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Background. First-line conservative treatment for stress urinary incontinence (SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM) exercise and bladder control strategies. Objective. The purposes of this study were: (1) to describe adherence and barriers to exercise and bladder control strategy adherence and (2) to identify predictors of exercise adherence. Design. This study was a planned secondary analysis of data from a multisite, randomized trial comparing intravaginal continence pessary, multicomponent behavioral therapy, and combined therapy in women with stress-predominant urinary incontinence (UI). Methods. Data were analyzed from the groups who received behavioral intervention alone (n = 146) or combined with continence pessary therapy (n = 150). Adherence was measured during supervised treatment and at 3, 6, and 12 months post- randomization. Barriers to adherence were surveyed during treatment and at the 3-month time point. Regression analyses were performed to identify predictors of exercise adherence during supervised treatment and at the 3- and 12-month time points. Results. During supervised treatment, ->86% of the women exercised [greater than or equal to]5 days a week, and[greater than or equal to]80% performed at least 30 contractions on days they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of women, respectively, indicated they were still performing PFM exercises. During supervised treatment and at 3 months post-randomization, [greater than or equal to]87% of the women reported using learned bladder control strategies to prevent SUI. In addition, the majority endorsed at least one barrier to PFM exercise, most commonly 'trouble remembering to do exercises.' Predictors of exercise adherence changed over time. During supervised intervention, less frequent baseline UI and higher baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted exercise adherence. At 3 months post- randomization, women who dropped out of the study had weaker PFMs at baseline. At 12 months post-randomization, only 'trouble remembering' was associated with exercise adherence. Limitations. Adherence and barrier questionnaires were not validated. Conclusions. Adherence to PFM exercises and bladder control strategies for SUI can be high and sustained over time. However, behavioral interventions to help women link exercise to environmental and behavioral cues may only be beneficial over the short term., Stress urinary incontinence (SUI) is defined as the complaint of involuntary urine leakage with physical effort or exertion, such as sneezing or coughing. (1) Behavioral interventions, including muscle (PFM) exercise [...]

A study is conducted to measure the associations between bowel symptoms and pelvic organ prolapse in women through validated questionnaires. Results indicate that bowel symptoms do not increase with increase in prolapse stage in women presenting for sacrocolpopexy or surgery for pelvic organ prolapse.

Background: Urinary incontinence is common in women. Because treatments differ, urge incontinence should be distinguished from stress incontinence. To make this distinction, current guidelines recommend an extensive evaluation that is too time-consuming for primary care practice. Objective: To test the accuracy of a simple questionnaire to categorize type of urinary incontinence in women. Design: Multicenter, prospective study of the accuracy of the 3 Incontinence Questions (3IQ) compared with an extended evaluation to distinguish between urge incontinence and stress incontinence. Setting: 5 academic medical centers in the United States. Participants: 301 women enrolled from April to December 2004 who were older than 40 years of age (mean age, 56 years [SD, 11]) with untreated incontinence for an average of 7 years (SD, 7) and a broad range of incontinence severity. Measurements: All participants included in the analyses answered the 3IQ questionnaire, and a urologist or urogynecologist who was blinded to the responses performed the extended evaluation. Sensitivity, specificity, and likelihood ratios were determined for the 3IQ. Results: For classification of urge incontinence and with the extended evaluation as the gold standard, the 3IQ had a sensitivity of 0.75 (95% CI, 0.68 to 0.81), a specificity of 0.77 (CI, 0.69 to 0.84), and a positive likelihood ratio of 3.29 (CI, 2.39 to 4.51). For classification of stress incontinence, the sensitivity was 0.86 (CI, 0.79 to 0.90), the specificity was 0.60 (CI, 0.51 to 0.68), and the positive likelihood ratio was 2.13 (CI, 1.71 to 2.66). Limitations: Participants were enrolled by urologists and urogynecologists at academic medical centers. Conclusions: The 3IQ questionnaire is a simple, quick, and noninvasive test with acceptable accuracy for classifying urge and stress incontinence and may be appropriate for use in primary care settings. Similar studies are needed in other populations. We also need a clinical trial comparing the outcomes of treatments based on the 3IQ and the extended evaluation.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2004.11.032 Byline: Lily A. Arya (a), Joseph M. Novi (a), Alka Shaunik (a), Mark A. Morgan (a), Catherine S. Bradley (b) Abstract: This study was undertaken to determine whether there is an association among pelvic organ prolapse, constipation, and dietary fiber intake. Author Affiliation: (a) Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pennsylvania, Philadelphia, Pa (b) Department of Obstetrics and Gynecology, Division of Urogynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa Article Note: (footnote) Presented at the Joint Scientific Meeting of the Society of Gynecologic Surgeons and the American Urogynecologic Society, San Diego, Calif, July 29-31, 2004.

The objective of the study is to develop a psychometrically sound, symptom-based questionnaire for urinary incontinence diagnosis in women and to test its reliabity and validity, with incontinence specialists' clinical evaluations as the gold standard. The Questionnaire of the Urinary Incontinence Diagnosis is reliable and able to diagnose stress urinary incontinence in a referral urogynecology patient population with accuracy.

Altered Toll-like receptor (TLR)4 activation has been identified in several chronic pain conditions but has not been well studied in interstitial cystitis/bladder pain syndrome (IC/BPS). Our previously published human studies indicated that patients with IC/BPS present altered systemic TLR4-mediated inflammatory responses, which were significantly correlated with reported pain severity. In the present study, we sought to determine whether altered TLR4 activation plays a role in pelvic/bladder pain seen in patients with IC/BPS using our validated IC/BPS-like transgenic autoimmune cystitis model (URO-OVA). URO-OVA mice developed responses consistent with pelvic and bladder pain after cystitis induction, which was associated with increased splenocyte production of TLR4-mediated proinflammatory cytokines IL-1β, IL-6, and TNF-α. Increased spinal expression of mRNAs for proinflammatory cytokines IL-6 and TNF-α, glial activation markers CD11b and glial fibrillary acidic protein, and endogenous TLR4 ligand high mobility group box 1 was also observed after cystitis induction. Compared with URO-OVA mice, TLR4-deficient URO-OVA mice developed significantly reduced nociceptive responses, although similar bladder inflammation and voiding dysfunction, after cystitis induction. Intravenous administration of TAK-242 (a TLR4-selective antagonist) significantly attenuated nociceptive responses in cystitis-induced URO-OVA mice, which was associated with reduced splenocyte production of TLR4-mediated IL-1β, IL-6, and TNF-α as well as reduced spinal expression of mRNAs for IL-6, TNF-α, CD11b, glial fibrillary acidic protein, and high mobility group box 1. Our results indicate that altered TLR4 activation plays a critical role in bladder nociception independent of inflammation and voiding dysfunction in the URO-OVA model, providing a potential mechanistic insight and therapeutic target for IC/BPS pain.

Office-based biofeedback therapy is effective for constipation with dyssynergic defecation, but must be performed by skilled staff, is only available in selected centres, and requires multiple visits. The efficacy of home-based biofeedback therapy is unknown. We compared clinical and subjective outcomes with home-based and office-based approaches.

There is a high prevalence of poor sleep quality among ambulatory women with urgency urinary incontinence, and greater frequency of incontinence is associated with a greater degree of sleep dysfunction.

In a randomized controlled trial of participants with urge-predominant urinary incontinence, older age, being married and higher parity significantly moderated and potentiated the effects of pharmacological therapy on incontinence frequency.

The Pelvic Floor Disorders Registry (PFDR) is an active, online, multi-centered, national prospective cohort study of patients undergoing treatment for POP that is designed to collect both provider and patient-reported outcomes through broad participation from specialists and generalists performing surgery for prolapse.Pelvic floor disorders affect up to 24% of adult women in the United States, and many patients with pelvic organ prolapse (POP) choose to undergo surgical repair to improve their quality of life. While a variety of surgical repair approaches and techniques are utilized, including mesh augmentation, there is limited comparative effectiveness and safety outcome data guiding best practice. In conjunction with device manufacturers, federal regulatory organizations, and professional societies, the American Urogynecologic Society developed the Pelvic Floor Disorders Registry (PFDR) designed to improve the quality of POP surgery by facilitating quality improvement and research on POP treatments. The PFDR will serve as a resource for surgeons interested in benchmarking and outcomes data and as a data repository for Food and Drug Administration–mandated POP surgical device studies. Provider-reported clinical data and patient-reported outcomes will be collected prospectively at baseline and for up to 3 years after treatment. All data elements including measures of success, adverse events, and surgeon characteristics were identified and defined within the context of the anticipated multifunctionality of the registry, and with collaboration from multiple stakeholders. The PFDR will provide a platform to collect high-quality, standardized patient-level data from a variety of nonsurgical (pessary) and surgical treatments of POP and other pelvic floor disorders. Data from this registry may be used to evaluate short- and longer-term treatment outcomes, patient-reported outcomes, and complications, as well as to identify factors associated with treatment success and failure with the overall goal of improving the quality of care for women with these conditions.

The American Urogynecologic Society’s Pelvic Floor Disorders Registry (PFDR), a product of collaboration between medical practitioners, researchers, industry and federal agencies, has an overall goal of promoting safe and effective care for women with pelvic organ prolapse.Pelvic organ prolapse (POP) is a common problem that negatively impacts women's quality of life. A variety of surgeries exist for POP treatment, including procedures performed with and without mesh augmentation. The growing use of mesh in prolapse surgeries in the 2000s was associated with increasing reports of complications, resulting in Food and Drug Administration (FDA) Safety Notifications, and in 2012, the FDA ordered transvaginal mesh manufacturers to conduct prospective studies to evaluate longer-term outcomes. These requirements provided incentives and an environment conducive to collaboration. American Urogynecologic Society leaders collaborated with device manufacturers, the FDA, and other professional organizations to establish the Pelvic Floor Disorders Registry (PFDR), a collection of interrelated registries, which could meet manufacturers' needs but also allow surgeons to track individual and aggregate outcomes for quality improvement. The PFDR was developed and launched by American Urogynecologic Society with objectives of (1) collecting, storing, and analyzing clinical data related to POP treatment; (2) establishing common data elements and quality metrics; and (3) providing a framework for external stakeholders to conduct POP research. The PFDR includes industry-sponsored studies, as well as 2 options for volunteer registry participation, the PFDR-Quality Improvement and PFDR-Research. The PFDR promotes quality improvement and national benchmarking and will provide real-world comparative safety and effectiveness data for prolapse surgeries. The PFDR can serve as a model for collaboration between medical practitioners, researchers, industry, and federal agencies and may allow progress toward our similar goal of high-quality surgical care of women with prolapse.

To describe the frequency of use and recent change in use of synthetic mesh and biologic grafts in pelvic organ prolapse (POP) and stress urinary incontinence surgery by American Urogynecology Society (AUGS) members.

The objective of this study was to determine if differences exist in pelvic symptom distress and impact on women randomized to pessary versus behavioral therapy for treatment of stress urinary incontinence (SUI).

(1) To describe sexual function in women seeking treatment of stress urinary incontinence (SUI), (2) to compare the impact on sexual function of 3 SUI treatments, and (3) to investigate whether nonsurgical treatment of SUI is associated with improved sexual function.

To review recently published studies on stress urinary incontinence surgery outcomes in older women.

The definition and significance of female bladder outlet obstruction (BOO) are poorly understood. We identified patients with urodynamic evidence of BOO in a cohort of women with stress urinary incontinence (SUI).

Objective.To report a case of stage IIIc poorly differentiated endometrial adenocarcinoma with trophoblastic differentiation and to review previously reported cases.

A large number of women with urinary incontinence do not receive appropriate care because of delays in diagnosis resulting from failure of primary care providers to ask routine questions about incontinence as well as failure of patients to volunteer information. Diagnosis of incontinence only after referral to specialists increases the cost of care and delays treatment. A simple, brief questionnaire-based screening instrument has been developed to allow primary care providers to diagnose and treat urgency-predominant urinary incontinence (UUI) in women without more extensive specialist evaluation. The longer-term efficacy and safety of treating patients with incontinence based on this questionnaire are unknown.

A 39-year-old woman with stress urinary incontinence underwent a retropubic midurethral sling procedure. On postoperative day 1, she presented with persistent abdominal pain and fever. A computed tomographic scan showed subcutaneous lower abdominal wall edema and gas above the fascia suggesting a necrotizing soft tissue infection. She was surgically debrided twice, which included removal of the mesh sling on postoperative day 4. Cystoscopy suggested unrecognized bladder perforation had occurred during the initial procedure, and record rerevealed untreated bacteriuria before sling placement. The patient required wound vacuum therapy and a later secondary wound closure procedure. Six months after the initial surgery, she was reevaluated for stress urinary incontinence and underwent a transobturator midurethral sling procedure with resolution of these symptoms. Necrotizing postsurgical infection is a rarely described complication of midurethral slings. Treatment for this potentially life-threatening complication includes aggressive surgical debridement, administration of broad-spectrum antibiotic, removal of infected implants, and supportive therapy. Unrecognized bladder injury and preoperative bacteriuria are discussed as potential risk factors for postsling necrotizing infection.

(Abstracted from Obstet Gynecol2018;131:204–211)Both incontinence and sleep disturbance are common and bothersome conditions in middle-aged and older women. Any treatment that improves both conditions may provide clinical value.

A case report is presented of a patient with vaginal vault prolapse that could only be reduced under anesthesia with subsequent placement of a pessary. Spontaneous expulsion of the pessary and recurrence of the irreducible prolapse led to exploratory laparotomy revealing a large multiloculated cyst adherent to the vaginal cuff.