Despite its common use, there is limited contemporary evidence regarding the place of simple cystometry (SC) in the evaluation of urinary function. Our objective was to assess the accuracy of SC with respect to complex urodynamic study (UDS), evaluate the correlation between them, and determine whether performing both tests on the same patient offers any additional benefit. In this retrospective cohort study, 609 consecutive women aged >18 years who underwent both UDS and SC within the same 6-month period between January 1, 2017, and December 31, 2022, were evaluated at a tertiary academic center. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SC were evaluated for detecting stress urinary incontinence (SUI) and detrusor overactivity (DO), using UDS as the gold standard. Pearson correlation for filling parameters was calculated. Each patient served as their own control for each test. There was a weak correlation between SC and UDS for first sensation ( r =0.30), first urge ( r =0.38), and maximum cystometric capacity (MCC) ( r =0.43). SC detected DO with a sensitivity of 38% (28-48%) and a specificity of 86% (82-89%). SC detected SUI with a sensitivity of 79% (75-83%) and a specificity of 53% (46-60%). When UDS was performed in conjunction with SC, an additional 14% of patients (n=87) were found to have SUI. The correlation between SC and UDS with respect to filling phase parameters is low. SC testing demonstrated a high sensitivity for SUI and a high specificity for DO. The combination of SC and UDS may enhance SUI detection rates.

Pelvic muscle training and electrostimulation to treat weak pelvic floor: a multicentre-randomised parallel group trial.

Surgeons traditionally place the synthetic midurethral sling (MUS) after completing the apical suspension procedure during surgical procedures for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesize it may be more efficient to perform the MUS procedure at the beginning of the case without compromising MUS treatment success. The objective of this study was to determine whether MUS timing affects SUI treatment outcomes 3 months after surgery. A retrospective cohort study was performed of patients who had minimally invasive sacrocolpopexy (SCP) at a single tertiary care center between June 2023 and June 2024. As routine practice, 4 surgeons place MUS before and 4 place MUS after completion of the SCP. Surgical cases were categorized into "MUS pre-SCP" and "MUS post-SCP". SUI treatment failure was defined as (1) patient report of persistent or de novo SUI, (2) positive cough stress test result, and/or (3) retreatment for SUI (including pelvic floor physical therapy, pessary, or surgery). Sixty-six participants had MUS placed before the SCP (MUS pre-SCP), and 111 had MUS placed after completing the SCP (MUS post-SCP). The MUS pre-SCP group was more likely to have advanced stage 3/4 POP ( P < 0.001). The MUS pre-SCP group was more likely to have had a concomitant hysterectomy ( P = 0.01), total hysterectomy ( P < 0.001), single-port robotic procedure ( P <0.001), and shorter operative times ( P < 0.001). Overall, SUI treatment failure was similar between MUS pre-SCP and post-SCP cohorts ( P = 0.54). Placing an MUS before minimally invasive SCP did not affect SUI treatment outcomes at 3 months and was associated with shorter operative time.

Stress urinary incontinence (SUI) adversely impacts millions worldwide due to weakened pelvic floor muscles and urethral sphincter dysfunction. To date, there is a lack of effective non-surgical treatment for SUI, and no clear consensus has been reached on the optimal stem cell source under regenerative therapy. Existing studies have shown no precise molecular mechanisms underlying stem cell-mediated external urethral sphincter (EUS) regeneration. Therefore, we investigated the regenerative and reparative potential of our clinical-grade human amniotic fluid stem cells (hAFSCs) for treating SUI. We determined the immunophenotype, multi-differentiation potential, and secretome of AFSCs. Treated animals were grouped into sham, UI, phosphate buffer saline, and hAFSC groups. Pudendal nerve injury was created to induce SUI in female rats and treated with hAFSCs by administering them into the external urethral sphincter. Isolated AFSCs showed trilineage potential and expressed neuronal-specific markers such as Nestin, Tuj-1, MAP2, and GFAP. hAFSCs-treated group showed significantly (p < 0.01) improved leak point pressure, intercontractile interval, and total muscle cell proliferation numbers. hAFSCs showed elevated levels of VEGF, IL-8, TIMP-1, and TIMP-2. Histological assessment of bladder tissues reveals that hFASCS ameliorated lower ulceration and edema. Immunofluorescence staining and myogenic differentiation markers, i.e., Myf5, Myogenin, and MyoD, indicate the bladder tissue regenerating potential of hAFSCs. No hAFSC trafficking was observed in other tissues and organs. These findings highlight hAFSCs' potential as a novel therapy for SUI, warranting more extensive clinical trials to optimize dosing and long-term efficacy while addressing scalability and safety challenges in translating this regenerative approach to clinical practice.

To measure the morphology of the pelvic floor muscle and levator ani hiatus (LAH) using 3D MRI segmentation in females with (SUI) and to assess correlations with age, body mass index (BMI), and parity. This study includes 80 patients with SUI who underwent 3.0 T pelvic MRI. Patients were grouped based on age, BMI, and parity. Manual segmentation and 3D modeling of the pelvic floor muscle and LAH were performed to get volumetric and dimensional measurements. Statistical analysis included Kruskal-Wallis, Mann-Witney, and post hoc testing to evaluate group variations. The cohort included patients from 20 to 90 years old (mean 53.9 ± 11.7), with a mean BMI of 25.3 ± 3.4 and a mean parity of 1.85 ± 1.03. Significant variations in LAM surface (H(2) = 6.650, p = 0.036), flatness (H(2) = 6.471, p = 0.039), median intensity (H(2) = 8.218, p = 0.016), and curvature mean (H(2) = 7.382, p = 0.025) among age groups. The greatest LAM surface rankings were found in the 50-65 age range, whereas the highest LAM flatness ranks were found in those over 65 years old. BMI demonstrated a limited association, with overweight/obese participants exhibiting 11.3% larger LAM surface area compared to normal/underweight individuals (p = 0.044, r = 0.225). No significant associations were found between parity and any pelvic floor morphometric parameters (all p > 0.05). This study identifies age-dependent morphological changes in levator ani muscle architecture as the primary determinant of pelvic floor structural adaptation in women with stress urinary incontinence. These quantitative shape-based parameters offer novel diagnostic and therapeutic insights, advancing precision medicine approaches in urogynecological assessment and management.

Comparison of transobturator tape and functional electrical stimulation methods in pure stress urinary incontinence.

This study evaluates changes in bladder storage capacity and function following mid-urethral sling (MUS) surgery in women with urodynamic stress incontinence (USI). In this retrospective cohort study, 685 women with USI underwent MUS using single-incision sling devices (Ophira, Solyx, or I-Stop Mini) between 2015 and 2024 at a tertiary urogynecology center. Preoperative and postoperative assessments included validated quality-of-life (QoL) questionnaires, 1-h pad test, and multichannel urodynamic studies. Subgroup analysis was performed in women with greater baseline leakage burden (pad test ≥5 g). The primary outcome was change in cystometric capacity (CC); secondary outcomes included urodynamic parameters, QoL, and continence outcomes. Objective cure was defined as a 1-h pad test <2 g with no leakage on urodynamics and subjective cure as Urogenital Distress Inventory-6 Question 3 ≤1. At 1 year, objective and subjective cure rates were 89.5% and 87.0%, respectively. Although overall CC increased modestly (369.6 ± 118.8 to 377.1 ± 121.3 mL; P = 0.097), a significant improvement was observed in women with greater baseline leakage (374.1 ± 118.2 to 391.8 ± 122.5 mL; P = 0.005). Mean 1-h pad test weight decreased markedly (25.1-2.7 g; P < 0.001). QoL scores improved significantly across both success and failure groups. De novo detrusor overactivity occurred in 3.9% of patients. Mid-urethral sling surgery achieved high continence rates and significant QoL improvement in women with USI. Although overall postoperative changes in cystometric capacity were modest and did not reach statistical significance, patients with greater baseline leakage (pad test ≥5 g) demonstrated significant improvements in bladder storage parameters. These findings suggest a possible association between successful continence restoration and improved bladder storage function in selected patients. Further prospective studies are warranted to confirm these observations and clarify underlying mechanisms.

Urinary incontinence (UI) is a highly prevalent condition worldwide, with stress urinary incontinence (SUI) and overactive bladder (OAB) representing major clinical subtypes. Pelvic floor muscle training (PFMT) has been studied extensively as a conservative intervention for UI, yet the global research landscape of PFMT-related UI studies, particularly in terms of collaboration patterns and evolving research themes, has not been mapped in a targeted manner. This study was aimed at providing a bibliometric overview of publication trends, knowledge structure, and emerging hotspots in UI/PFMT research. Literature published between 2000 and 2025 was retrieved from the Web of Science Core Collection. Scientometric analyses were conducted to examine co-authorship networks (countries, institutions, and authors), co-citation structures, and keyword co-occurrence patterns. China, the USA, the UK, and Brazil were among the major contributors to UI/PFMT research, with China showing rapid growth in publication output in recent years. Thematic mapping suggested increasing research attention to implementation- and technology-assisted rehabilitation topics, including biofeedback, electrical stimulation, and digital or artificial-intelligence-supported training approaches. This bibliometric analysis offers an updated descriptive map of the UI/PFMT research field over the past 25years, highlighting major contributors, collaboration structures, and shifting thematic emphases. The findings may support future research planning by identifying active areas of investigation and emerging directions within the PFMT-related UI literature.

Multifetal Gestation and Long-Term Maternal Health.

Dear Editor, Urinary incontinence (UI) is defined as the involuntary loss of urine and divided into 3 subtypes: stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI). These conditions are often caused by dysfunction of the pelvic floor muscles (pFM) [...].

This study aimed to evaluate the association between gestational diabetes mellitus and urinary incontinence during pregnancy, including symptom subtype, symptom severity, and incontinence-related quality of life. This cross-sectional study included pregnant women who underwent a 75-g oral glucose tolerance test at 24-28 weeks of gestation. GDM was diagnosed using International Association of Diabetes and Pregnancy Study Groups criteria. Urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and incontinence-related quality of life with the Incontinence Quality of Life (I-QOL) questionnaire. Participants were compared by GDM status. Multivariable logistic regression analysis was performed to evaluate factors associated with urinary incontinence. A total of 309 pregnant women were included, of whom 110 had GDM. Incontinence subtype distribution differed by GDM status. Urinary incontinence was observed in 146 women (47.2%), with no significant difference in prevalence between women with and without GDM. Subtype distribution differed: urgency urinary incontinence was significantly more frequent in women with GDM, whereas stress and mixed urinary incontinence were more common in those without GDM. Total ICIQ-UI SF scores were comparable between groups. Women with GDM had higher total I-QOL and psychosocial impact scores. Parity was higher among women with urinary incontinence than among those without. Gestational diabetes mellitus was not associated with increased prevalence of urinary incontinence during pregnancy. Obstetric factors, particularly parity, appeared to be more closely associated with urinary incontinence than GDM status. Higher I-QOL scores in women with GDM should be interpreted cautiously and may reflect healthcare-related or perceptual factors rather than a protective association. However, urgency urinary incontinence was more frequent in women with GDM.

Stress urinary incontinence (SUI) significantly affects women's quality of life (QoL). Patient-reported outcome measures (PROMs) are widely used to assess QoL; however, the content validity of many instruments has not been systematically evaluated in women with SUI. This study aimed to evaluate the content validity of PROMs used to assess QoL in women with SUI. EMBASE, MEDLINE and PsycINFO were searched from database inception to December 2025. Additional records were identified through hand-searching Google Scholar. Studies describing PROM development or evaluating content validity of PROMs assessing QoL or the impact of urinary symptoms in women with SUI were included. Two reviewers independently screened studies, extracted data using a standardised form, and assessed methodological quality using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Evidence for relevance, comprehensiveness and comprehensibility was synthesised, and quality of evidence graded using a modified GRADE approach. Nineteen studies describing 22 PROMs were included. Methodological quality of PROM development was rated as inadequate for 21 instruments. Only one PROM had been developed specifically for women with SUI. Concept elicitation was inadequate for most instruments and patient involvement in development was limited. Evidence supporting content validity varied across PROMs. Evidence supporting the content validity of PROMs used in women with SUI is heterogeneous and often limited. Greater adherence to COSMIN guidance is needed to ensure instruments adequately capture patient-relevant outcomes.

Transvaginal mesh, used to treat Pelvic Organ Prolapse and Stress Urinary Incontinence, has caused substantial injury to a growing number of women. The impact of mesh injury is far-reaching, significantly disrupting women's lives. Whilst there is a growing body of literature examining the impacts, there is little research that specifically aims to understand the sexual and relational implications of mesh injury. This study aimed to systematically review evidence regarding the impacts of mesh injury reported by women in relation to sexual and relational functioning. A systematic search of five databases (CINAHL, MEDLINE, PubMed, PsycINFO, and ProQuest Dissertations and Theses) and a grey literature search was conducted in April 2026. Studies and inquiries reporting data about women's experiences of mesh injury where sexual and relational impacts were reported were included. The quality of each study was assessed using the qualitative CASP checklist. The data was thematically synthesised. A total of nine reports were included, comprising of six published studies, one unpublished Doctoral thesis, and two government inquiries. Sample sizes were varied, with individual study sample sizes ranging from 7-84, and a secondary analysis of 399 accounts from one study. Participants included in government inquiries ranged between 517 and 555. A conservative total of 1483 participants is represented, reflecting the heterogeneity of the evidence base and limitations in the reporting of inquiry data. Of the nine included reports, eight were rated high quality with one rated as moderate. Seven overlapping themes were developed from the data: 1) Sexual functioning: changes due to pain, 2) Changes to sexuality, 3) Relational activity: changes due to pain, 4) Changes to relationship satisfaction, 5) Identity: changing sense of self navigating life with mesh injury, 6) Changes in relational roles and a seventh central theme of disrupted embodied sexual-relational self. Women with mesh injury experience significant sexual and relational disruption as a result of chronic pain, contributing to psychological distress. Psychological flexibility may be a protective mechanism for relational distress. Further research that seeks to understand these impacts is needed, which may inform the development of appropriate psychological interventions. PROSPERO ID: CRD420251077730.

Urinary incontinence (UI) is a frequent yet often underrecognized morbidity among postpartum women. Understanding its prevalence, trajectory, and risk factors is essential for informing preventive and management strategies. This study aimed to investigate the prevalence and progression of UI across four postpartum periods-first week (M1), first month (M2), first year (M3), and third year (M4)-and to identify predictors associated with UI persistence at three years postpartum. A prospective longitudinal cohort study was conducted including 139 women who completed the validated Portuguese version of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Data were collected at M1, M4, and at least one intermediate time point (M2 or M3). Descriptive statistics and logistic regression analyses were performed to assess prevalence patterns, symptom severity, and predictors of long-term UI. UI prevalence was highest at M1 (51.1%), declined at M2 (23.0%), increased again at M3 (41.2%), and stabilized at M4 (38.1%). Stress urinary incontinence was the predominant subtype across all time points. Symptom severity tended to progress from mild-moderate (M1-M2) to moderate-severe (M3-M4) among women with persistent symptoms. Higher body mass index (BMI) and gestational duration ≥ 39 weeks were independently associated with long-term UI, increasing the odds by approximately 13% per BMI unit and 3.7-fold, respectively. Persistent urinary incontinence remains relatively common up to three years postpartum, particularly among women with higher body mass index and longer gestational duration. Early postpartum screening may help identify women at increased risk of persistent symptoms, although the impact of specific therapeutic interventions was not assessed in this study. Promoting pelvic floor health awareness together with weight-management counselling within routine postpartum care may inform preventive strategies for postpartum continence care, although further interventional studies are required to confirm effectiveness.

Management of Urethrovaginal Fistula and Stress Urinary Incontinence Using a Martius Flap and Laparoscopic Artificial Urinary Sphincter Implantation.

Local anesthesia protocol for a safe and effective outpatient injection of polyacrylamide hydrogel (Bulkamid®).

The current evidence on pelvic floor rehabilitation management for females with stress urinary incontinence (SUI) is diverse and complex, and standardized pelvic floor rehabilitation protocols are lacking. The study aimed to retrieve and summarize the evidence related to pelvic floor rehabilitation management in females who experience SUI and provide guidance for healthcare workers. Following the 6S evidence resource pyramid model, two researchers searched the computer decision support system, guidelines networks, urological professional society websites, obstetrics and gynecology professional society websites, and related databases from top to bottom and collected the best clinical practice information books, clinical decision-making, recommendation practice, evidence summaries, guidelines, systematic reviews, and expert consensuses on the management of pelvic floor rehabilitation in females suffering SUI. The searches were carried out from database inception to September 2022. Literature quality was independently assessed by two researchers, and evidence was then obtained and summarized from eligible studies. Forty-eight studies were eligible to be included, comprising 1 best clinical practice information book, 4 clinical decision-making, 3 recommended practices, 10 evidence summaries, 8 guidelines, 18 systematic reviews, and 4 expert consensus studies. Best-evidence strategies summarized the evidence for pelvic floor rehabilitation management in females with SUI, which included a total of 51 recommendations in 5 aspects: screening and assessment, lifestyle management, pelvic floor muscle training (PFMT), follow-up, and health education. The review summarized 51 best-evidence strategies for pelvic floor rehabilitation management in females with SUI. To ensure clinical efficacy and improve nursing quality, these strategies should be integrated into structured, multidisciplinary clinical pathways, carefully tailored to specific patient contexts and local healthcare resources.

Male sling implants are an acceptable treatment for post-prostatectomy stress urinary incontinence, but more long-term follow data is needed to assess clinical effectiveness. This study provides long-term continence and quality of life outcomes using complete 10-year follow up data from patients with AdVance™/AdVance XP™ Male Sling Systems. In an observational multicenter study, prospective data collection included preoperative patient characteristics, perioperative course, and postoperative outcomes. Continence was assessed using the 24 h pad weight test and patient-reported outcome measures (PROMs) were measured with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF). Follow-up over 10 years included re-intervention. Of 111 patients who underwent surgery between February 2008 and February 2012, 87 completed 10-year follow-up (median follow-up was 136.6 months (range:121.9-170.5). At 3-month follow-up, 59 patients (67.8%) were considered cured. Of the 59 patients initially cured, 17 patients (28.81%) lost continence during follow-up, 11 due to stress urinary incontinence recurrence (65%), four due to de novo urge incontinence (23%), and two due to salvage radiotherapy (12%). Of the 17 who lost continence, six received a second surgical treatment, with no reported intra or preoperative surgical problems due to the first surgery. In cured patients, surgery resulted in a reduction of the median ICIQ-SF score from 16.27 (SD 3.53) to 4.03 (SD 3.36) (p < 0.01). In the patients considered not cured, a reduction on the median ICIQ-SF score from 16.39 (SD 3.05) to 11.29 (SD 5.34) was observed (p < 0.01). Our findings suggest that long-term continence rates after sling implant are acceptable, especially in ideal patients with mild to moderate incontinence and naïve for prior pelvic irradiation or surgical treatment for urinary incontinence or urethral stricture disease.

Hypermobile Ehlers-Danlos Syndrome (hEDS) is the most common subtype of Ehlers-Danlos Syndrome, a group of connective tissue disorders caused by collagen abnormalities. While musculoskeletal features of hEDS are well characterized, its impact on visceral organs, including the bladder, remains underexplored. Despite frequent patient reports of urinary symptoms, a definitive link between hEDS and bladder pathology has not been established. This study aims to characterize lower urinary tract symptoms (LUTS) and urodynamic (UDS) findings in patients with hEDS to better understand potential mechanisms underlying bladder dysfunction in this population. A retrospective chart review was conducted on patients with hEDS who underwent video UDS at a single tertiary-care center between 2022 and 2025. Inclusion criteria included age > 18, confirmed hEDS diagnosis (2017 criteria), and completed UDS. Data were analyzed using Welch's t-test and Fisher's Exact Test. Among 27 patients, the mean age at hEDS diagnosis was 30.9 years (range 18-49), 92.6% (n = 25) were female, and 92.6% (n = 25) were white. Common LUTS seen in these patients included frequency in 74.1% (n = 20), incontinence in 14.8% (n = 4), frequent urinary tract infections in 25.9% (n = 7), bladder pain in 33.3% (n = 9), nocturia in 48.1% (n = 13), and weak stream in 51.8% (n = 14) of patients. UDS findings revealed no evidence of detrusor overactivity, stress urinary incontinence, or abnormalities in compliance. 1 patient had incomplete emptying with a pre-study post-void residual of 500 mL. Pelvic floor dysfunction was seen in 18.5% (n = 5) with active EMG noted during emptying. Pelvic floor physical therapy was the most common intervention recommended, followed by beta-3 agonists for overactive bladder symptoms. Our findings demonstrate that LUTS are prevalent in patients with hEDS, with evidence pointing to pelvic floor and neurologic dysfunction as key contributors rather than intrinsic bladder pathology. These results support prioritizing a pelvic floor-focused approach to evaluation and management of hEDS-related LUTS.

Coital urinary incontinence (CUI), defined as involuntary urine leakage during or after sexual activity, is a common yet underreported condition affecting both women and men, with significant effects on emotional wellbeing, sexual satisfaction and intimate relationships. This article reviews the evidence on the prevalence, pathophysiology and management of CUI in women and men, and outlines key clinical considerations for nursing practice. In women, CUI may occur at penetration, during intercourse, or at orgasm, often linked to stress, mixed, or urgency urinary incontinence and pelvic floor dysfunction. In men, CUI is frequently associated with prostate surgery, particularly following treatment for prostate cancer, where sphincter and pelvic floor impairment contribute to leakage. Despite its prevalence, stigma often prevents open discussion. Effective management includes pelvic floor muscle exercises, behavioural modifications, pharmacological treatments and, in some cases, surgery. Health professionals play a critical role in normalising conversations, identifying symptoms, and providing holistic, evidence-based care. Addressing both the physical and psychosocial aspects of CUI can improve quality of life and help individuals regain confidence and intimacy.