Pelvic Floor Impact Questionnaire Research Articles

Single-center study for robotic-assisted laparoscopic sacropexies: a one-fits-all strategy for pelvic organ prolapse?

PurposeSarcopenia has been established as the “gold standard” for the treatment of pelvic organ prolapse (POP). Minimal invasive laparoscopy can help to reduce the risks of open access surgery. We compare the surgical results and outcomes of robotic-assisted sacropexies.MethodsIn this monocentric retrospective study we enrolled 49 patients operated on symptomatic POP. Patients were divided into two groups according to the type of robotic-assisted sacropexy: patients with a history of hysterectomy received robotic-assisted sacrocolpopexy (RSCP; n = 19), while patients with subtotal hysterectomy received robotic-assisted cervicosacropexy (RCSP; n = 30). Failure was defined as recurrence of the disease with a need for reoperation. Validated questionnaires (the Pelvic Floor Distress Inventory—20 (PFDI-20) and Pelvic Floor Impact Questionnaire—7 (PFIQ-7)), were used for evaluation of patients quality of life postoperatively.ResultsThe comparison between RCSP versus RSCP showed that the latter is related to slightly but not significantly increased recurrence rates and a higher impact of POP symptoms on quality of life in long-term follow-up (p = 0.04). Perioperative data showed similar complication rates in both RSP types but shorter postoperative time of bladder catheterization in the case of RCSP (p = 0.008).ConclusionsThe monocentric long-term data confirm that RSP is a safe and effective method of surgical POP treatment, regardless of the site of the anatomical compartment. In comparison to RSCP, RCSP is associated with a lower impact of POP symptoms on patients’ quality of life with a tendency to slightly lower rates of POP recurrence.

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the Vulvovaginal Symptoms Questionnaire.

The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability). Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient. Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.

Six-year follow-up outcomes of the P(LLA-CL)/Fg bio-patch for anterior vaginal wall prolapse treatment.

There were few data about the long-term outcomes of bio-compatible patches for pelvic organ prolapse (POP). The efficacy of poly (L-lactide-co-caprolactone) blended with fibrinogen [P(LLA-CL)/Fg] bio-patches were investigated for anterior vaginal wall prolapse treatment in a 6-year follow-up. The P(LLA-CL)/Fg bio-patch was fabricated through electrospinning. Nineteen patients with symptomatic anterior prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage ≥ 2) were treated with anterior pelvic reconstruction surgery using a P(LLA-CL)/Fg bio-patch and were followed up at 1, 2, 3, 6 months, and 6 years. The primary outcome was objective anatomical cure (anterior POP-Q stage ≤ 1). Secondary outcomes included complications, MRI evaluation, and scores of the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and the Pelvic Floor Distress Inventory-20 (PFDI-20). The micro-morphology of the bio-patch resembled the extracellular matrix, which was suitable for the growth of fibroblasts. Sixteen (84.2%) patients were finally assessed, with a mean follow-up of 6.08 ± 0.18 years. The cure rate without anterior prolapse recurrence was 93.8% at 6 years. Compared with baseline, the POP-Q measurements of Aa, Ba, and C points and scores of PFIQ-7 and PFDI-20 manifested significant differences at all times (all p < 0.05). One (5.26%) case of bio-patch-related infection, 1 (5.26%) case of urinary retention, and no exposures and erosion occurred. MRI evaluation showed that the bio-patch gradually degraded to fragments at 1 month and was completely absorbed at 3 months. Among long-term follow-ups, anterior pelvic reconstruction surgery with a P(LLA-CL)/Fg bio-patch demonstrated significant improvements in anatomical correction of anterior pelvic prolapse and pelvic function without severe morbidity.

Impact of pelvic floor dysfunction in Aboriginal and Torres Strait Islander women attending an urban Aboriginal medical service.

Pelvic floor dysfunction causes high-level disease burden, with Aboriginal and Torres Strait Islander women less likely to have access to best management for these issues due to multiple sociocultural barriers. There is limited data on the impact of pelvic floor dysfunction in this specific population. To explore the impact of pelvic floor dysfunction on Aboriginal and Torres Strait Islander women attending an urban Aboriginal medical service, considering barriers and facilitators for care, and the services that are desired to address these conditions. This is a mixed methods project utilising the validated Pelvic Floor Impact Questionnaire 7 in combination with qualitative data from semi-structured interviews. Quantitative data were analysed using SPSS Version 24 and analysis included the use of means, SD and Fisher's exact test for comparison. Interview transcriptions were coded into initial themes using thematic analysis and a theoretical approach was used to capture common patterned responses. The majority of women reported urinary incontinence. Higher scores on the urinary impact questions were significantly associated with comorbid risk factors of chronic cough and obesity. Salient themes from interviews included help-seeking behaviours, embarrassment and normalisation of the condition. Women desired access to a pelvic floor physiotherapist, and preferred a female doctor and a consistent care provider. Pelvic floor disorders cause high disease burden for Aboriginal women across a broad age range with associated comorbid risk factors frequently occurring. This study suggests service improvement and care delivery strategies that may improve long-term outcomes for Aboriginal women with pelvic floor conditions.

Pelvic floor symptoms in cisgender women with Ehlers-Danlos syndrome: an international survey study.

Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders associated with abnormal collagen, and is more prevalent in women than in men. The aim of this cross-sectional study was to characterize pelvic floor symptoms in cisgender women with EDS and to describe their impact on quality of life. An online questionnaire on obstetric and gynecological experiences of cisgender women with EDS was disseminated through EDS patient societies and social media. This study was a sub-analysis of the broader questionnaire and focused on pelvic floor disorders, whereby self-reported symptoms and validated questionnaires were used to assess pelvic floor symptom severity (Pelvic Floor Distress Inventory, PFDI-20), impact on quality of life (Pelvic Floor Impact Questionnaire, PFIQ-7), and sexual function (Female Sexual Function Index, FSFI-6). Groups based on age and EDS type were compared using Kruskal-Wallis and Chi-squared tests. A total of 1,303 participants were included in the analysis. Pelvic floor symptom prevalence included: stress urinary incontinence in 60%, urgency urinary incontinence in 54%, fecal incontinence in 24%, and pelvic organ prolapse in 21%. Bladder symptoms were reported to be the most bothersome. The impact of prolapse symptoms on quality of life was higher in women under age 40 than in older participants (p<0.001). Pelvic pain was reported in 71%. Pain ratings were highest for dysmenorrhea, muscle and joint pain, and backache (median 7 out of 10 for each). Almost half of participants screened positive for possible sexual dysfunction and 36% reported dyspareunia more than half the time. This large, observational study demonstrated that cisgender women with EDS report a high prevalence of pelvic floor symptoms that appear to be more severe than in the general population.

Impact of treatment modality on pelvic floor dysfunction among uterine cancer survivors

ObjectivePelvic floor dysfunction is a common adverse effect of uterine cancer treatment. In this study we compared patient-reported outcomes regarding pelvic floor dysfunction among uterine cancer survivors after hysterectomy and...

Urogenital dysfunction and quality of life in women after stroke: Pilot study

Introduction: Research shows that urinary and sexual dysfunction is very common neurological sequelae of stroke with a markedly significant impact on body self-image and quality of life. Still, there is a lack of recent research to address this problem in female stroke survivors. The study aimed to examine the existence and level of urinary and sexual dysfunction, quality of life, and self-reported body image in a group of women after stroke and compare findings with those found in a group of women with other chronic non-neurological diseases. Methods: This study’s sample consisted of 30 females; two groups composed of 15. The stroke group consisted of subjects after stroke and the non-neurological group with different chronic non-neurological, mainly muscle-skeletal conditions. This study’s specific interest data were collected from respondents through pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), female sexual function index (FSFI), and an eight-item body image scale (BIS). The SPSS v.26 program was used for statistical processing. Results: Results show a statistically higher scores in stroke group (M = 219.65 ± 34.573) on PFDI-20 than in non-neurological group (M = 118.54 ± 27.734). Furthermore, statistically significant higher scores were found in stroke group in PFIQ-7 (Mdn = 233.33) and BIS (Mdn = 16.00) than in non- neurological group (Mdn = 28.57) – PFIQ-7; (Mdn = 11.00) – BIS. Also, statistically significant lower scores were found in stroke group (Mdn=10.40) on FSFI index than in non-neurological group (Mdn=24.60). Conclusions: Women after stroke show significantly more urinary and sexual dysfunction, lower quality of life, and poorer body self-image than the non-neurological group of chronic non-neurological conditions. There is a clear need for research on this issue in women after stroke.

Mid-term efficacy of surgical treatments for post-hysterectomy vaginal vault prolapse: a retrospective study

The surgical treatment of post-hysterectomy vaginal vault prolapse (PHVP) has been reported in several clinical studies, but mostly are short-term studies. This study aims to explore the mid-term efficacy of surgical treatments for PHVP. A total of 138 PHVP patients underwent surgery from January 2005 to January 2020 at the Fourth Medical Center of PLA General Hospital, Beijing. The clinical data of 119 patients who completed follow-up were retrospectively analyzed. Both groups of patients are diagnosed Pelvic Organ Prolapse Quantification system (POP-Q) III-IV stage of prolapse, with obvious prolapse-related symptoms and requiring surgical treatment. Among them, pelvic floor reconstruction surgery (RPS) was performed in patients who wanted to retain vaginal function and colpocleisis were used for frail patients who cannot tolerate RPS. We used the POP-Q scores for the objective efficacy evaluation, and use the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) to evaluate the subjective symptom during follow up. Among them, 61 patients underwent pelvic floor RPS (Group R), and 58 received colpocleisis (Group C). The surgeries in both groups were successfully completed, the median follow-up time after surgery was 4.3 years (0.25-13 years) and 5.3 years (0.33-15 years), respectively; the overall surgical success rate was 86.9% (53/61) and 100% (58/58), respectively; the subjective satisfaction rate was 90.2% (55/61) and 91.4% (53/58), respectively; and the PFDI-20 and PFIQ-7 scores in both groups were significantly improved compared with the preoperative levels (P<0.05). In Group R, 6 cases (9.8%, 6/61) were dissatisfied after surgery; in Group C, 5 cases (8.6%, 5/58) were dissatisfied after surgery. Reconstructive surgery and colpocleisis have a good mid-term effect on PHVP, with good outcome and few complications. The surgeon is expected to ascertain an appropriate surgical procedure based on the characteristics of the patient, the degree and the location of prolapse, in order to achieve the best surgical efficacy and minimize the damage.

Factors associated with pelvic floor dysfunction in women with breast cancer

Purpose:To determine the prevalence of pelvic floor (PF) dysfunction according to breast cancer characteristics and examine the association between breast cancer characteristics and the prevalence, distress and impact of PF dysfunction in women with breast cancer. Outcome measures:The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence, distress and impact of PF dysfunction. Results:Data from 120 women with breast cancer were included in this analysis. Women who underwent chemotherapy experienced the highest rates of UI (n=23/29; 79%) and FI (n=7/29; 24%). The associations between breast cancer characteristics and the presence of pelvic floor dysfunction were not statistically significant. Being older (β 0.25 95%CI 0.05, 0.44), and having stage IV breast cancer (β 0.83 95%CI 0.24, 1.42) were statistically significant predictors of reporting high distress of PF dysfunction. Being older (β 0.22 95%CI 0.01, 0.45), having breast irradiation (β 0.51 95%CI 0.08, 0.93) and more time since diagnosis (β 0.35 95%CI 0.16, 0.54) were also statistically significant predictors of experiencing higher impact of PF dysfunction. Implications:Our findings show that UI and FI are prevalent in women receiving breast cancer treatment, with increasing distress demonstrated in older women with more advanced disease. The impact of PF dysfunction appears to increase with more time after breast cancer diagnosis. A greater focus by health services and clinicians to assess and offer treatment for PF dysfunction may be warranted in women with breast cancer.

Effect of Psychological Intervention on Pelvic Floor Function and Psychological Outcomes After Hysterectomy.

BackgroundHysterectomy is one of the most frequently performed operations worldwide. However, postoperative complications and body image changes may induce psychological distress after hysterectomy. The study aimed to evaluate the effect of psychological intervention on pelvic floor function and psychological outcomes following hysterectomy among patients with benign indications.MethodsNinety-nine patients underwent hysterectomy were randomly divided into intervention group (n = 50) and control group (n = 49). Patients in the control group received routine postoperative nursing care, while extra psychological intervention was provided to patients in the intervention group, including psychological support, regular lectures and family support. After 6 months, patient's psychological statuses were assessed by Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). The pelvic floor function of patients was evaluated using Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Furthermore, the incidence of postoperative complications, including uracratia, pelvic organ prolapses, sexual dysfunction and chronic pelvic pain, was evaluated.ResultsAfter 6-month intervention, the GAD-7 and PHQ-9 scores were significantly decreased in the intervention group (p < 0.001 and p = 0.018 respectively). Both scored were significantly lower than that in the control group (p < 0.001 and p < 0.001). Compared with control group, the incidence of uracratia, pelvic organ prolapse, sexual dysfunction and chronic pelvic pain for intervention group was significantly lower (p = 0.003, p = 0.027, p = 0.001, p = 0.002 respectively) and the pelvic floor muscle strength was significantly stronger (p = 0.001). Besides, the postoperative Urinary Incontinence Impact Questionnaire (UIQ-7), Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7), and Colorectal-Anal Impact Questionnaire (CRAIQ-7) scores were significantly lower (p = 0.025, p = 0.04, p < 0.001) and PISQ-12 score was significantly higher in intervention group (p < 0.001).ConclusionPsychological intervention could effectively improve the psychological condition of patients with hysterectomy, which may facilitate patients' postoperative recovery in pelvic floor function. These findings emphasized the necessity of psychological intervention in routine postoperative nursing care.

Robot-assisted sacrocolpopexy for recurrent pelvic organ prolapse: Insights for a challenging surgical setting

Background: No consensus exists regarding the management of recurrent pelvic organ prolapse (POP). The aim of this study was to evaluate robot-assisted laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse (POP), and to investigate postoperative outcomes.Methods: We conducted a single-center retrospective study including 10 consecutive patients who underwent a robot-assisted sacrocolpopexy for symptomatic POP recurrence from February 2017 to December 2019. Recurrence rates and patient satisfaction, measured by the Pelvic Floor Impact Questionnaire (PFIQ-7) were recorded.Results: Median age was 57 years (IQR: 54–67). No intraoperative complications were reported. The median hospital stay after surgery was 2 nights (IQR: 1–4). Two patients (20%) experienced early recurrence: at 1 month for one and at 4.5 months for the other. The median follow-up for the remaining eight patients was 18 months (IQR: 12–23). Among the recurrence-free patients, the median PFIQ-7 score was 11.4 at 12 months.Conclusions: Robot-assisted sacrocolpopexy is feasible and safe for the management of POP recurrence, with a high patient satisfaction.

Autologous rectus fascia graft in the treatment of high-stage apical vaginal prolapse: preliminary results of a new surgical approach with native tissue.

Since vaginal meshes in pelvic organ prolapse have been associated with more complications in the last decades, native tissue vaginal repair is still the mainstay of prolapse surgery. This study introduces a new transvaginal approach with bilateral sacrospinous ligament fixation augmented by autologous rectus fascia graft to repair high-stage apical vaginal wall prolapse. Between December 2018 and June 2020, 13 patients with high-stage apical vaginal wall prolapse (point C ≥ + 1) accompanied by high-stage anterior vaginal wall prolapse (paint Ba ≥ + 1) were included. In this procedure, the central part of the anterior rectus fascia graft (6-8cm in length and 1-1.5cm in width) is sutured to the underlying tissue of the vaginal apex or cervix and the arms of the rectus graft augmented to the sacrospinous ligament with a Capio suture capturing device (Boston Scientific). The patients are evaluated by history taking, physical examination, Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Floor Distress Inventory (PFDI-20) Questionnaire. The patient's mean age was 61.2 ± 2.7years and they were followed up to 12months. The anatomical success rate was 92.3%. The PFDI-20 and PFIQ-7 were significantly improved (P < 0.001). There were no significant perioperative complications. Three patients complained of unilateral groin or buttock pain which resolved gradually at the first post-operative month. The transvaginal bilateral sacrospinous ligament fixation augmented by autologous rectus fascia graft is an effective and safe surgical approach in treating high-stage apical vaginal prolapse with short-term follow-up.

Influence of toileting behavior on the natural course of anterior vaginal wall prolapse

BackgroundMany risk factors for pelvic organ prolapse (POP) have been proposed, and the cause is most likely multifactorial. This study aimed to investigate the effect of toileting behaviors on the natural course of anterior vaginal wall prolapse (AVWP).MethodsData on 75 women who underwent surgery for symptomatic AVWP were collected. Patients with grade ≥ II AVWP were included in this study and were divided into two groups according to their voiding and defecation position. The volunteers who voided and defecated in a sitting position comprised Group 1, and those who voided and defecated in a squatting position comprised Group 2. The Colorectal-Anal Impact Questionnaire (CRAIQ), Pelvic Floor Impact Questionnaire (PFIQ), Pelvic Organ Prolapse Impact Questionnaire (POPIQ), Urinary Impact Questionnaire (UIQ) and visual analog scale (VAS) pain scores were used to evaluate the patients’ symptoms.ResultsForty-four patients were included in Group 1 (sitting position), and 31 patients were included in Group 2 (squatting position). The groups were similar in terms of BMI, parity, menopause duration, topical estrogen use, comorbidities, the presence of constipation and urinary incontinence, and the pad count for incontinence. The time from initial symptoms to surgery was shorter in Group 2 than in Group 1 12 (3–73) and 24 (2–182) months (p = 0.001), respectively. The PFIQ, POPIQ and POP-related VAS scores were significantly higher in patients who voided and defecated in a squatting position.ConclusionIn patients with symptomatic POP, increased IAP while performing the squat position during defecation and voiding may increase the severity of patients' symptoms related to prolapse more than that of sitting position. Therefore, questioning the toileting position of patients with AVWP may help inform management decisions, with changing to a sitting position encouraged.

Sacrospinous Ligament Fixation Using an Anchor Versus Suture-Capturing Device: A Prospective Cohort Study.

The aim of the study was to compare rates of persistent gluteal and posterior thigh pain, procedural efficacy, and postoperative complications at 1 year after sacrospinous ligament fixation using either an anchor-based or suture-capturing device. This prospective cohort study evaluated outcomes 1 year after operation in patients previously enrolled in a randomized controlled trial comparing an anchor-based versus suture-capturing device for sacrospinous fixation. Symptom scores were evaluated via Pelvic Floor Distress Inventory 20 and Pelvic Floor Impact Questionnaire 7. Pain was evaluated using the Numerical Rating Scale. Composite surgical failure was defined as prolapse beyond the hymen or C-point greater than one half down the vagina, vaginal bulge symptoms, or a need for prolapse retreatment via surgery or pessary management. Descriptive and bivariate statistics were performed. Forty three (21 anchors, 22 sutures) of the original 47 patients (91%) returned for follow-up. The mean follow-up time was 15.4 months, age was 69 years old, body mass index was 30, and preoperative Pelvic Organ Prolapse Quantification stage was 2.7. No patients reported significant increase in pain at sacrospinous fixation site above baseline, and there was no significant difference in posterior thigh or gluteal pain on the side of fixation compared with baseline in the anchor-based or suture-capture groups (-0.2 ± 0.9 and -0.5 ± 1.6, respectively, P = 0.719). Two patients demonstrated surgical failure (anchor group) due to bulge symptoms (P = 0.233). The devices similarly improved Pelvic Floor Distress Inventory 20 (-71.0 ± 45.5 vs -66.3 ± 64.4, P = 0.652) and Pelvic Floor Impact Questionnaire 7 (-40.6 ± 62.4 vs -26.4 ± 65.7, P = 0.768) scores. Persistent gluteal or posterior thigh pain and surgical failure is uncommon 12 months after sacrospinous fixation and was not associated with the type of fixation device.

Perinatal Incontinence Assessment Tools: A Psychometric Evaluation and Scoping Review.

Background: Approximately 40% of women report incontinence during pregnancy and postpartum (known as the perinatal period). Due to the lack of an established measurement standard, this scoping review aimed to investigate the psychometric properties of tools, which assess incontinence-related symptoms and quality of life (QOL) during this period. Materials and Methods: Articles in English, which assessed psychometric properties of tools for perinatal incontinence-related symptoms or QOL, were included and evaluated by a 16-item checklist. Nine databases were searched from 2000 to 2020. Results: Four studies met the inclusion criteria, and five assessment tools were identified and included in this review. The modified Pelvic Floor Questionnaire (mPFQ), Leakage Index (LI), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) demonstrated internal consistency (Cronbach's α > 0.60, >0.70, and mean inter-item correlations >0.39, respectively). The mPFQ demonstrated moderate test-retest reliability (intraclass correlation coefficient >0.60). Construct validity of the ICIQ-UI SF was established by significant (p < 0.05) differences across age and obesity, whereas the mPFQ demonstrated significant (p < 0.001) discriminant validity in symptoms prepartum and postpartum. Convergent validity of telephone-administered Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) was established with the written version (p > 0.05, correlation coefficient >0.90). Responsiveness to change was described for the ICIQ-UI SF and mPFQ. Conclusions: The mPFQ and ICIQ-UI SF demonstrated acceptable reliability, validity, and responsiveness to change, therefore suggesting good clinical utility. Since most studies included primiparous women, future research in heterogeneous samples of women with perinatal incontinence may be needed.

Comparing Laparoscopic Sacrocolpopexy with Vaginal Sacrospinous Ligament Fixation in the Treatment of Vaginal Apical Prolapse; the First Randomized Clinical Trial: A pilot study.

To compare two methods of laparoscopic sacrocolpopexy (LSCP) and sacrospinous ligament fixation (SSLF) in terms of efficacy and safety in the treatment of vaginal apical prolapse. This prospective, randomized controlled clinical trial was conducted on 32 patients with symptomatic vaginal apical prolapse, referred to the female urology clinic of Kerman University, Iran, during 2018-2019. The patients were re-examined at 12 months after surgery. Objective success was recorded using Pelvic Organ Prolapse Quantification (POP-Q) classification as primary outcome. The subjective success of the methods was determined by the quality-of-life parameters, based on Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20), and Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores as secondary outcomes. Moreover, complications were recorded in both groups. The amount of intraoperative bleeding was significantly higher in the SSLF group, compared to the LSCP group (P = 0.01). Persistent pain was observed in two (12%) patients in the LSCP group and five (31%) patients in the SSLF group (P = 0.2). The decrease in the total PFIQ-7 score was in favor of the LSCP group but not statistically significant (p = 0.06). The LSCP group showed bigger improvement in vaginal (p = 0.04) and bowel (p = 0.03) scores. The results of the PISQ-12 and PFDI-20 questionnaires as well as POP-Q examination were not different in two groups. Although the surgical methods of LSCP and SSLF can be equally effective in the treatment of apical prolapse, LSCP appears to be superior to SSLF regarding less bleeding.

Does aging affect the elastic properties of the bladder and the urethra in nulliparous women: An ultrasound shear-wave elastography study.

To investigate how aging and menopausal status in absence of pregnancy and childbirth affect the elasticity of the bladder and urethra. A single-center prospective observational study including nulliparous 10 pre- and 12 postmenopausal women. Data collection included baseline characteristics, physical examination data, questionnaire scores, PDFI and the Pelvic Floor Impact Questionnaire, and pelvic floor sonographic measurements as well as elastography measurements. The shear wave elastography (SWE) of tissue was measured using Kilopascal (kPa). The elastography measurements were taken over the rhabdosphincter, the suburethra smooth muscle, and the trigonal areas. A total of 22 nulliparous subjects were enrolled in the study. The cohort's mean age was 43.5 years, the mean body mass index (BMI) was 26.8, and 86% were of Caucasian ethnicity. The postmenopausal group was older and with higher BMI (p < 0.001 and p = 0.05). They also had higher scores in all the questionnaires (p < 0.05 for all) and did not demonstrate prolapse in any compartments. The SWE results for the whole group were 35.2 kPa in the rhabdosphincter measuring point, 40.2 kPa in the sub-urethra point, and 20.6 kPa in the trigone point. Comparing the premenopause and postmenopause groups, we found lower measurements in the rhabdosphincter area and equivocal measurements for the suburethral zone. No statistically significant differences were found between the groups CONCLUSIONS: The elastic properties of the different bladder components and the urethra change with age and menopause. Using elastic properties of the tissues, we can further explore both stress urinary incontinence and overactive bladder.

Urinary and sexual impact of pelvic reconstructive surgery for genital prolapse by surgical route. A randomized controlled trial

The main objective of the study was to evaluate the rates of de novo stress urinary (SUI) and postoperative dyspareunia after both sacrocolpopexy/hysteropexy (SCP) and vaginal mesh surgery. A prospective, multicenter, randomized, open-label study with two parallel groups treated by either SCP or Uphold Lite vaginal mesh was carried out. Study participants were ≥ 50 and < 80years old patients with Pelvic Organ Prolapse Quantification (POP-Q) stage ≥2 who were considered eligible for reconstructive surgery and who were sexually active with no dyspareunia and free from bothersome SUI at presentation. Women were assessed before surgery and at 4-8weeks and 11-13months after using validated measures including POP-Q, Pelvic Floor Disability Index (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Patient Global Impression of Improvement (PGI-I). Data were also collected for health economics evaluation. Of the required sample of 156 women, 42 women (19 SCP and 23 vaginal mesh) were only recruited owing to the discontinuation of vaginal mesh worldwide. The median follow-up was 376days. The rates of bothersome de novo SUI were similar in the SCP and Uphold vaginal mesh groups (15.79 vs 15.00%, OR 0.95 [95% CI 0.22-4.14]). Among 30 sexually active patients at follow-up, the rates of women reporting de novo dyspareunia "usually or always" were 6.7% after SCP vs 13.3% after vaginal mesh (p = 1). Health economics evaluation showed a cost saving of 280€ in favor of the Uphold vaginal mesh technique, but no significant difference in the total cost (2,934.97€ for SCP vs 3,053.26€ for Uphold vaginal mesh). Bothersome de novo SUI and de novo dyspareunia occurred in approximately 15% and 23% of our study cohorts, with no significant difference between sacrocolpopexy/hysteropexy and anterior/apical vaginal mesh surgery. However, these results should be interpreted with caution owing to the small sample size.

Female Sexual Dysfunction and Pelvic Floor Muscle Function Associated with Systemic Sclerosis: A Cross-Sectional Study.

Only a few studies have addressed sexual health in patients with systemic sclerosis (SSc). This study aimed to compare female sexual function and pelvic floor muscle function in SSc patients with healthy controls (HC) matched by age, and to identify the potential implications of clinical features on sexual function. Our cohort included 90 women with SSc and 90 HC aged 18–70 years that completed six well-established and validated questionnaires assessing sexual function (Brief Index of Sexual Function for Women, Female Sexual Function Index, Sexual Quality of Life Questionnaire–Female, Sexual Function Questionnaire) and pelvic floor function (Pelvic Floor Impact Questionnaire–Short Form 7 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form). Results from women with SSc and HC were contrasted and correlated with relevant clinical features. The prevalence of female sexual dysfunction was 73% in SSc patients (vs. 31% in HC). Women with SSc reported significantly worse pelvic floor function and sexual function than HC. Impaired sexual function was correlated with higher disease activity, the presence of dyspnea and interstitial lung disease, increased systemic inflammation, reduced physical activity, functional disability, more severe depression, more pronounced fatigue, and impaired quality of life. We demonstrate that sexual dysfunction is highly prevalent among women with SSc. This aspect of the disease deserves more attention both in clinical care and at the level of international research collaboration.

Application of health behavior change integration theory in pelvic floor muscle exercise in patients with early cervical cancer surgery

Objective: To explore the effect of nursing intervention based on the integration theory of health behavior change on pelvic floor muscle exercise in patients with pelvic floor dysfunction after early cervical cancer surgery.Methods: Select 40 patients with pelvic floor dysfunction after surgery for early cervical cancer, and divide them into experimental group (20 cases) and control group (20 cases) by random number table method. Based on the pelvic floor muscle exercise based on the integration theory of healthy behavior change, the control group received routine pelvic floor rehabilitation nursing, and Oxford pelvic floor muscle strength was used before the intervention (T0), after 1 month of intervention (T1) and at the end of the intervention (T2). Scoring systems, Short Form of Pelvic Floor Dysfunction (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), General Self-Efficacy Scale (GSES), and Social Support Rating Scale (SSRS) were assessed.Results: (1) In terms of pelvic floor muscle strength, the muscle strength ratings of TO, T1 and T2 in the control group were (1.10±0.70), (1.46+0.64 (1.90+0.70), respectively, and (1.12±0.73) in the experimental group. , (1.96±0.73), (3.04+0.81) levels, the difference between the two groups at each time point after intervention was statistically significant (F group=25.730, F time=329.809, F interaction=56.688, all P<0.001); (2) On the PFDL20 score, the total scores of TO, T1 and T2 in the control group were respectively (80.19+18.75)>(78.67+17.99 (77.47+15.91) points, the test group was (77.77+19.97 ) >(69.11±15.97), (66.54+14.04) points, the difference between the two groups at each time point after the intervention was statistically significant (F group=6.876, F time=62.536, F interaction=29.196, all P<0.05); ( 3) On the PFIQ-7 score, the total scores of T0, T1 and T2 in the control group were (82.80+12.04)> (80.88+11.62)> (78.39+8.51) points, and the experimental group were (82.66±11.24), (82.66±11.24), (80.88+11.62) 76.69±10.12) and (73.20+7.41) points, the difference was statistically significant between the two groups at each time point after the intervention (F group=3.551, P=0.062; postmortem time=69.943, F interaction=13.213, all P<0.001 ); (4) In general self-efficacy, the total scores of TO, T1 and T2 in the control group were (2.44±0.53), (2.49+0.49) respectively (2.51+0.34) points, the experimental group was respectively (2.47+0.53)> (2.67+0.38 (2.86+0.30) points, the difference between the two groups at each time point after the intervention was statistically significant 3 group = 6.788, F time = 50.994, F interaction=25.664, all <0.05); (5) In terms of social support, the total scores of T0, T1 and T2 in the control group were (45.16±3.28), (45.84±3.02),(46.42+2.82) points, and the experimental group were respectively (45.48+3.43(48.25+2.83)> (5037+2.45) points, the difference was statistically significant between the two groups at each time point after the intervention (F group=20.12, F time = 199.34, F interaction = 70.24, both P<0.001).Conclusion: Nursing intervention scheme based on the integration theory of health behavior change can significantly improve the pelvic floor muscle strength, self-efficacy, social support level and quality of life of patients with pelvic floor dysfunction after early cervical cancer surgery, and improve the short-term and long-term pelvic floor rehabilitation.