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OBJECTIVE: To develop evidence- and consensus-based clinical practice guidelines for management of high-tone pelvic floor dysfunction (HTPFD). High-tone pelvic floor dysfunction is a neuromuscular disorder of the pelvic floor characterized by non-relaxing pelvic floor muscles, resulting in lower urinary tract and defecatory symptoms, sexual dysfunction, and pelvic pain. Despite affecting 80% of women with chronic pelvic pain, there are no uniformly accepted guidelines to direct the management of these patients. METHODS: A Delphi method of consensus development was used, comprising three survey rounds administered anonymously via web-based platform (Qualtrics XM) to national experts in the field of HTPFD recruited through targeted invitation between September and December 2021. Eleven experts participated with backgrounds in urology, urogynecology, minimally invasive gynecology, and pelvic floor physical therapy (PFPT) participated. Panelists were asked to rate their agreement with rated evidence-based statements regarding HTPFD treatment. Statements reaching consensus were used to generate a consensus treatment algorithm. RESULTS: A total of 31 statements were reviewed by group members at the first Delphi round with 10 statements reaching consensus. 28 statements were reposed in the second round with 17 reaching consensus. The putative algorithm met clinical consensus in the third round. There was universal agreement for PFPT as first-line treatment for HTPFD. If satisfactory symptom improvement is reached with PFPT, the patient can be discharged with a home exercise program. If no improvement after PFPT, second-line options include trigger or tender point injections, vaginal muscle relaxants, and cognitive behavioral therapy, all of which can also be used in conjunction with PFPT. Onabotulinumtoxin A injections should be used as third line with symptom assessment after 2-4 weeks. There was universal agreement that sacral neuromodulation is fourth-line intervention. The largest identified barrier to care for these patients is access to PFPT. For patients who cannot access PFPT, experts recommend at-home, guided pelvic floor relaxation, self-massage with vaginal wands, and virtual PFPT visits. CONCLUSION: A stepwise approach to the treatment of HTPFD is recommended, with patients often necessitating multiple lines of treatment either sequentially or in conjunction. However, PFPT should be offered first line.

Background Purpose Methods Results Conclusions Although the uterus, bladder, and rectum are distinct organs, their muscular fasciae are often interconnected. Clinical experience suggests that they may share common risk factors and associations. When one organ experiences prolapse, it can potentially affect the neighboring organs. However, the current assessment of disease severity still relies on manual measurements, which can yield varying results depending on the physician, thereby leading to diagnostic inaccuracies.This study aims to develop a multilabel grading model based on deep learning to classify the degree of prolapse of three organs in the female pelvis using stress magnetic resonance imaging (MRI) and provide interpretable result analysis.We utilized sagittal MRI sequences taken at rest and during maximum Valsalva maneuver from 662 subjects. The training set included 464 subjects, the validation set included 98 subjects, and the test set included 100 subjects (training set n = 464, validation set n = 98, test set n = 100). We designed a feature extraction module specifically for pelvic floor MRI using the vision transformer architecture and employed label masking training strategy and pre‐training methods to enhance model convergence. The grading results were evaluated using Precision, Kappa, Recall, and Area Under the Curve (AUC). To validate the effectiveness of the model, the designed model was compared with classic grading methods. Finally, we provided interpretability charts illustrating the model's operational principles on the grading task.In terms of POP grading detection, the model achieved an average Precision, Kappa coefficient, Recall, and AUC of 0.86, 0.77, 0.76, and 0.86, respectively. Compared to existing studies, our model achieved the highest performance metrics. The average time taken to diagnose a patient was 0.38 s.The proposed model achieved detection accuracy that is comparable to or even exceeds that of physicians, demonstrating the effectiveness of the vision transformer architecture and label masking training strategy for assisting in the grading of POP under static and maximum Valsalva conditions. This offers a promising option for computer‐aided diagnosis and treatment planning of POP. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor rehabilitation is common in patients with colorectal cancer, the purpose of this study is to analyze the role of pelvic floor rehabilitation in patients with colorectal cancer and to understand the specific details of pelvic floor rehabilitation intervention in patients with colorectal cancer. Methods: Six databases were searched for this scoping review and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. Results: A total of 1014 studies were searched, and 12 studies were finally included for analysis. The study found that pelvic floor rehabilitation for colorectal cancer patients can help improve bowel symptoms, quality of life, and psychological status of colorectal cancer patients after surgery, but details of the interventions for pelvic floor rehabilitation for colorectal cancer patients are not standardized. Conclusions: Pelvic floor rehabilitation has shown positive significance in patients with colorectal cancer, but there is a lack of uniform standards in the process of pelvic floor rehabilitation intervention in patients with colorectal cancer. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low “take‐off”.A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit. Clinical data, AAR, and conventional anal manometry were analysed according to the Oxford prolapse grade.A total of 108 (102 [94%] female, median age 62 years [range: 26–95]) patients were recruited into three groups according to prolapse grade: Oxford grades I and II (intrarectal RI, n = 34), Oxford grades III and IV (intra‐anal RI, n = 35) and Oxford grade V (ERP, n = 39). As the grade of prolapse increased, resting AAR measurements of opening pressure, opening elastance, closing pressure, and closing elastance decreased (p < 0.001). Maximum resting pressure with manometry was reduced in ERP and intra‐anal RI compared to intrarectal RI (p < 0.001). However, incremental squeeze function was not different between the three groups with either AAR or manometry (p > 0.05).There were no differences in AAR or manometry variables between grade IV RI (n = 18) and high take‐off ERP (n = 20) (p > 0.05). By contrast, opening pressure (p = 0.010), closing pressure (p = 0.019) and elastance (p = 0.022) were reduced in low take‐off ERP (n = 19).Increasing rectal prolapse grade is associated with reduced anal sphincter function at rest indicating internal anal sphincter dysfunction. Physiological differences exist between high and low take‐off ERP with sphincter function in the former similar to that seen in grade IV RI. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Design Setting Population Methods Main Outcome Measures Results Conclusion This study aimed to evaluate the training and self‐assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision‐making, the surgical techniques employed, the training received, and the management of complications.A cross‐sectional survey.An electronic questionnaire.European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members.A total of 33 questions evaluating surgeon preference regarding vaginal surgeries.Demographics, surgical selection, proficiency and technique, and training methods.There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two‐thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10–30 cases were needed to achieve and maintain proficiency.Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine‐sparing prolapse repairs, the decision‐making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques. [ABSTRACT FROM AUTHOR]

Background While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment. Objective To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention. Methods Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway : Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months. Results While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (n  = 5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (n  = 15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms. Conclusion Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic ELAPE surgery has been carried out in our center for a long time, and some modifications have been made in clinical practice. In this study, we compared conventional ELAPE operation with modified ELAPE operation to investigate the efficacy and safety of modified ELAPE operation. Methods: We retrospectively analyzed the data from 339 patients with low rectal cancer undergoing abdominoperineal resection from 2017 to 2021 in the Department of General Surgery, Qilu Hospital of Shandong University. Patients were classified into modified ELAPE groups (199 patients) and conventional ELAPE groups (140 patients). Total operation time, reconstruction time, postoperative hospital stay, total cost, intraoperative data, postoperative short-term and long-term complications and tumor recurrence were compared. Results: The baseline characteristics were comparable between the two groups. Total operation time was less with modified ELAPE group compared to conventional ELAPE group (190.6 ± 33.1 min vs 230.1 ± 51.6 min, P = 0.022). Pelvic floor reconstruction time was also less with modified ELAPE group compared to conventional ELAPE group (4.3 ± 1.2 min vs 11.9 ± 1.7 min, P = 0.004). Positive CRM was observed in 11 and 9 patients in modified ELAPE groups and conventional ELAPE groups (P = 0.744). IOP occurred in 12 and 7 patients in modified ELAPE group and conventional ELAPE group (P = 0.701). Total cost was also less with modified ELAPE group compared to conventional ELAPE group (9004 ± 1146 USD vs 10,336 ± 2047 USD, P = 0.031). The incidence of parastomal hernia was less with modified ELAPE group compared to conventional ELAPE group (7/199 vs 22/140, P < 0.001). Three-year follow-up data did not show any difference in overall survival rate or local occurrence between the two groups. Conclusion: Modified ELAPE surgery is technically safe and feasible, and oncologically comparable to that of conventional ELAPE surgery, which can be considered for popularization and application. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor dysfunction (PFD) is a disease of weakened pelvic floor support tissues, leading to changes in the pelvic organ position and function of pelvic organs, with long-term effects on women. This study aimed to assess pelvic floor function using electrophysiology and clinical symptoms, exploring the risk factors for PFD one month postpartum. Methods: This cross-sectional study included 845 women from postpartum outpatient clinic of Nantong Affiliated Hospital from August 2019 to October 2021. Pelvic floor muscle strength was evaluated via pelvic floor surface electromyography. Clinical symptoms (urinary incontinence (UI) and pelvic organ prolapse) were diagnosed by gynecologists. Sociodemographic, pregnancy, and obstetrical data were obtained from self-reported questionnaires and electronic records. Results: The study identified maternal age, parity, immigrant status, and economic income as factors were related to PFD. Gestational constipation increased the risk of abnormal resting muscle strength (OR:1.553, 95%CI: 1.022–2.359). Cesarean delivery was associated with higher rates of abnormal resting muscle strength than vaginal delivery (post-resting stage: OR, 2.712; 95% CI, 1.189–6.185), but a decreased incidence of UI (OR: 0.302; 95% CI, 0.117–0.782). Increased gestational weight gain was correlated with a greater risk of developing UI (OR:1.030, 95%CI: 1.002–1.058). Women with vaginal inflammation faced a higher risk of abnormal fast-twitch muscle (OR: 2.311, 95%CI: 1.125–4.748). Conclusions: In addition to uncontrollable factors like mode of delivery, age, and parity, interventions targeting weight gain and constipation during pregnancy and vaginal flora could mitigate the risks of PFD. Educational programs for pregnant women should emphasize a proper diet and lifestyle. For women with vaginal inflammation, clinical treatment should be carried out as soon as possible to avoid further aggravating the damage to the pelvic floor muscles. [ABSTRACT FROM AUTHOR]

Background: Pelvic organ prolapse (POP) is one of the most common pathologies of the pelvic floor, and it can be found among 40–60% of women who have given birth. Correction of the defect of the DeLancey level II without reconstruction of the apical defect is doomed to failure. Also, in the structure of pelvic floor defects, there is often an incompetency of the perineal body, as a consequence of traumatic delivery. Perineoplasty is considered to be the main method of correction for perineal body incompetency. However, it is worth mentioning that there are no randomized trials, which estimate the influence of simultaneous correction of the perineal body on the effectiveness of transvaginal apical fixation. Methods: It is planned to include 310 patients in this trial. Patients who met the inclusion/exclusion criteria will be randomized into 2 groups: 1st group—patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy without perineoplasty, 2nd group—patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy and perineoplasty. Patients will be called to an appointment 6, 12, and 24 months after discharge. Discussion: The aim of this trial is to evaluate the efficiency and safety of simultaneous perineoplasty on the clinical and anatomical efficacy of mesh-augmented sacrospinal fixation in advanced pelvic organ prolapse repair. Based on previous studies, it was difficult to estimate and comprehend whether colpoperinoplasty actually reduces the risk of prolapse recurrence. Trial registration: NCT05422209. Registered on 18 May 2022. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic floor muscle training (PFMT) for urinary incontinence (UI) is recommended in combination with biofeedback to visualize pelvic floor muscles. The focus is on non‐invasive hand‐held ultrasound (US) measurement methods for PFMT, which can be performed at home. Recently, self‐performed US measurements in which the patient applies the US to themself have gradually spreading. This study aimed to develop an educational program for the biofeedback method using self‐performed US and to evaluate its feasibility. Methods: This study was an observational study. The ADDIE model (Analysis, Design, Development, Implementation, and Evaluation) was utilized to create an e‐learning program for women aged ≥40 years with UI. Participants self‐performed bladder US via e‐learning, using a hand‐held US device with a convex probe. The primary outcome was the number of times the bladder area was successfully extracted using an existing automatic bladder area extraction system. The secondary outcome was the total score of the technical evaluation of the self‐performed US, which was evaluated across three proficiency levels. Descriptive statistics were conducted for participant characteristics, presenting categorical variables as percentages and continuous variables as means ± SD. Results: We included 11 participants with a mean age of 56.2 years. Nine participants were able to record US videos, and two were unable to record bladder videos. Regarding the technical evaluation scores, all participants scored ≥80%; four had perfect scores. Conclusions: This study showed that transabdominal self‐performed bladder US can be performed in 81.8% of women with UI in their 40–60s by using an e‐learning program. [ABSTRACT FROM AUTHOR]

Sexual abuse is common, especially among people with physical, sensory or mental disabilities living in an institution. In a residential institution, patients are dependent on professional caregivers, which is a risk factor for abuse. Sexually transgressive behaviour can also occur among residents. There is increasing evidence for the link between urological problems and a history of sexual abuse. Understanding the relationship between sexual abuse, pelvic floor overactivity and urological problems offers opportunities for trauma processing. This article describes how urologists can apply this knowledge in their work with patients who live in institutions, taking into account the shame and guilt associated with these experiences. Concrete questions and psychoeducation to apply in the consulting room are also provided. [ABSTRACT FROM AUTHOR]

Dysfunctional voiding (DV), the involuntary pelvic floor muscle contraction during micturition, affects both children and adults and often leads to mental health issues. Its multifactorial etiology includes incorrect toileting posture and genetic predisposition. The developmental trajectory of DV remains unclear due to a lack of consensus on definition and diagnosis. Some studies suggest DV may persist into adulthood despite childhood treatment, or childhood DV may predispose individuals to lower urinary tract symptoms (LUTS) later in life. Moreover, LUTS appear to increase the risk of mental health issues. The absence of an explicit request for care may warrant active patient monitoring by healthcare providers, due to potential risks of LUTS and mental health issues. Further research is needed for conclusive understanding. [ABSTRACT FROM AUTHOR]

Skeletal muscle architecture is a strong predictor of in vivo functional capacity and is evaluated in fixed tissues, accommodating the study of human muscles from cadaveric donors. Previous studies evaluating the pelvic floor muscles (PFMs) demonstrated that the rat is the most appropriate small animal model for the study of female PFM architecture, but the rat's suitability for the study of male PFMs is undetermined. We aimed to determine (1) whether PFM architecture exhibits sexual dimorphism in rats or humans, and (2) if the rat is also a suitable animal model for the study of male human PFMs. PFMs were fixed in situ and harvested en bloc from male and female cadaveric donors and 3-month-old male and female Sprague-Dawley rats. Three architectural parameters influenced by species size were used to compare male versus female PFMs within species, while four size-independent measures compared species within sex. All comparisons were made with two-way analysis of variances and Tukey's multiple comparisons tests post hoc. Sarcomere length (rats and humans, p = 0.016 and = 0.002) and normalized fiber length (rats, p < 0.001) were significantly larger in male PFMs. Three of the size-independent measures exhibited similar species trends in both sexes, while the size-independent sarcomere length measure (Ls/Lso) differed between male rats and humans (p < 0.001). Thus, sexual dimorphism is present in rat and human PFM architecture, and the male rat is suitable for studies of human male PFMs. [ABSTRACT FROM AUTHOR]

• This manuscript is about bibliometric analysis and Visual analysis for laparoscopic pelvic floor surgery from 1996-2022. Further, we believe that this paper will be of interest to the readership of your journal. Because this is the first bibliometric analysis to identify the importance of laparoscopic pelvic floor surgery. • It has guiding significance for the treatment of pelvic organ prolapse in the future. Pelvic organ prolapse is a common condition in middle-aged and older women. Laparoscopic pelvic floor surgery is frequently researched as a treatment for this issue. However, the effectiveness of this procedure has only been the subject of a few studies. To quantitatively evaluate and display the relevant literature from the Web of Science database, we set the publication period of the literature from 1996 to 2022 and used VOSviewer and CiteSpace for visual analysis. Laparoscopic pelvic floor surgery research has increased year-on-year, with 1003 publications identified from 63 countries and published in 210 journals. In the global ranking of studies, the United States was the leader (n = 306; 30.5 %), with the most published authors being Campagna, Giuseppe (n = 17) and Scambia, Giovanni (n = 17). The International urogynecology journal included the most significant articles (n = 173; 17.2 %). Keyword analysis suggests that complications, rectal prolapse, native tissue repair, and warranty may have become hotspots in recent years. This bibliometric study shows that the depth and breadth of research on pelvic floor laparoscopic surgery have expanded rapidly over the last twenty-five years and that laparoscopic surgery has been recognized by different scholars or countries as an essential modality for the treatment of pelvic floor organ prolapse. [ABSTRACT FROM AUTHOR]

• Objectives: - to determine the relationship of diastasis of the rectus abdominis with pelvic floor muscle function. • Conclusions: There was a weak relationship between diastasis of the rectus abdominis and stress urinary incontinence and pelvic floor muscle dysfunction examined by manometry. To determine whether diastasis of the rectus abdominis muscles was related to stress urinary incontinence, dysfunction of pelvic floor muscles, and of hiatal area size in postpartum women. This observational prospective study included 150 women from 6 weeks to 6 months postpartum, with a mean age of 33.1 years. Diastasis Recti Abdominis is a condition in which the abdominal muscles are separated by an increased inter-rectus distance due to widening of the linea alba, measured using 2D ultrasound. Pelvic floor muscle function was examined using manometry, and the size of the hiatal area was examined using 3D/4D ultrasonography. Stress urinary incontinence symptoms were assessed using the International Incontinence Consultation Questionnaire (ICIQ–UI SF). We identified a significant weak correlation between diastasis of the rectus abdominis and symptoms of stress urinary incontinence (r = 0.283). We also found weak significant correlations of diastasis of the rectus abdominis with the maximum voluntary contraction (r = −0.278) and with the duration voluntary contraction (r = −0.274). No correlation was found between diastasis of the rectus abdominis and size of the hiatal area. Diastasis of the rectus abdominis was weakly related to stress urinary incontinence and also to pelvic floor muscle dysfunction. [ABSTRACT FROM AUTHOR]

• Combination therapy is efficacious in treating women with OAB. • Rapid effect and persistent clinical improvement were evident from week 2. • There were fewer side effects over time. We hypothesized that combination therapy would provide a synergistic effect to improve treatment outcomes for overactive bladder (OAB), thus enhancing the motivation for continuous exercise, and that it would be associated with fewer adverse events than monotherapy. Therefore, we investigated whether biofeedback-assisted pelvic floor muscle training (PFMT), drug therapy, or a combination of both would be more effective in improving the symptoms of OAB. This randomized controlled trial included women diagnosed with OAB. Group 1 received biofeedback-assisted pelvic muscle floor training (PFMT) for 12 weeks; group 2 took 5 mg of solifenacin/day for 12 weeks; and group 3 received 5 mg of solifenacin/day in combination with biofeedback-assisted PFMT during the first 4 weeks and biofeedback-assisted PFMT for another 8 weeks. All participants had 5 follow-up visits. The primary outcomes were objective improvement of OAB symptoms and quality of life. The secondary outcomes were treatment-related adverse events, subjective improvement of OAB symptoms, and electromyographic activity of pelvic floor muscle (PFM) contraction. All participants reported significant improvement of OAB symptoms and quality of life. Participants in group 2 experienced more pronounced adverse events than those in group 3. Intervention duration was positively associated with subjective improvement in OAB symptoms in groups 2 and 3. Drug-related adverse events, including dry mouth, myalgia, and restlessness, had a negative impact on the subjective improvement of OAB symptoms in group 2. In group 1, exercise adherence was positively correlated with subjective improvement of OAB symptoms, whereas in group 3, PFM contraction and biofeedback effect were positively correlated with symptom improvement. Combination therapy is efficacious in treating women with OAB. [ABSTRACT FROM AUTHOR]

• This study contributes an understanding about women's PFH knowledge despite having PFD or not. • A psychometric and feasibility comparison of three PFH knowledge scales is demonstrated. Scales assess PFH knowledge in diverse female populations for clinicians and researchers. Despite high prevalence and burden of pelvic floor dysfunctions (PFD), there is a limited number of scales assessing knowledge of pelvic floor health (PFH), and no studies comparing their psychometric or feasibility properties. The study aimed both to investigate the psychometric properties and feasibility of Incontinence Quiz (IQ), Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and Pelvic Floor Health Knowledge Questionnaire (PFHKQ), and to compare level of PFH knowledge in women with and without PFD. In this prospective cross-sectional study, a total of 150 women were included. After recording physical-sociodemographic characteristics, obstetric histories and menstrual status, Pelvic Floor Distress Inventory-20 and Female Sexual Function Index were administered to classify them into study groups as women with and without PFD. Their PFH knowledge was assessed using IQ, PIKQ and PFHKQ, which were filled twice with one week interval for the test–retest purpose. The scores, reliability, validity, ceiling-floor effects and feasibility of the knowledge scales were compared with each other, and between the study groups. IQ, PIKQ, and PFHKQ scores of women with and without PFD were similar. Based on response patterns to items, PFHKQ had the highest internal consistency followed by PIKQ and IQ. The PIKQ was the most stable scale across the total sample and in the PFD group. The PFHKQ had the highest ICC value in women without PFD. There was a strong correlation between the total scores of knowledge scales in both groups. Scores of knowledge and symptom scales were not significantly correlated. IQ was completed in the shortest time, and was easier to complete than PFHKQ. Only the diagnosis/treatment subscale of PFHKQ had a ceiling effect. It was concluded that PFH knowledge of women with and without PFD were at a low-moderate level and similar to each other; IQ, PIKQ and PFHKQ were reliable, valid and feasible scales, which can be used in measuring knowledge level about PFH. [ABSTRACT FROM AUTHOR]

Objective The purpose of the study was to determine if antegrade continence enema (ACE) alone is an effective treatment for patients with severe functional constipation and segmental colonic dysmotility. Methods A retrospective study of patients with functional constipation and segmental colonic dysmotility who underwent ACE as their initial means of management. Data was collected from six participating sites in the Pediatric Colorectal and Pelvic Learning Consortium. Patients who had a colonic resection at the same time as an ACE or previously were excluded from analysis. Only patients who were 21 years old or younger and had at least 1-year follow-up after ACE were included. All patients had segmental colonic dysmotility documented by colonic manometry. Patient characteristics including preoperative colonic and anorectal manometry were summarized, and associations with colonic resection following ACE were evaluated using Fisher's exact test and Wilcoxon rank-sum test. p -Values of less than 0.05 were considered significant. Statistical analyses and summaries were performed using SAS version 9.4 (SAS Institute Inc., Cary, North Carolina, United States). Results A total of 104 patients from 6 institutions were included in the study with an even gender distribution (males n = 50, 48.1%) and a median age of 9.6 years (interquartile range 7.4, 12.8). At 1-year follow-up, 96 patients (92%) were successfully managed with ACE alone and 8 patients (7%) underwent subsequent colonic resection for persistent symptoms. Behavioral disorder, type of bowel management, and the need for botulinum toxin administered to the anal sphincters was not associated with the need for subsequent colonic resection. On anorectal manometry, lack of pelvic floor dyssynergia was significantly associated with the need for subsequent colonic resection; 3/8, 37.5% without pelvic dyssynergia versus 1/8, 12.5% (p = 0.023) with pelvic dyssynergia underwent subsequent colonic resection. Conclusion In patients with severe functional constipation and documented segmental colonic dysmotility, ACE alone is an effective treatment modality at 1-year follow-up. Patients without pelvic floor dyssynergia on anorectal manometry are more likely to receive colonic resection after ACE. The vast majority of such patients can avoid a colonic resection. [ABSTRACT FROM AUTHOR]

Background. Dyspareunia and restriction of sexual activity are often reported by patients with chronic pelvic pain, but less is known about which conditions or factors contribute most to these symptoms. Methods. This is a cross-sectional study of consecutive new patients who presented to a chronic pelvic pain and endometriosis referral clinic between January 2013 and December 2015. Patients completed a detailed questionnaire prior to their first visit and underwent a comprehensive standardised pelvic examination at their first visit. Patients were grouped according to description of sexual activity as 'normal activity without pain', 'normal activity but painful', 'severely restricted by pain', or 'absent due to pain.' Primary outcome was restriction of sexual activity due to pain. Multinomial logistic regression was performed with 'normal activity without pain' group as reference category and adjusted for age, depression, history of endometriosis, and pelvic myofascial pain. Results. Over half of the 187 patients with chronic pelvic pain described severely restricted (n = 75, 40.1%) or absent (n = 21, 11.2%) sexual activity due to pain. Pelvic myofascial pain was highly prevalent in this population and pelvic myofascial tenderness score was associated with higher odds of sexual activity that was severely restricted by pain (OR 1.05, 95% CI 1.01-1.09, P = 0.006) or absent due to pain (OR 1.09, 95% CI 1.04-1.13, P < 0.001). History of endometriosis and depression were not independently associated with restriction of sexual activity due to pain. Conclusion. Dyspareunia and sexual dysfunction are highly prevalent among patients with chronic pelvic pain, and pelvic myofascial pain is strongly associated with restriction of sexual activity due to pain. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is the most prevalent pelvic floor disorder following treatment for gynaecological cancer with a distressing impact on quality-of-life in survivors. Physiotherapist-supervised pelvic floor muscle (PFM) training is recommended as the first-line intervention for UI in community-dwelling women. However, it is not known if this intervention is effective in women following treatment for gynaecological cancer, nor whether PFM training can be delivered entirely remotely. The primary aim of this study is to investigate if a telehealth-delivered PFM training program incorporating a novel biofeedback device reduces UI compared with usual care, following gynaecological cancer. Methods: This is a pragmatic, two-arm parallel-group, stratified superiority randomised controlled trial recruiting 72 participants (ACTRN12622000580774). Recruitment sites include gynaecology-oncology outpatient clinics, supplemented by advertisements through community foundations/social media/care groups. Participants must have completed primary cancer treatment at least 6 months prior or adjuvant therapy at least 3 months prior, for Stage I, II or III uterine, cervical, fallopian tube, primary peritoneal or ovarian cancer or borderline ovarian tumour, and have UI occurring at least weekly. Participants randomised to the usual care group will receive bladder and bowel advice handouts and one audio telehealth physiotherapist consultation to answer any queries about the handouts. Participants randomised to the intervention group will receive the same handouts plus eight video telehealth physiotherapist consultations for PFM training with a biofeedback device (femfit®), alongside a home-based program over 16 weeks. The primary outcome measure is a patient-reported outcome of UI frequency, amount and interference with everyday life (measured using the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form), immediately post-intervention compared with baseline. Secondary outcomes include quality-of-life measures, bother of pelvic floor symptoms, leakage episodes, use of continence pads and global impression of change. We will also investigate if the intervention improves intra-vaginal resting and squeeze pressure in women in the intervention arm, using data from the biofeedback device. Discussion: If clinical effectiveness of telehealth-delivered physiotherapist-supervised PFM training, supplemented with home biofeedback is shown, this will allow this therapy to enter pathways of care, and provide an evidence-based option for treatment of post-cancer UI not currently available. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ID 12622000580774. Registered 20 April 2022. [ABSTRACT FROM AUTHOR]

AbstractWomen Veterans constitute a distinctive cohort whose exposure to military service can contribute to development of bladder conditions, such as urinary incontinence (UI), as they age. Behavioral therapies are recommended as first-line treatment for incontinence, yet many VA Medical Centers do not have staff trained to administer them. The purpose of this research study was to conduct a qualitative program evaluation of MyHealtheBladder, a mobile telehealth version of an evidence-based eight‐week behavioral treatment program designed for women Veterans with incontinence. MyHealtheBladder uses mobile telehealth technology to teach pelvic floor muscle exercises, bladder control strategies, fluid management, risk factor reduction, and self‐monitoring. Eighteen women Veterans who completed a pilot study of MyHealtheBladder participated in semi-structured telephone interviews exploring their experience with the program. A directed content analysis was conducted of the transcribed interview data. Participants described ease of accessing MyHealtheBladder using smart phones and other mobile devices, emphasizing the flexibility of using the program at home, work, or while traveling. Most participants described program content as understandable, relevant, and easy to follow. They discussed how the program increased knowledge of UI, promoted consistency in practicing behavioral therapy, strengthened pelvic floor muscles, reduced urine leakage, and improved psychosocial wellbeing. Suggestions for improvement included more interaction with staff, more individualized tailoring of content to UI type, incorporating in-person clinic visits, and including supplementary material. Participants uniformly endorsed the program and recommended it for other women Veterans, as well as for those in active duty to prevent or treat UI earlier in the life course. [ABSTRACT FROM AUTHOR]

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain condition creating a wide range of urologic and pain symptoms. There is currently limited evidence to understand the mechanisms of IC/BPS. There have been recent studies suggesting that altered function in brain motor areas, particularly the supplementary motor cortex (SMA), relates to altered bladder sensorimotor control and may play an important role in IC/BPS. This study aims to provide evidence that non-invasive stimulation targeting the motor cortex may help reduce IC/BPS pain, as well as better understand the neural mechanism by which this stimulation targets neuromuscular dysfunction. This study is a two-group quadruple-blinded randomized controlled trial (RCT) of active vs. sham repetitive transmagnetic stimulation (rTMS). In addition, our study will also include functional magnetic resonance imaging (fMRI), pelvic floor electromyography (EMG), pelvic exam, and outcome measures and questionnaires to further study outcomes. Ethics and dissemination: All aspects of the study were approved by the Institutional Review Board of the University of Southern California (protocol HS-20–01021). All participants provided informed consent by the research coordinator/assistants. The results will be submitted for publication in peer-reviewed journals and disseminated at scientific conferences. Trial registration: ClinicalTrials.gov NCT04734847. Registered on February 1, 2021. [ABSTRACT FROM AUTHOR]

Scientific treatments for postpartum urinary incontinence, including pelvic floor muscle exercises (such as Kegel exercises) and infrared therapy, can effectively improve pelvic floor and urethral function, thus enhancing quality of life. However, clinical research on the combined use of these interventions for postpartum urinary incontinence is limited. To investigate the combining efficacy of pelvic floor muscle exercises with infrared physiotherapy on postpartum urinary incontinence. Clinical information of 102 patients with postpartum urinary incontinence (June 2021–June 2022) were collected and analyzed. Patients were randomly divided into control (conventional intervention) and observation (pelvic floor muscle exercises combined with infrared physiotherapy) groups, with 52 and 50 cases respectively. We compared pelvic floor muscle strength, urodynamic indicators, leakage volume, quality of life, and overall clinical efficacy between the two groups. Before intervention, both groups had similar pelvic floor function scores and urodynamic indicators. Post-intervention, the pelvic floor function scores in the observation group were significantly lower than control. The urodynamic indicator levels of the observation group were markedly higher than control after 2 months of intervention. Leakage volume was similar before intervention, while the observation group had significantly lower volumes after 1 and 2 months of intervention. Quality of life scores were similar initially, but after 2 months, the observation group scored higher. The observation group showed notably better pelvic floor rehabilitation at 2 months post-intervention. Combining pelvic floor muscle exercise with infrared physiotherapy has been shown to be a highly effective approach in enhancing pelvic floor muscle strength and improving the quality of life for postpartum women experiencing urinary incontinence. This combined therapy also demonstrates positive effects on urodynamic indicators, reducing leakage volume, and facilitating pelvic floor rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is a highly prevalent condition in women with a profound influence on their well-being and quality of life. Pelvic floor muscle training (PFMT) is a widely accepted conservative management of incontinence. Adequate knowledge of PFMT can enhance the ability of individuals to perform them effectively unsupervised. Objectives: This study aimed to determine the prevalence of UI and knowledge of PFMT among older women in a selected suburban community in Nigeria. Design: A cross-sectional design. Methods: This study consecutively recruited 121 older women (65 years and above) with a mean age of 68.59 ± 4.94 years in Nnewi North LGA Anambra state, Nigeria. The International Consultation on Incontinence Questionnaire Short Form and an adopted pre-tested questionnaire were used to assess the prevalence of UI and knowledge of PFMT. Data was analyzed using Statistical Package of Social Sciences (SPSS) version 26 Descriptive statistics, and the chi-square test was utilized with significance determined at an alpha level of 0.05. Results: The results revealed that 33.88% of the respondents experience UI, and 3.3% of them have heard about PFMT. There was significant association between prevalence of UI and number of pregnancies (χ2 = 11.16, p = 0.03) and children (χ2 = 9.77, p = 0.04). There was no significant association between the prevalence of UI and level of education (χ2 = 4.20, p = 0.12) and knowledge of PFMT (χ2 = 0.48, p = 0.42). There was no significant association between knowledge of PFMT and number of pregnancies (χ2 = 04.25, p = 0.37), and number of children (χ2 = 4.02, p = 0.40). There was a significant association between knowledge of PFMT and level of education among the participants (χ2 = 7.46, p = 0.02). Conclusion: The study showed a significant prevalence of UI and poor knowledge of PFMT in older women. Health professionals should sensitize older women in hospitals and care homes on the benefits of PFMT to improve their knowledge of PFMT. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of urethral catheterization on the accuracy of EMG uroflowmetry in children with non-neurogenic voiding disorders during pressure-flow (PF) studies compared to the non-invasive EMG uroflowmetry test. Methods: A retrospective study of children undergoing a urodynamic evaluation at our institution between 8/2018 and 7/2022 was employed. Urination curves and pelvic floor muscle activity were compared between PF studies and non-invasive EMG uroflowmetry test. The non-invasive test was selected as the standard benchmark. Results: 104 children were tested, with 34 children (33%) being able to urinate only in a non-invasive EMG uroflowmetry. The percentage of boys unable to urinate with a catheter was significantly higher than girls (54% vs. 13%, p-value < 0.001). In 70 children, a normal bell-shaped urination curve was found in 13 compared to 33 children in the PF studies and non-invasive uroflowmetry, respectively. PF studies demonstrated a specificity of 39% (95% CI 23–57) and a positive predictive value (PPV) of 61% (95% CI 53–67) in finding non-bell-shaped curves. Relaxation of pelvic muscles was found in 21 (30%) as opposed to 39 (55%) of children in invasive and non-invasive EMG uroflowmetry, respectively (p-value = 0.5). Conclusion: The accuracy of PF studies in children, primarily in boys, compared to the non-invasive uroflowmetry, was poor. This may pose potential errors in diagnosis and subsequent treatment. We recommend completing a non-invasive EMG uroflowmetry in cases where the child refused to urinate, or pathology was found, requiring a modification in treatment. [ABSTRACT FROM AUTHOR]

Background: Pelvic pain worsened by orgasm is a poorly understood symptom in patients with endometriosis. Aim: To assess the prevalence of pelvic pain worsened by orgasm in patients with endometriosis and explore its association with potential etiologic factors, including pelvic floor myalgia, uterine tenderness and adenomyosis, and central nervous system sensitization. Methods: An analysis was done of a prospective data registry based at a tertiary referral center for endometriosis. Eligible participants were patients aged 18 to 50 years who were referred between January 1, 2018, and December 31, 2019, diagnosed with endometriosis, and subsequently underwent surgery at the center. Clinical features were compared between participants reporting worsening pelvic pain with orgasm and those without worsening pain with orgasm, including patient-reported variables, physical examination findings, and anatomic phenotyping at the time of surgery. Pelvic floor myalgia and uterine tenderness were assessed by palpation on pelvic examination, adenomyosis by ultrasound, and central nervous system sensitization via the Central Sensitization Inventory (range, 0-100). Outcomes: Outcomes included pelvic or lower abdominal pain in the last 3 months that worsened with orgasm (yes/no). Results: Among 358 participants with endometriosis, 14% (49/358) reported pain worsened by orgasm while 86% (309/358) did not. Pain with orgasm was significantly associated with pelvic floor myalgia (55% [27/49] vs 35% [109/309]; Cohen's h = 0.40, P =.01) and higher scores on the Central Sensitization Inventory (mean ± SD, 53.3 ± 17.0 vs 42.7 ± 18.2; Cohen's d = 0.60, P <.001) but not with uterine tenderness or adenomyosis. Other clinical features associated with pain with orgasm were poorer sexual health (higher scores: deep dyspareunia, Cohen's h = 0.60; superficial dyspareunia, Cohen's h = 0.34; and Female Sexual Distress Scale–Revised, Cohen's d = 0.68; all P <.05) and poorer mental health (higher scores: Patient Health Questionnaire–9, 12.9 ± 6.7 vs 9.1 ± 6.3, Cohen's d = 0.59, P <.001; Generalized Anxiety Disorder–7, 9.4 ± 5.6 vs 6.8 ± 5.5, Cohen's d = 0.48, P =.002). Anatomic findings at the time of surgery did not significantly differ between the groups. Clinical Implications: Interventions targeting pelvic floor myalgia and central nervous system sensitization may help alleviate pain worsened by orgasm in patients with endometriosis. Strengths and Limitations: A strength is that pain worsened by orgasm was differentiated from dyspareunia. However, pain with orgasm was assessed by only a binary question (yes/no). Also, the study is limited to a single center, and there were limited data on sexual function. Conclusion: Pelvic pain exacerbated by orgasm in people with endometriosis may be related to concurrent pelvic floor myalgia and central sensitization. [ABSTRACT FROM AUTHOR]

Pelvic floor dysfunctions (PFD) are prevalent conditions that affect millions of women worldwide, encompassing a range of issues severely affecting women's quality of life. Pelvic floor muscle strength and function are fundamental to the management and prevention of PFD, and pelvic rehabilitation is a non-invasive approach that effectively improves symptoms, restores function, and prevents complications. This study aimed to evaluate the impact of pelvic floor muscle training program using weighted vaginal cones, on pelvic floor muscle function and quality of life in women with pelvic floor dysfunction (PFD). Fifty-four women aged 26-62 years, with different type of urinary incontinence, cystocele, and prolapse participated in this pre-post intervention comparative analysis. Pelvic floor muscle function was assessed using the PC test, which measures strength, endurance and fatigability, while the impact on patients' quality of life was assessed with the Pelvic Floor Impact Questionnaire - Short Form 7 (PFIQ-7). A three-month vaginal cone training regimen was implemented, with as-sessments conducted before the intervention (T0), one month later (T1), and three months later (T2). Data analysis showed a change with significant differences between the PC test score values at the level of each parameter and at each assessment (p<0.05, ES=0.254-511). The scores for bladder and urinary problems Urinary Impact Questionnaire (UIQ-7) significantly de-creased from 38.901 ± 1.268 at T0 to 29.366 ± 2.493 at T2 (W = 1082.000, p < 0.001, ES=0.570). In contrast, the scores for vaginal or pelvic problems (POPIQ-7) showed a slight, insignificant decrease from 12.699 ± 1.128 at T0 to 10.499 ± 2.362 at T2 (W = 278.000, p = 0.800, ES=0.053). fVaginal cone training significantly improves pelvic floor mus-cle function and reduces urynary symptoms in women with PFD [ABSTRACT FROM AUTHOR]

The objective benefit of transvaginal mesh with concomitant total hysterectomy (TVM-HTX) repair to high-grade uterine prolapse (UP) patients has not been fully established. This study aimed to clarify the impact of TVM-HTX on the voiding function of high-grade UP patients by comparing pre- and post-operatively measured pressure–flow and pressure–volume investigations. Urodynamic and thermodynamic studies were conducted on 15 high-grade UP patients (stage III/IV, POP-Q system) who underwent TVM-HTX (January 2019–December 2022) in a tertiary-care university hospital. The parameters analyzed included voiding resistance (Rvod), voiding pressure (Pvod), voiding flow (Fvod), voided volume (Vvod), voiding time (Tvod), and the trajectory-enclosed area of the pressure–volume loop (Apv). Post-operative results showed a significant reduction in Rvod (p < 0.001, N = 15), Pvod (p = 0.021, N = 15), and Apv (p = 0.006, N = 15), along with an increase in Fvod (p = 0.003, N = 15) and a decrease in Tvod (p < 0.001, N = 15). The operation-associated changes in Rvod (ΔRvod) correlated with alterations in Pvod and Fvod (ΔPvod and ΔFvod, r = 0.444, p = 0.004, r = 0.717, p = 0.003, respectively; both N = 15); ΔFvod correlated with the change in Tvod (ΔTvod, r = 0.629, p = 0.012, N = 15) but not with that in ΔVvod (r = 0.166, p = 0.555, N = 15). Changes in Apv (ΔApv) correlated with ΔPvod (r = 0.563, p = 0.029, N = 15) but not with ΔVvod (r = 0.353, p = 0.197, N = 15). Collectively, TVM-HTX reduced the voiding resistance, which improved the voiding efficacy and decreased the pressure gradient required for driving urine flow, thereby lessening the bladder's workload. [ABSTRACT FROM AUTHOR]

(1) Background: Female sexual dysfunction (FSD) and overactive bladder (OAB) are prevalent disorders that significantly impair women's quality of life. While pelvic floor muscle training (PFMT) is a well-established treatment for OAB, its effectiveness for FSD remains uncertain. Recent studies suggest that intravaginal electrical stimulation (IVES) may enhance the effects of PFMT. Therefore, this study aimed to evaluate the efficacy of combining IVES with PFMT to improve sexual function and bladder control in women with OAB and FSD. (2) Methods: A total of 40 women with FSD and OAB as determined by the Female Sexual Function Index (FSFI) and Overactive Bladder Symptom Score (OABSS) were randomized into two groups: group 1, the intravaginal electrical stimulation group (IVESG) (n = 20), and group 2, the placebo control group (CG) (n = 20). Patients in both groups received PFMT during the trial, and the IVESG underwent 10 weeks of electrical stimulation. The primary outcome was the change in the FSFI score from baseline to week 4 and week 10. The secondary outcome was a comparison of the OABSS values at week 4 and week 10 of the trial. (3) Results: After treatment, the IVESG scores for the total FSFI, sexual arousal and orgasm, increased significantly (p < 0.05). After 10 weeks of treatment, the OABSS values for IVESG were significantly lower (p < 0.01). After 10 weeks of treatment, the percentage of patients with mild OAB in the IVESG and CG increased by 53.33% and 60%, respectively, while the percentage of patients with both moderate and severe OAB decreased, especially in the IVESG, where patients with severe OAB were non-existent after 10 weeks of treatment. (4) Conclusions: IVES combined with PFMT improved objective and subjective measures of FSD and OAB. There was a significant improvement in FSD (including arousal and orgasmic domain scores). This study concludes that IVES is an effective conservative treatment. [ABSTRACT FROM AUTHOR]

Aim: With the rise of structured, remote follow‐up of colorectal cancers, there is the potential risk of underdiagnosing and undermanaging low anterior resection syndrome (LARS). This cohort study aims to determine the rate of LARS and its patterns of care, with the aim of generating a risk‐stratified management algorithm that can be employed for nurse‐led follow‐up. Method: Patients who underwent elective anterior resection for the management of colorectal cancer between 1 January 2017 and 31 December 2021 were sent quality‐of‐life questionnaires (EORTC‐QLQ‐CR29 and LARS score) and surveyed for LARS symptoms and management utilized. Results: Out of 70 patients who completed questionnaires, 71.4% had LARS and 42.9% had major LARS. The international Delphi consensus definition identified more patients (n = 50) with LARS than the LARS score (n = 41). Tumours located <8 cm from the anal verge, ULAR, and temporary stoma were predictive of major LARS on univariate analysis. However, only temporary stoma was predictive for LARS (OR 7.89 (1.15–53.95), P = 0.035) and majors LARS (8.14 (1.79–37.01), P = 0.007) on multivariate analysis. Forty‐four percent of patients with LARS did not have input from any health professional for this condition. Consultation with specialist allied health and/or colorectal surgeons ranged from 4% to 22%. Conclusions: Our study highlights that with the current remote follow‐up system focused on cancer outcomes a significant proportion of patients with LARS are overlooked, resulting in the underutilization of relevant health professionals and management options. We propose a nurse‐led management algorithm to address this issue while still minimizing surgical outpatient load. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Despite the high prevalence of fecal incontinence, existing treatment options may be inadequate. Drugs that enhance the tone of the anal sphincter complex could potentially be an effective pharmacological approach. This study investigated the effect of the tricyclic antidepressant imipramine on anal sphincter tone in healthy women, employing anal acoustic reflectometry as the evaluating method. Methods: In a double-blind, randomized, placebo-controlled crossover study, 16 healthy female volunteers were randomized to one of two treatment sequences. The participants attended two study visits separated by at least 7 days' washout. At each visit, they received a single dose of 50 mg imipramine or matching placebo, in alternating order. We assessed the anal opening pressure under the resting state and during voluntary squeezing of the pelvic floor. Measurements were performed pre-dose and 1 h after drug administration, corresponding to the estimated time of peak plasma concentration of imipramine. Results: All participants completed the study. In total, 44% of the participants reported at least one adverse effect, primarily anticholinergic. Compared with placebo, imipramine increased anal opening pressure by 15.2 cmH2O (95% confidence interval [CI] 2.0–28.2 cmH2O, p = 0.03) in the resting state and 15.1 (95% CI 4.2–26.0 cmH2O, p = 0.01) cmH2O during squeezing. Conclusions: The findings indicate that imipramine increases anal sphincter tone in healthy women. However, further research is required to evaluate its clinical impact on individuals with fecal incontinence. This research also demonstrates the effectiveness of using anal acoustic reflectometry for assessing pharmacological effects on anal sphincter function. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to compare the rate of levator ani muscle avulsion following vaginal birth after routine and restrictive episiotomy. Methods: This study consists of two cohorts of pregnant women prospectively enrolled between September 2015 and December 2017 at a university hospital. The pregnant women were subject to a randomized controlled trial, in which participants received a restrictive episiotomy protocol versus a routine episiotomy protocol for vaginal delivery. Levator ani avulsion was evaluated by four-dimensional ultrasound screening. Results: Sixty-one post-partum primipara women were enrolled in our study. Thirty-two women (52.5%) had undergone routine episiotomy whereas 29 women (47.5%) had gone through restrictive episiotomy. Right mediolateral episiotomies were performed in all cases. The rate of anal sphincter tear was 12.5% in the routine episiotomy group versus 13.8% in the restrictive episiotomy group (p = 1.00). Levator ani avulsion was detected in 9.4% of the routine episiotomy group (only on the right side) and in 10.3% of the restrictive episiotomy group (p = 1.00). No bilateral levator avulsion was detected in either of the groups. There were no statistical differences in the distances of the bladder neck descent, cystocele descent, uterine descent, rectocele descent, and the ballooning of the genital hiatus area between the groups. Conclusions: In our pilot study, there was no reduction of the rate of levator ani avulsion in women with restrictive episiotomy compared with routine episiotomy. There were no differences in pelvic floor ultrasound parameters between the two groups. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to evaluate the safety and effectiveness of an intrapartum electromechanical pelvic floor dilator designed to reduce the risk of levator ani muscle (LAM) avulsion during vaginal delivery. Methods: A multicenter, randomized controlled trial enrolled nulliparous participants planning vaginal delivery. During the first stage of labor, participants were randomized to receive the intravaginal device or standard-of-care labor management. The primary effectiveness endpoint was the presence of full LAM avulsion on transperineal pelvic-floor ultrasound at 3 months. Three urogynecologists performed blinded interpretation of ultrasound images. The primary safety endpoint was adverse events (AEs) through 3 months. Results: A total of 214 women were randomized to Device (n = 113) or Control (n = 101) arms. Of 113 Device assignees, 82 had a device placed, of whom 68 delivered vaginally. Of 101 Control participants, 85 delivered vaginally. At 3 months, 110 participants, 46 Device subjects who received full device treatment, and 64 Controls underwent ultrasound for the per-protocol analysis. No full LAM avulsions (0.0%) occurred in the Device group versus 7 out of 64 (10.9%) in the Control group (p = 0.040; two-tailed Fisher's test). A single maternal serious AE (laceration) was device related; no neonate serious AEs were device related. Conclusions: The pelvic floor dilator device significantly reduced the incidence of complete LAM avulsion in nulliparous individuals undergoing first vaginal childbirth. The dilator demonstrated an acceptable safety profile and was well received by recipients. Use of the intrapartum electromechanical pelvic floor dilator in laboring nulliparous individuals may reduce the rate of LAM avulsion, an injury associated with serious sequelae including pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Pelvic floor muscle training (PFMT) is effective at improving urinary incontinence (UI) symptoms; however, patients often cannot properly contract their pelvic floor muscles. We hypothesized that contraction of the gluteal muscles alone would have the same effect as PFMT on improving UI symptoms. The aim of this study was to compare the effectiveness of gluteal muscles contraction alone with that of conventional PFMT at home for reducing UI symptoms in women. Methods: Sixty women 30–59 years in age who had stress urinary incontinence (SUI) were randomly assigned to the gluteal muscles training (GMT) group or the PFMT group. The participants in each group performed 3 min of training twice/day using a leaflet unsupervised at home during the 12-week intervention period. Three self-administered UI symptom measures (UI episodes/week, 1-h pad test, and the International Consultation of Incontinence Questionnaire-Short Form score) were compared before the observation period (baseline) and at the 6th or 12th week of the intervention period. Results: Fifty women who completed the 12-week intervention period were analyzed. After the 12-week intervention period, the three UI symptom outcome measures significantly decreased compared with baseline in both groups (α < 0.05). The rate of improvement in UI symptoms (decrease of at least 50% in UI episodes/week and in the 1-h pad test compared with baseline) was 65.2% in the GMT group and 63.0% in the PFMT group, with no significant differences between the two groups (p = 0.898). Conclusions: In unsupervised training using a leaflet at home, contraction of the gluteal muscles alone was shown to be as effective as conventional PFMT in reducing UI symptoms in women with SUI. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to evaluate the clinically beneficial effect of adding transvaginal monopolar non-ablative radiofrequency (RF) to pelvic floor muscle training (PFMT) on leakage severity, quality of life and urinary incontinence-related symptoms in women with stress urinary incontinence (SUI). Methods: A double-blind randomised controlled trial was conducted, with a 6-week intervention and a 6-month follow-up. Participants were randomly assigned to the experimental group (PFMT plus RF; n = 18) or the control group (PFMT plus placebo; n = 20). The primary outcome was the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Secondary outcomes included the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), self-efficacy, female sexual function, pelvic floor muscle dynamometry, 1-h pad test and number of SUI episodes per week. Inferential analyses of the data were performed using a two-factor analysis of variance. Results: Both groups achieved a statistically significant improvement in ICIQ-SF over time. However, the differences observed in the experimental group exceeded the minimal clinically important differences by 4 points (MD = −9.4, 95% CI = −12.6 to −6.3), which was not observed in the control group (MD = −3.9, 95% CI = −6.9 to −1.0). This was maintained at the 6-month follow-up with a significant time*group interaction (p < 0.001, ηp2 = 0.150). There was no time*group interaction in the other variables (p > 0.05). Additionally, a significant difference in favour of the experimental group was observed in the 1-h pad test and episodes of SUI per week (p < 0.05). Conclusions: This study highlights the beneficial effects of adding transvaginal RF to PFMT on the severity and amount of leakage, as well as on the quality of life and urinary incontinence-related symptoms in women with moderate SUI. Future trials are needed to assess the effects of this intervention in women with severe SUI. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The aim was to assess the association between the degree of physical activity (PA) and the presence of pelvic floor disorders (PFDs) in a cohort of parous Ugandan women. Methods: In this cross-sectional study, PFDs were measured using symptom assessment, standardized questionnaires (Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire), and a standardized physical examination (POP-Q and cough stress test [CST]). Degree of PA was assessed using the International Physical Activity Questionnaire. Interquartile ranges were used to describe the age, parity, and body mass index (BMI) of participants. To examine the association between PA and PFDs, a log transformation was applied to the weekly minutes of PA variable and a logistic regression model was constructed with weekly minutes of moderate/vigorous PA, age, BMI, and parity as the predictors. Results: A total of 159 women were enrolled. Median age was 35 (IQR 32–37), median parity 4 (IQR 3–5), and median BMI 29.0 (IQR 24–33). The prevalence of PFD as determined by symptom assessment was 28% (n=44). The most frequent stage of prolapse identified by POP-Q was stage II (57%, n=91). Thirty-six percent of the women (n=58) reported vigorous PA. Ninety-nine percent of the cohort (n=158) reported moderate PA. When controlling for age, parity, and BMI there was a significant positive association between PFD (defined as a combination of stage II prolapse, positive CST, and urinary incontinence (UI)) and moderate PA (OR 2.20, 95% CI 1.08–5.14, p value 0.045). Conclusions: Pelvic floor disorders are common among parous Ugandan women and are associated with moderate PA when controlling for age, BMI, and parity. Understanding the risk factors associated with PFD in this population may better equip providers to screen and care for individuals. [ABSTRACT FROM AUTHOR]

Background/Objectives: Laparoscopic sacrocolpopexy is regarded as the gold standard treatment for apical or multicompartment prolapse, predominantly with anterior compartment descent. However, the optimal surgical approach for concurrent rectocele is still debated. The aim of this study was to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥stage II), analyzing the anatomical outcomes, the necessity for concomitant or subsequent posterior repair, and the impact on bowel function in women undergoing surgery. Methods: Data from all women who underwent laparoscopic sacrocolpopexy with or without posterior repair between 01/2017 and 07/2022 for symptomatic multicompartment prolapse, including apical and posterior compartment descent ≥ stage II, were retrospectively evaluated. All women underwent a standardized urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system, and completed the German-validated Australian Pelvic Floor Questionnaire before and after surgery (6–12 weeks). Preoperative anatomic support and bowel symptoms were compared with postoperative values. Results: In total, 112 women met the criteria for surgical correction. The majority (87%) had stage II posterior descent, with only 10% undergoing concurrent posterior repair during laparoscopic sacrocolpopexy. Significant (p < 0.001) objective improvement was seen for all compartments post- compared with preoperatively (Ba: 0 (−1/2) vs. −3 (−3/−2), C: −1 (−2/0) vs. −8 (−12/−7), Bp: 0 (−1/0) vs. −3 (−2/−2); (median (25%/75% quartiles)). Subsequent surgery for persistent rectocele and/or stool outlet symptoms was required in 4% of cases. Most bowel-specific questions in the German-validated Australian Pelvic Floor Questionnaire showed significant improvement (p < 0.001). Conclusions: Nerve-sparing sacrocolpopexy alone appears to be a suitable surgical approach to correct multicompartment prolapse, including a rectocele ≥ stage II, and results in a reduction of objective signs and symptoms of pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Material and Methods: Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Results: Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Conclusion: Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of pre‐ and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot‐assisted laparoscopic radical prostatectomy (RARP). Patients and Methods: We carried out a single‐blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24‐h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score. Results: Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0–908.0] g vs 21.0 [0.0–750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24‐h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores. Conclusion: Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra‐anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP. [ABSTRACT FROM AUTHOR]

Objectives: To detail the history of synthetic mid‐urethral slings (SMUSs) and fascial slings, their efficacy, associated complications, and changes to practice that have occurred after the issuing of the 2011 US Food and Drug Administration (FDA) Safety Communication statement on transvaginal mesh (TVM), and to highlight the need for surgical registries and high‐quality randomised controlled data to guide recommendations for continence procedures, in view of current concerns regarding mesh. Methods: A literature search was conducted in EMBASE, PubMed, and the Cochrane Database of systematic reviews to identify articles published from 2011 onward, following the FDA Safety Communication regarding TVM. Results: Prior to the formal FDA Safety Communication in 2011, TVM was considered a safe option for the treatment of both pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The 2011 FDA safety communications and ensuing widely publicised litigation against TVM manufacturers have shifted both surgeon and patient acceptance of mesh products. Several efforts by medical and government bodies have been made to establish ways to monitor the surgical outcomes and safety of mesh products. The Australasian Pelvic Floor Procedure Registry is one such example. Although SMUSs have a long and established safety profile, perceptions of mesh products for SUI have also been negatively affected. The extent of this, however, has yet to be adequately measured through qualitative and quantitative data. The available data suggest it has been difficult for patients and consumers to distinguish between TVM morbidity for POP vs SUI. Furthermore, there remains a lack of high‐quality randomised or real‐world registry data to definitively exclude the SMUS from the SUI treatment algorithm. Since SMUSs are a viable option for SUI treatment, the concept of a 'post‐mesh world' remains contentious. Conclusion: Controversies surrounding SMUSs have changed the treatment landscape of SUI. Against the background of significant litigious action following the FDA warnings against mesh use, there has been significant reduction in the uptake of synthetic mesh products. Although there are ample data related to surgical outcomes and safety for both autologous fascial and retropubic SMUSs in carefully selected patients, informed consent and surgical training will be of paramount importance as newer synthetic materials reach clinical maturity. [ABSTRACT FROM AUTHOR]

Pelvic Floor Muscle Training (PFMT) is the first primary solution to improve urinary incontinence (UI) symptoms, but many challenges stems from certain PFMT-related practices. Exploring PFMT experience will help to increase treatment satisfaction, enjoyment, and empowerment. Hence, the aim of this study was to investigate the experience of pelvic floor muscle training (PFMT) in Italian people with UI. A qualitative semi-structured interview study was conducted. The interviews' transcriptions were analysed using a constructionist epistemology lens and adopting the "Reflexive Thematic Analysis". Sixteen Italian participants (Women N = 10, Men = 6) with UI who experienced PFMT were interviewed. Four themes were generated: (1) 'Learn to Control the Unconscious Consciously' as participants learned to control continence through active exercises; (2) 'Starting PFMT, Changing Mind' as they realised they can have an active role in managing their condition; (3) 'Into the unknown intimacy', as they bridged the gap in their (mis)understanding of the pelvic floor area, overcoming the discomfort linked to intimacy; (4) The Importance of Not Being Alone in this Process', as the participants emphasised the paramount role of the physiotherapists in the healing process. To conclude, in people with UI, PFMT enhanced pelvic floor knowledge and understanding, fostering awareness, positive mindset, and symptom relief. The physiotherapist's pivotal role as an educator and empathetic guide in exercise programs, along with a preference for active exercises. Overall, our results proved that PFMT has positive consequences in people's beliefs and mindset about and in the management of UI. [ABSTRACT FROM AUTHOR]

To develop an algorithm for the automated localization and measurement of levator hiatus (LH) dimensions (AI-LH) using 3-D pelvic floor ultrasound. The AI-LH included a 3-D plane regression model and a 2-D segmentation model, which first achieved automated localization of the minimal LH dimension plane (C-plane) and measurement of the hiatal area (HA) on maximum Valsalva on the rendered LH images, but not on the C-plane. The dataset included 600 volumetric data. We compared AI-LH with sonographer difference (ASD) as well as the inter-sonographer differences (IESD) in the testing dataset (n = 240). The assessment encompassed the mean absolute error (MAE) for the angle and center point distance of the C-plane, along with the Dice coefficient, MAE, and intra-class correlation coefficient (ICC) for HA, and included the time consumption. The MAE of the C-plane of ASD was 4.81 ± 2.47° with 1.92 ± 1.54 mm. AI-LH achieved a mean Dice coefficient of 0.93 for LH segmentation. The MAE on HA of ASD (1.44 ± 1.12 mm²) was lower than that of IESD (1.63 ± 1.58 mm²). The ICC on HA of ASD (0.964) was higher than that of IESD (0.949). The average time costs of AI-LH and manual measurement were 2.00 ± 0.22 s and 59.60 ± 2.63 s (t = 18.87, p < 0.01), respectively. AI-LH is accurate, reliable, and robust in the localization and measurement of LH dimensions, which can shorten the time cost, simplify the operation process, and have good value in clinical applications. [ABSTRACT FROM AUTHOR]

• PFMT and MPE have similar effects on the frequency of SUI and the level of exposure to symptoms on elderly women. • PFMT and MPE can be used in combination because they provide improvement on elderly women with SUI through different mechanism. • MPE can be seen as alternative treatment for elderly women with SUI who do not want ro receive PFMT for various reasons. The aim of this study was to compare the effects of pelvic floor muscle training (PFMT) and modified pilates exercises (MPE) in elderly women with stress urinary incontinence (SUI). Both randomized groups [Group 1: PFMT (n = 17), Group 2: MPE (n = 17)] performed their exercises twice a week for 12 weeks. Incontinence Severity Index (ISI), Urogenital Distress Inventory-Short Form (UDI-6) and Incontinence Impact Questionnaire-Short Form (IIQ-7) were used to assess SUI frequency and level of exposure from symptoms, electromyography (EMG) device was used to assess PFM activation response and a stabilizer was used to assess transversus abdominis (TrA) muscle strength. The assessments were performed at baseline and at week 12. While in-group assessment there were statistically significant differences in ISI, UDI-6, IIQ-7 in both groups at week 12 (p < 0.05); in the assessment between groups, there were statistically significant difference for EMG-work avarage (U = 60.00, P = 0.02), EMG-work peak (U = 62,50, P = 0.03) and EMG-rest peak (U = 61,50, P = 0.03) in favor of Group 1 and TrA muscle strength (U = 61.00, P = 0.02) in favor of Group 2 from baseline to week 12 (p < 0.05). In summary, MPE can be considered alternative and safe exercise in clinic for elderly women with SUI who do not want to receive PFMT for various reasons. [ABSTRACT FROM AUTHOR]

• Australian Pelvic Floor Questionnaire (APFQ) as a comprehensive female pelvic floor questionnaire. Moreover, the APFQ was recently acknowledged as an attractive tool for patients, clinicians, and researchers. • There has been no study validating APFQ in Indonesia. • The translation and cross-cultural adaptation were conducted by forward translation to Bahasa Indonesia by two medical translators along with consultants of urogynecology, backward translation to English by another medical translator, comparison between the original and the translated version of the questionnaire, and debriefing of the new translation to the physicians and patients. • The Indonesian version of APFQ was administered consecutively to women aged ≥ 18 years old in two study groups. The urogynecology patient group consisted of urogynecology clinic patients with pelvic floor disorders and, the community (control) group consisted of similarly aged women without any pelvic floor disorders within the last 6 months prior to the recruitment. • The questionnaire can significantly discriminate between pelvic floor dysfunction patients and those without dysfunctions. The results of each domain of the questionnaire correlated with clinical examinations and another questionnaire. • The Indonesian version of the Australian Pelvic Floor Questionnaire (APFQ) is a valid and reliable questionnaire for assessing pelvic floor symptoms among women in Indonesia. To adapt and determine the validity and reliability of the Indonesian version of the Australian Pelvic Floor Questionnaire (APFQ). The original APFQ was translated and validated to obtain an Indonesian, physician-administered version on 41 urogynecology patients and 41 age-matched women without pelvic floor dysfunction. Missing answers never exceeded 2%. The questionnaire can significantly discriminate between pelvic floor dysfunction patients and those without dysfunctions. The results of each domain of the questionnaire correlated with clinical examinations and another questionnaire. Cronbach's alpha scores of all domains were 0.859 for bladder function, 0.829 for bowel function, 0.892 for prolapse symptoms, and 0.766 for sexual function. The Indonesian version of the Australian Pelvic Floor Questionnaire (APFQ) is a valid and reliable questionnaire for assessing pelvic floor symptoms among women in Indonesia. [ABSTRACT FROM AUTHOR]

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Context: Athletes are almost 3 times more at risk of experiencing urinary incontinence (UI) than sedentary women, with prevalence rates varying from 10.9% in low-impact sports such as cycling to 80% when engaging in high-impact sports such as trampoline gymnastics. To treat UI, pelvic floor muscle (PFM) training (PFMT) is recommended as a first line of treatment. Objective: The aim of the present study was to perform a meta-analysis of the available literature on the efficacy of PFMT interventions in young, nulliparous female athletes. Data Sources: A literature research was conducted using PubMed, Sport Discus, and Web of Science. Study Selection: The inclusion criteria were studies with PFMT intervention in female athletes or recreationally active women. Interventions could be carried out for treatment or prevention of pelvic floor dysfunctions. Study Design: Systematic review with meta-analysis. Level of Evidence: Level 5. Data Extraction: A descriptive analysis of the articles included in the systematic review was carried out. Meta-analyses could be performed on 6 of the included articles, evaluating the maximal voluntary contraction (MVC) of the PFMs, the amount of urinary leakage (AUL), and the vaginal resting pressure (VRP). Random-effects model and standardized mean differences (SMD) ± 95% CI were reported. Results: The meta-analysis showed that PFMT produced a significant increase in MVC (SMD, 0.60; 95% CI, 0.11 to 1.08; P = 0.02) and a significant reduction of AUL (SMD, -1.13; 95% CI, -1.84 to -0.41; P < 0.01) in female athletes. No effects were shown in VRP (SMD, -0.05; 95% CI, -1.27 to 1.17; P = 0.93). Conclusion: PFMT is shown to be effective in increasing PFM strength and reducing urine leakage in female athletes, being a powerful tool to prevent and treat pelvic floor dysfunction in this population. [ABSTRACT FROM AUTHOR]

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating condition characterized by symptoms such as bladder pain, frequent urination, and nocturia. Pain is typically perceived in the lower abdomen, pelvic floor, or urethra, causing significant discomfort and impacting quality of life. Due to the similarity of its symptoms with those of overactive bladder and acute bacterial cystitis, patients often face misdiagnosis and delayed appropriate treatment. Hunner's (HIC) and non-Hunner's IC (NHIC), each with distinct clinical presentations, urothelial dysfunction, chronic inflammation, and central sensitization and thus multimodal symptomatic treatment approaches, may be the most common pathogeneses of IC/BPS. Treatment of IC/BPS should involve identifying the different clinical phenotypes and underlying pathophysiology causing clinical symptoms and developing strategies tailored to the patient's needs. This review discusses the roles of urine biomarkers, bladder inflammation, and glycosaminoglycans in the pathogenesis of IC/BPS. Various bladder treatment modalities are explored, including glycosaminoglycan replenishment, botulinum toxin A injection, platelet-rich plasma injection, low-energy shock waves, immunosuppression, and low-dose oral prednisolone. Pelvic floor muscle physiotherapy and bladder therapy combined with psychiatric consultation can help alleviate psychological stress and enhance the quality of life of patients with IC/BPS. Elucidating the pathological mechanisms and exploring diverse treatment options would help advance the care of individuals suffering from this challenging bladder condition. [ABSTRACT FROM AUTHOR]

Background and Objectives: Urinary incontinence (UI) is the involuntary loss of urine caused by a weakness in the pelvic floor muscles (PFMs) that affects urethral closure. Myostatin, which prevents the growth of muscles, is a protein expressed by human skeletal muscle cells. Indeed, it has been observed that myostatin concentration rises during skeletal muscle inactivity and that suppressing serum myostatin promotes muscle growth and strength. Furthermore, therapeutic interventions that reduce myostatin signalling may lessen the effects of aging on skeletal muscle mass and function. For this reason, the aim of the study was to assess if flat magnetic stimulation technology affects serum myostatin levels, as myostatin can block cell proliferation at the urethral sphincter level. Materials and Methods: A total of 19 women, 75% presenting stress urinary incontinence (SUI) and 25% urgency urinary incontinence (UUI), were enrolled. A non-invasive electromagnetic therapeutic system designed for deep pelvic floor area stimulation was used for eight sessions. Results: The ELISA (enzyme linked immunosorbent assay) test indicated that the myostatin levels in blood sera had significantly decreased. Patients' ultrasound measurements showed a significant genital hiatus length reduction at rest and in a stress condition. The Pelvic Floor Bother Questionnaire consistently revealed a decrease in mean scores when comparing the pre- and post-treatment data. Conclusions: Effective flat magnetic stimulation reduces myostatin concentration and genital hiatus length, minimizing the severity of urinary incontinence. The results of the study show that without causing any discomfort or unfavourable side effects, the treatment plan significantly improved the PFM tone and strength in patients with UI. [ABSTRACT FROM AUTHOR]

Pelvic floor muscle (PFM) strength is a critical factor for optimal pelvic floor function. Fluctuations in strength values based on different phases of the menstrual cycle (MC) could signify a need for a paradigm shift in evaluating, approaching, and planning training. This research aims to examine and contrast the pelvic floor muscle strength during different phases of the menstrual cycle. A prospective observational study employing digital assessment with the modified Oxford scale and vaginal dynamometry measurements was performed, in order to assess the baseline strength and the contraction strength of the PFMs in eumenorrheic females at three different phases of the MC: the early follicular phase (EFP), the late follicular phase (LFP), and the mid-luteal phase (MLP). During two complete cycles, tympanic temperature and body weight were measured and the urinary luteinizing hormone concentration was tested to determine the time of ovulation. In total, 216 dynamometric measurements of PFM strength were obtained from eighteen nulliparous women (25.72 ± 5.03 years). There were no differences between the baseline strength (p = 0.886) and the contraction strength (p = 0.756) with the dynamometric speculum. In the post hoc analysis, the baseline strength, contraction strength, and strength showed no significant differences between MC phases. As no differences in PFM strength in women were found, the PFMs do not seem to be weaker at any time during the menstrual cycle. It appears that the assessment, establishment, and monitoring of a PFM training program could be initiated at any point in the cycle. [ABSTRACT FROM AUTHOR]