specific challenges included gastrointestinal concerns (e.g., gas, odor, diarrhea) that may affect social activities and personal relationships.

Despite a limited sample size, this study provides patient-centered, patient-derived data regarding long-term QOL in validated measures following treatment of low rectal cancers. Ostomies may have multidimensional negative impacts on QOL, and these findings warrant continued investigation in a prospective setting. These results may be used to inform shared decision making for individuals with low rectal cancers in both the settings of organ preservation and permanent ostomy.

Lower urinary tract symptoms (LUTS) are common among adolescent girls. Physical activity (PA) has been implicated as both a risk (high-impact PA) and protective factor (low-impact, moderate to vigorous intensity PA) for LUTS in adult women, but its role in adolescent girls is unclear. This study investigated the prospective association between physical activity and LUTS risk in adolescent girls.

The sample comprised 3,484 female participants in the Avon Longitudinal Study of Parents and Children. Multivariate logistic regression models were used to examine daily minutes of moderate to vigorous PA (MVPA) at ages 11 and 15 years in relation to LUTS at ages 14 and 19 respectively. MVPA was assessed by 7-day accelerometer data. LUTS were assessed by questionnaire. MVPA were analyzed as continuous (minutes/day) and categorical variables (<10th percentile, 10-89th percentile, ≥90th percentile).

Prevalence of LUTS ranged from 2.0% for bedwetting to 9.5% for nocturia at age 14 and from 2.0% for straining to urinate to 35.5% for interrupted urine flow at age 19. Physical activity was not associated with LUTS at either time-point.

Given the prevalence of LUTS in female adolescent populations, although this study did not find an association with accelerometer-measured MVPA, other aspects of PA that may serve as risk or protective factors deserve investigation.

This study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria.

Patients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student's t-test and non-parametric Mann-Whitney two-sample test.

Of the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point.

PPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase.

To compare rates of urinary retention and postoperative urinary tract infection between women with immediate versus women with delayed removal of indwelling catheter following benign non-hysterectomy gynaecological laparoscopic surgery.

This randomised clinical trial was conducted between February 2012 and December 2019, with follow-up to 6 weeks.

Two university-affiliated teaching hospitals in Sydney, Australia.

Study participants were 693 women aged 18 years or over, undergoing non-hysterectomy laparoscopy for benign gynaecological conditions, excluding pelvic floor or concomitant bowel surgery.

Three hundred and fifty-five participants were randomised to immediate removal of urinary catheter and 338 participants were randomised to delayed removal of urinary catheter.

The co-primary outcomes were urinary retention and urinary tract infection. Secondary outcomes included hospital readmission, analgesia requirements, duration of hospitalisation and validated bladder function questionnaires.

Urinary retention was higher after immediate compared with delayed removal of the urinary catheter (8.2% vs 4.2%, RR 1.8, 95% CI 1.0-3.0, p = 0.04). Although urinary tract infection was 7.2% following delayed removal of the urinary catheter and 4.7% following immediate removal of the urinary catheter, the difference was not statistically significant (RR 0.7, 95% CI 0.3-1.2, p = 0.2).

There is an increased risk of urinary retention with the immediate compared with the delayed removal of the urinary catheter following benign non-hysterectomy gynaecological laparoscopic surgery. The difference in urinary tract infection was not significant. There is 1/12 risk of re-catheterisation after immediate urinary catheter removal. It is important to ensure that patients report normal voiding and emptying prior to discharge, to reduce the need for readmission for the management of urinary retention.