Pelvic Floor Research Articles

Prenatal Exercise Decreases Urinary Incontinence in Late Pregnancy and Three Months Postpartum: A Randomized Controlled Trial

ABSTRACT Purpose This study aimed to evaluate the impact of a supervised exercise program, including Pelvic Floor Muscle Training (PFMT), throughout pregnancy on Urinary Incontinence (UI). Methods A randomized clinical trial (NCT04563065) was conducted. Initially, 600 pregnant women were screened for eligibility, with data from 356 participants eventually analyzed. Of these, 172 were allocated to the Exercise Group (EG) and 184 to the Control Group (CG). Participants in the EG engaged in a supervised moderate exercise program three days per week, each session lasting 60 minutes, from 8-10 weeks to 38-40 weeks of gestation, achieving an adherence rate of 73.5%. Results A lower prevalence of UI in the EG compared to the CG was observed during late pregnancy (χ2 = 20.04; p = 0.001) and at three months postpartum (χ2 = 12.52; p = 0.03), as well as in birth weight (F = 4.16; p = 0.04). No significant differences were found between the groups in other maternal and newborn outcomes. Conclusions Supervised exercise during pregnancy, which included PFMT, effectively reduced the incidence of urinary incontinence in late pregnancy and at three months postpartum.

A VISÃO DOS ACADÊMICOS DE FISIOTERAPIA EM RELAÇÃO ÀS DISFUNÇÕES DO ASSOALHO PÉLVICO

INTRODUCTION: The undergraduate course in Physiotherapy aims to educate its students so that they become generalist Physiotherapists. It is part of their training to study human movement with the aim of preserving, developing and restoring the integrity of organs, systems and functions, in a global way. This study aimed to investigate the perception of physiotherapy students about pelvic floor dysfunctions, a topic of increasing relevance in physiotherapy practice, especially in the areas of women’s health and urogynecology. Considering the importance of the pelvic floor for essential functions, such as continence and support of pelvic organs. OBJECTIVE: To evaluate the level of knowledge of undergraduate students of the Physiotherapy course, from a private university in Teresina-PI, on the subject of the pelvic floor. METHODOLOGY: This is a cross-sectional exploratory study with a quantitative approach, of 180 students, and 91 volunteers who agreed to participate in the research. The descriptive statistical analysis was presented with their respective absolute, relative (mean and standard deviation) and percentage values. As a data collection instrument, a self-administered questionnaire was used, with open and closed questions related to the pelvic floor theme. Students enrolled in the Physiotherapy course at the Santo Agostinho University Center – UNIFSA, Teresina-PI, Brazil, of both sexes, and who were studying between the 1st and 9th period were interviewed. RESULTS: Regarding knowledge of the pelvic floor, 85.7% have knowledge about the pelvic floor, and 14.3% have no knowledge about the pelvic floor. When asked about knowledge about how to strengthen the pelvic floor, 20.9% have no knowledge about it, and 79.1% have knowledge about how to strengthen the pelvic floor. CONCLUSION: The results suggest that there is a discrepancy in the participants’ knowledge and that, although they claim to know about the pelvic floor, most also know how to strengthen the pelvic floor. However, it is necessary that the subject be addressed more in basic and pre-professional disciplines.

New Non‐Invasive Approach for a Woman With Dyssynergic Defecation Associated With Dyspareunia: A Case Report

ABSTRACTBackgroundThe pelvic floor muscles are a complicated muscular structure with three major functions: defecation, urination, and sexual function. Constipated patients rarely have sexual or urinary complaints. The objective of this case is to provide a new and successful therapy strategy for a patient with dyssynergic defection and dyspareunia.Study DesignThe case study below discusses physical therapy rehabilitation and the consequences for both current and future physical therapy programs of constipation caused by PFM dyssynergia and dyspareunia.Case DescriptionA 22‐year‐old married nulliparous woman was referred by her urogynecologist for the management of PFM tightness, with the main complaints being pain during intercourse and chronic constipation. The diagnosis had been confirmed by MR defecography, which revealed puborectalis and external anal muscle tightness. Neuromuscular reeducation employing electromyography biofeedback, improved rectal sensation, intravagival massage, the application of an intermittent pneumatic compression belt on the abdominiopelvic region, and suprapubic water bag ultrasound therapy were among the pelvic floor rehabitation strategies.ConclusionThe intermittent pneumatic compression belt and water bag ultrasound approach, combined with standard program rehabitation, was successfully used in patients with defection dyssynergia and dyspareunia. After 3 weeks, stool frequency decreased from once every 10 days to one bowel movement per week; a condition reported less bloating and stomach pain, as well as a pain rating of 5/10 during sexual activity and 0/10 immediately afterward; and FSFI increased from 15.1 to 19.1. After 12 weeks, stool frequency is three bowel movements per week, a condition has less bloating and stomach discomfort and rates pain as 1/10 during sexual activity and 0/10 immediately, and FSFI has risen from 15.1 to 25.1.

FORTALECENDO O CONTROLE PÉLVICO PARA UMA VIDA SEM LIMITAÇÕES: UMA REVISÃO DE LITERATURA SOBRE A EFICÁCIA DA FISIOTERAPIA COM EXERCÍCIO DE KEGEL NO TRATAMENTO DA INCONTINÊNCIA URINÁRIA

The pelvic floor muscles support organs such as the bladder and uterus, and can weaken due to pregnancy and aging, which results in problems such as urinary incontinence or prolapse. The latter affects millions of women, being associated with factors such as age and number of births. Evaluation, especially through ultrasound, is crucial. Treatments include Kegel exercises, behavioral therapy, and mechanical devices. Innovative strategies, such as the gamification of Kegel exercises, have shown promise for improving adherence and treatment outcomes. The importance of pelvic floor muscles and their dysfunctions, such as urinary incontinence, was addressed, highlighting the need for effective and innovative approaches to improve patients' quality of life. An analysis of the efficacy of Kegel exercise on urinary incontinence in women was conducted, reviewing studies, synthesizing results, and offering recommendations for future research. A systematic review of the literature, conducted between February and May 2024, was adopted to analyze studies on Kegel exercise in urinary incontinence in women, searching for articles in databases such as VHL, PubMed, ScienceDirect, and JSTOR, with strict inclusion criteria. Studies on treatments for pelvic floor dysfunctions, such as prolapse and urinary incontinence, have revealed several approaches. Some have shown effectiveness in personalized training of the muscles, while others have compared methods such as electrical stimulation and active training. In addition, innovative techniques such as position detection during Kegel exercises and mechanotherapy were explored. The efficacy of simple interventions, such as Kegel exercises combined with behavioral therapy, was highlighted. These studies highlighted the complexity of pelvic floor dysfunctions and the importance of multifaceted and individualized approaches to treatment, highlighting the challenges faced and the need for more effective interventions to improve patients' health and quality of life. Authors have emphasized the importance of pelvic muscles and treatments such as training and behavioral therapy, while innovative strategies such as gamification have shown promise for promoting better physical, emotional, and social well-being and outcomes.

Management of Post-RALP SUI and ED - What are and What Should we be Doing?

Although there have been advancements in minimally invasive surgical techniques for radical prostatectomy, surgery can still significantly impact continence and erectile function (EF), resulting in considerable quality-of-life impairment. This review critically evaluates existing treatment options for male stress urinary incontinence (SUI) and erectile dysfunction (ED) post-robotic-assisted laparoscopic prostatectomy (RALP), alongside exploring emerging trends and discussing future directions for managing and preventing both conditions. Patient history is pivotal in guiding surgical decisions, with the intensity of symptoms and their impact on the patient's life being primary influences for deciding the best treatment options for both SUI and ED. Penile rehabilitation strategies (PR) show promise in mitigating the effects of prostate cancer treatments on EF and improving overall health, though consensus is lacking on specific programs or initiation of timing for optimal recovery post-surgery. All patients undergoing RALP should receive preoperative counseling about SUI and early pelvic floor physical therapy. Fixed and adjustable slings effectively treat mild-to-moderate post-RALP SUI, while the artificial urinary sphincter is the gold standard for men with moderate or severe SUI. EF recovery after RALP faces obstacles such as patient characteristics, compliance, and cost, with no standardized PR approach. Future research should prioritize studies aiming to optimize treatment methods and enhance patient compliance.

Pelvic floor and sexual dysfunctions after genital gender-affirming surgery: a systematic review and meta-analysis.

Genital gender-affirming surgery has become a crucial step in the transitioning process of numerous transgender people. To highlight the consequences of genital gender-affirming surgery on pelvic floor function in transgender people. Medical databases (PubMed, EMBASE, and Cochrane Library) were consulted according to a combination of keywords. All papers published up to February 29, 2024 were considered. Two reviewers independently screened the abstracts of the selected studies and extracted data from the full-text articles included. Data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the Observational Study Quality Evaluation (OSQE) method. This study is registered on PROSPERO number CRD42024522580. Pelvic floor dysfunctions in individuals who undergo gender-affirming surgery, factors that may be involved in the increased prevalence of these dysfunctions and perspectives of treatment of the complications through pelvic floor physical therapy. Twenty-five papers were considered for systematic review, while 17 studies were included for meta-analysis. There was significant statistical heterogeneity across the included studies. Among transwomen who had undergone vaginoplasty, pelvic organ prolapse occurred in 1%-7.5% of patients, urinary incontinence affected up to 15% of patients, while urinary irritative symptoms up to 20%. Sexual dysfunctions were reported by 25%-75% of patients. Among transmen who underwent hysterectomy and phalloplasty, pelvic organ prolapse occurred in 3.8% of patients, urinary incontinence affected up to 50% of patients, while urinary irritative symptoms up to 37%. Finally, sexual dysfunctions were reported by 54% of patients. The findings of this study could be helpful for transgender patients pre-operative counselling. This is the first systematic review and meta-analysis about pelvic floor dysfunctions in transgender people undergoing genital gender-affirming surgery. The main limitations are the limited number of studies included and their heterogeneity. Pelvic floor dysfunctions following genital gender-affirming surgery are an emerging issue. Adequate information for each surgical procedure, explicit postoperative instructions, continuity of care, communication with healthcare providers, and recommendation for tailored perioperative pelvic floor physiotherapy are necessary for a better surgical result.

Use of transanal irrigation (TAI) in the treatment of persistent bowel disorders in patients with endometriosis: A retrospective study

Abstract Purpose Endometriosis has a strong impact on women’s quality of life (QoL). Pain is the main symptom of the disease, but bowel dysfunctions such as fecal incontinence, constipation and voiding difficulties are also reported. Patients could suffer from a Low Anterior Resection Syndrome (LARS)-like syndrome. Transanal irrigation (TAI), known to alleviate LARS-related symptoms, has been suggested to aid bowel dysfunction in endometriosis patients, potentially facilitating pelvic floor rehabilitation. Methods We retrospectively collected data from 60 patients with endometriosis and bowel dysfunction who had been prescribed with the Peristeen® Plus TAI system. Patient satisfaction, pain, QoL and LARS score were evaluated before (baseline) and after TAI treatment (follow-up of approximately 12 months). Results Of the 60 patients meeting the inclusion criteria, 12 patients did not complete the questionnaires at follow-up and 16 patients discontinued treatment. Data analysis performed on 32 patients showed a mean increase of 3.6 points in patient satisfaction after TAI treatment and a mean pain reduction of 1.8 points (both, p-value < 0.001). LARS score decreased from a mean of 21.9 at baseline to a mean of 12.7 (p-value < 0.001). Accordingly, there was a notable improvement in patients’ QoL. Conclusion TAI is a useful treatment for bowel dysfunctions in patients with endometriosis. When offered to these patients, TAI seems to represent a valuable strategy to reduce pelvic floor stress. This study confirms that TAI was associated to a significantly higher patients’ satisfaction, as well as to a reduction of pain and LARS-like symptoms.

Associations between menstrual pain and sexual function: the role of visceral hypersensitivity on developing sexual pain.

Dyspareunia, defined as pain before, during or after intercourse, is a subset of female sexual dysfunction with overlapping gynecologic, urologic and psychosocial etiologies. This study aimed to evaluate the impact of menstrual pain and visceral hypersensitivity on sexual function and to identify risk factors for sexual pain in healthy reproductive-age females. In this prospective cohort study, we evaluated gynecologic and psychologic self-reported histories, validated sexual function questionnaires, and conducted a standardized gynecologic examination enhanced by quantitative sensory testing in reproductive-aged females with menstrual pain versus pain-free controls. Correlation analysis was conducted between the Female Sexual Function Index (FSFI) pain subdomain score and a priori hypothesized risk factors for dyspareunia: menstrual pain severity, experimentally provoked bladder sensitivity, anxiety, depression, pain catastrophizing, and vaginal pressure-pain sensitivity. The primary outcome was severity of sexual pain as measured by the FSFI, comparing participants with moderate-to-severe dysmenorrhea (n = 99), dysmenorrhea with bladder hypersensitivity (n = 49) identified on non-invasive oral water challenge, and pain-free controls (n = 37). In our young (median age 22 [IQR 19, 29]), nulliparous, predominantly heterosexual cohort (78.3%, 144/185), 64.3% (119/185) engaged in sexual intercourse within the four-week recall period. The median total FSFI score was 27.2 (22.0, 30.2). Across groups, only the dysmenorrhea with bladder hypersensitivity phenotype met the threshold for sexual dysfunction as measured by total FSFI score (24.6 [20.0, 28.1], p= 0.008). Dysfunction was driven by difficulties with lubrication and higher pain levels during and after intercourse. On physical examination, those with and without dyspareunia were largely indistinguishable, with little to no tenderness of the pelvic floor, bladder, uterus and uterosacral ligaments. Amongst the six hypothesized risk factors for sexual pain, only experimentally provoked bladder pain was significantly associated with the severity of dyspareunia (r = 0.41, corrected p< 0.001). Young, otherwise healthy individuals with dysmenorrhea and occult visceral hypersensitivity exhibit signs of sexual dysfunction and significantly higher rates of dyspareunia in the absence of reliable clinical examination findings. Strengths include the use of a nonclinical sample of almost exclusively nulliparous females with no co-morbid pelvic pain diagnoses and prospective diary confirmation of dysmenorrhea severity. The study is limited by the narrow heteronormative, cisnormative sexual experience of penile-vaginal intercourse captured by the FSFI. Sexual pain is more prevalent in those with dysmenorrhea with bladder hypersensitivity than isolated dysmenorrhea, suggesting visceral hypersensitivity may be a non-structural mechanistic driver for dyspareunia.

Spanish-Speaking Latinas with Pelvic Floor Disorders: Understanding the Misunderstood.

Challenges to providing care to Spanish-speaking Latinas with pelvic floor disorders (PFDs) are well studied. Limited data exist on patient and provider perspectives on the unique challenges in providing language-discordant care. Our study was aimed at highlighting these challenges and providing evidence-based recommendations on how to optimize the care of these women. Both Spanish-speaking patients with PFDs and non-Spanish speaking providers at the University of South Florida were recruited for this study. Interviews were conducted by a single bilingual interviewer. Topics included providers' experiences, specifically barriers, when caring for Spanish-speaking Latinas, and patients' experiences, focusing on differences between Spanish and non-Spanish speaking providers, while receiving care for PFDs. All interviews were analyzed using grounded theory qualitative methods. Thirteen interviews were conducted, 7 Spanish-speaking Latinas with PFDs and 6 non-Spanish-speaking urogynecology providers. Qualitative analysis yielded three major themes noted by both patients and providers: cultural stigma, barriers influencing care, and behavioral adaptations to language discordance. Concepts identified from these themes included: generational shame and embarrassment, aversion to treatment, interpreter use barriers, lack of resources, accommodation between patient and provider, and time constraints. Culturally competent recommendations were made based on study findings and review of the literature to improve care of Spanish-speaking Latinas. This study highlights common themes experienced by both patients and their non-Spanish-speaking providers caring for Spanish-speaking Latinas. The study provides recommendations and implementable strategies that can improve care and help providers to build a stronger therapeutic relationship with Spanish-speaking Latinas.

GIANT LUMBO-SACRAL TUMORS

Objectives Despite comprising just 8% of all spinal tumors, sacral tumors present a long list of issues that should be taken in consideration when neurosurgical approach is tempted. Their unique anatomic location, close relation with neural structures and pelvic organs and high-vascularity are just a few nuances of these type of conditions. This paper outline the importance of a good preoperative and intraoperative management in order to facilitate the maximum recovery of the patients. Material and Methods This paper analyses retrospectively a series of 2 cases of giant sacral tumors (&gt;100 cm3) that were operated in our clinic in 2024 by a multidisciplinary team (neurosurgeons and general surgeons). Follow-up data were obtained from the charts and medical records. All the lesions were localised under L4 vertebra with invasion of sacrum. Results Our first case was a 47-years old man who accused diffuse mild lumbar pain for more than 2 years, but acutely aggravated in the last months with lumbosacral radicular pain, palsy of the inferior lumbar nerves, urinary incontinence and paraesthesia. MRI showed a giant L5-S2 mass and biopsy diagnostic was myxopapillary ependymoma. Second case was of a young woman with lumbosacral radicular pain debuted a few months ago, whose clinical state worsened rapidly becoming paralytic of lower limbs. MRI showed a giant sacral mass with invasion of the pelvic musculature and surrounding the iliac vessels (intraoperative aspect: sarcoma). Both patients ameliorated postoperatively, and are currently enrolled in a recovery program. Sub-total resection and near-total resection were obtained. Conclusions Sacral tumors exhibit a challenge in the field of spine surgery being clinical silence over a period of months and years, and then followed by gross deficit. We diagnosed sacral tumors based on clinical, radiographic and laboratory aspects. Prognostic factors were preoperative clinical status and gross-total resection.

The Efficacy of Botulinum Toxin A Injection in Pelvic Floor Muscles in Chronic Pelvic Pain Patients: A Double-Blinded Randomised Controlled Trial.

To evaluate and compare the efficacy and safety of Botulinum Toxin A (BTA) injections versus placebo injections, combined with pelvic floor muscle therapy (PFMT), in women with chronic pelvic pain (CPP). Randomised, double-blinded clinical trial (January 2020-April 2023). This multicentre study was conducted at four hospitals in the Netherlands. Ninety-four women with CPP and increased pelvic floor muscle tone despite previous PFMT, were enrolled. Participants received either BTA injections (100 units) or placebo injections into the pelvic floor muscle, followed by four PFMT sessions. Primary outcomes included the number of women with at least a 33% reduction in pain and those reporting (very) much improvement of their pain. Secondary outcomes covered quality of life and pelvic floor function. Follow-up visits were scheduled at 4, 8, 12, and 26 weeks post-treatment. Mixed models for repeated measurements were used for analysis. A 33% reduction or more in average pain score was reported by 15 participants (33%) after BTA treatment and 9 participants (20%) after placebo treatment (odd ratio placebo/BTA 1.88; 95% CI 0.72-4.90, p = 0.19). In both groups, 8 women (17%) reported their improvement as (very) much better (odd ratio placebo/BTA 0.947; 95% CI 0.32-2.80, p = 0.92). Pelvic floor resting activity decreased significantly after BTA treatment compared to placebo (p = 0.001). The results from this study do not support the use of BTA injections in the management of CPP in women.

Cytokine modulation in pelvic organ prolapse and urinary incontinence: from molecular insights to therapeutic targets.

Pelvic organ prolapse (POP) and urinary incontinence (UI) are common disorders that significantly impact women's quality of life. Studies have demonstrated that cytokines, including pro- and anti-inflammatory immune mediators, play a role in illness genesis and progression. Research on the inflammatory milieu of the pelvic floor has shown that POP patients have increased inflammation in vaginal tissues. This evidence revealed that significant changes in the inflammatory milieu of the pelvic floor are an aspect of the pathogenesis of POP. POP patients exhibit increased levels of inflammatory cytokines (IL-1, TNF, IFN, and others) in the front vaginal wall, which may alter collagen metabolism and contribute to POP. Studies indicate that cytokines such as IL-6, IL-10, and TGF, which are involved in inflammation, remodelling, and repair, have dual effects on POP and UI. They can promote tissue healing and regeneration but also exacerbate inflammation and fibrosis, contributing to the progression of these conditions. Understanding the dual roles of these cytokines could help us improve the vaginal microenvironment of women and treat POP and UI. Given the considerable changes in these cytokines, this review addresses studies published between 2000 and 2024 on the molecular mechanisms by which pro- and anti-inflammatory cytokines affect women with POP and UI. Furthermore, we explain novel therapeutic strategies for cytokine regulation, emphasizing the possibility of personalized treatments that address the underlying inflammatory milieu of the vagina in POP and UI patients. This thorough analysis aims to establish a foundation for future research and clinical applications, ultimately improving patient outcomes via designed cytokine-based therapies.

Late Local Recurrence of Carcinoma &amp;lt;i&amp;gt;in situ &amp;lt;/i&amp;gt;- Only Bladder Cancer

Late recurrence (LR) of bladder cancer after radical cystectomy (RC) is rare, and few studies have been conducted. We report a case of local LR of bladder cancer 10.3 years after RC. The pathology at RC was almost carcinoma &amp;lt;i&amp;gt;in situ&amp;lt;/i&amp;gt; (CIS) only. The patient underwent metastasectomy, and treatment with an immune checkpoint inhibitor (ICI) achieved a complete response (CR). A 61-year-old woman was referred to our hospital for macrohematuria and bladder irritability in June 2012. She underwent RC along with pelvic lymph node dissection and ileal conduit creation. The pathologic findings were CIS, G2&amp;gt;G3, pT1, pN0. She visited our hospital with complaints of lower abdominal discomfort in November 2022, and recurrence was found on the pelvic floor by abdominal computed tomography. Metastasectomy confirmed metastasis of urothelial carcinoma. As salvage therapy, systemic chemotherapy with a platinum agent and an ICI were administered, leading to CR. Long-term follow-up should be considered for patients with bladder cancer, even for early-stage CIS-only tumors. Metastasectomy could be the primary option for LR of bladder cancer after RC.

Cutting-Edge Approaches in Urinary Incontinence Treatment: A Comprehensive Review

Introduction: Urinary incontinence is a prevalent health issue that profoundly impacts the quality of life for patients worldwide. Traditional treatments, including pharmacotherapy and surgical procedures, often fall short, leaving many individuals struggling with bladder control issues that restrict physical and social activities and cause significant psychological distress. Recent advancements in therapeutic methods—encompassing behavioral therapies, cutting-edge medical technologies, innovative pharmacotherapy, and advanced surgical techniques—offer promising alternatives. By exploring the effectiveness and advantages of these novel approaches, we can enhance treatment accessibility and elevate the quality of care for those affected by urinary incontinence, ultimately improving their daily functioning and overall well-being. Abbreviated description of the state of knowledge:Current research on innovative treatments for urinary incontinence indicates significant advancements in enhancing patients' quality of life. These cutting-edge methods encompass behavioral therapies like pelvic floor muscle training, state-of-the-art medical technologies such as nerve stimulation, new pharmacological treatments with high efficacy and minimal side effects, and advanced surgical interventions, including artificial sphincter implants and urinary tract modifications. Conclusions: Urinary incontinence is a prevalent health issue that significantly deteriorates the quality of life, particularly affecting half of women and one-third of men over the age of 80. As our society ages and the number of individuals affected by this condition rises, understanding and advancing treatment methods become increasingly crucial. Ongoing research aims to discover new and improved therapeutic approaches with minimal side effects, offering hope for enhanced patient outcomes and better management of urinary incontinence in the future.

Clinical Evidence Regarding Spermidine–Hyaluronate Gel as a Novel Therapeutic Strategy in Vestibulodynia Management

Background: Vestibulodynia (VBD) represents a summation and overlapping of trigger factors (infections, hormonal disturbances, allergies, genetic aspects, psychological vulnerability, and others) with broad individual variability. As there are no standard treatment options for VBD, the disease is still in need of appropriate therapeutic tools. Objectives: A prospective observational trial was performed to confirm the efficacy of a topical gel containing a spermidine–hyaluronate complex (UBIGEL donna™) as either a stand-alone or companion treatment through a multicenter study on a large sample population. Methods: For women with VBD (n = 154), the treatment consisted of approximately two months (4 + 4 weeks) of applications according to the posology of UBIGEL. Evaluation of symptoms was performed on relevant clinical endpoints: dyspareunia and vulvovaginal pain/burning by a visual scale (VAS); vestibular trophism by a vestibular trophic health (VeTH) score; vulvoscopy through a cotton swab test; and the level of hypertonic pelvic floor by a physical graded assessment of levator ani hypertonus. Results: A total of 154 patients treated with UBIGEL donna™ showed significant improvements across all five evaluated parameters, including pain, dyspareunia, swab test results, muscle hypertonicity, and vestibular trophism. Pain and dyspareunia scores decreased by 46.5% and 33.5%, respectively, while significant improvements were also observed in the other parameters (p &lt; 0.0001). These improvements were consistent across various stratifications, including age and disease duration. Conclusions: The findings of the present study suggest that UBIGEL donna™ is effective in alleviating pain and dyspareunia, as well as reducing vestibular hypersensitivity in women with VBD. Although UBIGEL donna™ alone cannot serve as a comprehensive substitute for all recommended therapies, we suggest that multimodal therapy strategies may be crucial for attaining substantial improvement in any aspect of the condition.

Implementation of Robotic-Assisted Sacrocervicopexy for Apical Organ Prolapse Using the Semitendinosus Tendon-Pilot Study and Analysis of Clinical Outcome.

This video demonstrates a robotic-assisted sacrocervicopexy using the semitendinosus tendon. Between June 2022 and February 2023, we performed the worldwide first Da Vinci robotic-assisted sacrocervicopexies (SCP) for apical organ prolapse using the semitendinosus tendon of the left knee. Analysis of safety, feasibility, and clinical outcome of the first ten patients operated on using this new surgical technique included the German pelvic floor questionnaire (GPFQ) as well as a clinical examination. Ten patients with a follow-up of 12months were included. There was a significant reduction of the patient's symptoms according to the GPFQ regarding the domain bladder (preoperatively versus 3 months postoperatively, mean 3.85 vs 1.61, p = 0.034), total score (preoperatively versus 3 months postoperatively, mean 12.79 vs 3.28, p = 0.034), and descensus symptoms (preoperatively versus 12months postoperatively, mean 4.74 vs 0.67, p = 0.022). POP-Q stage (point C) was significantly reduced between the preoperative period and at the time of discharge (mean 2.2 vs 0, p = 0.004). No serious intra- and postoperative complications occurred. This pilot study showed satisfying clinical outcomes after a follow-up of 12months, with a low mid-term complication rate.

Does Adding TENS to Pelvic Floor Rehabilitation Effect on Urodynamics and Clinical Results in Children With Spina Bifida?

Children with spina bifida (SB) experience a reduced quality of life due to neurogenic bladder dysfunction and the risk of renal failure later in life. Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) have gained prominence in recent years due to their positive effects in treating different types of bladder issues in both adults and children. Our study aims to investigate the effects of using these two methods together in children with SB and to delineate their potential value for clinical practice. Children with neurogenic bladder dysfunction due to SB who admitted to our spina bifida center were enrolled. Those patients, between 5 and 15 years of age, with only neurogenic detrusor overactivity (NDO) were randomly divided into two groups using an online computer application. While only the PFR was applied to Group PFR (n = 14), TENS was used in addition to this therapy in Group PFR + T (n = 14). The PFR sessions included abdominal massage, strength exercises, diaphragmatic breathing exercises, and contracting pelvic floor muscles. TENS was used in a standard fashion as previously described in patients with SB. Before and after treatment, patients' clinical data, dysfunctional voiding symptom score (DVSS), lower urinary tract symptoms, and quality of life scores due to urinary incontinence were evaluated. Urodynamic outcomes such as detrusor pressure, bladder capacity, contractility, and residual urine amount were also evaluated. Twenty eight children out of 750 SB patients were enrolled in our center. Children with only NDO due to SB were included in the study (Group PFR, mean age 8.3 ± + 2.7 years, 10 boys, four girls; Group PFR + T, 7.86 ± 2.03 years, eight boys, six girls). Treatment duration was 6 weeks (18 sessions). There was a decrease in voiding and lower urinary tract symptoms in both groups regardless of the use of TENS (p < 0.05). Maximum detrusor pressure significantly decreased only in the TENS group after treatment (from 82.143 ± 58.069 cmH2O to 58.077 ± 39.872 cmH2O) (p < 0.05). The difference in clinical parameters, quality of life scores and other urodynamic parameters were not found to be significant between groups. PFR and TENS may be effective in SB with NDO to reduce voiding symptoms, and protect bladder from increased pressures. PFR seems to be a useful conservative approach in patients with NDO, adjunt to standard treatment. Further studies are needed in delineation of a personalized holistic treatment approach in these patients. Addition of TENS to standard PFR in NDO may be effective in reducing maximum detrusor pressures, however, it does not seem to specifically contribute for improving incontinence and incontinence-related quality of life.

Do Women with Urinary Incontinence and Pelvic Organ Prolapse Receive Optimal First-Line Treatment?

There is scant knowledge on previous pelvic floor muscle training (PFMT) in women with urinary incontinence (UI) and pelvic organ prolapse (POP) referred to hospitals. We hypothesized that women with predominately UI and POP had not received optimal primary care conservative management. This was a descriptive, cross-sectional survey among women attending a gynecological outpatient's clinic. The questionnaire included questions about demographics, PFMT dosage, whether ability to contract had been assessed and whether the patients had used precontraction before increase in intra-abdominal pressure ("the knack"). One hundred two women, mean age 52.5 (SD 13.4) years, responded; 37.3% had never been treated previously. There was no statistically significant difference in age, BMI, level of education, parity, time since last birth, SUI, or POP between the women who had been treated conservatively or not before the hospital visit. Thirty-three percent had trained with a physiotherapist and > 35% reported that their ability to contract had not been assessed or were unsure whether it had been assessed; 37% were not able to stop their urine stream; 52% reported that they performed "the knack," with 15.7% reporting it to be effective. Reasons for not having trained the PFM before visiting the hospital included not being motivated, not knowing how to do PFMT, not being told/advised to do PFMT and not believing PFMT would help. The results of this study indicated that there is a need for improvement within first-line health care service for women with predominately UI and POP.

Voiding sonography: Technical description of a novel ultrasound method for assessment of micturition in women

AbstractVoiding sonography (VS) is a novel non‐invasive method that can be used to assess micturition in real time. When performed in a functional seated position and combined with free uroflowmetry, detailed evaluation of voiding can be conducted. VS presents advantages over current invasive assessment methods such as urodynamics. This methodological paper describes the rationale; advantages and disadvantages of VS; participant preparation; technique; a practical approach to obtain the video/image (including transducer placement to achieve an assessment of voiding with minimal obstruction of urine flow); recommended machine and transducer specifications; and the potential usefulness of ultrasound measurements. These measurements might provide information regarding the function of the pelvic floor muscle and urethral dynamics during voiding. Measures assessed with VS can also provide information regarding urine storage. In summary, VS is a new method to assess female voiding. Future work should evaluate the potential utility of the method to evaluate characteristics and mechanisms for voiding dysfunction in females with a variety of relevant clinical conditions. Use of VS as a screening tool before and after surgical or non‐surgical treatment intervention may also be a future consideration to assess progress and provide feedback to clinicians and patients.

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.