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BACKGROUND: Female sexual function in pregnancy is an under-investigated topic by care providers. This study aimed to investigate the sexual function and the impact of traditional risk factors for pelvic floor disorders (PFDs) during the third trimester of pregnancy. METHODS: This is a secondary analysis of a multicenter cross-sectional study conducted in eight hospitals in Italy and Italian-speaking Switzerland. Women at the third trimester of pregnancy aged 18 years and over completed the Italian- PFQPP questionnaire anonymously. RESULTS: Overall, 927 patients in the third trimester of pregnancy answered the questionnaire. About 29.5% of women reported reduced or absent sexual activity. The less reported symptom was coital incontinence (1.3%), while painful intercourses was the most frequent one (50.3%). Nicotine abuse was associated with traumatic sexual intercourses, impaired vaginal sensibility, and negative impact on sexual life and well-being. Familiarity for pelvic floor disorder resulted as a risk factor for coital incontinence (OR=3.61). CONCLUSIONS: Sexual symptoms, with pain during intercourses being the most widely reported, are extremely common in the third trimester of pregnancy and can greatly affect quality of life. Familiarity for pelvic floor disorders and nicotine abuse resulted as significant risk factors for at least one sexual symptom.

Marta Barba,1 Alice Cola,2 Clarissa Costa,1 Antonio Liberatore,3 Matteo Frigerio2 1Obstetric and Gynecology Department - University of Milano-Bicocca, Monza, Italy; 2Gynecology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; 3School of Medicine, University of Milano-Bicocca, Monza, ItalyCorrespondence: Marta Barba, University of Milano-Bicocca, Via Pergolesi, 33, Monza, Italy, Tel +39 233 9434, Email m.barba8792@gmail.comObjective: Single-incision slings (SISs) are not considered the first surgical choice for stress urinary incontinence due to few data about long-term results. Our aim was to evaluate the outcomes of SISs 12 years after implantation and to search for consequences such as deterioration after a certain amount of time.Methods: We included women with stress urinary incontinence both clinically and urodynamically proven who underwent SISs procedure. Objective and subjective cure rates were compared to short-term outcomes to detect possible deterioration over time.Results: A total of 85 patients were analysed with a median follow-up of 12.0 (IQR 10.4– 12.8) years. Objective and subjective cure rates were 81.0% and 82.1%, respectively. Median (IQR) PGI-I scores and ICIQ-SF, respectively, were 1 (1– 2) and 0 (0– 6.8). No significant deterioration of outcomes over time was shown after comparison between short-term and long-term follow-ups (objective cure rate 84.5% vs 81.0%, p=0.684; subjective cure rates 92.9% vs 82.1%, p=0.060). Also, voiding symptoms and overactive bladder did not differ over time (20.2% vs 21.4%, p=1.000; 20.2% vs 33.3%, p=0.080, respectively).Conclusion: SISs were shown to be a procedure with a great efficacy and safety profile at very long-term follow-up.Keywords: complications, functional outcomes, long-term follow-up, quality of life, single-incision sling, stress urinary incontinence

Marta Barba,1 Matteo Frigerio,2 Tomaso Melocchi,1 Desirèe De Vicari,1 Alice Cola2 1Gynecology and Obstetric Department, University of Milano-Bicocca, Monza, Italy; 2Gynecology and Obstetric Department, Fondazione IRCCS San Gerardo Dei Tintori, Ospedale San Gerardo, Monza, ItalyCorrespondence: Marta Barba, University of Milano-Bicocca, ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33, Monza, 20900, Italy, Tel +39 2339434, Email m.barba8792@gmail.comIntroduction and Hypothesis: Lower urinary tract tears after vaginal delivery are a very rare event, estimated to occur in 0.03– 0.05% of women and may be associated with severe stress urinary incontinence, due to great reduction of urethral resistance resulting in a significant intrinsic urethral deficit. Urethral bulking agents represent an alternative, minimally invasive anti-incontinence procedure in the management of stress urinary incontinence. Our aim is to present the management of severe stress urinary incontinence in a patient with concomitant urethral tear caused by obstetric trauma using a minimally invasive treatment option.Methods: A 39-year-old woman referred to our Pelvic Floor Unit for severe stress urinary incontinence. Our evaluation demonstrated an undiagnosed urethral tear involving the ventral portion of the middle and distal urethra, for about 50% of urethral length. Urodynamic evaluation confirmed the presence of severe urodynamic stress incontinence. After proper counseling, she was admitted to mini-invasive surgical treatment with urethral bulking agent injection.Results: The procedure was completed in 10 minutes and she was successfully discharged home on the same day, and no complications occurred. The treatment resulted in total relief of urinary symptoms, which persists at 6-month follow-up.Conclusion: Treatment with urethral bulking agent injection represents a feasible mini-invasive option to manage stress urinary incontinence related to urethral tears.Keywords: urinary incontinen

Objective: This multicenter study aimed to evaluate risk factors, prevalence and severity of pelvic floor disorders (PFDs) as well as their consequences on women's emotional well-being, using a questionnaire validated specifically for pregnancy and postpartum. Methods: Prospective study conducted in eight teaching hospitals in Italy and Italian-speaking Switzerland. Pregnant and postpartum women completed the Italian Pelvic Floor Questionnaire for Pregnancy and Postpartum anonymously. Prevalence of, severity of, and risk factors for PFDs were evaluated for all the four domains considered: bladder, bowel, prolapse, and sexual function. Results: A total of 2007 women were included: 983 of the patients were bothered by at least one kind of PFD: bladder, bowel, and sexual dysfunction were more frequently reported. There were no significant differences in PFD prevalence between pregnancy and postpartum, except for bladder disorders, which were more prevalent in pregnancy. Familiarity for PFDs, pelvic floor contraction inability, cigarette smoking, body mass index more than 25 (calculated as weight in kilograms divided by the square of height in meters), and age more than 35 years were confirmed risk factors for the development of PFDs during pregnancy and postpartum. Conclusion: Almost half of the women included in the study suffered from PFD-related symptoms with important consequences on quality of life. Validated questionnaires are fundamental in early diagnosis and treatment of PFDs.

Marta Barba,1 Tetyana Lazar,1 Alice Cola,1 Giuseppe Marino,1 Stefano Manodoro,2 Matteo Frigerio3 1University Milano-Bicocca, San Gerardo Hospital, Monza, Italy; 2ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy; 3ASST Monza, San Gerardo Hospital, Monza, ItalyCorrespondence: Marta BarbaUniversity Milano-Bicocca, San Gerardo Hospital, Via Pergolesi 33, Monza, 20900, ItalyTel +390392339434Email m.barba8792@gmail.comPurpose: Intradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB.Patients and Methods: This retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients’ outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident.Results: Twenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2– 2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0± 4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and per

Objective: Overactive bladder (OAB) symptoms are frequently associated with pelvic organ prolapse (POP) and both postoperative improvement and de novo onset of OAB symptoms have been described. The aim of the study is to identify risk factors for persistent, de novo and overall postoperative OAB after POP repair. Study design: This was a retrospective study including patients who underwent primary POP surgery. Medical interview, urogenital examination and urodynamics were performed preoperatively; patients were examined one and six months after surgery and then yearly. Results: 518 patients were included. 36.1% of women preoperatively complained of OAB symptoms while detrusor overactivity was found in 20.5%. The rate of persistent and de novo OAB after surgery were respectively 14.1% and 13.5%. Multivariate analysis found age, BMI, preoperative OAB, sling placement and postoperative SUI as independent risk factors for overall OAB after surgery. Moreover, preoperative OAB and postoperative constipations were associated with OAB persistence after surgery. Finally, age, sling placement, postoperative SUI and voiding symptoms were independently associated with de novo OAB. Conclusion: Preoperative OAB symptoms are associated with OAB persistence after POP surgery, while age and sling placement correlate with de novo OAB. Finally, increased BMI is related to postoperative OAB

The aim of the present study was to assess, in a population of dichorionic twin pregnancies with selective growth restriction, the effect of inter-twin differences by use of Doppler velocimetry and fetal growth discordancy on perinatal outcomes. This was a retrospective study including dichorionic twin pregnancies from January 2008 to December 2015 at the Department of Obstetrics and Gynecology of Fondazione MBBM. Only dichorionic twin pregnancies affected by selective intrauterine growth restriction (IUGR) delivering at ≥24 weeks were included in the study. We found that twin pregnancies with inter-twin estimated fetal weight (EFW) discordance ≥15% were significantly associated with a higher risk of preterm delivery before 32 (P=0.004) and 34 weeks (P=0.04). Similarly, twin pregnancies with inter-twin abdominal circumference (AC) discordance ≥30° centiles were associated with a higher rate of neonatal intensive care unit (NICU) admission (P=0.02), neonatal resuscitation (P=0.02) and adverse neonatal composite outcome (P=0.04). Of interest, when comparing twin pregnancies according to Doppler study, growth restricted twins had a higher rate of composite neonatal outcome and in multivariate analysis, an abnormal Doppler was an independent risk factor for this outcome. Our study associated growth discrepancy with specific pregnancy outcomes, according to defined cut-offs. In addition, we demonstrated that an abnormal umbilical artery Doppler is independently associated with a composite neonatal adverse outcome in growth restricted fetuses

Introduction and hypothesis: Rectovaginal fistula repair is one of the most challenging gynecological surgical procedures. This video is intended to serve as a tutorial for surgical repair. Methods: An 80-year-old woman who developed a traumatic suprasphincteric rectovaginal fistula was managed through layered transvaginal repair without flaps. Results: Anatomy restoration was completed without complications. Conclusion: The procedure described in this video was effective and safe. Vaginal route should be considered as a valid surgical approach for rectovaginal fistula repair.

OBJECTIVE: After transplantation heart is denervated, resulting in increased resting heart rate (HR) and altered physiologic response to exercise. In heart transplant (HTX) recipients, absence of blood pressure (BP) dipping phenomenon has been reported, but information on central blood pressure, pulse wave velocity (PWV) and Augmentation Index (Aix) is scanty. Aim of our study was to investigate 24 h modulation not only of brachial BP but also of central-aortic BP (CABPM), HR, PWV and Aix in hypertensive HTX patients. DESIGN AND METHOD: We enrolled 24 hypertensive patients, 12 HTX recipients (Ht-HTX), at a mean time after HTX of 10,4 years, and 12 matched controls (Ht-C). All the patients were clinically stable and had normal LV systolic function. Ambulatory brachial BP, CABPM, PWV and Aix were recorded over 24 hours by Mobilograph device. RESULTS: Baseline brachial and central BP were similar in Ht-HTX vs Ht-C, as were 24 h brachial (128/78 mmHg ± 11/8Vs124/79mmHg ± 14/2) and central BP (119/81 mmHg ± 12/8 vs114/79 mmHg ± 13/7), HR (74.5 ± 11 vs 69 ± 10 bpm), PWV (8.15 ± 1.8 vs 8.2 ± 1.3 m/s) and Aix (23.6 ± 7.5 vs 22.8 ± 5.8%). PWV showed a dipping phenomenon in Ht-C (daily 8.3 ± 1.2, night 7.9 ± 1.4 m/s), p < 0.001) but not in Ht-HTX (daily 8.15 ± 1.8, night 8.15 ± 1.8). This was the case also for HR. Central systolic BP remained unchanged from day to night in Ht-HTX (118 ± 12 vs 119 ± 16 mmHg) but not in Ht-C (117 ± 15 vs 95 ± 33 mmHg), with night central systolic BP being higher in Ht-HTX vs Ht-C (p < 0.05). An index of 24 h variability (standard deviation) of BP and HR was lower in Ht-HTX than in Ht-C, reaching statistical significance only for 24h-HR (4.3 ± 1.7 vs 6.7 ± 2.3, p: 0.01). CONCLUSIONS: Our study shows for the first time that in Ht-HTX there is no nocturnal dipping not only of brachial BP and HR but also of CABPM, and PWV up to 10 years after HTX, probably due to persistent cardiac denervation and/or interference by immunosuppressant drugs. Altered

Introduction and hypothesis The aim of this study was to evaluate the functional outcome of a single-incision sling procedure for the treatment of female stress urinary incontinence (SUI) and to correlate the cure rate with a pelvic floor ultrasound examination Methods Fifty-seven patients treated with a single-incision sling procedure between January 2009 and September 2010 were included in the study. Functional outcome was evaluated as objective cure rate assessed with stress test and subjective cure rate determined by the International Consultation on Incontinence-Short Form and Patient Global Impression of Improvement scores. Women underwent perineal ultrasound examination by a combined 2D translabial and 3D transvaginal approach to assess bladder neck and tape mobility, tape position along the urethral axis, and tape anchorage. According to the position of self-fixating tips, we divided patients into group A (both tips crossed the obturator membrane), group B (only one tip crossed the obturatormembrane) and group C (none of the tips crossed the obturator membrane). Objective cure rate and type of anchorage were compared with all ultrasound parameters. Results At an average follow-up of 13 months objective cure rate was 87.7 % with a significant subjective improvement. A significant difference in tape mobility was noted between group A and group C. Bladder neck mobility significantly increased in failures. Sling was significantly closer to midurethra in cured than in failures. Conclusions In 77 % of patients MA didn't reach the obturator membrane on both sides. This feature conditioned significantly bladder neck mobility but not the efficacy of the procedure. Tape position seems to be the most important factor for success. © The International Urogynecological Association 2013.