Incontinence Sexual Function Questionnaire Research Articles

Effects of external neuromuscular electrical stimulation in women with urgency urinary incontinence: a randomized sham-controlled study

Background and PurposeThe present study aims to investigate the effects of external neuromuscular electrical stimulation (NMES) on urinary symptoms, pelvic floor muscle strength (PFMS), quality of life (QoL), sexual function, perception of subjective improvement (PSI), and satisfaction in urgency urinary incontinence (UUI).Materials and MethodsThe randomized sham-controlled study design was employed in this study. Women aged 18–65 years, who were diagnosed with UUI, were randomly allocated into the NMES (external NMES + lifestyle advice, n = 15) and sham groups (sham NMES + lifestyle advice, n = 15). Both groups performed the application for 30 min, three days a week for eight weeks. Urinary symptoms were evaluated by using the International Incontinence Consultation Questionnaire-Short Form (ICIQ-SF) and a 3-day bladder diary. PFMS was assessed using the Modified Oxford Scale (MOS), QoL using the King’s Health Questionnaire (KHQ), and sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). The PSI and satisfaction were questioned.ResultsThere was a higher level of decrease in the ICIQ-SF score, the mean number of voids/night and UI, all scores related to the KHQ (excluding interpersonal relationships), and a higher level of increase in maximum voiding volume, MOS scores, PISQ-12-emotional, PISQ-12-physical, and PISQ-12-total scores in the NMES group when compared to the sham group (p < 0.05). PSI and satisfaction were at higher levels in the NMES group than in the sham group (p < 0.05).ConclusionsExternal NMES was an effective and complementary method in reducing urinary symptoms and improving PFMS, QoL, sexual function, PSI, and satisfaction level in women with UUI.Clinical Trial RegistrationNCT04727983.

Polypropylene anterior-apical single-incision UPHOLD-LITE mesh surgery in women with severe pelvic organ prolapse: Outcome at 53 months follow up

Background and purposeWe present this current study to complement with mesh inlays plausible benefits (UPHOLD-LITE System) on available long-term study amidst FDA's concern on mesh complications. This study aims to assess the medium-term outcomes of UPHOLD-LITE system for treatment of advanced pelvic organ prolapse (POP) and its complications, and lower urinary tract symptoms. MethodsThis is a retrospective case series of 53 months follow-up of 123 consecutive patients who underwent UPHOLD-LITE system. Objective outcome measures the anatomical correction of prolapse with POP-Q ≤ Stage 1. Subjective outcome was patient's feedback to questions 2 and 3 of POPDI-6. Secondary outcome measures the quality of life, presence of lower urinary tract symptoms and complications. Quality of life is assessed by validated questionnaires on Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire 7 (IIQ-7), Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 (PISQ-12) at 1 and 3 years post-operatively. ResultsObjective outcome at 1 and 3 years was at 96.7 % and 95.4 % respectively. The subjective cure was 95.1 % and 91.6 %. Five-year cumulative cure rate maintained at 87.2 %. Secondary outcomes observed improvement on UDI-6, IIQ-7, POPDI-6 and PISQ-12 postoperatively. Bladder outlet obstruction improved while de novo urodynamic stress incontinence (USI) increased slightly post surgically. Mesh erosion rate was 0.8 %. ConclusionThe UPHOLD-LITE system demonstrated good medium term anatomical correction of apical and anterior prolapse, with good subjective cure and improved quality of life. Whilst complication rate was low, slight increase in de novo USI was observed.

MP07-14 THE ASSOCIATION BETWEEN SOCIOCULTURAL AND PSYCHOSOCIAL FACTORS AND THE SEXUAL FUNCTION OF LATINA WOMEN WITH PELVIC FLOOR DISORDERS

You have accessJournal of UrologyCME1 Apr 2023MP07-14 THE ASSOCIATION BETWEEN SOCIOCULTURAL AND PSYCHOSOCIAL FACTORS AND THE SEXUAL FUNCTION OF LATINA WOMEN WITH PELVIC FLOOR DISORDERS Unwanaobong Nseyo, Nanjun Chen, Madeleine Burg, Claudia Sevilla, Nahid Yousif, Christina Dancz, David Ginsberg, Mariana C. Stern, and Larissa V. Rodriguez Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Nanjun ChenNanjun Chen More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Claudia SevillaClaudia Sevilla More articles by this author , Nahid YousifNahid Yousif More articles by this author , Christina DanczChristina Dancz More articles by this author , David GinsbergDavid Ginsberg More articles by this author , Mariana C. SternMariana C. Stern More articles by this author , and Larissa V. RodriguezLarissa V. Rodriguez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female sexual function is impacted by the presence of pelvic floor disorders (PFDs). Racial disparities exist in the relationship between PFDs and sexual function. Little is understood regarding the factors that influence these disparities. We evaluated the demographic, sociocultural, and psychosocial factors, namely stress and discrimination, associated with sexual function among Latina women in a clinical setting. METHODS: We conducted a prospective cross-sectional study of Spanish and English-speaking Latina women with and without PFDs recruited from Urology and Urogynecology clinics at a large private or public hospital. We used validated questionnaires to assess the presence of PFDs, Pelvic Floor Disorders Inventory (PFDI-20), and sexual function, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12). We performed a subset analysis of sexually active women with PFDs. Self-reported psychosocial stress was assessed with the 10-item Perceived Stress Scale (PSS), including protective and negative domains, and the Everyday Discrimination Scale (EDS). We performed linear regression analysis to assess the relationship between PISQ-12 score and demographic, cultural and psychosocial metrics, significant at a value of p-value ≤0.05. RESULTS: Of the 153 total study participants, 53 (34.6 %) completed the PISQ-12 with mean PISQ-12 scores of 29.9 with 8.0, 8.6 and 13.2 on the partner, behavior, and physical domains, respectively. Compared to non-sexually active women, sexually active women were slightly older (50.1 vs 47.9, p=0.34), with significantly worse bowel (27.3 vs 15.2, p=0.005), urinary (67.3 vs 31.8, p<0.001), and prolapse symptoms (45.9 vs 20.8, p<0.001). On linear regression analysis, positive associations were seen with better sexual function and Mexican-American values of familism (p=0.05), respect (p=0.04), religion (p=0.02), and being employed (p=0.05), with a trend towards significance for the PSS negative subscore (p=0.06). A negative correlation was observed for Mainstream values of independence (p=0.05), age (p=0.05). CONCLUSIONS: Among Latina women who presented to clinic for management of their PFDs, better sexual function was more associated with Mexican-American values. The specific domains of the Mexican-American values scale highlight areas of importance for maintaining sexual function despite PFDs for Latina women and suggest sociocultural drivers of disparities in sexual function among racial/ethnic minority women with PFDs. Source of Funding: CTSI Pilot Grant Funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e90 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Unwanaobong Nseyo More articles by this author Nanjun Chen More articles by this author Madeleine Burg More articles by this author Claudia Sevilla More articles by this author Nahid Yousif More articles by this author Christina Dancz More articles by this author David Ginsberg More articles by this author Mariana C. Stern More articles by this author Larissa V. Rodriguez More articles by this author Expand All Advertisement PDF downloadLoading ...

Changes in sexual function over 12months after native-tissue vaginal pelvic organ prolapse surgery with and without hysterectomy.

There is a need to determine how preoperative sexual activity, uterine preservation, and hysterectomy affect sexual function after pelvic organ prolapse surgery. (1) To determine changes in sexual function in women, stratified by preoperative sexual activity status, after native-tissue pelvic organ prolapse surgery. (2) To examine the impact of hysterectomy and uterine preservation on sexual function. (3) To determine predictors for postoperative dyspareunia. This was a planned secondary analysis of a prospective cohort study. Sexual function was evaluated preoperatively and 6 and 12months postoperatively. Sexual function was compared between those who had a hysterectomy and those who had uterine-preserving prolapse surgery. A logistic regression analysis was performed to assess predictors for dyspareunia. Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire. At 12months, 59 patients underwent surgery and were followed up (hysterectomy [n = 28, 47.5%] vs no hysterectomy [n = 31, 52.5%]; sexually active [n = 26, 44.1%] vs non-sexually active [n = 33, 55.9%]). Of those who did not undergo a hysterectomy, 17 (54.8%) had a uterine-preserving procedure. At 12months, sexually active patients had significant improvement in sexual function (mean ± SD, 0.37 ± 0.43; P = .005), while non-sexually active patients reported significant improvement in satisfaction of sex life (P = .04) and not feeling sexually inferior (P = .003) or angry (P = .03) because of prolapse. No variables were associated with dyspareunia on bivariate analysis. It did not appear that either uterine preservation or hysterectomy had any impact on sexual function. There was a 10% increase in people who were sexually active after surgery. The major strength of our study is the use of a condition-specific validated questionnaire intended for sexually active and non-sexually active women. We interpreted our results utilizing a validated minimal clinically important difference score to provide interpretation of our results with statistical and clinical significance. The limitation of our study is that it was a secondary analysis that was not powered for these specific outcomes. At 12months, for patients who were sexually active preoperatively, there was a clinically meaningful improvement in sexual function after native-tissue pelvic organ prolapse surgery. Non-sexually active women reported improvement in satisfaction of sex life. There was no difference in the sexual function of patients undergoing uterine preservation or posthysterectomy colpopexy when compared with those with concurrent hysterectomy, though this sample size was small.

Sexual Dysfunction in Women Suffering from Gynecological Diseases

The analysis of long-term efficiency of operative treatment of pelvic prolapse for 213 women in periods ranging from 12 through questionnaire PISQ-12 (Pelvic Organ Prolapse and Incontinence Sexual Function Questionnaire), recommended for use in clinical practice of the international urogynaecologic Association and adapted by the authors for work . Method of evaluating the effectiveness of surgical treatment of pelvic and prostate has been streamlined through the introduction of a system of qualitative analysis of the results of the study of sexual function. Found that operational treatments pelvic prolapse have a positive effect on sexual function of women. Significant differences of sexual function in remote postoperative period depending on the type of operational benefits.The best effect with regard to the favourable dynamics of sexual function is achieved after laparoscopic operative treatment of pelvic prolapse compared with vaginal hysterectomy

Cross-cultural Adaptation and Validation of the Hebrew Version of the Vulvar Functional Status Questionnaire (VQ)

Background: As yet, no Hebrew language vulvar functional status questionnaire exists. Aims: To perform a cross-cultural adaptation of a Hebrew version of the Vulvar Functional Status Questionnaire (VQ), a validated tool used for evaluating dyspareunia among women, and to evaluate the psychometric properties of this version by examining the correlations between results of the questionnaire among women with pain during intercourse and quality of life, level of anxiety, and pelvic floor function. Methods: The English version of the VQ underwent cross-cultural adaptation to Hebrew according to accepted guidelines. Eighty Hebrew-speaking women with vulvar pain, aged older than 18 years, participated in the study. Participants completed the VQ-Hebrew (VQ-H) (see Supplemental Digital Content, available at: https://links.lww.com/JWHPT/A89), the Hebrew versions of the health-related quality-of-life questionnaire (SF-12), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and the State-Trait Anxiety Inventory (STAI). All the participants completed the VQ-H again after 2 to 3 weeks. Psychometric properties (test-retest reliability, internal consistency, convergent validity, and factor analysis) were calculated. Results: The VQ-H demonstrated excellent test-retest reliability: intraclass correlation coefficients ranged from 0.898 to 0.958 (P < .001); the Cronbach α was excellent (0.935). A significant correlation was found between the VQ-H and SF-12 scores (r =−0.360, P = .001). However, the correlation between the VQ-H and STAI and PISQ-12 scores was not statistically significant (r = 0.172, P = .127 and r =−0.185, P = .100, respectively). Factor analysis revealed a 4-factor solution representing daily function and pain provoked by or related to various activities. Conclusion: The VQ-H is a valid and reliable instrument. Its scores reflect the impaired function in all domains of vulvar pain among Hebrew-speaking women.

CO2 Surgical Laser for Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial

ABSTRACT The common condition of stress urinary incontinence (SUI) has a reported prevalence of 10% to 39% in adult women in most studies. Although treatment of SUI via surgical means is an option, factors such as adverse effects of surgery and mesh-related risks lead many to seek alternative options. In overweight and obese patients, lifestyle changes for improving SUI symptoms entail mainly weight loss. Although pelvic floor muscle training (PFMT) can lead to improvements, further treatment is often necessary. Because of this, interest is high for developing effective nonsurgical treatments for SUI. One such possible treatment is vaginal laser therapy, which has been used as treatment for various vaginal conditions. The authors therefore carried out a randomized controlled trial (RCT) comparing CO2 laser with sham treatment for SUI. This multicenter, participant-blinded, sham-controlled, parallel-group, superiority RCT involved participants from 2 hospitals in Southeast Melbourne in the outpatient setting. Patients aged 18 to 80 years experiencing symptomatic and objective SUI and seeking conservative management participated. Women with prior surgery for SUI were excluded. A positive cough stress test with a comfortably full bladder and uroflow was used to determine objective SUI. Participants lacking positive cough stress test were still eligible for study inclusion with a positive pad weight test in the absence of urgency incontinence symptoms. Intervention took place using FemTouch delivery system in conjunction with the AcuScan 120 Microscanner and the AcuPulse CO2 laser system for fractional treatment. Laser energy was delivered via a standard foot pedal in a fractional manner. The sham treatment used identical methods and settings but used an inactive pedal, which only made mechanical clicks and no electronic beeps. A total of 3 treatments were administered to participants, 4 weeks apart, with incrementally greater density settings. The primary outcome of the study was subjective SUI (defined as positive answers to the inquiries: “Do you leak when you cough or sneeze?” or “Do you leak when physically active/exercising?”). Secondary outcomes were assessed via the Patient Global Impression of Improvement, and International Consultation on Incontinence Questionnaire–urinary incontinence change, International Consultation on Incontinence Questionnaire-overactive bladder, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, the Incontinence Impact Questionnaire–Short Form, and EQ-5D scores. In addition, adverse events (such as pain during the procedure as measured on a visual analog scale) and objective SUI were recorded. A sample size of 101 was chosen to provide 80% power to detect differences between groups for the primary outcome (even assuming a 10% rate of attrition). A total of 97 participants ultimately were treated. Randomization of participants occurred with equal probability to sham treatment or the CO2 laser using a computer-generated random sequence, which allocated participants to blocks of 4, 6, and 8. Unblinding of participants to their allocation occurred following the 3-month review. Participants had a mean age of 53 years and a mean body mass index of 26.1 kg/m2, and 90% were vaginally parous. Most participants had attempted PFMT either independently or under supervision. No detectable difference was found between the sham and active treatment arm in the primary outcome of leak with laughter or cough. Furthermore, there were no significant differences between groups with regard to any of the secondary, patient-reported outcomes of questionnaires. The authors tested the reliability of their masking by assessing whether patients could identify their allocation group. Between the 2 groups, 17 (54%) of the sham group and 15 (63%) of the active treatment group believed they received sham treatment. Adverse events were rare in both groups, with similar visual analog pain scores during treatment and only rare vaginal bleeding and urgency incontinence in both groups. Strengths of this study are several and include its blinded design and randomization methods. The primary outcome was focused on patient-reported outcomes. Responsive and validated questionnaires were utilized for assessment of secondary outcomes. Study limitations include a lack of blinding for investigators, which could have introduced an element of detection bias for SUI. In conclusion, no benefit was shown for 3 treatment sessions of the CO2 vaginal laser when compared with sham therapy. Additional trials with various laser modalities are necessary to determine whether this may produce varying results. Women considering CO2 vaginal laser therapy for SUI should be made aware of the lack of consistent high-quality evidence in support of this treatment.

Role of top flat magnetic stimulation for urinary incontinence as a debilitating condition of pelvic floor dysfunction: an observational evaluation of Latin American population.

Urinary incontinence (UI) is a common dysfunction of the pelvic floor, affecting 10-20% of all women, and up to 70% in the elderly general prevalence of 17% 20-year-old women and 38% in women over 60years. It is estimated that only 25% of patients seek treatment for this debilitating condition. The aim of this study was to evaluate the efficacy of a device based on top flat magnetic stimulation to treat pelvic floor disorders especially female urinary incontinence. A total of 33 volunteer patients were divided into 5 groups according to the type of complaint. Subjects received 8 treatment sessions, with a frequency of twice a week with two different settings. Pelvic Floor Bother Questionnaire (PFBQ), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and Urinary Incontinence Short Form (ICIQ-UI-SF) were compiled by all patients at the beginning and after 3months from the end of the last treatment (3MFU). The patient's scores from validated Questionnaires significantly decreased (p < 0.01) from baseline up to 3MFU inside most of the groups. The noninvasiveness and safety of device make this approach an interesting tool as alternative approach for pelvic floor dysfunctions .

Quality of Life Following Pelvic Organ Prolapse Treatments in Women: A Systematic Review and Meta-Analysis.

Introduction: Quality of life (QoL) improvement is one of the main outcomes in the management of pelvic organ prolapse as a chronic illness in women. This systematic review aimed to investigate the impact of surgical or pessary treatment for pelvic organ prolapse (POP) on quality of life. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was applied. Electronic databases, including PubMed, Scopus, and Web of Science, were searched for original articles that evaluated the QoL before and after surgical interventions or pessary in pelvic organ prolapse from 1 January 2012 until 30 June 2022 with a combination of proper keywords. Included studies were categorized based on interventions, and they were tabulated to summarize the results. Results: Overall, 587 citations were retrieved. Of these, 76 articles were found eligible for final review. Overall, three categories of intervention were identified: vaginal surgeries (47 studies), abdominal surgeries (18 studies), and pessary intervention (11 studies). Almost all interventions were associated with improved quality of life. The results of the meta-analysis showed a significant association between the employment of surgical approach techniques (including vaginal and abdominal surgeries) and the quality of life (Pelvic Floor Distress Inventory (PFDI) (MD: −48.08, 95% CI: −62.34 to −33.77, p-value < 0.01), Pelvic Floor Impact Questionnaire (PFIQ) (MD: −33.41, 95% CI: −43.48 to −23.34, p < 0.01)) and sexual activity of patients with pelvic organ prolapse (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) (MD: 4.84, 95% CI: 1.75 to 7.92, p < 0.01)). Furthermore, narrative synthesis for studies investigating the effect of the pessary approach showed a positive association between the use of this instrument and improvement in the quality of life and sexual activity. Conclusions: The results of our study revealed a significant improvement in the women’s quality of life following abdominal and vaginal reconstructive surgery. The use of pessary was also associated with increased patient quality of life.

Uterine-sparing laparoscopic lateral suspension in the treatment of pelvic organ prolapse.

Apical prolapse is an important component of pelvic organ prolapse. The aim of our study was to investigate the effectiveness of laparoscopic lateral suspension (LLS) surgery, which we performed while sparing the uterus. LLS surgery was performed on 62 patients due to apical prolapse, preserving their uterus. The patients' pelvic organ prolapse quantification system (POP-Q) points and sexual function using pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) prior to and 12 months following the surgery were compared, and the results were evaluated. The POP-Q points and PISQ-12 scores evaluating sexual function of the patients who underwent LLS were significantly improved compared to pre-operation values (p˂0.001). No intraoperative complications were observed in the patients. Recurrence was observed in 6 (9.6%) of 62 total cases in post-operative follow-up. Apical prolapse was seen in two patients (3.2%), and anterior vaginal wall recurrence was observed in one patient (1.6%). Posterior vaginal wall recurrence was seen in three patients (4.8%). Pelvic pain complications were observed in four patients (6.4%) in the postoperative follow-up. Mesh erosion was not observed in any of the cases. It was observed that 5 (38%) of 13 patients with stress urinary incontinence (SUI) had improved SUI complaints after surgery. The mean operation time was 66.3 ± 12.3 min. LLS is an effective and safe method for patients with apical prolapse who want to preserve their uterus. LLS can be applied as an alternative to the sacrocolpopexy procedure, which has risks such as potentially serious neurological and life-threatening vascular injury in the sacral region.

Validation of the Serbian version of the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Questionnaire short form (PISQ-12).

Urinary incontinence (UI) and pelvic organ prolapse (POP) significantly decrease quality of life and sexual health. This study aimed to evaluate the reliability and validity of a Serbian adaptation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) used in assessing sexual function in women with UI and/or POP. This study included 416 women, 310 (74.5%) with UI and/or POP and 106 (25.5%) without UI and/or POP. The adaptation of the PISQ-12 to Serbian language was performed via back-translation. The content validity of the questionnaire was conducted by experts in the field. The reliability and validity of the PISQ-12 were analyzed. Evaluation of the data was performed using Content Validity Index (CVI), Cronbach's alpha, test-retest reliability, item total correlation and confirmatory factor analysis. Content validity of the Serbian PISQ-12 was 1.00 (100%). Item total correlations were between 0.459 and 0.819 (P < 0.001). The PISQ-12 had an adequate and high internal consistency (Cronbach's alpha 0.806) as well as high test-retest reliability (Pearson correlation coefficient r = 0.807; P < 0.001). Factor analysis results revealed strong construct validity. The mean scores of PISQ-12 were significantly better in the control group compared with the women with UI and/or POP. Sexual function was negatively affected by UI and/or POP as assessed with SF-36 and I-QoL questionnaires. This study showed that the Serbian version of the PISQ-12 is a reliable, consistent, valid and condition-specific instrument to assess sexual function in women with UI and/or POP.

Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery

Peri-urethral bulking injections (PBI) gain popularity for the treatment of stress urinary incontinence (SUI), but - in contrast to mid-urethral sling (MUS) surgery - little is known about its impact on sexual function. This was a secondary analysis of a prospective cohort study that included patients with moderate to severe SUI undergoing either MUS surgery or PBI with polydimethylsiloxane Urolastic (PDMS-U). The validated Dutch and English version of the 'Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Function Questionnaire - IUGA Revised' (PISQ-IR) was used to assess sexual function at baseline, at 6 and 12 months of follow-up. For between-group analysis, differences in baseline characteristics were corrected using multivariate analysis of covariance. The primary outcome was the PISQ-IR single summary score of sexually active (SA) women following both procedures, calculated by mean calculation. Secondary outcomes were the PISQ-IR subscale scores of SA and non-sexually active (NSA) women, the proportions of sexual activity and subjective improvement ('Patient Global Impression of Improvement' (PGI-I)). A total of 259 women (MUS: n = 146, PBI: n = 113) were included in this study. The PISQ-IR single summary score of SA women improved following both interventions (in the MUS group from 3.2 to 3.4 and in the PBI group from 3.0 to 3.3 after 12 months). After correcting for differences in baseline characteristics, the PISQ-IR summary score at 6 and 12 months was similar for both treatment groups. For SA women, condition-specific and condition-impact subscale scores significantly improved following both procedures. In treating SUI, PBI is inferior to MUS surgery. However, there is a need for less invasive strategies, especially for women who are unfit for surgery or have contraindications. Sexual function improves after PBI using PDMS-U, which is relevant for the counselling of women with SUI about available treatment options. Strength: until this study, there was a lack of knowledge about the effects of PBI on sexual function. Limitation: there may be indication bias as we did not perform a randomized controlled trial. PBI using PMDS-U and MUS surgery for the treatment of SUI improve sexual function equally in SA women, mainly by decreasing the condition's impact on sexual activity and quality.

Transvaginal single-port versus multi-port laparoscopic sacrocolpopexy: a retrospective cohort study

BackgroundSacrocolpopexy is the gold standard treatment for apical prolapse. With the development of minimally invasive surgical techniques, the new approach of transvaginal single-port laparoscopic sacrocolpopexy (TS-LSC) has become available. However, its therapeutic effects remain unclear. The aim of this study is to compare the middle-term clinical outcomes of transvaginal single-port laparoscopic sacrocolpopexy with multi-port laparoscopic sacrocolpopexy (LSC) for apical prolapse.MethodsWe conducted a retrospective cohort study. Patients with advanced apical prolapse who underwent either TS-LSC or LSC between May 2017 to June 2019 were enrolled. Baseline demographics, perioperative results, perioperative and postoperative complications, pelvic organ prolapse quantification (POPQ) scores, pelvic floor distress inventory (PFDI-20) score and pelvic organ prolapse/urinary incontinence sexual function questionnaire (PISQ-12) score were collected at 2 years.Results89 subjects were analyzed: 46 in TS-LSC and 43 in LSC group. Follow-up time was 38.67 ± 7.46 vs 41.81 ± 7.13 months, respectively. Baseline characteristics and perioperative outcomes were similar except that pain score was lower (2.37 ± 0.90 vs 3.74 ± 1.05) and cosmetic score was higher (9.02 ± 0.75 vs 7.21 ± 0.89) in TS-LSC group (P < 0.05). Complication rates did not differ between groups. 3 mesh exposure in each group were noted. Recurrence rate was 2.17% in TS-LSC and 6.98% in LSC, no apical recurrence occurred. Constipation was the most common postoperative symptom. Besides, patients in TS-LSC group had better POP-Q C point (− 6.83 ± 0.54 vs − 6.39 ± 0.62, P < 0.05), and similar Aa, Ap and TVL values. Bladder and pelvic symptoms were improved in both groups, but colorectal symptoms were not relieved. There were no differences of PISQ-12 scores between groups.ConclusionTS-LSC was not inferior to LSC at 2 years. Patients may benefit from its mild pain, better cosmetic effect and better apical support as well as good safety and efficacy. TS-LSC is a promising considerable choice for advanced vaginal apical prolapse.Trial registration ChiCTR2000032334, 2020-4-26 (retrospectively registered)

Improvement in dyspareunia after vaginal mesh removal measured by a validated questionnaire.

The objective was to examine the effect of the surgical removal of vaginally placed prolapse and incontinence mesh on sexual function. We hypothesize that patients with painful complications of mesh will experience improvement in dyspareunia and sexual function after mesh removal. The eligible cohort consisted of 133 women who presented with a new onset of pain attributed to mesh-augmented incontinence or prolapse surgery and who elected to undergo mesh removal between 1 August 2012 and 1 July 2013. Sexual function symptoms were assessed before and after mesh removal surgery using the Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12). Multivariate analysis was performed to identify predictors of improvement in dyspareunia. Ninety-four patients undergoing mesh removal completed a pre-operative questionnaire, 63 of whom also completed a post-operative questionnaire. After mesh removal, there was a nearly 50% reduction in the proportion of women reporting always experiencing post-operative pain with intercourse among those experiencing pre-operative pain. There was a statistically significant quantitative improvement in pain with intercourse after mesh removal based on mean change score of PISQ-12 question 5 "How often do you experience pain with intercourse?". In multivariate analysis, only history of vaginal delivery was associated with symptom improvement. Removal of transvaginal prolapse mesh is associated with improvement in self-reported dyspareunia based on a standardized question on a validated instrument in a small cohort of women. Although larger studies are needed to confirm the relationship between mesh-augmented surgeries and post-procedural dyspareunia, these data suggest that consideration of mesh removal is a reasonable step for patients with painful intercourse attributed to mesh-augmented prolapse and incontinence surgeries.

Minimal Clinically Important Difference (MCID) for the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire – IUGA Revised (PISQ-IR)

BackgroundTo put statistically significant changes in patient reported outcome measurement (PROM) questionnaires into a clinical perspective, the concept of the minimal clinically important difference (MCID) can be used. AimTo determine the MCID for the summary score for sexually active (SA) women of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), a validated instrument which assesses sexual functioning (SF) for patients suffering from a symptomatic pelvic floor disorder. MethodsPatients participating in a multicentre prospective cohort study comparing pessary therapy with surgery for a symptomatic pelvic organ prolapse (POP) filled in the PISQ-IR at baseline and 12 months’ follow-up. We used both an anchor-based as well as a distribution-based method to calculate the MCID for both treatment groups. The Patient Global Impression of Improvement (PGI-I) questionnaire and PISQ-IR question 19a about satisfaction with sexual functioning were used as anchors. For the distribution-based approach we used the effect size (ES). OutcomesMCID for the SA summary score of the PISQ-IR. ResultsData of 243 women were used to calculate the MCID. In the pessary group, Kendall's tau-b correlation coefficients between the PISQ-IR summary score and both anchors were below the cut-off of 0.21, which implies the anchors cannot be used to calculate an MCID. In our surgery group, the PISQ-IR question 19a met the anchor criteria and 0.31 points increase in the PISQ-IR summary score was equal to an improvement of 1 point on question 19a about satisfaction with sexual functioning. Clinical implicationsFuture research on this subject should focus on clinical relevance of results rather than statistical significance only. Strengths & LimitationsOur main strength is the fact that we used both anchor-based and distribution-based methods to determine our MCID. Secondly, we set out to determine an MCID for both treatment groups separately, which relatively enhances the generalisability of our results. A limitation is that we were not able to estimate an MCID for the pessary group.Pruijssers B, van der Vaart L, Milani F, et al. Minimal Clinically Important Difference (MCID) for the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire – IUGA Revised (PISQ-IR). J Sex Med 2021;18:1265–1270. ConclusionWe estimated the MCID for the PISQ-IR SA summary score to be 0.31 in our surgery group.

Generic Health-Related Quality of Life in Patients Seeking Care for Pelvic Organ Prolapse

Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry for Research, we (1) compared generic quality of life (QOL) in women planning pelvic organ prolapse (POP) treatment (surgery vs pessary), (2) correlated generic and condition-specific QOL scores, and (3) identified associations between generic QOL and other factors. This cross-sectional analysis assessed generic physical and mental QOL using the Patient-Reported Outcomes Measurement Information System Global Health Scale at baseline. Global Physical and Mental T-scores center on a representative US population sample (mean [SD], 50 [10]; higher scores, better health). Condition-specific QOL was assessed with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire. Linear regression models identified associations between clinical factors and Global Physical/Mental scores. Five hundred sixty-eight women (419 surgery, 149 pessary) were included. Surgery patients were younger, heavier, and more often sexually active (all P's ≤ 0.01). Global Physical scores were lower in the surgery versus pessary group, but not likely clinically meaningful (mean [SD], 48.8 [8.1] vs 50.4 [8.5]; P = 0.035); Global Mental scores were similar (51.4 [8.4] vs 51.9 [9.5], P = 0.56). Global Health scores correlated with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire scores (all P's < 0.0001). In multivariable models, menopause was associated with better physical QOL, and constipation, coronary artery disease, pelvic pain, and increased body mass index with worse physical QOL. Age was associated with better mental QOL, and constipation, fecal incontinence, pelvic pain, and coronary artery disease with worse mental QOL. Women choosing POP surgery versus pessary had similar physical and mental generic QOL.

A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine.

Patient-reported outcome measures (PROMs) are widely used in clinical practice and research in urogynaecology. There is no consensus on which PROMs should be used. No unifying document identifies all available PROMs and compares the psychometric properties of these. Systematic review of the literature following PRISMA guidelines. Studies where women had been administered an English-language PROM which assessed pelvic-floor symptomatology and psychometric properties had been reported were included. 85 PROMs assessing pelvic-floor symptoms in a urogynaecology population were identified. 43 PROMs assessed lower urinary tract symptoms in 95 studies, four PROMS assessed vaginal symptoms in seven studies, 20 PROMs assessed bowel symptoms in 27 studies and three PROMs assessed sexual symptoms in seven studies. 15 PROMs assessed two or more of these symptom areas in 60 studies. PROMs with the with the best available psychometric evidence within these five areas were (urinary symptoms) the Incontinence Quality-of-Life questionnaire (I-QOL aka ICIQ-UIqol) and International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), (bowel symptoms) the Accidental Bowel Leakage Evaluation (ABLE) questionnaire and the International Consultation on Incontinence Bowel questionnaire (ICIQ-B), (vaginal symptoms) the Pelvic Organ Prolapse Symptom Score (POPSS), (sexual symptoms) the Pelvic organ prolapse- urinary Incontinence Sexual function Questionnaire- IUGA revised (PISQ-IR) and (comprehensive PROMs) the Australian Pelvic Floor Questionnaire and the Electronic Personal Assessment Questionnaire-Pelvic-Floor (ePAQ-PF). Multiple PROMs with robust psychometric properties are available. Some widely used PROMs have weak evidence. Formal recommendations on which English-language PROMs to use within clinical practice and research in urogynaecology are required.

Randomized trial comparing efficacy of pelvic floor muscle training with a digital therapeutic motion-based device to standard pelvic floor exercises for treatment of stress urinary incontinence (SUV trial): An all-virtual trial design

ObjectiveTo compare the efficacy of an Intravaginal Motion-Based Digital Health System (PDHS) compared to standardized Pelvic Floor Muscle Training (PFMT) for the treatment of stress or stress-predominant urinary incontinence (SUI). MethodsThis is a virtually conducted prospective randomized controlled trial. The primary outcomes are change in urinary incontinence episodes by 3-day bladder diary and change in Urogenital Distress Inventory-6 score, measured at 8 weeks. Secondary outcomes include: Patient Global Impression of Severity (PGI-S), PGI-Improvement (PGI-I), Pelvic Floor Distress Inventory-20(PFDI-20), Pelvic Floor Impact Questionnaire-7(PFIQ-7), Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire (PISQ-IR), Short Form-2 (SF-20), and assessment of adverse event (AE). Subjects are randomized 1:1 to an intervention group using leva PDHS for PFMT or a control group, using a home Kegel exercise program. Sample size needed to identify a 60% difference in incontinence episodes from baseline to 8 weeks post-randomization using alpha = 0.05, and a power of 0.8 is 156 subjects. To identify a 30% difference in the UDI-6 score from Baseline to Week 8 (alpha = 0.05, power = 0.8, using a one-tailed t-test) the needed sample size is 278, and allowing for an attrition rate of 15%, will require approximately 350 subjects, providing power to detect differences in both primary outcomes. ResultsRecruitment was initiated September 2020 and is on target to date. The trial is projected to be complete in 2021and is registered at clinicaltrials.govNCT04508153. ConclusionThis novel virtual recruitment approach may provide more efficient recruitment of large numbers of subjects and provide input into the use of app-based management of pelvic floor interventions.

Prospective Study of Fractional Carbon Dioxide Laser Therapy for Symptoms of Genitourinary Syndrome of Menopause: One-Year Follow-Up

Background: Our objective is to prospectively evaluate pixelated carbon dioxide (CO 2 ) laser therapy for the treatment of symptomatic genitourinary syndrome of menopause (GSM) over 1 year using both subjective and objective assessment methods. Methods: Subjects with symptomatic GSM completed pre-treatment evaluations. Subjects underwent three standardized pixelated CO 2 laser treatments 4 weeks apart. Use of other treatments during the study period was prohibited. Subjects completed five subjective GSM questionnaires (visual analog grading scale for vaginal atrophy symptoms (VAS-VA), Symptoms of Atrophic Vaginitis Questionnaire (SAVQ), and a modified Vulvovaginal Symptom Questionnaire (mVSQ), Urinary Distress Inventory (UDI-6) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12)) and physical assessments (Bachmann Vaginal Health Index (BVHI) and Vaginal Health Assessment (VHA)) 2 weeks after each treatment, and at 1 year. Vaginal cytologic maturation assessment was performed before and after each treatment. Three random subjects also underwent vaginal biopsy after treatments were completed. A P value of less than 0.05 was considered statistically significant. Results: Fifteen subjects were recruited with an average age of 58.3 years (range 43 - 70). Subjects had significant improvements on four of the five subjective assessments of GSM and on the two objective indices, from baseline to shortly after the third treatment, and were maintained at 1-year follow-up, with no worsening of the improvements. Subjects did not have significant improvement in urinary symptoms. Histologically, the surface epithelium ranged from within normal limits to mild squamous atrophy. There was mild submucosal vascular congestion in all specimens, with evident neovascularization. Conclusions: Clinically significant improvement was noted in subjective and objective assessments of GSM, and was sustained for 1 year following pixelated CO 2 laser therapy. Histologic changes were consistent with mild submucosal neovascularization rather than estrogen-like epithelial squamous maturation. J Clin Gynecol Obstet. 2021;10(1):11-17 doi: https://doi.org/10.14740/jcgo729

Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence.

IntroductionThe pelvic floor muscle (PFM) could affect female sexual functions. The hip muscles are morphologically and functionally linked to PFM and are important elements of female sexual attraction.AimTo determine the relationship between female sexual function and hip muscle strength and PFM functions in women with stress urinary incontinence (SUI).MethodsA total of 42 women with SUI were recruited in this study. Female sexual function was measured using the pelvic organ prolapse urinary incontinence sexual function questionnaire (PISQ). PFM functions were measured using a perineometer. Hip muscle strength was measured using a Smart KEMA tension sensor. The relationship between female sexual function and PFM function and hip muscle strength was assessed using Pearson correlation coefficients and multiple regression analyses with forward selection.Main Outcome MeasuresPISQ score, PFM functions (strength and endurance), and strength of hip extensor, abductor, and adductor were the main outcome measures.ResultsFor the behavioral/emotive domain in the PISQ, hip extensor strength (r = 0.452), PFM strength (r = 0.441), PFM endurance (r = 0.362), and hip adductor strength (r = 0.324) were significantly correlated and hip extensor strength emerged in multiple regression. For the physical domain in the PISQ, hip abductor strength (r = 0.417), PFM endurance (r = 0.356), hip adductor strength (r = 0.332), and PFM strength (r = 0.322) were significantly correlated and hip abductor strength entered in multiple regression. For partner-related domain in the PISQ, hip adductor (r = 0.386) and abductor strength (r = 0.314) were significantly correlated and hip adductor strength appeared in multiple regression. For the PISQ total score, hip extensor strength (r = 0.484), PFM endurance (r = 0.470), hip adductor strength (r = 0.424), hip abductor strength (r = 0.393), and PFM strength (r = 0.387) were significantly correlated and hip extensor strength and PFM endurance emerged in multiple regression.ConclusionThe female sexual function could be related to not only PFM functions but also hip muscle strength in women with SUI. Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021;9:100325.