Pelvic Pain Research Articles

Recurrent infections drive persistent bladder dysfunction and pain via sensory nerve sprouting and mast cell activity.

Urinary tract infections (UTIs) account for almost 25% of infections in women. Many are recurrent (rUTI), with patients frequently experiencing chronic pelvic pain and urinary frequency despite clearance of bacteriuria after antibiotics. To elucidate the basis for these bacteria-independent bladder symptoms, we examined the bladders of patients with rUTI. We noticed a notable increase in neuropeptide content in the lamina propria and indications of enhanced nociceptive activity. In mice subjected to rUTI, we observed sensory nerve sprouting that was associated with nerve growth factor (NGF) produced by recruited monocytes and tissue-resident mast cells. Treatment of rUTI mice with an NGF-neutralizing antibody prevented sprouting and alleviated pelvic sensitivity, whereas instillation of native NGF into naïve mice bladders mimicked nerve sprouting and pain behavior. Nerve activation, pain, and urinary frequency were each linked to the presence of proximal mast cells, because mast cell deficiency or treatment with antagonists against receptors of several direct or indirect mast cell products was each effective therapeutically. Thus, our findings suggest that NGF-driven sensory sprouting in the bladder coupled with chronic mast cell activation represents an underlying mechanism driving bacteria-independent pain and voiding defects experienced by patients with rUTI.

Low uptake of gynecological consultation following domestic or sexual violence: A case-control study during pregnancy follow-up

ObjectiveThe aim of this study was to examine the association between exposure to domestic and sexual violence and low uptake of gynecological consultation. Study designBetween October 2021 and October 2022, a case-control studywas conducted in mother andchild centers and sexual health centers in the Paris, France area. The case group included pregnant women who did not have a scheduled gynecological consultation in the past two years. The control group included pregnant women who had a scheduled gynecological consultation in the past two years. Pregnant women were interviewed using a standardized questionnaire about a history of domestic and sexual violence, the date of their last gynecological consultation and the gynecological health. ResultsA total of 405 pregnant women were included in the case group (n = 129) or in the control group (n = 276). After adjustment for age, couple, social security, supplementary health insurance, dyspareunia, abnormal vaginal discharge, dysmenorrhea, regular pelvic pain, mastodynia, vulvodynia and history of difficult delivery, a history of intimate partner violence was associated with the absence of a gynecological consultation in the past two years (OR 2.13; CI95% 1.21–3.73, p = 0.008). A history of sexual violence, regardless of age, was associated with the absence a gynecological consultation in the past two years (OR 1.92; CI95% 1.05–3.49, p = 0.03). The absence of a gynecological consultation was associated with dyspareunia and domestic or sexual violence (p < 0.0001 and p < 0.0001, respectively). ConclusionsThis study highlighted the association between domestic and sexual violence and the absence of gynecological consultations in the past two years. It underlines the importance of screening for domestic and sexual violence during gynecological consultations and its impacts on mental health, in particular psychotraumatic symptoms, and on gynecological health, in particular dyspareunia.

World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: V. Physical examination standards in endometriosis research

The World Endometriosis Research Foundation (WERF) established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation tools (with common data elements) to facilitate the comparison and combination of data across different research sites and studies. In 2014, four data research standards were published: clinician-reported surgical data, patient-reported clinical data, and fluid and tissue biospecimen collection. Our current objective is to create an EPHect standard for the clinician-reported physical examination (EPHect-PE) for research studies. An international consortium involving 26 clinical and academic experts and patient partners from 11 countries representing 25 institutions and organizations. Two virtual workshops, followed by the development of the physical examination standards that underwent multiple rounds of iterations and revisions. N/A MAIN OUTCOME MEASURE(S): N/A RESULT(S): The EPHect physical examination (EPHect-PE) tool provides standardised assessment of physical examination characteristics and pain phenotyping. Data elements involve examination of a) back and pelvic girdle; b) abdomen including allodynia and trigger points; c) vulva including provoked vestibulodynia; d) pelvic floor muscle tone and tenderness; e) tenderness on unidigital pelvic exam; f) presence of pelvic nodularity; g) uterine size and mobility; h) presence of adnexal masses; i) presence of incisional masses; j) speculum examination; k) tenderness and allodynia at an extra-pelvic site (e.g. forearm); and l) recording of anthropometrics. The EPHect physical examination standards (EPHect-PE) will facilitate the standardised documentation of the physical examination, including the assessment and documentation of examination phenotyping of endometriosis-associated pelvic pain.

Ayurvedic Management of Primary Infertility Due to Chocolate Cyst: A Case Report

Background: Endometriosis presents in three different entities, which are frequently found together: peritoneal lesions, deep endometriosis and ovarian endometriotic cysts (endometriomas) Ovarian endometrioma is a benign estrogen dependent cystic mass arising from ectopic endometrial tissue within the ovary. It contains thick, brown, tar like fluid, which may be referred to as a chocolate cyst. The presence of endometriomas indicates more severe stage of endometriosis. Endometriomas can lead to chronic pelvic pain and infertility, and often requires surgery for treatment. Endometriosis has been found in nearly 50% of women experiencing issues with infertility, and nearly 70% of women with pelvic pain. Classic symptoms includes dysmenorrhoea, dyspareunia, menorrhagia and infertility. Management of the ovarian cyst through surgery is available to meet urgent need of the patient, but to establish a satisfactory conservative medical treatment is the need of the hour. According to Ayurveda, depending upon most common symptoms it can be compared as a syndrome complex of Granthi, Vidradhi, Udavartini Yonivyapada, Paripluta yonivyapada and Vataja Yonivyapada. It is a Tridoshaja vyadhi with vitiation of Vata And Artava. Chocolate cysts can also be managed on the line of treatment of Granthi, (nodular/glandular swellings) Vidradhi (abscess), Raktapachana and Raktaprasadana. Aim: To manage Female infertility with chocholate cyst with shodhana and shamana therapy. Materials and methods: A patient aged 25years came to outdoor patient department of Prasutitantra Evum Streeroga with the complaint of lower abdominal pain and infertility since2 years. Her Ultrasonography report reveals bilateral chocolate cyst with no dominant follicle. She has tendency of formation of recurrent chocolate cyst since 3 years. She was administered Virechana after completion of menses on 1st cycle, Dashmoola Shodhan Basti along with Uttara Basti with uttarabasti with kasisadi taila and sahachara taila in 2nd cycle, Yastimadhu Ksheera Basti for 3rd cycle along with the Uttara Basti with kasisadi taila and sahachara taila, on the fourth month Uttarabasti with 5 ml of Dhanvantra taila was done, Shigru Patra Avagaha Swedana and Jeevaniya Choorna 3 gm orally with warm milk after Basti treatment. Results: Patient has marked reduction in the size of the chocolate cyst and she conceived with the treatment protocol of 4 months Conclusion: Above mentioned treatment plan has effective result due to Shothahara, Vatanulomana, Raktaprasadana properties which may have effectively curtailed the progress of ovarian cyst and helped in treating infertility.

Optimizing Hysterectomy: A Prospective Comparative Analysis of Surgical Techniques and Their Impact on Women's Lives.

To investigate diverse hysterectomy techniques to determine their influence on patient outcomes, including pain levels, sexual function, anxiety, and quality of life. Of particular focus is the comparison between vessel sealing and traditional suturing in abdominal, vaginal, and laparoscopic hysterectomies. This study is unique in its comprehensive evaluation, considering patient satisfaction, recommendation rates, recovery times, and various other aspects. Our prospective cohort study adhered to ethical guidelines, involving a meticulous assessment of patients, including medical history, anxiety levels, pelvic pain, sexual function, and quality of life. Surgical methods were explained to patients, allowing them to actively participate in the decision-making process. Sociodemographic information was collected, and exclusion criteria were applied. Hysterectomy methods included total abdominal hysterectomy (TAH), laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and a modified vaginal technique known as VH Mujas. Several parameters were recorded, including operation indications, uterine volume, hospital stay, operation duration, pre-operative and post-operative complications, and more. In all groups, a statistically significant increase was found in pre-operative-post-operative FSFI sexual function values (p < 0.001). The patient's basal Beck Anxiety Scale scores significantly decreased following the decision for vaginal surgery, both in the VH and VH Mujas groups (p < 0.05). However, Beck Anxiety Scale scores at patients' initial assessments significantly increased following the decision for abdominal and laparoscopic surgery (p < 0.001). According to the results of the SF-36 quality of life assessment, an increase was observed in all post-operative quality of life parameters in patients who underwent surgery with different methods due to VH (p < 0.05). Our comprehensive comparison of hysterectomy techniques demonstrated that VH, particularly when utilizing the Mujas technique, outperforms other hysterectomy methods regarding patient safety and post-operative satisfaction but also offers the benefit of minimal invasiveness. Notably, this is reflected in improved quality of life, enhanced sexual function, lower pain scores, and favorable cosmetic results. The success of a hysterectomy procedure depends on precise indications, surgical planning, proper patient selection, and effective communication. This study emphasizes the significance of these factors in achieving optimal outcomes. The development of specialized vascular closure devices can further enhance the feasibility of vaginal hysterectomy, making it a preferable choice in gynecological surgery. The study contributes valuable insights into selecting the most suitable hysterectomy method for patients and optimizing their recovery.

ROLE OF BASTI IN THE MANAGEMENT OF GARBHASHYAGATA ARBUDA WITH SPECIAL REFERENCE TO UTERINE FIBROID: A CASE STUDY

Fibroids are the most common abnormal growth which develops in or on the uterus. They are also called as leiomyomas or myomas, which are common in childbearing age, generally between 30’s and 40’s. 70 to 80% of women will develop them in their lifetime. Most of the cases are symptomless. At the same time, some may present with symptoms like heavy or prolonged bleeding, pelvic pain and pressure, bleeding between periods, pain during intercourse, low backache, etc. In the present case study, a 47-year-old female came to OPD with complaints of heavy menstrual bleeding. On USG examination, she was having uterine fibroids with focal adenomyosis. She was treated with yog basti along with internal medications, which were found beneficial. USG was repeated after the procedure, which showed no uterine fibroids.

To Study the Efficacy of Intrauterine Device and Endometrial Regeneration Therapy versus Endometrial Regeneration Therapy Alone in the Prevention of Adhesions after Hysteroscopic Resection of Uterine Septum

Abstract Background: Septate uterus is a very common defect of the female reproductive system. Septate anomalies are associated with diminished fertility and increased risks for adverse pregnancy outcomes. Treatment must aim for optimization of pregnancy outcomes with minimum adverse effects. Aims: The aim of this study was to compare the presence or absence of adhesions and assess the efficacy of intrauterine device (IUD) along with endometrial regeneration therapy (ERT) vis-a-vis ERT alone in the prevention of adhesions after hysteroscopic resection of septum. Objectives: (1) To compare the two groups with respect to their efficacy. (2) To analyze the side effects of therapy in each group, e.g., intermittent spotting/bleeding and cyclical pain. (3) To assess endometrial thickness after 3 months, i.e., preovulatory endometrium without therapy. Settings and Design: This was a prospective observation study. Materials and Methods: A sample size of 42 was calculated for each study group for comparative analysis and subjects were randomly allocated into one of the two groups using computer-generated randomization tables. Group 1 received IUD and ERT while group 2 received ERT alone. Results: In first group receiving IUD + ERT therapy, 10 patients reported side effects in the form of hypomenorrhea, amenorrhea, severe pelvic pain and prolonged spotting as compared to only 8 patients developing side effects in the second group which received ERT alone therapy.: The rates of postsurgical intrauterine adhesion and other complications were not statistically significant in both groups (P = 0.457). There was no statistically significant difference between the groups with respect to preovulatory endometrial thickness. Conclusion: The findings from this clinical study reconfirm the results of already published efficacy and safety studies of the use of IUD and ERT preventive therapies following hysteroscopic metroplasty.

Ureteral duplication with ectopic implantation of the ureter into the prostatic urethra

An ectopic ureter is a ureter that terminates in or below the bladder neck. The incidence of ectopic ureter remains unclear because this malformation is often asymptomatic. Eighty percent of ectopic ureters are associated with a duplicate ureter. In our case, it was a 29 years old man, who consulted for intermittent pelvic pain. The patient underwent a prostatic magnetic resonance imaging (MRI), which showed an ectopic ureteral abruption at the level of the prostate. The uroscanner showed a ureteral duplicity with a silent superior kidney.

Association of Intrauterine Device Malposition With Previous Cesarean Delivery and Related Uterine Anatomical Changes.

We sought to determine the association between intrauterine device (IUD) malposition and previous cesarean delivery (CD) and related uterine anatomical changes. A retrospective cohort of all persons with an IUD presenting for two- and three-dimensional pelvic ultrasonography over 2 years, for any gynecologic indication, was compiled. IUD malposition was defined as IUD partially or completely positioned outside the endometrial cavity. Uterine position, uterine flexion, and cesarean scar defect (CSD) size were assessed. Patient characteristics and sonographic findings were compared between those with normally positioned and malpositioned IUD. Primary outcome was the rate of IUD malposition in persons with and without a history of CD. Logistic regression analysis was used to control for potential confounders. Two hundred ninety-six persons with an IUD had a pelvic ultrasound, 240 (81.1%) had a normally positioned IUD, and 56 (18.9%) had a malpositioned IUD. The most common location of IUD malposition was low uterine segment and cervix (67.9%). Malpositioned IUD was associated with referral for evaluation of pelvic pain (P = .001). Prior CD was significantly associated with a malpositioned IUD, after adjusting for confounders (aOR 3.50, 95% CI 1.31-9.35, P = .01). Among persons with prior CD, uterine retroflexion and a large CSD were independent risk factors for IUD malposition (aOR 4.1, 95% CI 1.1-15.9, P = .04 and aOR 5.4, 95% CI 1.4-20.9, P = .01, respectively). Prior CD is associated with significantly increased risk of IUD malposition. Among persons with previous CD, those with a retroflexed uterus and a large CSD are more likely to have a malpositioned IUD.

Клінічна характеристика жінок із жіночою сексуальною дисфункцією та ендометріозом

Endometriosis is a disease characterized by the presence of endometrial tissue outside the uterine cavity. Endometriosis refers to estrogen-dependent diseases, clinically manifested by dysmenorrhea, dyspareunia, dyschezia. Decreased fertility in women with endometriosis is associated with the presence of chronic inflammation that leads to pelvic pain and infertility. It is believed that endometriosis is associated with mood disorders such as anxiety or depression, which can create a pathological background for sexual dysfunction. Purpose - to establish the relationship between female sexual dysfunction (FSD) and external genital endometriosis in order to optimize women's pregravid preparation. Materials and methods. 100 women of reproductive age were examined. The main group (the Group I) consisted of 70 women who had external genital endometriosis (diagnosed by ultrasound examination of the pelvic organs, ovarian endometrioma size up to 5 cm). The main group was divided into 2 subgroups: IA - 40 women with FSD and endometriosis; IB - 30 women with FSD without endometriosis. The control group (the Group II) included 30 healthy reproductively active women in the pre-gravid stage. In the course of the study, the nosological unit approved by the World Health Organization (1999) was taken into account and taken as a basis - FSD, which include disorders of desire, arousal and reaching orgasm, dyspareunia and vaginismus. The results of clinical and biochemical studies were processed using a specialized package of statistical programs Statistica 8.0 (StatSoft Inc., USA). The following criteria were used for statistical processing of the obtained data: Kruskal-Wallis test, Mann-Whitney U test, Pearson chi-squared (χ2) test, Wilcoxon test. Results. The analysis of the definition of FSD in women with endometriosis clearly indicates the presence of signs of FSD in all areas and is statistically significantly different from the indicator of healthy women. Conclusions. There is a relationship between endometriosis and FSD that can be determined using the FSFI Questionnaire Calculator. Since FSD and endometriosis have a polymorbid background, treatment should be carried out by a multidisciplinary team of doctors and be personalized. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy.

Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.

Chronic pelvic pain in women: the path to outpatient discharge

Objective: To understand the meaning of chronic pelvic pain from the perspective of diagnosed women and analyze the determining factors for outpatient discharge. Methods: This is qualitative research, using strategic social research as its theoretical methodological framework. 14 women participated in the study, seven of whom were undergoing outpatient follow-up and seven who were discharged from the gynecology outpatient clinic of a university hospital in the city of Goiânia, Goiás, Brazil. Semi-structured interviews were carried out with guiding questions. The analysis of results was based on the thematic modality of content analysis, according to Bardin. Results: Data analysis culminated in three thematic categories: “Before the pain”, “Living with the pain” and “Treating the pain”. Parental emotional abandonment, grief, disagreement with parents and childhood difficulties were prominent before the onset of pain. The onset of pain was related to the birth of children, menarche, surgeries and family conflicts. Living with pain promoted great suffering, fear, harm to relationships and work activity. The improvement in emotional state and financial conditions, the resolution of marital conflicts, the opportunity to express oneself and talk to other patients, the use of medication and some surgical procedures were decisive for pain control and outpatient discharge. Conclusion: Chronic pelvic pain was related to socioeconomic, emotional and physical suffering. The resolution of these aspects contributed to outpatient discharge.

Mesh-less laparoscopic extraperitoneal linear suspension treatment of vaginal vault prolapse

ObjectivesTo report the results of a mesh-less laparoscopic extraperitoneal linear suspension technique for the treatment of post-hysterectomy vaginal vault prolapse (PHVP). Study designA retrospective observational study was conducted collecting medical records of 41 patients with symptomatic PHVP treated between November 2017 to November 2019 in Gynecologic department of China-Japan Friendship Hospital. All patients had Pelvic Organ Prolapse Quantification (POP-Q) scores indicating stage 3–4 PHVP and underwent mesh-less laparoscopic extraperitoneal linear suspension.The primary outcome was the subjective satisfaction rate based on responses to validated questionnaires. The secondary outcomes were the objective anatomical cure rate based on POP-Q scores and complication rates. All listed parameters were determined before the surgery and at control examinations in 1 year and 3 years after the treatment. ResultsThe operation was completed successfully without serious complications in all patients. Mean operation time was 53.8 mins. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.The subjective satisfaction rates were 100 % (41/41) and 95 % (38/40) at 1 year and 3 years after surgery. The objective cure rates were 100 % (41/41) and 97.5 % (39/40) at 1 year and 3 years after surgery, respectively. During the follow-up, none of the patients experienced suture exposure, infection, chronic pelvic pain, or other related complications. ConclusionThe mesh-less laparoscopic extraperitoneal linear suspension technique avoids the use of implantable synthetic mesh. It has been shown to lead to favorable postoperative outcomes, considerable patient contentment, and low complication rates. It offers a new, cost-effective treatment option for PHVP patients.

Interventional Hydrogel Microsphere Controlled‐Releasing Curcumin for Photothermal Therapy against Endometriosis

AbstractEndometriosis is a prevalent gynecological disorder characterized by the presence of endometrial‐like tissue outside the uterus, causing chronic pelvic pain, painful periods, and infertility. Despite the common use of hormone therapy and surgical lesion excision in its treatment, there remain significant postoperative risks and potential side effects, with a high recurrence rate. An efficient nonsurgical treatment for this condition is therefore urgently needed. In this study, an interventional hydrogel microsphere with near‐infrared (NIR)‐controlled curcumin release is developed for the non‐invasive thermal therapy of endometriosis. The hydrogel microspheres demonstrate good biocompatibility and photothermal activities, causing the death of endometrial stromal cells under NIR and controlled curcumin (Cur) release. When injected into endometriotic lesions and stimulated by NIR light, the interventional hydrogel microspheres (Cur‐FeHMPs) can raise the temperature of the endometriotic lesions to 43.65 °C, inducing endometriotic lesion elimination. Furthermore, the controlled curcumin release from the interventional hydrogel inhibits the proinflammatory environment in endometriosis. The Cur‐FeHMPs in combination with NIR present a novel strategy for endometriosis treatment.

Identification of Molecular Mechanisms in Radiation Cystitis: Insights from RNA Sequencing.

Pelvic cancer survivors who were treated with radiation therapy are at risk for developing (hemorrhagic) radiation cystitis (RC) many years after completion of radiation therapy. Patients with RC suffer from lower urinary tract symptoms, including frequency, nocturia, pelvic pain, and incontinence. In advanced stages, hematuria can occur, potentially escalating to life-threatening levels. Current therapeutic options for RC are limited, partly due to ethical concerns regarding bladder biopsy in patients with fragile bladder tissue. This study aimed to leverage our established preclinical model to elucidate the molecular pathways implicated in radiation-induced tissue changes in the bladder. Female C57Bl/6 mice received a single dose of 40 Gy using CT-guided imaging and a two-beam irradiation approach using the SARRP irradiator. Bladders from irradiated and age-matched littermate controls were harvested at 1 week [n = 5/group] or 6 months [n = 5/group] after irradiation, RNA was harvested, and mRNA sequencing was performed at paired-end 150bp on the Illumina NovaSeq6000 with a target of 30 million reads per sample. Following RNA sequencing, thorough bioinformatics analysis was performed using iPathwayGuide v2012 (ADVAITA Bioinformatics). Findings of the RNA sequencing were validated using qPCR analysis. At 1 week post-irradiation, altered gene expression was detected in genes involved in DNA damage response, apoptosis, and transcriptional regulation. By 6 months post-irradiation, significant changes in gene expression were observed in inflammation, collagen catabolism, and vascular health. Affected pathways included the p53, JAK-STAT, and PI3K-Akt pathways. These findings were validated in vivo in bladder tissues from our preclinical model. This is the first study to determine the molecular changes in the bladder in response to radiation treatment. We have successfully pinpointed several pathways and specific genes that undergo modification, thereby contributing to the progression of radiation cystitis. These insights enhance our understanding of the pathophysiology of radiation cystitis and may ultimately pave the way to the identification of potential new therapeutic targets.

A Treatment Algorithm for High-Tone Pelvic Floor Dysfunction.

To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

High glucose intake exacerbates experimental autoimmune prostatitis through mitochondrial reactive oxygen species-dependent TGF-β activation-mediated Th17 differentiation

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common inflammatory immune disease of the urogenital system. High glucose intake is considered to be a potential promoter of autoimmune diseases. However, the influence of high glucose intake on CP/CPPS is unknown. This research aimed to explore the influences of high glucose intake on experimental autoimmune prostatitis (EAP), a valid animal model of CP/CPPS, and the underlying mechanism. NOD mice received 20% glucose water or normal water treatment during EAP induction. EAP severity and Th17 cell responses were evaluated. Then, we explored the effects of an IL-17A neutralizing antibody, an inhibitor of TGF-β, the reactive oxygen species (ROS) inhibitor NAC, and the mitochondrial ROS (mtROS) antioxidant MitoQ on glucose-fed EAP mice. The results demonstrated that high glucose intake aggravated EAP severity and promoted Th17 cell generation, which could be ameliorated by the neutralization of IL-17A. In vitro experiments showed that high dextrose concentrations promoted Th17 cell differentiation through mtROS-dependent TGF-β activation. Treatment with TGF-β blockade, NAC, or MitoQ suppressed Th17 cell generation both in vivo and in vitro, resulting in the amelioration of EAP manifestations caused by high glucose intake. This study revealed that high glucose intake exacerbates EAP through mtROS-dependent TGF-β activation-mediated Th17 differentiation. Our results may provide insights into the molecular mechanisms underlying the detrimental effects of an environmental factor, such as high glucose intake, on CP/CPPS.

An artificial intelligence approach for investigating multifactorial pain-related features of endometriosis.

Endometriosis is a debilitating, chronic disease that is estimated to affect 11% of reproductive-age women. Diagnosis of endometriosis is difficult with diagnostic delays of up to 12 years reported. These delays can negatively impact health and quality of life. Vague, nonspecific symptoms, like pain, with multiple differential diagnoses contribute to the difficulty of diagnosis. By investigating previously imprecise symptoms of pain, we sought to clarify distinct pain symptoms indicative of endometriosis, using an artificial intelligence-based approach. We used data from 473 women undergoing laparoscopy or laparotomy for a variety of surgical indications. Multiple anatomical pain locations were clustered based on the associations across samples to increase the power in the probability calculations. A Bayesian network was developed using pain-related features, subfertility, and diagnoses. Univariable and multivariable analyses were performed by querying the network for the relative risk of a postoperative diagnosis, given the presence of different symptoms. Performance and sensitivity analyses demonstrated the advantages of Bayesian network analysis over traditional statistical techniques. Clustering grouped the 155 anatomical sites of pain into 15 pain locations. After pruning, the final Bayesian network included 18 nodes. The presence of any pain-related feature increased the relative risk of endometriosis (p-value < 0.001). The constellation of chronic pelvic pain, subfertility, and dyspareunia resulted in the greatest increase in the relative risk of endometriosis. The performance and sensitivity analyses demonstrated that the Bayesian network could identify and analyze more significant associations with endometriosis than traditional statistical techniques. Pelvic pain, frequently associated with endometriosis, is a common and vague symptom. Our Bayesian network for the study of pain-related features of endometriosis revealed specific pain locations and pain types that potentially forecast the diagnosis of endometriosis.

Incidental Zinner Syndrome in Nigeria: A Case Report

Zinner syndrome (ZS) is a rare urogenital condition characterised by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction, resulting from malformation during early embryogenesis of the mesonephric (Wolffian) duct. The authors present a 35-year-old male who was being evaluated for chronic hepatitis B virus infection. He was referred to the urology outpatient clinic on account of incidental ultrasound finding of solitary right kidney. General physical examination revealed a healthy-looking young male with a flat abdomen and no palpable enlarged organs. Digital rectal examination revealed normal sized prostate with no palpable pararectal masses. MRI of the pelvis revealed a triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. The clinical diagnosis was asymptomatic ZS. He is on yearly follow-up at the urology outpatient clinic for lower urinary tract symptoms, pelvic pain, painful ejaculation, features of infertility, and pelvic ultrasound. If any of these symptoms occur, he will be treated with an α-adrenergic receptor blocker, drainage of the seminal vesicle cyst, and appropriate treatment for infertility. He is also on active surveillance for viral hepatitis by the gastroenterology team. In conclusion, prompt referral and comprehensive radiological imaging investigations of patients with unilateral agenesis of the kidney will lead to increased identification and report of patients with ZS. There is paucity of literature reports on ZS in the authors’ environment, and this case report, to the best of the authors’ knowledge, is the first from Nigeria.

Menstrual cycles and the impact upon performance in elite British track and field athletes: a longitudinal study.

To assess the prevalence of menstrual disorders and the perceived effect of menstrual cycles upon performance in elite athletes. A longitudinal survey in the form of a questionnaire was sent to female track and field athletes at British Athletics every 6 months, over a five-year period between 1st October 2014 and 1st October 2019 in the United Kingdom (UK). 128 athletes completed an average of 4.2 ± 2.9 questionnaires across the study period. The mean age of menarche was 14.2 ± 1.4 years, 13.4 ± 1.3 years and 12.8 ± 1.4 years in endurance, power, and thrower athletes respectively (p < 0.05). Two-thirds (66%; n = 82) reported consistently regular cycles, 30% (n = 37) irregular at some point during the period of observation and 4% (n = 5) were amenorrhoeic. 87 athletes (68%) reported dysmenorrhoea and 40 (31%) menorrhagia. More than three quarters (76.8%; n = 96) described their cycle negatively affected performance. Amongst those who reported when the negative impact occurred (n = 91), 40% (n = 36) reported this in the late luteal phase and 35% (n = 32) during the early follicular phase. 79% (n = 100) of athletes reported at least one cyclical symptom, of which bloating, lower back and pelvic pain were most frequently experienced. This data highlights the complex interrelationship between women's health and elite athletic performance. Athletes perceive a negative impact from their menstrual cycles upon performance with a desire to manage these more effectively, particularly during competition. Female reproductive health expertise in the multi-disciplinary management of elite athletes is required.