Search

Objective: To evaluate the diagnostic performance of pelvic floor ultrasound (PFUS) to recognize prosthetics exposure in the bladder and/or urethra in women with lower urinary tract symptoms (LUTS). Methods: A cross‐sectional study evaluating patients with LUTS after mesh/sling surgery. PFUS was performed with both transvaginal (TVUS) and translabial (TLUS) approaches. A distance of 1 mm or less from the bladder and/or urethra was considered highly suspect for mesh exposure. After PFUS, patients underwent diagnostic urethrocystoscopy. Results: A total of 100 consecutive women were analyzed. According to urethrocystoscopy, the rate of tape exposure in the lower urinary tract was 3%. PFUS showed 100% sensitivity and 98%–100% specificity in detecting lower urinary tract mesh exposure. The negative predictive value was 100% and the positive predictive value ranged from 33% to 50% for urethral and 100% for bladder exposure. Conclusions: PFUS represents an effective and reliable non‐invasive screening test to exclude prosthetics exposure in the bladder and/or urethra in women with LUTS. Synopsis: Pelvic floor ultrasound represents an effective and reliable non‐invasive screening test to exclude prosthetics exposure in the bladder and/or urethra in women. [ABSTRACT FROM AUTHOR]

Objective: To prospectively compare power Doppler ultrasound diagnostic performance with reference standard cystoscopy in evaluating ureteral patency in a population at high risk of ureteral lesions. Methods: We analyzed 100 women who underwent pelvic organ prolapse repair. All ultrasound scans were obtained, at the end of the procedures, before cystoscopic evaluation. Bilateral simultaneous ureteral jet evaluation with power Doppler was performed at the level of the ureterovesical junctions with a pulse repetition frequency set to detect low flow for a maximum of 3 min. Results: According to the reference standard urethrocystoscopy, at least one ureter not ejaculating was observed in 6% of patients, for a total of seven ureters jets not visualized. No false‐negative results were obtained. Ultrasound with power Doppler showed 100% sensitivity and 95.9% specificity in detecting the lack of ureteral jet. The negative predictive value was 100%, and the positive predictive value was 46.7%. Conclusions: Ultrasound with power Doppler represents an effective and reliable non‐invasive screening test to exclude ureteral kinking and reduce the need for intraoperative cystoscopy. Synopsis: Power Doppler ultrasound represents an effective and reliable non‐invasive screening test to exclude ureteral kinking and reduce the need for intraoperative cystoscopy. [ABSTRACT FROM AUTHOR]

Objective: To present clinical and instrumental sequelae after obstetric anal sphincter injuries (OASIS), evaluating correlations between intrapartum severity of lesions, postpartum symptoms, and sonographic and manometric findings; outcomes during subsequent deliveries were also evaluated. Methods: This retrospective study evaluated all consecutive women who sustained an OASIS between 2015 and 2020. Postpartum symptoms, anorectal manometry (ARM), and three‐dimensional endoanal ultrasonography (3D‐EAUS) were analyzed. Results: A total of 107 women underwent OASIS primary repair; 84 (78.5%) of them were asymptomatic after 1 month. The presence and severity of symptoms showed a great correlation with instrumental outcomes in terms of maximum resting pressure, squeeze pressure increment (SPI), circumferential extension of defect for both external anal sphincter (EAS) and internal anal sphincter (IAS), and EAS, IAS and total Starck scores. There was a significant correlation between ARM and 3D‐EAUS findings, with the exception of SPI, for which the abnormalities were not predictable based on EAUS results. Conclusion: Both ARM and EAUS findings after OASIS are directly related to each other, and associated with symptoms. These instrumental tools may be useful for OASIS assessment and counseling. Synopsis: Endoanal ultrasound and anal manometry after obstetric anal sphincter injuries are directly related to each other, and are associated with symptoms and quality of life. [ABSTRACT FROM AUTHOR]

Objective: The coexisting overactive–underactive bladder (COUB) syndrome could be related to the increased urethral resistance caused by severe pelvic organ prolapse (POP). We aimed to evaluate the clinical and urodynamic findings of patients with COUB and/or detrusor overactivity–underactivity (DOU) in a cohort of patients scheduled for POP surgery and the possible risk factors of COUB after surgery. Methods: This retrospective study analyzed all patients who underwent POP repair between 2008 and 2013, excluding women with a history of pelvic floor surgery. Patients were divided into COUB and non‐COUB according to baseline symptoms and into DOU and non‐DOU based on urodynamic findings. A multivariate model was performed to identify risk factors for COUB symptoms after surgery. Results: A total of 533 women underwent POP surgery. Preoperatively, patients with COUB had more severe anterior compartment prolapse (Pelvic Organ Prolapse Quantification staging system Aa point, P = 0.008) and more frequently had overactive bladder compared with controls (P = 0.023). The rate of COUB decreased significantly after surgery. Preoperative opening detrusor pressure resulted as the only independent predictor of postoperative COUB symptoms (P = 0.034). Conclusion: POP is a valid pathogenetic model for COUB development. POP repair induced a significant decrease in COUB symptoms with low opening detrusor pressure resulting as the only independent predictor of postoperative COUB. Synopsis: Pelvic organ prolapse is a valid pathogenetic model of coexisting overactive‐underactive bladder syndrome. [ABSTRACT FROM AUTHOR]

Background: Primary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment. Objectives: To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions. Search Strategy: We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse", and "vaginal cancer", "vaginal carcinoma". Selection Criteria: No article type restrictions were applied. Data Collection and Analysis: Twenty‐one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients. Main Results: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed. Conclusion: A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases. Management of vaginal cancer with genital prolapse usually involves surgical or radiation therapy. Surgery may concomitantly treat malignancy and prolapse, and improve bladder/kidney function. [ABSTRACT FROM AUTHOR]

Background: Ovarian carcinoma (OC) is one of the most widespread tumors in the world and is characterized by low survival rates. Objective: To determine whether the levonorgestrel‐releasing intrauterine system (LNG‐IUS) can prevent OC. Search strategy: The literature until December 2020 were systematically reviewed according to the PRISMA Statement for Reporting Systematic Reviews (PROSPERO: CRD42019137957). Selection criteria: Studies assessing the impact of LNG‐IUS on the risk of OC were included. Data collection and analysis: Data were extracted independently by two authors to ensure accuracy and consistency. Main results: A total of 34 323 records were obtained, of which three satisfied the inclusion criteria. In total, 1687 events of OC in a population of 20 461 311 person‐years were considered. Data pooling revealed that the use of LNG‐IUS did not confer a lower risk of OC relative to the never‐use of LNG‐IUS, with an estimated odds ratio of 0.66 (95% confidence interval 0.41–1.08; I2 = 84%; P = 0.002). Conclusion: The meta‐analysis did not demonstrate a preventive role of LNG‐IUS on OC. However, it was carried out on a few papers, and a definitive conclusion on the topic still cannot be drawn. Further studies are indicated in the future to define the impact of LNG‐IUS on OC. The meta‐analysis carried out on three papers did not demonstrate a preventive role of the levonorgestrel‐releasing intrauterine device on ovarian cancer. The meta‐analysis carried out on three papers did not demonstrate a preventive role of the levonorgestrel‐releasing intrauterine device on ovarian cancer. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence and assess clinical factors that can predict the occurrence of postpartum urinary retention (PPUR). PPUR is a puerperal condition defined as the inability to void over 6 hours after birth or after catheter removal in case of cesarean section, requiring catheterization. Lack of prompt diagnosis of this condition may lead to severe sequelae, including infection, chronic voiding difficulties, and renal failure. Methods: This retrospective cohort study analyzed all deliveries from January 2011 to December 2017 in a single Italian university hospital. We used multivariate logistic regression to develop a predictive score for PPUR. Results: By multivariate logistic regression, our analysis shows as minor (odds ratio [OR] < 2) risk factors for PPUR: non‐Caucasian ethnicity (OR = 1.46, CI = 1.05‐2.03), nulliparity (OR = 1.47, CI = 1.01‐2.14), body mass index (BMI) at the end of the pregnancy <30 kg/m2 (OR = 1.54, CI = 1.10‐2.17). On the other hand, epidural analgesia (OR = 3.93, CI = 2.96‐5.22), meconium‐stained amniotic fluid (OR = 2.07, CI = 1.54‐2.77), nonoperative vaginal birth vs cesarean section (OR = 6.25, CI = 2.16‐18.13), vacuum extraction vs cesarean section (OR = 8.80, CI = 2.86‐27.01), pushing stage ≥60 minutes (OR = 3.00,CI = 2.26‐3.97), and perineal tear (OR = 2.87, CI = 1.86‐4.43) proved to be major (OR > 2) risk factors for PPUR. Using our final model (area under curve = 0.84), we created a nomogram for PPUR absolute risk calculation. Specifically, a 116‐point cutoff might be used to identify high‐risk patients who deserve more intensive micturition monitoring. Conclusions: Our study identified non‐Caucasian ethnicity, nulliparity, and a BMI <30 kg/m2 at the end of the pregnancy as minor and epidural analgesia, meconium‐stained amniotic fluid, vaginal nonoperative birth, vacuum extraction, pushing stage ≥60 minutes, and perineal tear as major independent risk factors for PPUR. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for postoperative stress urinary incontinence (POSUI) after native-tissue prolapse repair without a concomitant anti-incontinence procedure.Methods: The present single-center retrospective study included women with genital prolapse who underwent high uterosacral ligament suspension without a concomitant anti-incontinence procedure during 2008-2013. Univariate and multivariate analyses were performed to identify risk factors for POSUI (identified through clinical interview and International Consultation on Incontinence Modular Questionnaire-Short Form [ICIQ-SF] self-administration) at 6 months.Results: In total, 87 (20.9%) of 417 women developed POSUI. Preoperative stress urinary incontinence (SUI) and urodynamically diagnosed SUI were significantly associated with POSUI; moreover, women with POSUI had a higher preoperative ICIQ-SF score, a lower opening detrusor pressure, and a lower detrusor pressure at maximum flow than did women without POSUI (P<0.05 for all comparisons). In the multivariate analysis, preoperative SUI (odds ratio 3.11), a detrusor pressure at maximum flow of less than 30 cm H2 O (odds ratio 2.93), and urodynamically diagnosed SUI (odds ratio 2.26) were independent risk factors for POSUI.Conclusion: Preoperative urodynamic parameters, obtained before prolapse repair surgery, were associated with POSUI and could be useful in providing adequate counseling to facilitate decision making on whether to add a concomitant anti-incontinence procedure. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to identify in a pure stress urinary incontinence (SUI) population risk factors for recurrence after single‐incision slings (SIS). Methods: This retrospective study analyzed women with complaints of SUI symptoms and urodynamically proven SUI. Exclusion criteria were recurrent SUI, overactive bladder syndrome/detrusor overactivity, preoperative postvoid residual >100 mL, reduced urethral mobility (<10° at the Q‐tip test), concomitant anterior prolapse >I stage and previous history of radical pelvic surgery. Objective cure rate was assessed with stress test. Results: A total of 192 patients were analyzed. Objective cure rate was obtained in 86.5% of patients. According to univariate analysis, recurrences had higher prevalence of severe ICIQ‐SF score (≥18 points), higher prevalence of reduced urethral mobility (Qtip ≤30°), higher prevalence of low detrusor pressures during voiding phase (opening pressure <15 cmH2O, pressure at maximum flow <20 cmH2O, closing pressure <15 cmH2O), and higher prevalence of postoperative complications According to multivariate analysis ICIQ‐SF score ≥18 points (P = 0.02; OR = 2.7) and detrusor pressure at maximum flow <20 cmH2O (P < 0.01; OR = 3.6) resulted as independent risk factors for SUI recurrence (Table 3). A trend was found for urethral mobility ≤30° (P = 0.07; OR = 2.2). Conclusions: Our study identifies SUI severity expressed with ICIQ‐SF scores and low detrusor pressure at maximum flow as independent risk factors for SUI recurrence after SIS implantation while only a trend was found for reduced urethral mobility. Therefore, preoperative assessment of symptoms and urodynamics evaluation may play a key role in improving preoperative counseling and tailoring surgical treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the learning curve for the single-incision sling (SIS) procedure in a single-surgeon case series.Methods: Data were retrospectively analyzed from women with non-recurrent symptomatic stress urinary incontinence confirmed by urodynamics and treated at San Gerardo Hospital, Monza, Italy, between October 2008 and November 2015. All women underwent the SIS procedure using a MiniArc sling fitted by the same urogynecologic surgeon. Blood loss, operative time, and complications were recorded. At follow-up visits, objective cure was assessed with a stress test and subjective outcome was determined by International Consultation on Incontinence Questionnaire-Short Form and Patient Global Impression of Improvement scores. Postoperative overactive bladder syndrome and voiding symptoms were recorded.Results: In total, 192 patients underwent the SIS procedure. Estimated blood loss, operative time, and complication rate were not influenced by the number of procedures performed. Among 191 patients who completed 12 months of follow-up, neither objective nor subjective outcomes at longest follow-up available were influenced by surgeon's experience. Conversely, de novo overactive bladder syndrome (P<0.001) and voiding symptoms (P=0.029) decreased with increasing experience.Conclusion: SIS showed encouraging objective and subjective outcomes with a minimal complication rate even at the beginning of the learning curve. However, increasing experience reduced postoperative voiding symptoms and overactive bladder syndrome. [ABSTRACT FROM AUTHOR]

Proper surgical technique and adequate knowledge of native ‐ tissue repair can facilitate the successful treatment of recurrent prolapse and mesh repair ‐ related adverse events. [ABSTRACT FROM AUTHOR]

Transvaginal primary layered repair was safe and effective in restoring the anatomy of a small iatrogenic retrotrigonal vesicovaginal fistula. [ABSTRACT FROM AUTHOR]