Pelvic Support Research Articles

Interpretable Severity Scoring of Pelvic Trauma Through Automated Fracture Detection and Bayesian Inference.

Pelvic ring disruptions result from blunt injury mechanisms and are potentially lethal mainly due to associated injuries and massive pelvic hemorrhage. The severity of pelvic fractures in trauma victims is frequently assessed by grading the fracture according to the Tile AO/OTA classification in whole-body Computed Tomography (CT) scans. Due to the high volume of whole-body CT scans generated in trauma centers, the overall information content of a single whole-body CT scan and low manual CT reading speed, an automatic approach to Tile classification would provide substantial value, e. g., to prioritize the reading sequence of the trauma radiologists or enable them to focus on other major injuries in multi-trauma patients. In such a high-stakes scenario, an automated method for Tile grading should ideally be transparent such that the symbolic information provided by the method follows the same logic a radiologist or orthopedic surgeon would use to determine the fracture grade. This paper introduces an automated yet interpretable pelvic trauma decision support system to assist radiologists in fracture detection and Tile grading. To achieve interpretability despite processing high-dimensional whole-body CT images, we design a neurosymbolic algorithm that operates similarly to human interpretation of CT scans. The algorithm first detects relevant pelvic fractures on CTs with high specificity using Faster-RCNN. To generate robust fracture detections and associated detection (un)certainties, we perform test-time augmentation of the CT scans to apply fracture detection several times in a self-ensembling approach. The fracture detections are interpreted using a structural causal model based on clinical best practices to infer an initial Tile grade. We apply a Bayesian causal model to recover likely co-occurring fractures that may have been rejected initially due to the highly specific operating point of the detector, resulting in an updated list of detected fractures and corresponding final Tile grade. Our method is transparent in that it provides fracture location and types, as well as information on important counterfactuals that would invalidate the system's recommendation. Our approach achieves an AUC of 0.89/0.74 for translational and rotational instability,which is comparable to radiologist performance. Despite being designed for human-machine teaming, our approach does not compromise on performance compared to previous black-box methods.

Modification of Pelvic Support Osteotomy Technique in Patients with Sequelae of Hip Dysplasia: A Case Series.

The management of hip dislocation in patients older than 9 years of age is a challenge in terms of deciding which is the best treatment course to follow since the main sequelae are as follows: pain, discrepancy in the length of the pelvic extremities and lame gait, with the consequent disability for activities of daily living. In Ho Choi, Thabet A mention limited treatment options, including total hip arthroplasty and hip arthrodesis. These options have their benefits and limitations. The pelvic support osteotomy initially indicated for the treatment of septic arthritis of the hip and performed for the first time by Bavoier in 1838 and modified in 1970 by Ilizarov aims to improve the aforementioned sequelae. These cases report showed us the functional improvement with the treatment of dislocated hip dysplasia with pelvic support osteotomy with monolateral fixator and the 2nd osteotomy 4 cm distal to the hip. This was corroborated through the application of the modified Harris test. A series of six female Mexican adolescent patients from 11 to 17 years of age who come to the clinic due to long-standing pain symptoms in the coxofemoral joint, three patients in the right and three in the left hip when walking. All were treated with pelvic support osteotomy. The six patients continued with mild positive Trendelenburg but all of them diminished the discrepancy in the pelvic extremities, the mobility arcs were preserved and pain was suppressed in all. The modified Harris test showed increased scores (103.3%) after the surgery. There was just a minor complication in a patient, and it was resolved with surgical lavage. The modifications in the technique, monolateral fixator and second osteotomy 4 cm from the first one, allowed our patients to present functional improvement at the hip, which was assessed with the modified Harris scale. Patients achieved independent walking without pain and Trendelenburg less evident. The changes we found in our patients are evidence of the goodness and effectiveness of this type of osteotomy in patients older than 9 years of age, to improve the function of the hip.

The Value of Transperineal Three-Dimensional Pelvic Floor Ultrasound in the Observation of Pelvic Support in Primipara Women

Background: The pelvic floor support is weakened during pregnancy and delivery, probably leading to the pelvic floor dysfunction later on in life. An early assessment of the weakening of pelvic support can aid to prevent from developing Pelvic Floor Dysfunction (PFD).

Surgical treatment of genital prolapse in combination with endometrial hyperplastic processes in postmenopausal women

Aim. To study the long-term results of surgical treatment of postmenopausal patients with genital prolapse III and IV according to the POP-Q classification in combination with endometrial hyperplastic processes and to assess their quality of life.
 Materials and methods. Fifty one elderly and senile patients with grade III–IV prolapse according to the POP-Q classification in combination with endometrial hyperplastic processes. 2 groups were formed: 1st – 21 patients after one-stage vaginal extirpation of the uterus with appendages and unilateral sacrospinous fixation of the vaginal stump with a synthetic endoprosthesis-tape in combination with reconstruction of II and III levels of pelvic floor support according to DeLancey; 2nd – 30 patients after one-stage vaginal extirpation of the uterus with appendages and median colporrhaphy using the Lefort and Neugebauer technique.
 Results. The study was evaluated 1–7 years after surgical treatment. The average age of patients at the time of surgery in group 1 was 63.12±4.32 years, in group 2 – 74.2±3.28 years. The number of women with somatic pathology in the 1st group was 1.7 times less in percentage terms than in the 2nd. The disappearance of symptoms of an overactive bladder after surgery was noted by 4 (50.0%) of 8 patients of the 1st group and 4 (26.7%) of 15 women of the 2nd. Uroflowmetry after surgical treatment showed an increase in the maximum flow rate (Qmax) and a decrease in the volume of residual urine (Vom) in both groups (p0.001). Recurrence of genital prolapse was detected in the apical region in 1 (4.8%) woman, prolapse of the anterior vaginal wall in 1 (4.8%). There were no recurrences of genital prolapse in the 2nd group. A significant improvement in the quality of life after surgery, according to the results of processing the PFDI-20 questionnaire, was noted by 19 (90.5%) women in the 1st group and 29 (96.7%) – in the 2nd.
 Conclusion. The long-term results of the proposed operational benefits have shown satisfactory results and can be successfully used in the elderly and senile age. The choice of the volume of surgery taking into account age, sexual activity, concomitant gynecological and somatic pathology reduces the number of complications and improves the results of surgical treatment in this category of patients.

The mechanism of adipose mesenchymal stem cells to stabilize the immune microenvironment of pelvic floor injury by regulating pyroptosis and promoting tissue repair

Pelvic organ prolapse (POP) has a high incidence rate among Chinese women. Repeated mechanical stimulation is an important factor causing POP, but the injury mechanism has not yet been elucidated. The purpose of this study is to explore the related mechanisms of pelvic floor supporting tissue damage caused by mechanical force and the application of stem cell therapy. First, we obtained vaginal wall and sacral ligament tissue samples from clinical patients for examination. Pelvic floor support tissues of POP patients displayed high expression of inflammation and immune disorders. Then, we constructed a rat model of childbirth injury. In vivo and in vitro experiments investigated the key mechanism of pelvic floor support tissue injury caused by mechanical force. We discovered that after mechanical force, a large number of reactive oxygen species (ROS) and macrophages rapidly accumulated in pelvic floor tissues. ROS stimulated macrophages to produce NLRP3 inflammatory complex, induced the release of interleukin (IL-1β) and pyroptosis and exacerbated the inflammatory state of damaged tissues, persisting chronic inflammation of fibroblasts in supporting tissues, thus causing the pelvic floor's extracellular matrix (ECM) collagen metabolic disorder. Resultingly impeding the repair process, thereby causing the onset and progression of the disease. Through their paracrine ability, we discovered that adipose mesenchymal stem cells (ADSCs) could inhibit this series of pathological processes and promote tissue repair, asserting a good therapeutic effect. Simultaneously, to overcome the low cell survival rate and poor therapeutic effect of directly injecting cells, we developed a ROS-responsive PVA@COLI hydrogel with ADSCs. The ROS-scavenging properties of the gel could reshape the site of inflammation injury, enhance cell survival, and play a role in subsequent treatment. The findings of this study could serve as a basis for early, targeted intervention therapy for POP and representing a promising approach.

Urethral Prolapse in a Post-Menopausal Woman at the Sominé Dolo Hospital in Mopti (Mali)

Urethral mucosal prolapse is a rare and benign condition, which consists of a circular eversion of the distal urethral mucosa through the urinary meatus. It occurs most often in prepubertal and postmenopausal women for whom lack of estrogen and poor pelvic support remain the predisposing factors. Its presence in the post-menopausal period is rare. We report a case of urethral prolapse in a postmenopausal woman at the Sominé Dolo hospital in Mopti who presented with persistent urinary symptoms. We present a case of urethral prolapse observed in a 66-year-old woman referred to the urology consultation and who presented recurrent urinary symptoms with multiple treatments based on antibiotics and medicinal plants without success for a year. Physical examination noted a circular, non-reducible and non-painful swelling at the level of the urethral meatus with bleeding on contact, consistent with urethral prolapse. The option of surgical excision was discussed with the patient. The patient underwent surgery and the postoperative course was simple.

Reduction of High Hip Dislocation With a Distraction Nail and Arthroplasty (Preliminary Results of a Novel Technique)

A novel distraction technique is described for total hip arthroplasty in symptomatic high hip dislocation (Crowe IV) combining an intramedullary motorized lengthening nail with a pelvic support plate to gradually stretch hip soft tissues (distalization) and performing total hip arthroplasty with the cup in the primary acetabulum. Twelve patients (15 hips) were identified in a retrospective study via chart review. Medical records and radiographs were reviewed for details of the initial case parameters, surgical details, magnitude of distalization, duration of treatment, outcomes, and complications. Followed by an average of 67.4 mm of distalization, nearly anatomical cup placement, and equal leg length were achieved in all patients. During distalization, pain level was low with acceptable range of motion. One unplanned surgery and no complications with long-term sequelae occurred.

Лазерна корекція у поєднанні з перинеопластикою для підвищення сексуального задоволення

After vaginal delivery and improper episiotomy suturing about 40% of women complaint from wide vagina and defect in pelvic support which will lead to loss of satisfaction in sexual relationship with the partner. In recent years many different methods were used for solve the complaint for many of these ladies of wide vagina and loss of satisfaction in their sexual relationship, which was either surgical or non-surgical ways.The objective: to confirm that the fractional CO2 laser was emergency noninvasive modalities to solve problem with or without simple perineoplasty could be needed to restore pelvic support and improve sexual function of women.Materials and methods: 101 women took part in this prospective study. All women were old from 22 to 45 years. The degree of vaginal laxity severity was evaluated by vaginal examination in each patient. Perineal length, vaginal orifice length were measured and female sexual function index questionnaire was used to assess sexual satisfaction score. The women had different degree of vaginal laxity and underwent fractional CO2 laser from 2 to 3 sessions with or without simple perineoplasty and follow up them for gain vaginal tightness and improvement of their sexual function.Results. There was significant correlation between increase body mass index and parity with decrease sexual function of the women as the P values equal to 0.0001 and 0.029 consequently. Regarding the anatomical variation of the genital tract that occurs to women before and after doing the laser sessions and simple perineoplasty, our study show very significant correlation between partner satisfaction and anatomical variation were P value equal the following consequently 0.003, 0.035 and 0.57. Conclusion. The degree of vaginal laxity should be clinically evaluated and accordingly the use of only fractional CO2 laser with or without simple surgical perineoplasty to achieve vaginal tightness and improve in sexual function.

What is the role of hysterectomy in pelvic organ prolapse treatment?

Pelvic organ prolapse (POP) is a condition with an increasing incidence rate, affecting more than 40% of women over 50 years old. There are three levels of pelvic floor support, described by Delancey. The individual impact of each of them leads to the appearance of prolapse in a certain compartment (anterior, posterior or apical), the therapeutic conduct being individualized in each situation. In the case of symptomatic apical POP or after the failure of conservative treatment, the treatment of choice is the surgical one, with hysterectomy in the first place, followed by pelvic reconstruction procedures with the preservation of the uterus. These procedures can be performed through a vaginal approach, if access allows, or transabdominally, classically or through laparoscopy. Additionally, there are numerous procedures for ligamentous suspension of the remaining vaginal apex, thus having the freedom to combine different approaches with different procedures, with the aim of a lasting result. Regarding the recurrence rate, comparing vaginal hysterectomy followed by ligament fixation with native tissue with hysteropreservation interventions, there is a significant decrease in POP recurrence after hysterectomy. However, compared in general, no long-term difference in pelvic organ prolapse recurrence is observed. Moreover, being an invasive procedure that requires extensive dissection of the tissues, there is a longer duration of the operating time, with an above average hemorrhage in case of hysterectomy, the patients having a longer duration of hospitalization. The decision regarding the chosen surgical option must be taken together with the patient, after presenting the advantages and disadvantages of each method, as well as the evaluation of the biological state and the risks of a prolonged surgical intervention. An important factor is the existence of some gynecological background (metrorrhagia, endometrial polyps, uterine fibroids), an aspect that pleads for the excision of the uterus.

Twisted orientation of the muscle bundles in the levator ani functional parts in women: Implications for pelvic floor support mechanism.

This study presents a comprehensive investigation of the anatomical features of the levator ani muscle. The levator ani is a critical component of the pelvic floor; however, its intricate anatomy and functionality are poorly understood. Understanding the precise anatomy of the levator ani is crucial for the accurate diagnosis and effective treatment of pelvic floor disorders. Previous studies have been limited by the lack of comprehensive three-dimensional analyses; to overcome this limitation, we analysed the levator ani muscle using a novel 3D digitised muscle-mapping approach based on layer-by-layer dissection. From this examination, we determined that the levator ani consists of overlapping muscle bundles with varying orientations, particularly in the anteroinferior portion. Our findings revealed distinct muscle bundles directly attached to the rectum (LA-re) and twisted muscle slings surrounding the anterior (LA-a) and posterior (LA-p) aspects of the rectum, which are considered functional parts of the levator ani. These results suggest that these specific muscle bundles of the levator ani are primarily responsible for functional performance. The levator ani plays a crucial role in rectal elevation, lifting the centre of the perineum and narrowing the levator hiatus. The comprehensive anatomical information provided by our study will enhance diagnosis accuracy and facilitate the development of targeted treatment strategies for pelvic floor disorders in clinical practice.

A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques.

Contemporary understanding of the dynamic anatomy of pelvic floor support has led us to new conservative surgery for uterine prolapse (UP). In this study, we comprehensively evaluate the safety and feasibility of a new technique for uterine-preserving pelvic organ prolapse surgery: laparoscopic rectus abdominis hysteropexy for uterine prolapse (LRAHUP). A retrospective study was conducted between 2006 and 2016. Sixty-five women diagnosed with advanced prolapsed uterus were eligible and grouped into traditional vaginal surgery (TVS, n = 30) group and new laparoscopic surgery (NLS, n = 35) group. Evaluated items of 65 cases included surgery-related parameters and postoperative outcomes. Surgical safety evaluating indicators, including operation time, blood loss, postoperative hospitalized day, and operation complications, also showed great significant difference between two groups (P < 0.05). The subjective index of post-operative Pelvic Floor Distress Inventory-short form 20 scores and some objective anatomic outcomes all showed great difference between pre- and post-operation (P < 0.05). Although the TVL showed no difference between pre- and post-operation in the same group, the TVL displayed a remarkable elongation. And a remarkable tendency was a higher cumulative recurrence ratio in the TVS group and a shorter follow-up period in the NLS group. LRAHUP may be a good procedure to manage women with advanced prolapsed uterus.

A new concept of pelvic floor support function: Striated–smooth muscle complex

Pelvic floor and perineum muscles play an important role in the formation of an apparatus supporting pelvic organs. The functional insufficiency of myofascial structures frequently leads to the development of urinary and fecal incontinence, erectile dysfunction, prolapse of internal organs, and perineal hernias formation. Back in the 20th century, morphologists focused on the skeletal muscles in pelvic floor and perineum, highlighting their leading role in supporting organs and creating intraabdominal pressure. However, in the past two decades, particular attention has been paid to the smooth muscle structures and their relationship with the musculoskeletal system in the pelvic outlet area. The new concept of the striated–smooth muscle complex provides the basis for revising various aspects of pelvic organ prolapse and urinary and fecal incontinence pathophysiology. We believe that this may lead to improved early diagnosis and prevention of diseases of the pelvic floor and perineum.

The Correlation between Transperineal Shear-Wave Elastography and Transabdominal Ultrasound When Assessing Pelvic Floor Function in Nulliparous Women.

Pelvic floor muscles (PFMs) play a crucial role in maintaining pelvic organ support and continence. However, pelvic floor dysfunction (PFD), often resulting from insufficient PFM control, poses a substantial global health challenge for women. This study aims to explore the relationship between levator ani muscle elasticity when assessed through transperineal shear-wave elastography (SWE) and bladder base displacement, quantified using transabdominal ultrasonography (TAUS), as a means to comprehensively evaluate PFM function. A total of 42 nulliparous women participated in this study. Participants received instructions on proper PFM contractions using Kegel exercises. Levator ani muscle elasticity was assessed both at rest and during contractions using transperineal SWE, while bladder base displacement was simultaneously measured through TAUS. Repeated measures demonstrated strong intraclass correlation coefficients of 0.906 at rest and 0.687 during contractions for levator ani muscle elasticity. The mean elasticity values were 24.7 ± 4.5 kPa at rest and 62.1 ± 10.4 kPa during contractions. Additionally, the mean bladder base displacement was 7.2 ± 2.5 mm, and the normalized bladder base displacement via body mass index was 0.3 ± 0.1 mm. Significantly, a moderate correlation was identified between the PFM function, represented by the difference in levator ani elasticity during contractions and resting, and bladder base displacement (r = 0.486, p = 0.001). These findings underscore the potential utility of transperineal SWE as a reliable and noninvasive method to assess levator ani muscle elasticity and, consequently, PFM function. In conclusion, this study sheds light on the interplay between PFM elasticity and bladder base displacement, offering insights into PFM function assessments. The observed correlation suggests the clinical relevance of SWE in providing valuable information for treatment planning in PFD. These findings contribute to a deeper understanding of PFM dynamics, ultimately aiding in the effective management of PFD among women.

The effect of micronutrients on postpartum pelvic organ prolapse patients

HIGHLIGHTS Serum vitamin D levels were significantly different between POP and in healthy women. Micronutrient MMP-1 expression is increased in POP patients. ABSTRACT Objective: Pelvic Organ Prolapse (POP) is when pelvic tissues sink into the vagina due to weakened ligaments or muscles. POP is common globally. Adequate nutrition, including Vitamin D, is vital for prevention. Vitamin D maintains bone and muscle health, regulates MMP-9 to control collagen, essential for pelvic support. Increased MMPs lead to collagen breakdown and POP. Recognizing vitamin D's role in collagen and POP is crucial for prevention. This study aimed to determine definitive association between vitamin D, collagen type I and MMP-1 in POP patients. Materials and Methods: Our search yielded 1375 studies, of which 7 were included in the present investigation. Two studies addressed the micronutrient status of vitamin D, four investigated the micronutrient status of type 1 collagen, and two studied the micronutrient status of MMP-1 in postpartum POP patients. Results: The results showed that the mean of vitamin D levels from POP group was substantially decreased compared to a those of healthy women in the control group (95% confidence interval (CI), -3.64; -3.44 and p &lt;0.05). There was a decrease of collagen I protein in POP (95% CI, -3.26; -2.45. p &lt;0.05). Additionally, MMP-1 expression increased in POP patient (95% CI. 1.48-2.23, p &lt;0.05) Conclusion: Micronutrient status was severely compromised in POP group compared to control subjects.

Analysis of the anatomical and biomechanical characteristics of the pelvic floor in cystocele.

Stress urinary incontinence (SUI) occurs due to disruption of the pelvic floor anatomy; however, the complexity of the pelvic floor support structures and individual patient differences make it difficult to identify the weak points in the pelvic floor support that cause SUI to occur, develop, and recur. This study aimed to analyze the pelvic floor anatomy, structural features, and biomechanics of cystoceles to develop more effective treatment plans with individualized and precise healthcare. In this observational case-controlled study (clinical trial identifier BOJI201855L), 102 women with normal pelvic floor function and 273 patients diagnosed with cystocele degrees I-III were identified at Shanghai General Hospital from October 2016 to December 2019. We combined ultrasound and vaginal tactile imaging (VTI) to assess the anatomy and biomechanical functions of the anterior and posterior vaginal walls. Both examinations included relaxation and muscle tension tests. Of the 42 VTI parameters, 13 were associated with the degree of cystocele, six with an increase in the urethral rotation angle (pointing to the mobility of the urethra), and six with a decrease in the retrovesical angle (pointing to hypsokinesis and decrease in bladder position). According to these data, the strength of tissues, especially the muscles in both the anterior and posterior compartments, contributes to the stability of the pelvic floor structure. The strength of the levator ani muscle (LAM) is important for the degree of cystocele, mobility of the urethra, hypsokinesis, and decrease in bladder position. In general, the biomechanical status of the pelvic floor in patients with cystocele is complex and involves various muscles, ligaments, tendons, and fascia. Of these, repair and exercise of the LAM have not received much attention in the treatment of patients with cystoceles, which may be an important risk factor for the high recurrence rate.

Obstetrical ballooning and avulsion of levator ani muscle after vaginal delivery: a literature review

Link of Video Abstract: https://youtu.be/TWDe9uP4QX8 The levator ani muscle (LAM) is thought to be of central importance concerning pelvic organ support. 10-30% of women experience overstretched or 'ballooning' of the levator hiatus, sometimes followed by detachment or 'avulsion' of the muscle from its insertion. Both ballooning and avulsion of the LAM can occur by itself or co-exist at the same time. This literature review was conducted on multiple databases from previous studies, to help clinicians better understand the ballooning and avulsion phenomenon, thus making early diagnosis possible for earlier prolapse prevention for the patients. LAM avulsion can be diagnosed clinically using digital palpation or using imaging modalities such as ultrasound and magnetic resonance imaging (MRI). During maximal contraction (or at rest) using ultrasound, levator avulsion is indicated through a levator-urethra gap (LUG) diameter &gt; 2.5 cm. MRI is considered highly sensitive, but it requires a higher cost and an experienced radiologist. Hiatal ballooning can be diagnosed by clinical examination based on the sum of Genital hiatus and Perineal body (Gh+Pb) and imaging with 2D, 3D, or 4D ultrasound during the Valsava maneuver. Ballooning is diagnosed clinically if Gh+Pb &gt; 7 cm, by 2D imaging of levator hiatal anteroposterior (LHAP) diameter ≥ 6 cm, and by 3D/4D imaging of the hiatal area ≥ 25 cm2. Physiotherapeutic treatment and pelvic floor muscle (PFM) exercises can be used to treat ballooning and LAM avulsion to avoid urogynecological sequelae. There is some evidence to prevent this condition, including vitamin D consumption, epidural analgesia, kegel exercise, and vaginal dilator. PFM strength, posterior vaginal wall support, and ultrasound evidence of LAM tear can be used as potential indicators to predict pelvic floor injury. Since ballooning and avulsion of the LAM have lifelong morbidity and are not often identified early by clinicians, further research is still needed.

Standard Restrictions vs Expedited Activity After Pelvic Organ Prolapse Surgery

Restrictions on postoperative activity following pelvic organ prolapse (POP) surgery are not evidence based. Nonetheless, many pelvic surgeons place lifting and activity restrictions on patients following surgery. To evaluate whether expedited activity results in noninferior anatomic and symptomatic outcomes compared with standard activity restrictions after POP surgery. This randomized noninferiority clinical trial included patients undergoing vaginal or laparoscopic apical reconstructive surgery for POP between July 1, 2020, and October 31, 2021, at a single academic tertiary referral center in Durham, North Carolina. Anatomic outcomes were assessed by masked examiners, and subjective outcomes were assessed via validated surveys, both completed at 3 months postoperatively. Patients meeting minimum physical activity criteria with at least stage II bothersome POP were eligible. A total of 218 patients were approached, of whom 123 were randomly assigned and 107 had complete outcome data and were included in the analysis. Patients were randomly assigned to receive standard restrictions vs expedited postoperative activity instructions. The anatomic coprimary outcome was maximum anatomic POP support loss (SLmax), which is the most distal point of pelvic organ support loss according to the Pelvic Organ Prolapse Quantification System (noninferiority margin, 1.0 cm). The symptomatic coprimary outcome was the Pelvic Organ Prolapse Distress Inventory (POPDI) symptom score (noninferiority margin, 34.3 points). Differences between outcomes were assessed using linear regression models controlling for baseline SLmax and POPDI, respectively. Of 123 participants randomized, 107 had complete 3-month outcome data and were included in the analysis. Mean (SD) age was 62.8 (10.1) years. At 3 months, mean (SD) SLmax was -1.7 (1.4) cm in the expedited group and -1.5 (1.4) cm in the standard group (P = .44). After adjusting for baseline SLmax, the mean maximum support loss was 0.18 cm higher within the vaginal canal in the expedited group (95% CI, -0.68 to 0.33 cm). The coprimary outcome of POPDI score was a mean (SD) 23.7 (41.8) points in the expedited group vs 25.7 (39.3) points in the standard group (P = .80). After adjusting for baseline scores, mean POPDI scores were 5.79 points lower in the expedited group (95% CI, -20.41 to 8.84). The findings demonstrate that expedited activity after prolapse surgery results in noninferior anatomic and symptomatic prolapse outcomes. It is reasonable to instruct patients undergoing minimally invasive prolapse surgery to resume physical activities ad lib postoperatively. ClinicalTrials.gov Identifier: NCT04329715.

The spine intra-abdominal pressure (SIAP) trial. A prospective, observational, single arm, monocenter study looking at the evolutions of the IAP prior, during and after spine surgery

Background and aimsBoth anaesthesiologists and spine surgeons consider the intra-abdominal pressure (IAP) as an important peri-operative factor affected by patient positioning.We assessed the change in IAP caused by using a thoraco pelvic support (inflatable prone support, IPS) with the subject under general anesthesia. The IAP was measured before, during and immediately after surgery. MethodsThe Spine Intra-Abdominal Pressure study (SIAP trial) is a prospective, single-arm, monocenter, observational study looking at changes in IAP prior, during and after spine surgery. The objective is to assess the change in IAP, measured via an indwelling urinary catheter, using the inflatable prone support (IPS) device during prone positioning of patients in spinal surgery. ResultsForty (40) subjects requiring elective lumbar spine surgery in prone position were enrolled after providing informed consent. The inflation of the IPS results in a significant decrease of IAP (from a median of 9.2 mmHg to 6.46 mmHg (p < 0.001)) in patients undergoing spine surgery in prone position. This decrease in IAP was maintained throughout the procedure despite the discontinuation of muscle relaxants. No serious adverse events or unexpected adverse events occurred. ConclusionThe use of the thoraco-pelvic support IPS device was able to significantly lower the IAP during spine surgery.

MP07-12 PELVIC FLOOR SUPPORT FOLLOWING FEMALE RADICAL CYSTECTOMY: A LONGITUDINAL OBSERVATIONAL STUDY

You have accessJournal of UrologyCME1 Apr 2023MP07-12 PELVIC FLOOR SUPPORT FOLLOWING FEMALE RADICAL CYSTECTOMY: A LONGITUDINAL OBSERVATIONAL STUDY Shree Agrawal-Patel, Sandip Vasavada, David Rapp, Sarah Martin, Lauren Gleich, Tracey Krupski, Byron Lee, and Jacqueline Zillioux Shree Agrawal-PatelShree Agrawal-Patel More articles by this author , Sandip VasavadaSandip Vasavada More articles by this author , David RappDavid Rapp More articles by this author , Sarah MartinSarah Martin More articles by this author , Lauren GleichLauren Gleich More articles by this author , Tracey KrupskiTracey Krupski More articles by this author , Byron LeeByron Lee More articles by this author , and Jacqueline ZilliouxJacqueline Zillioux More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Women are at risk of pelvic organ prolapse and sexual dysfunction following radical cystectomy (RC); however, these outcomes are under-appreciated and understudied. We aimed to assess the natural history of pelvic floor support and vaginal symptoms following female RC. METHODS: This is an interim analysis of an IRB-approved multicenter prospective observational study of pelvic floor support in women undergoing RC from 3/2021 to 5/2022. All women undergoing RC at 2 institutions were recruited. Participants underwent pelvic exam including Pelvic Organ Prolapse Quantification System (POP-Q) measurements by an FPMRS-trained urologist at baseline and routine postoperative visits. Participants completed validated questionnaires (Pelvic Floor Disability Index (PFDI-20); International Consultation on Incontinence Questionnaire Vaginal Symptoms (ICIQ-VS)) at each visit. Surgical details including amount of vaginal tissue removed during non-vaginal-sparing RC were recorded. RESULTS: Fourteen women enrolled and had at least one postoperative visit through 6-months. Median age was 69 years. Approach was robotic in n=9 (64%) and vaginal-sparing in n=5 (38%). Indication was benign for 3 patients and all underwent non-orthotopic diversion. One vaginal-sparing benign case had concomitant mesh sacrocolpopexy for baseline stage 3 apical prolapse, while one patient from sparing and non-sparing groups had concurrent uterosacral ligament plication. All non-vaginal-sparing cases had clamshell reconstruction following excision of a median of 4.0 [4.0, 6.0] cm length and 2.5 [2.0, 4.0] cm width vaginal tissue, representing median 48% of baseline total vaginal length removed. Table 1 illustrates longitudinal POP-Q exam and questionnaire scores of vaginal sparing and non-sparing cases. One patient had anterior vaginal wall dehiscence requiring debridement under anesthesia but ultimately not reconstruction. CONCLUSIONS: To our knowledge, this is the first prospective study of pelvic floor support following female RC. Though further study is needed, preliminary findings through 6-month follow-up suggest vaginal foreshortening in both vaginal-sparing and non-sparing cases. Both groups appear to have mild anterior/posterior prolapse progression, although without worsened symptom scores. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e89 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shree Agrawal-Patel More articles by this author Sandip Vasavada More articles by this author David Rapp More articles by this author Sarah Martin More articles by this author Lauren Gleich More articles by this author Tracey Krupski More articles by this author Byron Lee More articles by this author Jacqueline Zillioux More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy of supervised pelvic floor muscle training with a home-based biofeedback device for urinary incontinence in postpartum women: protocol for a multicentre randomised controlled trial

IntroductionSupervised pelvic floor muscle training (PFMT) of at least 3 months duration has been strongly recommended as a first-line treatment for women with stress urinary incontinence (SUI) or SUI-predominant mixed...