Female Pelvic Floor Dysfunction Research Articles

A New Combined Urogynecology and Colorectal Surgery Pelvic Floor Clinic-1 Year On.

This study is aimed at characterizing patients seen at a new combined pelvic floor clinic (CPFC) established at a tertiary women's hospital in Singapore. Study goals include identifying patterns of symptom clusters and reviewing management strategies compared with international care standards, improving understanding of complex female pelvic floor dysfunction, and guiding future development of clinical and ancillary support. This is a single-center, retrospective cohort study of medical case record review for all patients seen at the CPFC between 1 September 2020 and 31 August 2021. All patients seen at CPFC during this study period were included for analysis. Data were deidentified and aggregated, with analysis performed for descriptive and summary statistics. Institutional Review Board approval was obtained with waiver of informed consent. Sixty-six referrals were made to the CPFC, with 57 patients seen in 11 clinic sessions across the 12-month period. The most common reasons for referral were fecal or flatus incontinence (30, 52.6%), severe constipation or defecatory dysfunction (21.1%), and rectal prolapse (17.5%). Most patients (78.9%) had multiple symptoms. Our patient demographic profile aligns with known risk factors for pelvic floor dysfunction, presenting with gastrointestinal symptoms-similar to PFCs worldwide. The new workflow and services were well positioned to address patients' needs, including those left previously untreated, or received uncoordinated care. Conservative approaches were first employed, like with other global PFCs. The combined multidisciplinary model of care resulted in good outcomes for patients managed both conservatively and surgically. Future studies to analyze patient satisfaction are planned.

Prevalence of depression and anxiety in women with pelvic floor dysfunctions: A systematic review and meta-analysis.

Female pelvic floor dysfunction (PFD) is a common condition affecting the emotional well-being of women. To estimate the prevalence of depressive and anxiety symptoms in women with PFD. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION AND ANALYSIS: Following prospective registration (PROSPERO CRD42022362095) we conducted a search of three electronic databases (PubMed, Web of Science and Scopus) from inception to April 2023 without language restriction to capture studies reporting the prevalence of depression/anxiety among women with PFD (chronic pelvic pain [CPP], urinary incontinence [UI], pelvic organ prolapse [POP], and/or fecal incontinence [FI]). Only studies with validated tools were included. Data extraction and study quality assessment were performed by two independent reviewers. Stratifying by type of PFD, rates of depression and anxiety were pooled using random effects model computing 95% confidence interval (CI) and assessing heterogeneity using the I2 statistic. Funnel plots were used to detect potential reporting biases and small-study effects. The search yielded 767 articles, from which 54 studies containing 632 605 women were included. All the studies were high quality. The prevalence of depression was: CPP 26.8% (95% CI: 19.2-34.4, I2 = 98.7%; 12 studies, 4798 participants with 491 cases; Egger's P value = 0.009); UI 26.3% (95% CI: 19.4-33.2, I2 = 99.9%; 26 studies, a total of 346 114 participants with 25 050 cases; Egger's P value = 0.944); POP 34.9% (95% CI: 24.3-45.6, I2 = 68%; three studies, 297 participants with 104 cases; Egger's P value = 0.973); and FI 25.3% (95% CI: 0.68-49.9, I2 = 99.7%; six studies, 14 663 participants with 1773 cases; Egger's P value = 0.780). The prevalence of anxiety was: CPP 29.5% (95% CI: 16.3-42.7, I2 = 97.7%; nine studies, 2483 participants with 349 cases; Egger's P value = 0.001); UI 46.91% (95% CI: 39.1-54.6, I2 = 99.6%; 11 studies, 198 491 participants with 40 058 cases; Egger's P value = 0.337); and POP 28% (95% CI: 13.6-42.4, I2 = 89%; three studies with 355 participants with 90 cases; Egger's P value = 0.306). The prevalence of mental health illness was variable in the different types of PFDs. This meta-analysis helps quantify the burden of depression and anxiety in PFD and will help inform the policies regarding screening of emotional well-being by healthcare professionals engaged in care of women with PFD.

Effect of Cox’s Interaction Model of Client Health Behavior Combined with Huangqi and Dangshen Decoction on Female Pelvic Floor Dysfunction

Huangqi and Dangshen have significant medicinal and medical value as natural bio-based materials, but there are few studies on female pelvic floor dysfunction. We aimed to explore the effect of the Cox’s interaction model of client health behavior (Cox-IMCHB) combined with Huangqi and Dangshen decoction on female pelvic floor dysfunction. 166 postpartum patients with Qi-deficiency syndrome of pelvic floor dysfunction were selected from Tongren Hospital of Wuhan University hospital and divided into two groups, Group A and Group B, each consisting of 83 cases. The allocation was done using the random number table method. Patients in Group A received routine nursing and biofeedback electrical stimulation treatment, while patients in Group B received Cox-IMCHB combined with Huangqi and Dangshen decoction based on Group A. We compared the clinical efficacy, syndrome efficacy, pelvic floor muscle strength scores, sexual life quality scores, VAS score, pelvic floor functional exercise compliance score, and the incidence of urinary incontinence and pelvic organ prolapse between the two groups. The results showed that Group B had better clinical efficacy and syndrome efficacy, as well as a higher total effective rate (clinical efficacy: 91.57% vs. 72.29%; syndrome efficacy: 95.18% vs. 74.70%). Moreover, compared to Group A, Group B had higher scores of pelvic floor muscle strength and sexual life quality, a lower proportion of mild pain (85.54% vs. 71.08%), and higher scores of pelvic floor functional exercise compliance. The scores of pelvic floor functional exercise compliance in both groups tended to increase with time, and there was an interactive effect between groups and time (intergroup effect: F = 322.900, time effect: F = 186.200, interaction effect: F = 27.410). The incidence of urinary incontinence (2.41% vs. 14.46%, ϰ2 = 6.319) and pelvic organ prolapse (3.61% vs. 16.87%, ϰ2 = 9.608) in group B was lower (all P > 0.05). The combination of Cox-IMCHB with Huangqi and Dangshen decoction can improve the pelvic function and exercise compliance of patients with pelvic floor dysfunction, relieve pain, and have significant clinical effects, which are worthy of promotion and application.

Pelvic Floor Dysfunction among Reproductive-Age Women in Israel: Prevalence and Attitudes—A Cross-Sectional Study

Objectives: Our study aimed to investigate the prevalence of female pelvic floor dysfunction (PFD) in Israeli women who experienced vaginal delivery and are in their reproductive years (premenopausal), as well as to understand their attitudes and health-seeking behavior and barriers towards treating this problem. Methods: In this cross-sectional study, we conducted a questionnaire-based Internet survey. The surveys were sent to Israeli women in their fertile years (18–50 years old). We asked the women about their PFD symptoms, attitudes, and help-seeking behaviors. We used two validated questionnaires, including the USIQ and the PFDI-20. The combined questionnaire was submitted in both Hebrew and Arabic. We assessed the prevalence of PFD symptoms in the study population. Symptomatic women were asked about their help-seeking behaviors and their beliefs, desires, and barriers regarding the clinical management of symptoms. Results: Between July and September 2020, 524 women completed the questionnaire (response rate 44%). In total, 95% reported at least one symptom (mostly urinary-related) at any grade of severeness in at least one category, and 66.8% suffered from at least one moderate to severe symptom in at least one category. Most women (93.7%) reported that they wanted to be asked and offered voluntary information about PFD from physicians and nurses; however, only 16.6% reported receiving such information. Barriers to seeking treatment were mainly related to low awareness. The study’s main limitation was selection bias due to the questionnaire’s design. Conclusions: These findings show the importance of raising awareness of the different therapeutic solutions to PFD symptoms and designing more available services for this common problem.

Static and Dynamic Magnetic Resonance Imaging in Female Pelvic Floor Dysfunction: Correlation With Pelvic Organ Prolapse Quantification.

Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points. A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements. Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse. POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.

Pelvic Recovery After Endometrial Cancer Treatment: Patient-Reported Outcomes and MRI Findings

Most women with endometrial cancer (EC) have an excellent prognosis and may be cured. However, treatment-related pelvic functional impacts may affect long-term quality of life. To better understand these concerns, we explored correlations between patient-reported outcomes and pelvic magnetic resonance imaging (MRI) features in women treated for EC. Women with histologic diagnosis of EC were consented preoperatively and completed the validated Female Sexual Function Index (FSFI) and Pelvic Floor Dysfunction Index (PFDI) questionnaires at preoperative, 6-week, and 6-month follow-up visits. Pelvic MRIs with dynamic pelvic floor sequences were performed at 6 weeks and 6 months. A total of 33 women participated in this prospective pilot study. Only 53.7% had been asked about sexual function by providers while 92.4% thought they should have been. Sexual function became more important to women over time. Baseline FSFI was low, declined at 6 weeks, and climbed above baseline at 6 months. Hyperintense vaginal wall signal on T2-weighted images(10.9 vs. 4.8, p=.002) and intact Kegel function (9.8 vs. 4.8, p=.03) were associated with higher FSFI. PFDI scores trended toward improved pelvic floor function over time. Pelvic adhesions on MRI were associated with better pelvic floor function (23.0 vs. 54.9, p=.003). Urethral hypermobility (48.4 vs. 21.7, p=.01), cystocele (65.6 vs. 24.8, p<.0001), and rectocele (58.8 vs. 18.8, p<.0001) predicted worse pelvic floor function. Use of pelvic MRI to quantify anatomic and tissue changes may facilitate risk stratification and response assessment for pelvic floor and sexual dysfunction. Patients articulated the need for attention to these outcomes during ECtreatment.

Factors Associated With Stress Urinary Incontinence and Diastasis of Rectus Abdominis in Women at 6-8 Weeks Postpartum.

In recent years, pelvic-abdominal dynamics has become a research topic in the field of pelvic floor dysfunction (PFD), and the relationship between diastasis of the rectus abdominis (DRA) and stress urinary incontinence (SUI) has been controversial. The study is helpful to further strengthen perinatal education, accurately identify the risk factors of SUI and DRA, and improve the quality of life of puerperae. This study aimed to investigate the association of SUI and DRA in women with PFD as measured by vaginal palpation or pelvic floor biofeedback machine testing. A total of 301 patients diagnosed with female PFD who were 6-8 weeks postpartum at The Fifth People's Hospital of Zhuhai between May 2018 and April 2021 were enrolled. The prevalence rates and potential influencing factors of SUI and DRA were analyzed. A total of 29.5% (89 of 301) of the patients were diagnosed with SUI, and 31.9% (96 of 301) were diagnosed with DRA. Binary logistic regression showed that a history of delivery ( P = 0.012; odds ratio [OR], 1.982) and vaginal delivery with perineal lacerations or episiotomy ( P = 0.016; OR, 2.187) were risk factors for SUI. High birth weight (weight>4.0 kg, P < 0.001; OR, 14.507) was a risk factor for DRA. A history of delivery and vaginal delivery with perineal lacerations or episiotomy increased the risk of SUI, and high birth weight was an independent risk factor for DRA. Early intervention, including exercise therapy, manual therapy, and neuromuscular electrical stimulation, may be important for patients with PFD having these risk factors.

Addressing Gender-Related Inequality in Continence Care

Addressing Gender-Related Inequality in Continence Care

Advances and Applications of Transperineal Ultrasound Imaging in Female Pelvic Floor Dysfunction

Advances and Applications of Transperineal Ultrasound Imaging in Female Pelvic Floor Dysfunction

Automatic Plane of Minimal Hiatal Dimensions Extraction From 3D Female Pelvic Floor Ultrasound.

There is an increasing interest in the applications of 3D ultrasound imaging of the pelvic floor to improve the diagnosis, treatment, and surgical planning of female pelvic floor dysfunction (PFD). Pelvic floor biometrics are obtained on an oblique image plane known as the plane of minimal hiatal dimensions (PMHD). Identifying this plane requires the detection of two anatomical landmarks, the pubic symphysis and anorectal angle. The manual detection of the anatomical landmarks and the PMHD in 3D pelvic ultrasound requires expert knowledge of the pelvic floor anatomy, and is challenging, time-consuming, and subject to human error. These challenges have hindered the adoption of such quantitative analysis in the clinic. This work presents an automatic approach to identify the anatomical landmarks and extract the PMHD from 3D pelvic ultrasound volumes. To demonstrate clinical utility and a complete automated clinical task, an automatic segmentation of the levator-ani muscle on the extracted PMHD images was also performed. Experiments using 73 test images of patients during a pelvic muscle resting state showed that this algorithm has the capability to accurately identify the PMHD with an average Dice of 0.89 and an average mean boundary distance of 2.25mm. Further evaluation of the PMHD detection algorithm using 35 images of patients performing pelvic muscle contraction resulted in an average Dice of 0.88 and an average mean boundary distance of 2.75mm. This work had the potential to pave the way towards the adoption of ultrasound in the clinic and development of personalized treatment for PFD.

An Electrophysiological Technique to Accurately Diagnose and Treat Erectile Dysfunction.

Erectile dysfunction (ED) is a common disease in males. In the past, the first-line treatment of ED was mainly noninvasive-psychotherapy and oral phosphodiesterase 5 (PDE5) inhibitors. Oral PDE5 inhibitors often need to be used before sexual intercourse and do not repair the pathological damage; hence, the therapeutic effect for secondary ED caused by neurological or endocrine disorders is poor. Second-line treatments mainly include penile corpus cavernosum injection of alprostadil, transurethral administration, vacuum negative pressure devices, and other methods, with obvious side effects such as local pain. The third-line treatment mainly refers to penile prosthesis implantation. Indications of this treatment are strict, complications such as mechanical failure and infection may occur after operation, and it is expensive. Other treatments such as stem cell therapy and gene therapy are still in the experimental research stage and have not been used in clinics. A new treatment based on an electrophysiological technique combines a medical infrared thermal imager with low-frequency (20-50 Hz) neuromuscular electrical stimulation, which has achieved good results in the prevention and treatment of female pelvic floor dysfunction. Male generative organs are located in the pelvic floor area, and their normal function not only depends on the integrity of the structure and function of the male generative organs, but is also closely related to the blood vessels, nerves, muscles, and other pelvic floor organs. Therefore, this electrophysiological technique was applied to male ED, focusing on the observation of the penis, groin, and hypogastrium for accurate diagnosis and treatment. This demonstrated effective improvement in the conscious erectile status and erectile function scores of patients suffering from ED.

Current practice in animal models for pelvic floor dysfunction.

The objective was to explore the current practice of using animal models for female pelvic floor dysfunction (PFD). By applying PFD and animal models as the keywords, we made a computerized search using PubMed, Ovid-Medline and Ovid-Embase from 2000 to 2022. The publications on the construction and application of animal models for PFD were included, and the results are presented in narrative text. Studies on PFD primarily use rodents, large quadrupeds, and nonhuman primates (NHPs). NHPs are closest to humans in anatomy and biomechanics of the pelvic floor, followed by large quadrupeds and rodents. Rodents are more suitable for studying molecular mechanism, histopathology of PFD, and mesh immune rejection. Large quadrupeds are adaptable to the study of pelvic floor biomechanics and the development of new surgical instruments for PFD. NHPs are suitable for studying the occurrence and pathogenesis of pelvic organ prolapse. Among modeling methods, violent destruction of pelvic floor muscles, regulation of hormone levels, and denervation were used to simulate the occurrence of PFD. Gene knockout can be used to study both the pathogenesis of PFD and the efficacy of treatments. Other methods such as abdominal wall defect, vaginal defect, and in vitro organ bath system are more frequently used to observe wound healing after surgery and to verify the efficacy of treatments. The rat is currently the most applicable animal type for numerous modeling methods. Vaginal dilation is the most widely used modeling method for research on the pathogenesis, pathological changes, and treatment of PFD.

Application of Transperineal Pelvic Floor Ultrasound in Changes of Pelvic Floor Structure and Function Between Pregnant and Non-Pregnant Women.

ObjectiveTo evaluate the changes of pelvic floor tissue structure and function between pregnant and non-pregnant women from the view of transperineal pelvic floor ultrasound.MethodsThirty-eight cases of women with a second singleton pregnancy and thirty-two cases of women with a first singleton pregnancy underwent transperineal pelvic floor ultrasound, and their results were compared with forty-two cases of healthy non-pregnant women.ResultsThe differences of bladder neck descent (BND), rectal ampulla distance and levator hiatus area (LHA) among the three groups were statistically significant (P<0.05), and the differences of BND, rectal ampulla distance, LHA between the women with a second singleton pregnancy group and non-pragnent group were statistically significant (P<0.05). The BND, retrovesical angle at rest (RVA-R) and retrovesical angle underwent Valsalva maneuver (RVA-V) in the group of stress urinary incontinence (SUI) during pregnancy were larger than those in non-SUI group, with significant difference (P<0.05), especially BND and RVA-V (P = 0.00).ConclusionTransperineal pelvic floor ultrasound has a high resolution of pelvic floor structure and function changes during pregnancy, and can dynamically evaluate pelvic floor function, providing a theoretical basis for early diagnosis and prevention of female pelvic floor dysfunction (FPFD) in subsequent pregnancies.

Application of a new biological material in obstetric nursing

Female postpartum pelvic floor dysfunction disease|(PFD) is a series of diseases caused by pelvic floor injury, defects, and dysfunction. The disease mainly includes pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Although PFD is not fatal, it can seriously affect the quality of life of patients. For this reason, women need to repair the pelvic floor muscles after childbirth. In this study, we used a new polypropylene mesh biomaterial implanted into the vagina and then repaired the pelvic floor and observed its repair effect. Pathological tests proved that the new biological material caused certain acute inflammatory reactions after implantation in the vagina, which increased the number of collagen cells in the pelvic floor muscle and restored its function.

The effectiveness of eHealth interventions on female pelvic floor dysfunction: a systematic review and meta-analysis.

Introduction and hypothesiseHealth interventions represent a promising novel strategy in pelvic floor management for women. Nevertheless, the effectiveness of eHealth interventions among women with or at risk of pelvic floor dysfunction (PFD) has not been adequately discussed to date. This study aimed to determine the effectiveness of eHealth interventions in preventing and treating PFD among women.MethodsEleven electronic databases were searched for randomized controlled trials (RCTs) from inception until August 28, 2021.ResultsTwenty-four RCTs were included in this meta-analysis that included 3691 women. The meta-analysis showed that eHealth interventions were not only vital for preventing PFD (pregnant women: pooled OR = 0.25, 95% CI: 0.14 to 0.45, p < 0.001; postnatal women: pooled OR = 0.19, 95% CI: 0.06 to 0.60, p = 0.005), but also for reducing the severity of PFD (pooled SMD = -0.63, 95% CI: -1.20 to -0.06, p = 0.031). In addition, compared with traditional care, eHealth interventions showed significant positive effects on several outcome indicators, including quality of life (pooled SMD = 0.49, 95% CI: 0.19 to 0.80, p = 0.002), pelvic floor type I muscle strength (pooled OR = 1.92, 95% CI: 1.30 to 2.82, p = 0.001), pelvic floor type II muscle strength (pooled OR = 2.04, 95% CI: 1.38 to 3.01, p < 0.001), sexual function (pooled SMD = 0.51, 95% CI: 0.29 to 0.73, p < 0.001), satisfaction (pooled OR = 3.93, 95% CI: 2.73 to 5.66, p < 0.001), and self-efficacy (pooled SMD = 2.62, 95% CI: 2.12 to 3.13, p < 0.001).ConclusionseHealth interventions are an effective emerging treatment and preventive modality for female PFD. Higher quality, larger scale, and strictly designed RCTs are warranted to evaluate the effectiveness of eHealth interventions on female pelvic floor management.

Enhancing Female Pelvic Anatomy Education with Clinical Vignettes and Problem‐Based Learning (PBL)

IntroductionFemale pelvic anatomy poses challenges for learners due to complexity of the spatial relationships between pelvic floor structures. As anatomy education continue to implement novel approaches such as use of 3D and interactive models to enhance student learning,1 strategies to improve the medical school curriculum remain vast. Problem‐based learning (PBL) is often recognized as a successful teaching method in which learners are encouraged to apply their own knowledge and investigative skills in solving defined problems.2 This study will analyze the effects of using clinical scenarios and PBL in combination with prosected cadavers on student recall ability and knowledge base improvement.ObjectivesIncorporation of clinical vignettes and PBL with prosected cadavers will facilitate improved understanding of female pelvic anatomy compared with using only prosected cadavers.MethodsFirst‐year medical students at Florida International University HWCOM class of 2025 were put into 16 groups of approximately 7 to 10 students (n=137) and rotated through four 25‐minutes stations. One station was facilitated by a 4th year medical student teaching assistant (TA), who used clinical vignettes and PBL combined with a prosected female cadaver that exposed pelvic floor structures. Students also rotated at three other 25‐minute stations (before or after) containing radiologic imaging of relevant anatomy, self‐study, and a procedural station (ureteral catheterization). Prior to the TA station, the students were provided a pre‐session examination containing 2 questions to assess their knowledge of common female pelvic anatomy concepts. Students were then provided the same questions after completing the station to assess for enhanced recall. Both the pre‐ and post‐session examinations used clinical vignettes with multiple choice answers (A through D). Students received 1 point if they answered correctly and 0 points if they answered incorrectly.ResultsFor the first question assessing proximity of the uterine artery to the ureter, 91% of students answered correctly in the post‐test, compared with 67% in the pre‐test. For the second question assessing ovarian torsion, 72% answered correctly in both the pre‐ and post‐tests.Conclusion/ Significance and ImplicationThe results of the first question supports that the use of clinical vignettes and PBL in addition to cadaver prosection can improve the student knowledge base. However, the results of the second question did not support the hypothesis. Possible contributors could be due to lack of standardization in teaching styles among different instructors on the female cadaver or that addition of PBL may be insufficient to generate better outcomes in learning for questions that are of higher complexity. Potential follow up to this study could include assessing for alternative confounders to explore discrepancies in the results.1. Hampton BS, Sung VW. Improving medical student knowledge of female pelvic floor dysfunction and anatomy: a randomized trial. Am J Obstet Gynecol. 2010 Jun;202(6):601.e1‐8. doi: 10.1016/j.ajog.2009.08.038. Epub 2010 Apr 28.2. Savery JR. Overview of problem‐based learning: definitions and distinctions. Interdiscip J Probl Based Learn. 2006;1(1):9–20.

Image Enhancement Algorithm-Based Ultrasound on Pelvic Floor Rehabilitation Training in Preventing Postpartum Female Pelvic Floor Dysfunction.

In order to explore the application value of image enhancement algorithm in evaluating pelvic floor rehabilitation training in the prevention of postpartum female pelvic floor dysfunction (FPFD), 70 patients with FPFD were selected as the study subjects and randomly divided into two groups. One group received routine nursing (control group, n = 35), and the other group received pelvic floor rehabilitation training based on routine nursing (experimental group, n = 35). In ultrasound images based on an image enhancement algorithm, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Pelvic Floor Distress Inventory-20 (PFDI-20) were used to evaluate the efficacy. The results showed that after image enhancement algorithm processing, the image signal-to-noise ratio (SNR), peak signal-to-noise ratio (PSNR), and structural similarity index (SSIM) of ultrasound images of patients with FPFD were significantly improved (P < 0.05); the mean square error (MSE) was significantly decreased (P < 0.05); the diagnostic accuracy of FPFD in the original ultrasound images was 73.34%, and that after image enhancement algorithm processing was significantly improved to be 89.86% (P < 0.05). In addition, the overall clinical response rate of FPFD in the experimental group (82.86%) was obviously higher than that in the control group (51.43%) (P < 0.05). After rehabilitation training, the ICIQ-SF and PFDI-20 scores of patients with FPFD in the two groups suggested a significant decrease (P < 0.05). In summary, using an image enhancement algorithm has a good application prospect in evaluating pelvic floor rehabilitation training in preventing postpartum FPFD and is worthy of further promotion.

What is the real burden of the overactive bladder? Results from a national prevalence study.

To describe the prevalence of overactive bladder determining patient-reported outcome measures (PROMS) and potential risk factors. A cross-sectional population-based study to estimate lower urinary tract symptoms (LUTS) prevalence in the Colombian population was performed (COBaLT study). Overactive bladder (OAB) was assessed using 2002 International Continence Society definitions and the Report on the Terminology for Female Pelvic Floor Dysfunction. PROMS were included to evaluate participant's perceptions of health-related quality of life (QoL). Spanish validated questionnaires were used, including the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Patient Perception of Bladder Condition (PPBC) scale. A total of 1060 individuals were assessed. The mean age of participants was 42.2 years, and most participants were Hispanic (93.15%). The overall prevalence of OAB syndrome was 31.70%, and it was more frequently reported in women than in men (39.25% vs. 24.15%). Most participants with OAB did not perceive their symptoms as bothersome. The most bothersome symptom, associated with moderate/severe impact in QoL was urinary urgency. According to the PPBC questionnaire 75.6% of the participants reported that their bladder condition does not cause any problem, while 11.% reported moderate to severe bother. The multivariable model showed high blood pressure and anxiety were associated with OAB in men. In females, depression, obstructive sleep apnea, IBS, and pelvic organ prolapse were associated with OAB syndrome. Using the symptomatic definition of OAB can overestimate the real impact and burden of the condition, and treatment should be targeted to those symptomatic patients with QoL impairment as they would benefit from further management. The questionnaires seem to overestimate the condition, since we assessed it from a PROMS perspective there is not such a marked QoL impact.

Injectable recombinant human collagen-derived material with high cell adhesion activity limits adverse remodelling and improves pelvic floor function in pelvic floor dysfunction rats

Female pelvic floor dysfunction (FPFD) is a life-changing condition that severely affects women's physical and mental health. Despite the effectiveness of current treatments for FPFD, there is a high rate of short-term recurrence. Here, we introduced an injectable recombinant human collagen (rhCOL)-derived material with high cell adhesion activity to achieve pelvic floor repair and extracellular matrix (ECM) assembly. In our study, rhCOL promoted human uterosacral ligament fibroblast (HULF) adhesion, migration, and collagen I and III expression and regulated the metabolism of HULFs in vitro. Subsequently, we established a rat model of FPFD. Then, rhCOL, including rhCOLI and rhCOLIII, was perivaginally injected into FPFD rats, resulting in a significant increase in abdominal urine leak point pressure (LPP) and maximum tensile strength compared to the FPFD model group. Better organization of the lamina propria and muscularis in FPFD rats was observed after 14 days of rhCOL treatment. Meanwhile, the expression of collagen I, collagen III, and TIMP1 was upregulated, and MMP2 was downregulated. Furthermore, rhCOL promoted HULF adhesion, migration, and ECM synthesis by upregulating the focal adhesion kinase (FAK)/RhoA/ROCK signalling pathway in vitro and in vivo. These findings suggest that the perivaginal injection of rhCOL is a promising treatment for FPFD with potential for future clinical use.

Experience of Individualized Pelvic Floor Rehabilitation Therapy for Female Pelvic Floor Dysfunction

Experience of Individualized Pelvic Floor Rehabilitation Therapy for Female Pelvic Floor Dysfunction