Abstract Background Metabolomics reflects the molecular communications within biological systems. Urine is a noninvasive biofluid, rich in metabolites that serve as potential biomarkers for human health and disease. The impact of storage conditions and DNA stabilizers for urine samples in metabolomic studies remain unclear. Objective To evaluate the impact of common storage conditions and the presence of a DNA stabilizer, AssayAssure® (Thermo Scientific), on the metabolite content of voided human urine. Methods We assessed the urinary metabolite composition under different storage conditions and with the addition of AssayAssure® to determine its effect on metabolomic analysis. Results Urinary metabolite composition remained consistent across different storage conditions. However, the addition of AssayAssure® significantly altered the metabolic profile due to adduct formation. Despite these alterations, the identification of parent metabolites was not compromised, and biological differences were still distinguishable. Conclusion These findings suggest that urine biobanked under the tested storage conditions is suitable for metabolomic analysis. The addition of AssayAssure® does not hinder the detection of parent metabolites, although it may affect the overall metabolic profile.

Abstract Introduction and Hypothesis The incidence of obstetric anal sphincter injury (OASI) is 3.6–6% of women with vaginal deliveries. Complications to OASI are common, and secondary repair is needed in 2.6–3%. Traditionally, secondary repair has been postponed until wound healing, but studies have shown that early secondary repair within 21 days can be safely performed. Methods The aim of this cohort study and literature review was to investigate the long-term outcomes after early secondary repair with focus on anal incontinence, quality of life and impact on sexual function with the use of International Consultation on Incontinence Questionnaire-Bowel (ICIQ-B). Results A total of 17 patients underwent early secondary repair after OASI within the study period and 11 answered and returned the long-term follow-up questionnaire. Seven had no postoperative complications, nine had infection and two developed recto-vaginal fistulas that needed subsequent surgical treatment. Median follow-up period was 5 years (2.3–5.7). At long-term, ten women (91%) reported fecal urgency, nine (82%) flatal and liquid incontinence, six (55%) problems with soiling and six (55%) unpredictable bowel accidents. Five women (45%) planned daily activities to accommodate their anal incontinence and three (27%) stayed at home because of anal incontinence. Seven women (64%) reported restrictions in their sexual relations due to anal incontinence. Conclusions In conclusion, early secondary repair of OASI in women with severe wound dehiscence involving the anal sphincter may be necessary. However, this group have a high risk of anal incontinence, negative impact on quality of life, and risk of sexual dysfunction at long-term follow-up.

Abstract Introduction and Hypothesis This study aims to systematically estimate the global prevalence of overactive bladder (OAB), identify demographic and regional factors contributing to prevalence variations, and assess trends in prevalence over the past two decades. Methods This cross-sectional study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. From inception to April 2024, computerized searches for OAB prevalence-related literature were conducted on PubMed, Embase, Web of Science, and Cochrane. Studies of OAB prevalence in the general population were included. Two independent researchers conducted the screening, data extraction, and quality assessment of the included studies. Results A total of 53 studies, encompassing 610,438 participants, were ultimately included in the analysis. The meta-analysis determined the global prevalence of OAB to be 20% (95% CI 0.18–0.21). Over the past 20 years, there has been an increase in OAB prevalence, rising from 18.1% (95% CI 0.13–0.23) to 23.9% (95% CI 0.19–0.29). Among women, the prevalence of OAB was 21.9% (95% CI 0.20–0.24), indicating higher rates compared to men (OR = 16.1, 95% CI 0.15–0.18). The study also found higher prevalence rates among overweight and obese individuals (OR = 18.6, 95% CI 0.13–0.24) and those aged 60 years and above (OR = 28.3, 95% CI 0.24–0.33). Middle-income countries exhibited higher prevalence rates compared to high-income countries. Conclusions The study highlights higher risks of OAB among obese individuals, women, and the elderly. OAB prevalence has shown an increasing trend over the past 20 years.

This study was aimed at comparing the efficacy of different modes of transvaginal temperature-controlled radiofrequency (TTCRF) in improving female stress urinary incontinence (SUI). A randomized trial with a nested prospective cohort included 89 women with SUI, who were randomized into a unipolar group (n = 35) and a comprehensive group (n = 54). The comprehensive mode group was treated with unipolar and bipolar combination therapy. The 1-h pad test (1-h PWT) was used as the primary metric by which to gauge improvement of SUI. The effective rate was defined as (cure + improvement cases/total cases) × 100%. Daily leakage episodes and urinary incontinence questionnaires were also documented to compliment this metric in assessing treatment efficacy. Patient satisfaction was assessed and adverse reactions were monitored. No significant difference in the effective rate between the unipolar and comprehensive groups was observed at 1, 3, 6, and 12 months after the end of treatment (62.9% vs 66.7%, 68.6% vs 68.5%, 80.0% vs 71.7%, 74.3% vs 62.5% respectively). Objective improvement of SUI symptoms and subjective satisfaction for all SUI patients were achieved after TTCRF treatment. Ten-course treatment of TTCRF achieved significantly greater treatment effects than five-course treatment as measured by 1-h PWT, daily leakage episodes, International Consultation on Incontinent Questionnaire-Short Form, and Pelvic Organ Prolapsed-Urinary Incontinence Sexual Questionnaire-12. No significant side effects occurred in any patients during treatment. We consider TTCRF treatment to be a viable outpatient option for SUI, with unipolar and comprehensive modes both showing similar efficacy for SUI.

CO2 laser (LS) and microablative radiofrequency (RF) are outpatient options for stress urinary incontinence (SUI) treatment. The aim of this study was to evaluate the lasting effects of SUI treatment using intravaginal CO2 LS and microablative RF. This is a long-term follow-up of a prospective double-blind multi-arm randomized controlled trial, involving women with pure or predominant SUI. Participants received three monthly sessions of LS, RF, or were part of a sham control group (SCT) and were followed up, every 6 months, for 48 months to assess continence rates, defined by the composed outcome: no symptoms, negative stress test, and negative 7-day voiding diary. One hundred and thirty-nine women were eligible and randomized into the three groups. One hundred and fourteen participants concluded the treatment protocol. The women’s mean age was 50.4 (± 9.5) years. The results showed that both LS and RF treatments led to a mean duration of urinary continence of 26.7 months and 24.58 months respectively, compared with 8.21 months in the SCT group. No major complications were observed. Although the continence rates declined over the time, more than 50% of women in perimenopause, with mild to moderate SUI, pure or predominant SUI, remained without complaints of SUI for at least 24 months after LS or RF application sessions, with no major complications reported.

Bladder pain syndrome (BPS) is associated with heightened inflammatory responses. We hypothesize that reduced A2A adenosine receptor (A2AR) expression exacerbates inflammation and pain, while A2AR activation mitigates these effects. In this study, we aimed to investigate the therapeutic potential of A2AR modulation in an autoimmune cystitis model. URO-OVA mice, a transgenic model that expresses ovalbumin (OVA) in the bladder urothelium leading to autoimmune-driven cystitis, were randomly divided into four groups (n = 6 per group): (1) control, (2) inflammation-induced (cystitis), (3) inflammation-induced treated with the A2AR agonist regadenoson (a selective A2AR agonist commonly used in cardiac stress tests), and (4) inflammation-induced treated with the A2AR antagonist ZM241385. Bladder inflammation was assessed via histological analysis, western blot, and RT-PCR of inflammatory markers (IL-6, TNF-α, CD11b, GFAP, HMGB1). Bladder pain was measured using bladder distention–evoked visceromotor responses (VMR) and von Frey filament–based pelvic nociception tests. Inflammation-induced mice showed significantly reduced A2AR expression (~50% lower vs. controls, p < 0.001), while other inhibitory factors (e.g., IL-10R, TGF-βR, PD-1) remained largely unchanged. Regadenoson treatment reduced IL-6 and TNF-α expression by ~60% compared to cystitis-induced mice and alleviated pain, whereas ZM241385 worsened inflammation and increased pain responses. A2AR downregulation correlates with increased inflammation in the URO-OVA model of BPS. Activation of A2AR via regadenoson significantly suppresses inflammatory responses and bladder pain, suggesting A2AR is a promising therapeutic target for BPS.

Abstract Introduction and Hypothesis Treatment options for female stress urinary incontinence (SUI) are often offered in a stepped-care approach. However, the shift towards patient-centred care and shared decision making (SDM) has prompted an increased interest in patients’ perceptions of treatment decision making. This scoping review maps the available qualitative research on women’s perceptions of the treatment decision-making process for SUI and identifies knowledge gaps. Methods This scoping review was performed according to the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Three databases were searched using a systematic search strategy, without restriction in publication date or language. After thorough screening, 19 of the initial 3,473 publications were included. Results Four themes were identified; pre-existing experiences and notions that women bring to the consultations (things women consider before their consultation); treatment and patient characteristics (treatment aspects and personal values patients deem important); aspects of the consulting health care professional and facilities (availability of treatment options and counselling styles of physicians); ways of reaching a decision (three different ways that women used to make their decision. There were gaps in the literature on aspects affecting women’s treatment preferences, their preferred decision-making style and how they want to be involved in this decision-making process. Conclusions This scoping review provides a global overview of women’s perceptions on and preferences for treatment for SUI, and highlights a lack of knowledge on women’s ideas of the treatment decision process. To provide clinicians with better guidance for their counselling and decision-making approaches, studies on women’s perceptions of the decision-making process and the different decision-making styles are needed.

Pelvic dysfunction, including urinary incontinence, significantly impacts the quality of life of affected women, diminishing their freedom and dignity. In many African countries, challenges such as limited funding, competing health priorities and cultural stigma on pelvic health further restrict access to care. This information gap may hinder the effective design and implementation of interventions aimed at improving urogynaecological healthcare delivery. The objective of this study was to estimate the urogynaecological workload, the availability of tools to investigate and treat urinary incontinence in women, and to understand the challenges faced by providers of urogynaecological healthcare in 10 African countries. A cross-sectional online survey of urogynaecological service providers. Forty-seven responses were analysed, revealing that 40% of gynaecological consultations addressed urogynaecological concerns, with 60% related to prolapse, 40% to bladder issues, 7.5% to bowel problems and 5% to sexual dysfunction. Among bladder issues, 35% involved obstetric fistulas, 22.5% stress urinary incontinence, 12.5% mixed urinary incontinence and 10% overactive bladder. Identified resource gaps included insufficient numbers and training of providers, limited access to diagnostic tools such as urodynamics equipment, and inadequate availability of neuromodulation and advanced surgical options. Key challenges in healthcare delivery were lack of patient awareness and inadequate funding, especially in public-sector facilities. Gaps exist in the access and delivery of urogynaecological healthcare to patients with pelvic floor dysfunction in sub-Saharan Africa. Specific areas of focus should include patient education and capacity building, including human resources, access to affordable screening and diagnostic tools and technologies, and investment in affordable management options.

The participation of women in sports such as powerlifting and weightlifting has grown over the years, and there is no consensus on the role of exercises in pelvic floor disorders (PFDs). We aimed to identify and summarize the current evidence on the impact of powerlifting and weightlifting on PFDs. A systematic literature search was conducted on databases with no language restriction, from inception to 20 January 2024. We included observational studies or randomized controlled trials investigating female athletes in powerlifting or weightlifting providing information regarding the impact of these sports on pelvic floor structures. Studies on CrossFit trainers, nonfemale athletes, age <18, and congress abstracts were excluded. Two researchers independently performed the data extraction and quality assessment. The risk of bias was assessed using the Risk Of Bias In Non-randomized Studies—of Interventions. The main outcomes were the prevalence of PFDs in women practicing powerlifting or weightlifting, the factors associated with PFDs, and exercise related to urinary loss. Of the 221 articles found, 5 studies with 1,809 participants were included in the qualitative synthesis. The prevalence of urinary incontinence (UI) in powerlifters ranged from 41.0% to 48.8% and in weightlifters from 36.6% to 54.1%. The main associated factors were age, parity, and body mass index. Deadlift was the exercise most commonly associated with UI (42.5%), followed by squats (36.3%). High loads and repetitions, along with competitions, were associated with UI. This systematic review reveals a clear connection between PFD, particularly UI, and the engagement of women in powerlifting and weightlifting.

Abstract Introduction and Hypothesis High uterosacral ligament suspension (HUSLS) can be used to treat apical pelvic organ prolapse (POP). This can be performed both vaginally and laparoscopically. Data comparing the two suspension procedures remain limited. The aim of this study is to compare the effectiveness and safety of vaginal HUSLS and laparoscopic HUSLS at the time of hysterectomy. Methods This is a retrospective cohort study of women who underwent hysterectomy between 2019 and 2021 at a tertiary urogynaecology unit. Either vaginal or laparoscopic hysterectomy was performed, followed by vaginal or laparoscopic HUSLS respectively. Women were followed up at 6 weeks, and at 6 and 12 months postoperatively. The primary outcome was symptomatic recurrence of vaginal bulge symptoms. Secondary outcomes were anatomical recurrence, re-treatment and safety. Results A total of 111 women met the inclusion criteria. Twelve were excluded, leaving 99 for analysis. HUSLS was performed vaginally in 47 and laparoscopically in 52 women. There was no significant difference in demographics between the groups. At 12 months, 92% in the vaginal group and 48% of the laparoscopic group reported no symptoms of prolapse, 67% vs 36% had no anatomical recurrence and 0% vs 34% had re-treatment respectively. Logistic regression (adjusting for age, BMI, menopausal status, preoperative stage apical prolapse, procedure type) demonstrated that the laparoscopic route was the only variable associated with recurrent prolapse at or beyond the hymen and symptomatic prolapse at 12 months. Conclusions Symptomatic and anatomical recurrent POP was associated with this technique of laparoscopic HUSLS. Further research should consider prospective evaluation of these or modified techniques.

Studies concerning the similarities and differences in relevant factors for PPUI in puerpera with delivery modes are scarce. This study aimed to investigate relevant factors for PPUI among primiparas grouped by different delivery modes using transperineal ultrasonography. This is a retrospective cohort study. Seven hundred thirty-eight primiparas were included and their clinical and ultrasonographic data were collected. First, they were divided into the UI group (n = 233) and non-UI group (n = 505). Then all participants were redivided into the vaginal delivery without episiotomy group (n = 271), the vaginal delivery with episiotomy group (n = 158), and the cesarean section group (n = 309). Independent relevant factors of PPUI were analyzed with the delivery mode as one of the variables and as a grouping factor, respectively. BMI, delivery modes, vertical distances between the location of bladder neck and the reference line of the inferior symphyseal margin at rest (BSDr), and [bladder neck descent (BND)]/BSDr were independently associated with PPUI in the overall study population. Among the participants grouped by delivery modes, the maternal BMI, BSDr, and retrovesical angle during Valsalva maneuver (RVAv) were independently associated with PPUI in the vaginal delivery without episiotomy group. BND/BSDr was the independent relevant factor of PPUI in the cesarean section group. In the vaginal delivery with episiotomy group, no factors were independently associated with PPUI. The independent relevant factors for PPUI in primiparas varied with delivery modes. Sonographic measurements were independently associated with PPUI related to different delivery modes, acting as differential markers to identify PPUI.

Stress urinary incontinence (SUI) is a common condition among women of childbearing age, often requiring surgical intervention. The midurethral sling (MUS), including first-generation tension-free vaginal tapes (TVT) and second-generation transobturator tapes (TOT, TVT-O), has long been the standard treatment. However, both approaches have associated risks, prompting the development of single-incision slings (SIS) as a third option. SIS have proven their efficacy in SUI treatment, but the impact of these slings on female sexual function specifically remains underexplored. A literature search was conducted using PubMed using the keywords “stress urinary incontinence,” “midurethral slings,” “single-incision slings,” “female sexual function,” and “dyspareunia.” The reviewed studies demonstrated that SIS generally maintain or improve sexual function postoperatively, but with varying impact on specific aspects of sexual function. While coital urinary incontinence often improved or resolved, new or worsened dyspareunia was reported in a significant number of patients. SIS placement for SUI generally preserves or enhances sexual function, though individual aspects, such as dyspareunia, may worsen for some patients. Given that an important goal of SUI treatment is to improve quality of life, it is crucial to identify preoperative factors that will identify patients at risk of developing dyspareunia after surgery or are more likely to experience an improvement in sexual function. Further research is needed to better understand these predictors and optimize surgical outcomes for women undergoing SUI treatment with SIS.

Midstream urine (MSU) samples are commonly collected at the time of patient evaluation despite known high rates of contamination. The primary objective of this study was to evaluate the rate of mixed flora results in urine specimens obtained by MSU compared to straight catheterization urine (SCU). This was a quality improvement project evaluating urine culture results of women who provided either an MSU or SCU sample for analysis. Adult women seen within urogynecology clinics at a tertiary care center between April and August 2023 who had urine cultures performed for any indication were included. Mixed flora was defined as the presence of ≥ 2 non-uropathogens or 1 uropathogen in low quantity (at least 10 times fewer) compared to the concentration of nonsignificant organisms. Three hundred forty women provided a urine specimen during the study period. SCU collection was performed for 171 (50.3%) women while 169 (49.7%) provided an MSU sample. Overall, 18.8% of urine cultures were reported as mixed flora (33.1% in MSU and 4.7% in SCU, p < 0.001). Mixed flora was more common with MSU specimens (87.5%, p < 0.001) and associated with a higher BMI compared to positive or negative cultures (mixed flora 29.8 kg/m2 ± 16.3, positive or negative cultures 27.8 kg/m2 ± 7.0, p = 0.04). MSU samples had increased odds of urine contamination compared to SCU collection (7.40 aOR, 95% CI 3.01–18.24). The prevalence of mixed flora was reduced significantly when SCU samples were obtained. Clinicians should consider performing SCU collection when a urine specimen is required for patient evaluation.

Chronic pelvic pain (CPP) affects approximately 26% of the world’s female population and has various proposed etiologies. This manuscript aims to review concepts related to pelvic organ prolapse (POP) and CPP, encompassing its etiology, risk factors, clinical findings, and pain management. A narrative review was performed using MeSH terms and text words on PubMed, and the Cochrane Database of Systematic Reviews through May 2024. A total of 33 references were used to address the questions posed in this review. Specific risk factors for CPP associated with POP include pain antedating POP onset, POP surgery duration, and extent of soft tissue trauma. Studies indicate that uterosacral ligament repair performed during surgical interventions for POP correction has alleviated CPP symptoms whether performed vaginally or laparoscopically. Women with preexisting CPP or central sensitization syndrome (CSS) undergoing pelvic reconstructive surgery for POP may experience less favorable postoperative outcomes compared to those without preexisting pain conditions. These outcomes include lower patient satisfaction, less resolution of discomfort, and poorer improvement in urinary symptoms. On the basis of current evidence, surgeries for POP correction, especially those involving the uterosacral ligament, have shown a positive impact on reducing pelvic pain. However, untreated CPP is associated with lower satisfaction and less improvement in outcomes after POP surgery regarding pelvic symptoms and quality of life. Screening for and treating CPP conditions prior to POP surgery should be prioritized. Pain management of CPP should be addressed preoperatively, perioperatively, and postoperatively.

Systemic autoimmune rheumatic diseases (SARDs) cause musculoskeletal disorders and are associated with various issues that affect the quality of life. Since the musculoskeletal system is affected, the pelvic floor muscles can also be impacted, leading to possible pelvic floor dysfunctions (PFDs). Thus, the purpose of this study was to investigate the presence of PFDs, such as urinary incontinence (UI), anal incontinence (AI), genital-pelvic pain/penetration disorder (GPPPD), and pelvic organ prolapse (POP) symptoms in women with SARDs compared to a control group composed of women without SARDs; and investigate the association between SARDs and PFDs. An online cross-sectional survey was carried out. Using a web-based questionnaire, data on demographic and anthropometric features, PFD (UI, nocturia, AI, GPPPD, and POP), and obstetric history were gathered. For quantitative variables, the Mann–Whitney U test was used, and for categorical variables, the chi-squared test was used for comparison between groups. The association between SARDs and PFD was investigated using logistic regression analysis. The questionnaire was completed by 326 women (224 with SARDs and 102 healthy controls). Women with SARDs reported significantly more symptoms of PFD, UI, nocturia, AI (flatus and fecal incontinence), POP, and GPPPD than healthy controls. SARDs were associated with PFD, flatus incontinence, fecal incontinence, dyspareunia, and vaginismus. PFD was much more common in women with SARDs than in healthy women. Women with SARDs were 1.8 to 5.2 times more likely than the control group to report PFD symptoms than women without SARDs.

This study was aimed at assessing the prevalence and factors contributing to pelvic floor disorder (PFD) symptoms. A community-based cross-sectional study was employed among 737 women in the central Gondar Zone of Northwest Ethiopia from September to December 2022. Participants were selected using a multi-stage cluster sampling. The Amharic version of the Pelvic Floor Disorder Inventory 20 (PFDI-20) tool was employed to evaluate the occurrence of PFDs. Bi-variable and multivariable logistic regression models were fitted to identify associated factors of PFDs. The prevalence of at least one form of PFD was 26.9% (95% CI 23.3 to 30.0%). Pelvic organ prolapse symptoms, urinary incontinence, and fecal incontinence were reported at rates of 19.9%, 19.7%, and 12.8% respectively. Factors associated with PFDs included increasing age (AOR = 3.61, 95% CI 1.01 to 6.91), residing in a rural area (AOR = 2.12, 95% CI 1.63 to 3.66), a history of difficult labor (AOR = 1.83, 95% CI 1.26 to 2.66), multiple vaginal deliveries (AOR = 2.41, 95% CI 2.18 to 3.92), home delivery (AOR = 1.29, 95% CI 1.86 to 2.93), and being postmenopausal (AOR = 1.62, 95% CI 1.55 to 2.89). Currently, more than 25% of women are experiencing distressing symptoms associated with PFDs. Contributing factors include older age, rural residence, having multiple vaginal deliveries, and postmenopausal status. Therefore, it is essential to focus on the early identification of PFD symptoms, raise awareness within the community and among women regarding the connections between advanced age, menopause, and multiparity, and advocate for family planning initiatives.