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Introduction: Surgeries for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are commonly performed in older adults, many of whom are also frail. A surgical risk calculator for older adults undergoing POP/SUI surgeries that incorporates frailty, a factor known to increase the risk of surgical complications, would be helpful for preoperative counseling but currently does not exist., Materials and Methods: Medicare Carrier, Outpatient, and MedPAR files were examined for beneficiaries undergoing POP and SUI surgery between 2014 and 2016. A total of 15 POP/SUI categories were examined. The Claims-Based Frailty Index (CFI), a validated measure of frailty in Medicare data, and Charlson Comorbidity Index were deconstructed into their individual variables, and individual variables were entered into stepwise logistic regression models to determine which variables were most highly predictive of 30-day complications and 1-year mortality. To verify the prognostic accuracy for each model for surgical complications of interest, calibration curves and tests of model fit, including C-statistic, Brier scores, and Spiegelhalter p values, were determined., Results: In total, 108 479 beneficiaries were included. Among these, 4.7% had CFI scores consistent with mild to severe frailty (CFI≥0.25). A total of 13 prognostic variable categories were found to be most highly predictive of postoperative complications. Calibration curves for each outcome of interest showed models were well-fit. Most models demonstrated high c-statistic values (≥0.7) and high Spiegelhalter p values (≥0.9), indicating good model calibration and excellent discrimination, and low Brier scores (<0.02), indicating high model accuracy., Conclusions: Urologic surgery for older Adults Risk Calculator serves as a novel surgical risk calculator that is readily accessible to both patients and clinicians that specifically factors in components of frailty. Furthermore, this calculator accounts for the heterogeneity of an aging population and can assist in individualized surgical decision-making for these common procedures., (© 2024 Wiley Periodicals LLC.)

Introduction and Hypothesis: Currently, little is known about how daily self-management of cube pessaries influences sexual function. We hypothesized that removing the cube pessary prior to sexual activity did not negatively influence the sexual function, and pessary self-care did not lead to a deterioration of sexual wellbeing., Methods: We conducted a planned secondary analysis of a prospective cohort study in which 214 patients with symptomatic pelvic organ prolapse (stage 2+) were enrolled (2015). Each patient was size fitted with a cube pessary and completed a questionnaire online or by phone ≥ 5 years after her initial fitting. Changes in quality of life were measured using the Patient Global Impression of Improvement (PGI-I)., Results: Of the 143 women included in our analyses, 92 (64.3%) were sexually active during the study period. These patients (73.9%; 68 out of 92) described their sexual wellbeing as "better" or "much better" than their pretreatment status. Sexually active patients had a better quality of life as measured by the PGI-I than the sexually inactive patients. Of the sexually active patients, 91.3% (84 out of 92) described their condition as "better" or "much better" than their pretreatment status, whereas 84.3% (43 out of 51) of the sexually inactive patients reported the same improvement. Over 90% of sexually active patients reported that removal of the vaginal cube pessary before sexual activity is not disruptive., Conclusions: The overwhelming majority of the patients with symptomatic pelvic organ prolapse using daily self-management of cube pessaries reported that removal of the vaginal cube pessary before sexual activity is not disruptive, and its use was accompanied by improved sexual wellbeing., Competing Interests: Declarations. Ethical Approval: This prospective cohort study was approved by the University of Pecs, Hungary, Institutional Ethical Review Board (IV/7737–3/2021/EKU). Conflicts of Interest: The corresponding author has multiple affiliations and has received financial support (salary) from the HUN-REN Hungarian Research Network of the Hungarian Academy of Sciences (MTA; Budapest, Hungary). The remaining authors have no conflicts of interest to report regarding the present study., (© 2024. The Author(s).)

Pelvic floor disorder (PFD) is a common gynecological disorder, and with the ageing of the population, PFD has a serious impact on the physical and mental health of patients and their quality of life. The most prominent of these are pelvic organ prolapse (POP) and urinary incontinence (UI), about which the etiology is still unclear, and it is urgent to explore their pathogenesis. Advances in genetics and epigenetics have provided new insights into the pathophysiology of PFD. Candidate genes and genome-wide association studies have identified susceptibility genes for POP and UI. These susceptibility genes typically promote POP by affecting pelvic floor connective tissue. The role of susceptibility genes in UI is multifactorial and includes promoting inflammation, damaging pelvic floor connective tissue, and modulating neurogenic effects. The association of epigenetic changes with POP and UI has also been investigated. DNA methylation studies have identified several important pathways associated with POP. miRNAs play an important role in the development of POP and UI, and this may be an important therapeutic direction for the future. The studies conducted so far have shown that genetic and epigenetic techniques are of great importance in exploring the etiology of PFD and that more in-depth studies are needed in the future., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Introduction and Hypothesis: Concurrent pelvic organ and rectal prolapse have an incidence of 38%. Dynamic pelvic magnetic resonance imaging (MRI) is the modality of choice for workup. We discuss dynamic pelvic MRI indications, interpretation, and clinical application to pelvic floor disorders., Methods: The pubococcygeal line (PCL) extends from the pubic symphysis to the last coccygeal joint. The "H line" demonstrates the levator hiatus size, drawn from the inferior pubic symphysis to the posterior rectal wall at the anorectal junction. The "M line" represents vertical descent of the levator hiatus and extends perpendicularly from the PCL to the posterior aspect of the H line. With rectovaginal fascial defects, the small bowel, the peritoneum, and the sigmoid colon can prolapse. Posterior compartment abnormalities include rectocele, rectal prolapse, and descending perineal syndrome. Pelvic MRI can evaluate functional disorders such as anismus, where the anorectal angle is narrowed and associated with lack of pelvic floor descent and incomplete evacuation., Conclusions: Particularly for patients with concurrent urogynecological and colorectal complaints, previous pelvic reconstructive surgery, or when clinical symptomatology does not correlate with physical examination, dynamic pelvic MRI can impact management. It is critical for pelvic reconstructive surgeons to be familiar with this imaging modality to counsel patients and interpret radiographic findings., Competing Interests: Declarations. Informed Consent: Written informed consent was obtained from the patient for publication of this video article and any accompanying images. Conflicts of Interest: The authors report no conflicts of interest. Disclaimer: The opinions expressed in this presentation are those of the authors and do not represent the Department of Health and Human Services or the Department of Defense., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction and Hypothesis: Risk factors for pelvic floor disorders (PFDs) are not well understood in lower resource settings. The objective of this study is to determine the risk factors associated with stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) among women of reproductive age in rural Nepal., Methods: This is a case-control study nested within a community-based cross-sectional survey of parous women of reproductive age with PFDs in the Sarlahi District of Nepal. The presence of PFDs was confirmed by clinical assessment. Detailed sociodemographic information and histories were captured., Results: We examined 406 women; the mean (SD, range) age was 32.7 (8.5, 16-49) years, mean BMI (SD) was 19.7 (3.3) kg/m 2 , and median (range) number of pregnancies was 4 (1-11). Two hundred and three women (50.0%) had either SUI or UUI, 85 (17.8%) had both SUI and UUI, and 71 (17.5%) had POP at or beyond the hymen. After controlling for other variables significant on bivariate analysis, age (adjusted odds ratio [aOR] 1.06 [95% CI 1.03-1.09]), illiteracy (aOR 2.24 [95% CI 1.04-4.80]), and presence of upper gastrointestinal issues (aOR 3.30, [95% CI 1.77-6.16]) were independently associated with SUI/UUI. Age (aOR 1.05 [95% CI 1.02-1.09]), bispinous diameter (aOR 2.88 ([95% CI 1.11-7.47]), and subpubic angle (aOR 2.78 [95% CI 1.55-5.03]) were independently associated with POP., Conclusion: Risk factors for PFDs in a homogenous community of parous women of reproductive age in rural Nepal are similar to those found in parous women in higher income countries., (© 2024. The International Urogynecological Association.)

Aims: Women of advanced age may choose between restorative or obliterative surgery for surgical management of pelvic organ prolapse. Obliterative surgery is traditionally reserved for a subset of older women with more severe medical comorbidities, since obliterative approaches are generally considered to be less morbid and older individuals have higher rates of perioperative complications than younger cohorts. This study compared perioperative complications amongst octogenarians undergoing obliterative versus reconstructive approaches. This data will help to inform perioperative counselling as previous studies have not been powered to evaluate complications in this population., Methods: The National Surgical Quality Improvement Program database was used to identify patients that had Pelvic organ prolapse surgery between 2012 and 2021, aged 80 years or older. Single-compartment procedures, vaginal mesh procedures, and oncologic surgery were excluded. The primary outcome was any complication within the first 30 days excluding urinary tract infection (UTI). UTI, readmission, and severe complications were secondary outcomes., Results: Of the 4149 patients identified, 2514 (60.6%) underwent reconstructive surgery and 1635 (39.4%) underwent obliterative surgery. Patients undergoing reconstructive surgery were more likely to have an American Society of Anesthesiologists (ASA) class of 1 or 2 (46.1% vs. 31.3%, p = 0.002) and were less likely to be on antihypertensive medication (72.0% vs. 75.8%, p = 0.006). Further, there was an increased length of stay (1.47 ± 1.84 vs. 1.03 ± 1.31 days, p < 0.001) in hospital for reconstructive surgery which was more often performed as an inpatient (45.7% vs. 37.9%, p < 0.001). There was no difference in the primary outcome: any complication excluding UTIs. However, UTI was more common in the reconstructive group (aOR 0.48; 95% confidence interval 0.34-0.0). The rate of serious complications (Clavien-Dindo Class IV) was low overall and not different between reconstructive and obliterative approaches (1.3% vs. 1.0%, respectively)., Conclusions: Both vaginal reconstructive and obliterative approaches have low complication rates in octogenarians, with only UTI rate being different between cohorts. When choosing surgical approach, we suggest a case-based, patient center discussion on the anatomic outcomes, durability and patient satisfaction., (© 2024 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Purpose: To define the normal range and threshold values for pathologic prolapse on MRI using the PICS line and assess its correlation with the pubococcygeal line (PCL)., Methods: This prospective, IRB-approved study included 20 nulliparous volunteers and 18 prolapse patients (POP-Q Stage ≥ 2). Organ positions (bladder, cervix, anorectal junction) relative to PICS and PCL were measured on dynamic MRI. Differences in organ position were compared. Receiver-operating characteristic (ROC) analysis was performed to identify cutoff values for prolapse using the PICS line. The correlation between PICS and PCL measurements was tested with Spearman's rank correlation., Results: In volunteers, median bladder and cervix positions measured to the PICS at rest were - 2.7 cm and - 5.3 cm compared to - 1.9 cm and - 2.7 cm in patients (p < 0.001). During straining, bladder and cervix were at - 0.9 cm and - 3.2 cm in volunteers versus + 2.5 cm and + 2.5 cm in patients (p < 0.001). Correlation was strong for PICS and PCL measurements for all three compartments (δ = 0.883-0.970, p ≤ 0.001). AUCs of PICS for the anterior and middle compartment were 0.98 (95% confidence interval [CI] 0.96-1.00, p < 0.001) and 0.96 (95% CI 0.89-1.00, p < 0.001) for differentiating patients from healthy volunteers. AUC for the posterior compartment was 0.76 (95% CI 0.57-0.96, p = 0.034)., Conclusion: PICS measurements reliably differentiate patients from volunteers in the anterior and middle compartment. Future studies need to identify a reliable threshold for the posterior compartment. PICS and PCL measurements are strongly correlated., (© 2024. The Author(s).)

Objective: To determine the association between different pelvic floor disorders and the presence of sexual dysfunction in women., Method: An observational study of non-pregnant women was carried out in Spain in 2021 and 2022. To assess the presence of pelvic floor problems, the Pelvic Floor Distress Inventory (PFDI-20) was used, consisting of the subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6; prolapse symptoms), Colorectal-Anal Distress Inventory (CRADI-8; colorectal symptoms), and Urinary Distress Inventory-6 (UDI-6; urinary symptoms). The validated tool, Female Sexual Function (FSF), was used to evaluate female sexual function., Results: In total, 1008 women participated. Of these, 288 (28.6%) had some type of sexual dysfunction. Regarding symptoms, 52 (5.2%) stated that they do not reach orgasm and 172 (17.1%) said they had never or occasionally felt sexual desire in the last month. Women with sexual dysfunctions had higher mean scores on the POPDI-6, CRADI-8, and UDI-6 subscales than those who did not have sexual dysfunction (P ≤ 0.005). Risk factors identified included being postmenopausal, with an adjusted odds ratio (aOR) of 2.98 (95% confidence interval [CI] 2.12-4.18), and a greater impact of the symptoms of pelvic floor problems as assessed by the PFDI-20 scale, in such a way that for each point increase the probability of sexual dysfunction increases with an aOR of 1.008 (95% CI 1.005-1.011)., Conclusion: Women with pelvic floor disorders and postmenopausal women present sexual dysfunction more frequently., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Introduction and Hypothesis: Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC., Methods: We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages., Results: A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment., Conclusions: This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP., (© 2023. The International Urogynecological Association.)

Objective: To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions., Methods: An observational study was conducted with women in Spain between 2021 and 2022. Information was collected using a self-developed questionnaire on sociodemographic data, employment, history and health status, lifestyle and habits, obstetric history, and health problems. The SF-12 questionnaire was used to assess quality of life. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor problems, and includes the POPDI-6 subscales for prolapse, CRADI- 8 for colorectal symptoms, and UDI-6 for urinary symptoms. Crude (MD) and adjusted mean differences (aMD) were estimated with their respective 95% confidence intervals (CI)., Results: Thousand four hundred and forty six women participated in the study with a mean age of 44.27 (SD = 14.68). A statistical association was observed between all the pelvic floor disorders and QoL, overall and in all its dimensions ( p < 0 .001), in the bivariable analysis. The lowest scores were observed in the emotional component. After adjusting for confounding factors, the pelvic floor disorders in general (aMD -0.21, 95% CI: -0.23 to -0.20), the impact of uterine prolapse symptoms (aMD -0.20, 95% CI: -0.27 to -0.12), the colorectal-anal symptoms (aMD -0.15, 95% CI: -0.22 to -0.09), and urinary symptoms (aMD -0.07, 95% CI: -0.13 to -0.03) was negatively associated on the score on the SF-12 questionnaire ( p < 0 .05)., Conclusions: Women who have a pelvic floor dysfunction, symptoms of pelvic organ prolapse, colorectal-anal symptoms, or urinary symptoms, have a worse perceived quality of life in all dimensions. Prolapse symptoms have the biggest impact, and the emotional component of QoL is the most affected sub-domains., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Peinado Molina, Hernández Martínez, Martínez Vázquez and Martínez Galiano.)

Objective: The aim of the study was to compare 12-month subjective and objective outcomes between 3 approaches to apical pelvic organ prolapse (POP) surgery in patients presenting with uterovaginal or posthysterectomy vaginal prolapse enrolled in the Pelvic Floor Disorders Registry for Research., Study Design: This was an analysis of a multicenter, prospective registry that collected both patient- and physician-reported data for up to 3 years after conservative (pessary) and surgical treatment for POP. Twelve-month subjective and anatomic outcomes for patients who underwent surgical treatment were extracted from the registry for analysis. Pelvic organ prolapse recurrence was defined as a composite outcome and compared between the 3 apical surgery groups (native tissue repair, sacrocolpopexy, colpocleisis) as well as the 2 reconstructive surgery groups (native tissue repair and sacrocolpopexy)., Results: A total of 1,153 women were enrolled in the registry and 777 (67%) opted for surgical treatment, of whom 641 underwent apical repair and were included in this analysis (404 native tissue repair, 187 sacrocolpopexy, and 50 colpocleisis). The overall incidence of recurrence was as follows: subjective 6.5%, anatomic 4.7%, retreatment 7.2%, and composite 13.6%. The incidence of recurrence was not different between the 3 surgical groups. When baseline patient characteristics were controlled for, composite POP recurrence between the native tissue and sacrocolpopexy groups remained statistically nonsignificant. Concurrent perineorrhaphy with any type of apical POP surgery was associated with a lower risk of recurrence (adjusted odds ratio, 0.43; 95% confidence interval, 0.25-0.74; P = 0.002) and prior hysterectomy was associated with a higher risk (adjusted odds ratio, 1.77, 95% confidence interval, 1.04-3.03; P = 0.036)., Conclusion: Pelvic Floor Disorders Registry for Research participants undergoing native tissue apical POP repair, sacrocolpopexy, and colpocleisis surgery had similar rates of POP recurrence 12 months after surgery., Competing Interests: C.F. received royalties from UpToDate and Elsevier. C.B. received research grants from the National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, travel support and textbook royalties from Elsevier, travel support and honorarium for FPMRS Division membership and oral board examiner work from the American Board of Obstetrics and Gynecology, and travel support for board of directors membership from the American Urogynecologic Society. R.G. is a consultant strategic advisory board member of Boston Scientific, UpToDate Royalties Urethral diverticulum section; expert witness slings of Johnson and Johnson. P.M. received NIH R012R01 HD083383-06, Mesh complications: The role of local mechanical stresses on tissue remodeling following mesh implantation; NIH R01 HD097187, Overcoming complications of polypropylene prolapse meshes: Development of novel elastomeric auxetic devices; and NIH UG3UG1HD06900-10S1, Pittsburgh Pelvic Floor Research Program; Pelvic Floor Disorders Network. J.A. received research grants from the Agency for Healthcare Research and Quality, Patient Centered Outcomes Research Institute. The other authors have declared they have no conflicts of interest., (Copyright © 2023 American Urogynecologic Society. All rights reserved.)

Background: Menopause and the decline in systemic estrogen are associated with the development of pelvic floor disorders, such as prolapse, urinary incontinence, overactive bladder, and vulvovaginal atrophy symptoms. Past evidence suggests that postmenopausal women with symptomatic prolapse gain benefit from the preoperative application of intravaginal estrogen, but it is unknown whether they would experience improvement in other pelvic floor symptoms when treated with intravaginal estrogen., Objective: This study aimed to determine the effects of intravaginal estrogen (compared with placebo) on stress and urgency urinary incontinence, urinary frequency, sexual function and dyspareunia, and vaginal atrophy symptoms and signs in postmenopausal women with symptomatic prolapse., Study Design: This was a planned ancillary analysis of a randomized, double-blind trial, "Investigation to Minimize Prolapse Recurrence Of the Vagina using Estrogen," which included participants with ≥stage 2 apical and/or anterior prolapse scheduled for transvaginal native tissue apical repair at 3 US sites. The intervention was 1 g conjugated estrogen intravaginal cream (0.625 mg/g) or identical placebo (1:1), inserted nightly for 2 weeks and then twice weekly for ≥5 weeks total before surgery and continued twice weekly for 1 year postoperatively. For this analysis, question responses were compared from participants' baseline and preoperative visits: lower urinary tract symptoms (Urogenital Distress Inventory-6 Questionnaire); sexual health questions, including dyspareunia (Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-IUGA-Revised); and atrophy-related symptoms (dryness, soreness, dyspareunia, discharge, and itching; each scored 1-4, 4 being quite a bit bothersome). Masked examiners assessed vaginal color, dryness, and petechiae (each scored 1-3, total range 3-9, with 9 being the most estrogenized appearing). Data were analyzed by intent to treat and "per protocol" (ie, those adherent with ≥50% of expected intravaginal cream use, per objective tube before and after weights)., Results: Of 199 participants randomized (mean age of 65 years) and contributing baseline data, 191 had preoperative data. The characteristics were similar between groups. Total Urogenital Distress Inventory-6 Questionnaire scores showed minimal change during this median time of 7 weeks between baseline and preoperative visits, but for those with at least moderately bothersome baseline stress urinary incontinence (32 in the estrogen group and 21 in the placebo group), 16 (50%) in the estrogen group and 9 (43%) in the placebo group showed improvement (P=.78). In addition, 43% of participants in the estrogen group and 31% of participants in the placebo group showed improvement in urgency urinary incontinence (P=.41), and 41% of participants in the estrogen group and 26% of participants in the placebo group showed improvement in urinary frequency (P=.18). There was minimal change in the Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire-IUGA-Revised scores among sexually active women; dyspareunia rates did not differ between intravaginal estrogen and placebo at the preoperative assessment: 42% and 48%, respectively (P=.49). The maximum score for most bothersome atrophy symptom (among those with baseline symptoms and adherent to study cream) improved slightly more with intravaginal estrogen (adjusted mean difference, -0.33 points; 95% confidence interval, -0.98 to 0.31), but this was not statistically significant (P=.19). However, on examination, among adherent participants, objective signs of atrophy were more improved with intravaginal estrogen treatment (+1.54 vs +0.69; mean difference, 0.85; 95% confidence interval, 0.05-1.65; P=.01)., Conclusion: Despite objective changes in the vaginal epithelium consistent with increased estrogenization among drug-adherent participants, the results were inconclusive regarding whether 7 weeks of preoperative intravaginal estrogen cream in postmenopausal women with symptomatic pelvic organ prolapse was associated with improved urinary function, sexual function, dyspareunia symptoms, and other symptoms commonly attributed to atrophy. Additional study is needed., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to describe adherence to behavioral and pelvic floor muscle training in women undergoing vaginal reconstructive surgery for organ prolapse and to examine whether adherence was associated with 24-month outcomes., Methods: Participants were women ≥18 years of age, with vaginal bulge and stress urinary incontinence symptoms, planning to undergo vaginal reconstructive surgery for stages 2 to 4 vaginal or uterine prolapse. They were randomized to either sacrospinous ligament fixation or uterosacral ligament suspension and to perioperative behavioral and pelvic floor muscle training or usual care. Measurements included anatomic failure, pelvic floor muscle strength, participant-reported symptoms, and perceived improvement. Analyses compared women with lower versus higher adherence., Results: Forty-eight percent of women performed pelvic floor muscle exercises (PFMEs) daily at the 4- to 6-week visit. Only 33% performed the prescribed number of muscle contractions. At 8 weeks, 37% performed PFMEs daily, and 28% performed the prescribed number of contractions. No significant relationships were found between adherence and 24-month outcomes., Conclusion: Adherence to a behavioral intervention was low following vaginal reconstructive surgery for pelvic organ prolapse. The degree of adherence to perioperative training did not appear to influence 24-month outcomes in women undergoing vaginal prolapse surgery., Impact: This study contributes to the understanding of participant adherence to PFMEs and the impact that participant adherence has on outcomes at 2, 4 to 6, 8, and 12 weeks and 24 months postoperatively. It is important to educate women to follow up with their therapist or physician to report new or unresolved pelvic symptoms., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To compare multi-slice (MS) MRI sequences of the pelvis acquired at rest and straining to dynamic midsagittal single-slice (SS) sequences for the assessment of pelvic organ prolapse (POP)., Methods: This IRB-approved prospective single-center feasibility study included 23 premenopausal symptomatic patients with POP and 22 asymptomatic nulliparous volunteers. MRI of the pelvis at rest and straining was performed with midsagittal SS and MS sequences. Straining effort, visibility of organs and POP grade were scored on both. Organ points (bladder, cervix, anorectum) were measured. Differences between SS and MS sequences were compared with Wilcoxon test., Results: Straining effort was good in 84.4% on SS and in 64.4% on MS sequences (p = 0.003). Organ points were always visible on MS sequences, whereas the cervix was not fully visible in 31.1-33.3% on SS sequences. At rest, there were no statistically significant differences of organ point measurements between SS and MS sequences in symptomatic patients. At straining, positions of bladder, cervix, and anorectum were + 1.1 cm (± 1.8 cm), - 0.7 cm (± 2.9 cm), and + 0.7 cm (± 1.3 cm) on SS and + 0.4 mm (± 1.7 cm), - 1.4 cm (± 2.6 cm), and + 0.4 cm (± 1.3 cm) on MS sequences (p < 0.05). Only 2 cases of higher-grade POP were missed on MS sequences (both with poor straining effort)., Conclusion: MS sequences increase the visibility of organ points compared to SS sequences. Dynamic MS sequences can depict POP if images are acquired with sufficient straining effort. Further work is needed to optimize the depiction of the maximum straining effort with MS sequences., (© 2023. The Author(s).)

Introduction and Hypothesis: Pregnancy and mode of delivery have a major effect on pelvic floor disorders (PFD). Assessing knowledge regarding PFD is essential not only for making more informed decisions regarding mode of delivery, but also for seeking help when PFD appear. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a validated tool that assesses women's knowledge regarding urinary incontinence (UI) and pelvic organ prolapse (POP). Validation of the Arabic version of the PIKQ had never been carried out. The purpose of this study was to conduct a condition specific validation among parturients of the PIKQ in the Arabic language., Methods: Translation of the PIKQ to the Arabic language was carried out according to international recommended guidelines. A cross-sectional study of pregnant women was conducted from June to September 2020 at the Soroka University Medical Center, Israel. The recommended 10:1 ratio between the number of subjects and the number of items in the questionnaire (n=24) was maintained. A total of 244 third trimester pregnant women have completed the Arabic version of the PIKQ. In addition to the validation of the psychometric characteristics, construct validity, criterion validity, and reliability were tested as well., Results: Initially, exploratory factor analysis (EFA) was conducted, resulting in two 12-item scales representing UI and POP. Then, to validate the scale construct we conducted confirmatory factor analysis (CFA). Results of the CFA demonstrated that the PIKQ displayed construct validity, with standardized factor loadings ranging from 0.30 to 0.62. Finally, Cronbach's alpha indicated a good internal reliability for the two factors UI and POP. Criterion validity further supported the validity of the scale., Conclusions: The Arabic version of the PIKQ is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding UI and POP in Arabic speaking pregnant women. This instrument may be used to assess women's knowledge about PFD and to direct the need for educational interventions that may empower women to make informed decisions regarding perinatal care., (© 2022. The International Urogynecological Association.)

Introduction and Hypothesis: The Australasian Pelvic Floor Procedure Registry (APFPR) collects both clinical and health-related quality of life (HRQoL) data on women undergoing surgery using a prosthesis such as mesh for pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The registry lacks a suitable instrument to assess pain in women following mesh surgery for SUI and POP. This qualitative study describes the views on pain following mesh surgery in women and clinicians through the development of a conceptual framework, which may inform the development of a new instrument for the APFPR., Methods: We conducted semi-structured interviews with women following mesh surgery for POP and SUI (n=17) and clinicians (n=6) in Victoria, Australia. We sought to reveal aspects of any sort of pain after a pelvic floor procedure. Interviews covered sensation, region, continuity of pain, triggers, and the mode and method of administration for a new pain-specific patient-reported outcome measure. Data were analysed using thematic analysis., Results: We identified the important components of pain felt by women with POP and SUI after surgery using mesh. From the seven themes outlined, a conceptual framework was developed compiling related components of pain into six specific domains., Conclusions: This study identifies the important components of pain felt by women following mesh surgery. It is hoped that the development of a pain-specific PROM, as supported by clinicians, will assist in the timely and appropriate diagnosis and management of POP and SUI., (© 2022. The Author(s).)

Background: The Australasian Pelvic Floor Procedure Registry (APFPR) captures clinical and surgical data in women undergoing pelvic floor procedures. The inclusion of patient reported outcome measures (PROMs) in the APFPR is a critical activity providing the additional patient perspective of their condition prior to surgery as well as monitoring beyond the usual post-surgical follow-up time. This study aimed to evaluate the acceptability of seven PROMs for women with pelvic organ prolapse (POP) and to determine the most suitable instrument for the APFPR., Methods: Semi-structured qualitative interviews were conducted with women with POP (n = 15) and their treating clinicians (n = 11) in Victoria, Australia. Interview topics covered appropriateness, content, and acceptability of seven POP-specific instruments identified through the literature to determine their suitability and acceptability for inclusion in the APFPR. We analysed the interview data using conventional content analysis., Results: All study participants agreed that PROMs were needed for the APFPR. Both women and clinicians suggested that some of the instruments were ambiguous, too long and confusing. The Australian Pelvic Floor Questionnaire was accepted widely amongst women and clinicians and recommended for inclusion in the APFPR. All participants agreed it would be appropriate to capture PROMs before surgery, and then followed up post-surgically. Email, phone call or postal mail-out were the preferred options for PROMs data collection., Conclusion: Most women and clinicians supported incorporating PROMs in the APFPR. Study participants believed that capturing PROMs would have potential use in individual care and improve outcomes of women with POP., (© 2023. The Author(s).)

Background: The effect of gestational weight gain (GWG) as a controllable factor during pregnancy pelvic floor function has rarely been investigated, and studies on twin primiparas are even less frequent. The objective of the present study was to explore the effect of GWG on postpartum pelvic floor function in twin primiparas., Methods: We retrospectively analyzed the clinical data of 184 twin primiparas in the pelvic floor rehabilitation system of the First Affiliated Hospital of Chongqing Medical University from January 2020 to October 2021. Based on the GWG criteria recommended by the Institute of Medicine, the study subjects were classified into two groups: adequate GWG and excessive GWG. Univariate and multivariate logistic regression models were applied to explore the relationship between GWG and pelvic floor function., Results: Among the 184 twin primiparas, 20 (10.87%) had excessive GWG. The rates of abnormal vaginal dynamic pressure (95% vs. 74.39%), injured type I muscle fibers (80% vs. 45.73%), anterior vaginal wall prolapse (90% vs. 68.90%), and stress urinary incontinence (50% vs. 20.12%) of twin primiparas with excessive GWG were significantly higher than those with adequate GWG. There was no significant difference between the total score of the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) or the scores of the Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), the Colorectal-Anal Distress Inventory 8 (CRADI-8), and the Urinary Distress Inventory 6 (UDI-6) in the two groups (P > 0.05). After adjusting for potential confounding factors, the results showed that excessive GWG was positively associated with abnormal vaginal dynamic pressure (OR = 8.038, 95% CI: 1.001-64.514), injured type I muscle fibers (OR = 8.654, 95% CI: 2.462-30.416), anterior vaginal wall prolapse (OR = 4.705, 95% CI: 1.004-22.054), and stress urinary incontinence (OR = 4.424, 95% CI: 1.578-12.403)., Conclusion: Excessive GWG in twin primiparas was positively correlated with the prevalence of pelvic floor dysfunction but did not exacerbate pelvic floor symptoms in twin primiparas. Controlling GWG within a reasonable range is recommended for reducing the risk of PFDs in pregnant women with twins., (© 2023. The Author(s).)

Aim: The incidence of complex pelvic organ prolapse in female patients is about 38%, and this disorder entails social and sexual restrictions. Treatment for this disorder is complex because it can enhance other, latent, problems. The aim of the present study is to describe a new robotic-assisted technique to simultaneously treat prolapses of different compartments with the use of a single titanized polypropylene mesh., Method: All patients referred from January 2018 to March 2019 to the Proctologic and Pelvic Floor Clinical Centre who were affected by complex pelvic organ prolapse underwent modified robotic ventral rectopexy with a folded single mesh (RVR-FSM). The anatomical and functional outcomes were respectively evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) grading system and Wexner scores of constipation and incontinence. The satisfaction rate was investigated using a five-point scale (1 = not satisfied to 5 = extremely satisfied)., Results: Twenty-two women underwent RVR-FSM with a homogeneous follow-up of 12 months. The mean total operation time was 148 min, without any robot-related or other intraoperative complications. No mesh-related complications occurred. The POP-Q grade improved for every patient, with complete resolution of bulging symptoms in 21 patients (95.4%) at 1 year of follow-up. The Wexner constipation score showed a significant improvement, while the incontinence score slightly improved at 1 year after surgery., Conclusion: The use of a single mesh that can be folded was shown to provide significant improvement in functional and anatomical results associated with patient satisfaction. The robotic approach allows surgeons to perform an easier procedure with correct and deep mesh fixation., (© 2022 Association of Coloproctology of Great Britain and Ireland.)

Background: Fibromyalgia (FM) is a rheumatic syndrome that causes musculoskeletal disorders and is associated with several problems that affect quality of life. As the musculoskeletal system is affected, it can have an impact on the pelvic floor muscles, leading to pelvic floor dysfunction (PFD)., Objective: Investigate the occurrence of PFD, such as urinary incontinence (UI) and anal incontinence (AI), sexual problems, and pelvic organ prolapse (POP), in women with FM compared to a control group composed of women without FM; and investigate the association between FM and PFD., Study Design: This was an online cross-sectional survey. Demographic and anthropometric data, the description of PFD (UI, nocturia, AI, genital-pelvic pain/penetration disorder, and POP), and previous obstetric history were collected through a web-based questionnaire. The groups were compared using the independent t-test for quantitative variables and the chi-square test for categorical variables. The association between FM and PFD was tested using logistic regression analysis., Results: A total of 175 women answered the questionnaire (97 with FM and 78 healthy controls). The women with FM reported significantly more UI, mixed urinary incontinence, AI, POP, and vaginismus than the healthy controls (p ≤ 0.05). FM was associated with mixed urinary incontinence (OR: 2.6; 95 % CI: 1.1-6.4; p = 0.04), anal incontinence (OR: 2.9; 95 % CI: 1.3-6.1; p = 0.01), and flatus incontinence (OR: 2.6; 95 % CI: 1.2-5.4; p = 0.01)., Conclusion: The prevalence of PFD was significantly higher in women with FM compared to healthy women. Indeed, the women with FM were 2.6-fold to 2.9-fold more likely to report mixed urinary incontinence, anal and flatus incontinence than those in the control group. The present findings show possible impairment of the pelvic floor musculature in women with FM., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The long-term effects of vaginal delivery, parity, and pregnancy on the pelvic floor remain uncertain and controversial issues. In comparison with studies using self-reported symptoms, surgical register data may offer a more valid means for evaluating the relative influence of these risk factors., Objective: This study used data from 3 high-quality nationwide registers, namely the Swedish National Quality Register of Gynecological Surgery, the Swedish Medical Birth Register, and the Total Population Register, to evaluate the contribution of vaginal and cesarean delivery, parity, and factors not related to childbirth to the long-term risk for reconstructive urogenital surgery., Study Design: This was a register-based linkage study among women aged ≥45 years who underwent urinary incontinence or prolapse surgery from 2010 to 2017. This surgical cohort was divided into nulliparous women, women with ≥1 cesarean deliveries only, those with ≥1 vaginal deliveries, and according to the number of births. A corresponding reference group was constructed based on women born in 1960 from the Total Population Register (n=2,309,765). The Swedish Medical Birth Register was used to determine the rate of women with cesarean and vaginal delivery and their respective parity. Absolute and relative risk were presented per 1000 women with 95% confidence intervals. Pairwise differences were analyzed with Fisher exact tests and the Mann-Whitney U test for dichotomous and continuous variables. The trend between ≥3 ordered categories of dichotomous variables was analyzed with Mantel-Haenszel statistics., Results: A total of 39,617 women underwent prolapse surgery and 20,488 underwent incontinence surgery. Among women with prolapse surgery, 97.8% had ≥1 vaginal delivery, 0.4% had ≥1 cesarean delivery only, and 1.9% were nullipara. Corresponding figures for those with incontinence surgery were 93.1%, 2.6%, and 4.3%, respectively. Women with vaginal deliveries were overrepresented in the prolapse surgery (relative risk, 1.23; 95% confidence interval, 1.22-1.24; P<.001) and incontinence surgery groups (relative risk, 1.17; 95% confidence interval, 1.15-1.19; P<.001). Nulliparous and cesarean delivered women were underrepresented in the prolapse surgery (relative risk, 0.14; 95% confidence interval, 0.13-0.15 and relative risk 0.055; 95% confidence interval, 0.046-0.065; all P<.001) and incontinence surgery groups (relative risk, 0.31; 95% confidence interval, 0.29-0.33 and relative risk, 0.40; 95% confidence interval, 0.36-0.43). The absolute risk for prolapse surgery was lowest after cesarean delivery (0.09 per 1000 women; 95% confidence interval, 0.08-0.11) and differed by a factor of 23 (absolute risk, 2.11 per 1000 women; 95% confidence interval, 2.09-2.13) from that after vaginal birth. The absolute risk for prolapse and incontinence surgery increased consistently with parity after vaginal births. This trend was not observed after cesarean delivery, which is on par with that of nulliparous women. The first vaginal birth contributed the highest increase in the absolute risk for pelvic organ prolapse surgery (6-fold) and stress urinary incontinence surgery (3-fold). The second vaginal birth contributed the lowest increase in the absolute risk for pelvic organ prolapse surgery (∼1/3 of the first vaginal birth) and for stress urinary incontinence surgery (∼1/10 of the first vaginal birth)., Conclusion: Surgery for urinary incontinence and prolapse was almost exclusively related to vaginal parity. The risk for prolapse surgery increased consistently with parity after vaginal births but not after cesarean delivery, whereas the risk associated with cesarean delivery was on par with that of nulliparous women. Thus, cesarean delivery seems to offer protection from the need for pelvic organ prolapse and stress urinary incontinence surgery later in life., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: Many women experience pelvic floor disorders which may require medical intervention such as transvaginal mesh implant surgeries (TVM; the abdominal or vaginal insertion of woven netting to support pelvic tissue). We examined women's perceptions of communication with their health professionals concerning TVM., Design: We analysed 153 women's written submissions to an Australian Government Inquiry regarding their experiences of transvaginal mesh surgery to explore their perceptions of TVM-related doctor-patient communication. Data were analysed using deductive and inductive reflexive thematic analysis., Results: Women expressed several challenges in their communication with their health professionals. Three themes regarding communication were generated: Insufficient information was abundant; Normalisation and minimisation of the procedure and risks; and, Desired communication interactions., Conclusions: According to women's accounts, doctor-patient communication was poor. Health professionals must be knowledgeable about medical procedures and their potential complications and provide their patients with adequate, accurate information to make informed choices about their health. Health professionals should also document informed consent., Practice Implications: Health professionals should be well-informed about TVM, including best-practice treatments for pelvic floor disorders, indications for TVM, the risks, outcomes and potential complications from various forms of TVM, and ways to adequately communicate sufficient information to women., Competing Interests: Declaration of Competing Interest The authors have no conflicts to declare., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Introduction and Hypothesis: The objective was to examine knowledge regarding pelvic floor disorders (PFDs) among women during the third trimester of pregnancy., Methods: A cross-sectional study was conducted at a large teaching medical center in Israel between June and September 2020. Women in their third trimester (N = 649) were asked to complete the validated Hebrew and Arabic versions of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). The PIKQ instrument examines the knowledge of two major PFDs: urinary incontinence (UI) and pelvic organ prolapse (POP). The study population included women over 18 years of age, in the third trimester, who speak and read Hebrew or Arabic fluently. Two separate scores were calculated, one for each section of the PIKQ. The association of questionnaire scores with the different independent variables was examined using Student's t test or one-way ANOVA. Correlations were examined using Pearson's or Spearman's correlation coefficient., Results: The Hebrew version was filled out by 405 women, and 244 women completed the Arabic version. The average questionnaire scores were 7.65 ± 2.8 and 5.32 ± 2 for the UI and POP sections respectively. Significantly higher average scores in both the UI and the POP sections were noted among health care workers (UI: 10.19 ± 2.3 vs 7.34 ± 2.6, p < 0.001; POP: 8.27 ± 2.7 vs 4.97 ± 2.6, p < 0.001), women with higher education (p < 0.001 in both parts) and those with higher incomes (p < 0.001 for both parts)., Conclusions: Knowledge of PFD among women in the third trimester of pregnancy in Israel was found to be low. Founding educational programs for targeted groups may improve both the knowledge of PFD and the quality of life for these women., (© 2022. The International Urogynecological Association.)

Introduction and Hypothesis: The aim of this study was to verify whether the Chinese version of the self-administered Australian Pelvic Floor Questionnaire (APFQ) can assess the changes in symptoms over a long time period (responsiveness) and to verify the reliability and validity of the questionnaire after 3 years of follow-up., Methods: The questionnaire was completed by 146 women using the WeChat platform after 3 years of follow-up. Reliability was assessed through internal consistency (Cronbach's alpha). Construct validity was evaluated by significantly distinguished differences in symptom scores between women who did and did not subjectively suffer bothersome symptoms. Responsiveness was evaluated in 146 women. The effect size (ES) and standardized response mean (SRM) were used to assess the degree of responsiveness., Results: Of the 146 women, all completed the questionnaire through the WeChat platform without missing any items. Reliability, Cronbach's alpha for the four domains and total APFQ were: bladder function 0.78, bowel function 0.71, pelvic organ prolapse 0.78, sexual function 0.68 and total APFQ 0.84. Concerning construct validity, the APFQ significantly distinguished the symptom scores between women who did and did not subjectively suffer from bothersome symptoms, and the score difference was 1.1-1.6 points, 1.2 points, 2.0-3.7 points and 1.4 points, respectively. For responsiveness, three domains showed slight (bowel domain) to moderate (bladder domain, sex domain) sensitivity to change. ES and SRM ranged from 0.21 to 0.75 and 0.16 to 0.60, respectively., Conclusions: The Chinese version of the self-administered APFQ is reliable and valid and can monitor the changes in symptoms over time., (© 2022. The Author(s).)

Background: Primary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment., Objectives: To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions., Search Strategy: We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse", and "vaginal cancer", "vaginal carcinoma"., Selection Criteria: No article type restrictions were applied., Data Collection and Analysis: Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients., Main Results: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed., Conclusion: A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Introduction and Hypothesis: Urinary incontinence (UI) and pelvic organ prolapse (POP) significantly decrease quality of life and sexual health. This study aimed to evaluate the reliability and validity of a Serbian adaptation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) used in assessing sexual function in women with UI and/or POP., Methods: This study included 416 women, 310 (74.5%) with UI and/or POP and 106 (25.5%) without UI and/or POP. The adaptation of the PISQ-12 to Serbian language was performed via back-translation. The content validity of the questionnaire was conducted by experts in the field. The reliability and validity of the PISQ-12 were analyzed. Evaluation of the data was performed using Content Validity Index (CVI), Cronbach's alpha, test-retest reliability, item total correlation and confirmatory factor analysis., Results: Content validity of the Serbian PISQ-12 was 1.00 (100%). Item total correlations were between 0.459 and 0.819 (P < 0.001). The PISQ-12 had an adequate and high internal consistency (Cronbach's alpha 0.806) as well as high test-retest reliability (Pearson correlation coefficient r = 0.807; P < 0.001). Factor analysis results revealed strong construct validity. The mean scores of PISQ-12 were significantly better in the control group compared with the women with UI and/or POP. Sexual function was negatively affected by UI and/or POP as assessed with SF-36 and I-QoL questionnaires., Conclusions: This study showed that the Serbian version of the PISQ-12 is a reliable, consistent, valid and condition-specific instrument to assess sexual function in women with UI and/or POP., (© 2022. The International Urogynecological Association.)

Introduction and Hypothesis: The aim of this study was to translate the English short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and evaluate its validity, internal consistency, and test-retest reliability., Methods: The questionnaire was translated into Italian by standardized procedural steps, and the final version was submitted to women referred to urogynecological outpatient care for genital prolapse or urinary incontinence reporting sexual disorders (cases) or not (controls). For the test-retest evaluation, cases received the questionnaire 2 weeks later. The Wilcoxon test (non-parametric) was used to assess differences between cases and controls. Convergent validity was tested with the Italian version of the FSFI-19. The internal consistency was tested using Cronbach's alpha. The degree of concordance/agreement was measured with Cohen's kappa. The absolute agreement of test-retest results was tested with the intraclass correlation coefficient (ICC)., Results: Sixty women were recruited for the study and answered the questionnaire. The overall rate of missing items was 1.3%. Construct validity was demonstrated, as the questionnaire discriminated significantly between patients with and without symptoms. Convergent validity with FSFI-19 was tested, and a linear correlation between scores was demonstrated (F < 0.001). Internal consistency reliability evaluated with Cronbach's alpha was satisfactory (0.54-0.81). Cohen's kappa values as absolute agreement coefficients were between 0.59 and 0.80 (good agreement). Intraclass correlation coefficients ranged between 0.88 and 0.94 (very satisfactory agreement) for each functional domain., Conclusions: The Italian version of the PISQ-12 is reliable, valid, and consistent., (© 2022. The Author(s).)

Introduction and Hypothesis: Pregnancy and delivery have a major effect on pelvic floor disorders. Assessing knowledge regarding pelvic floor disorders in childbearing age women and appropriate interventions will enable women to seek appropriate medical advice once pelvic floor disorders have developed. The purpose of this study was to validate the prolapse and incontinence knowledge questionnaire in the Hebrew language., Methods: Translation of the prolapse and incontinence knowledge questionnaire to the Hebrew language according to international recommended guidelines. A study was conducted to validate the questionnaire. The study took place between June to September 2020 in a tertiary medical center in Israel. A total of 240 third trimester pregnant women completed the Hebrew version of the prolapse and incontinence knowledge questionnaire. Construct validity, criterion validity and reliability tests were performed., Results: Factor analysis of the Hebrew version of the prolapse and incontinence knowledge questionnaire demonstrated 12 strong positive factor loadings to one principal factor in the prolapse and incontinence knowledge questionnaire-pelvic organ prolapse domain (FL > 0.3) and 10/12 in the prolapse and incontinence knowledge questionnaire-urinary incontinence domain. The Hebrew prolapse and incontinence knowledge questionnaire was found to have internal consistency, with Cronbach alpha coefficient of 0.745 for the urinary incontinence domain and 0.796 for the pelvic organ prolapse domain., Conclusions: The Hebrew version of the prolapse and incontinence knowledge questionnaire is a new, reliable, consistent, and valid instrument to examine the level of knowledge regarding pelvic floor disorders in Hebrew-speaking pregnant women., (© 2021. The International Urogynecological Association.)

Introduction and Hypothesis: To evaluate prevalence of pelvic floor disorders, association of endocrine therapy with pelvic floor disorders, and rates of pelvic floor surgery among breast cancer survivors compared to matched controls without history of cancer., Methods: This is a retrospective, cohort study using electronic medical record data from a ten-hospital regional healthcare system. A total of 19,483 women diagnosed with breast cancer between January 2008 and April 2020 were propensity score matched to 19,483 women without a history of cancer. Medical charts were abstracted for ICD-9 and ICD-10 codes for pelvic floor disorders, use of endocrine therapy, and CPT codes for pelvic floor surgeries and procedures., Results: Overall, the prevalence of pelvic floor disorders was lower among breast cancer survivors (8.8% vs. 22.6%, p < 0.001), and mean time to development of pelvic floor disorders among breast cancer survivors was 3 years. Selective estrogen receptor modulators and aromatase inhibitors were associated with pelvic organ prolapse and stress urinary incontinence, while estrogen antagonists were associated with urge urinary incontinence and lower urinary tract symptoms. Women with breast cancer had similar or higher rates of pelvic floor surgery compared to matched controls., Conclusions: Rates of pelvic floor disorders were lower among breast cancer survivors compared to controls but rates of surgical intervention did not differ and were higher for some conditions among breast cancer survivors., Implications for Cancer Survivors: Screening for these disorders should be considered as part of routine survivorship care., (© 2022. The International Urogynecological Association.)

This study aims to review the surgical complications and mesh erosion with a cohort of patients who underwent Elevate™ mesh repair. This was a single-centre, retrospective study of women undergoing Elevate™ mesh reconstruction between 2006 and 2016. Women who presented with symptomatic prolapse of stage II or above were enrolled. The study outcomes were intra-operative and peri-operative complications (including mesh complications) at six weeks, one year and five years reporting with a standardised communicable method-the International Urogynecological Association (IUGA)/International Continence Society (ICS) scale and the Clavien and Dindo Classification. A total number of 350 women had Elevate™ mesh insertion. The mesh exposure rate was 1.1% and the surgical complication rate in our series was low and self-limiting (2% were Dindo grade 3). With the low morbidity and mesh-related complications, Elevate™ mesh should be at least kept as an alternative treatment of pelvic organ prolapse. Impact statement What is already known on this subject? Transvaginal mesh repair surgery was popular to treat advanced pelvic organ prolapse 10 years ago. However, after announcement of the Food and Drug Administration (FDA) public notification regarding mesh-related complications, particularly mesh exposure, use of transvaginal mesh and its safety have been scrutinised. Despite the increasing challenging and difficult medico-legal climate, several studies on second generation mesh kits, such as Elevate™ have shown favourable outcomes with low complication rates including our group. What do the results of this study add? In this paper, the surgical complications and mesh erosion of Transvaginal mesh was reported in a quantified communicable method-the International Urogynecological Association (IUGA)/International Continence Society (ICS) scale and the Clavien and Dindo Classification. This is significant because it is the largest case studies from a single centre with 350 patients. What are the implications of these findings for clinical practice and/or further research? This study well demonstrated using a standardised way to classify mesh exposure and peri-operative complications which is lacking in the past, while majority studies only focus to discuss on surgical outcome instead of complications. This may make a spark for future research analysis.

Objective: This multicenter study aimed to evaluate risk factors, prevalence and severity of pelvic floor disorders (PFDs) as well as their consequences on women's emotional well-being, using a questionnaire validated specifically for pregnancy and postpartum., Methods: Prospective study conducted in eight teaching hospitals in Italy and Italian-speaking Switzerland. Pregnant and postpartum women completed the Italian Pelvic Floor Questionnaire for Pregnancy and Postpartum anonymously. Prevalence of, severity of, and risk factors for PFDs were evaluated for all the four domains considered: bladder, bowel, prolapse, and sexual function., Results: A total of 2007 women were included: 983 of the patients were bothered by at least one kind of PFD: bladder, bowel, and sexual dysfunction were more frequently reported. There were no significant differences in PFD prevalence between pregnancy and postpartum, except for bladder disorders, which were more prevalent in pregnancy. Familiarity for PFDs, pelvic floor contraction inability, cigarette smoking, body mass index more than 25 (calculated as weight in kilograms divided by the square of height in meters), and age more than 35 years were confirmed risk factors for the development of PFDs during pregnancy and postpartum., Conclusion: Almost half of the women included in the study suffered from PFD-related symptoms with important consequences on quality of life. Validated questionnaires are fundamental in early diagnosis and treatment of PFDs., (© 2021 International Federation of Gynecology and Obstetrics.)

Background: Uterine-preserving techniques are becoming increasingly popular in the last decade. This investigation evaluates a novel hysteropexy technique using a mesh in sling-alike configuration [Splentis (Promedon, Argentina)] which is attached anteriorly to the cervix and suspended to the sacrospinous ligaments bilaterally via the vaginal route in women undergoing surgery for uterine prolapse., Methods: This was a single-center cohort study, evaluating women who underwent transvaginal hysteropexy with Splentis for primary uterine descent. Data have been collected prospectively as part of the quality assurance system. Primary endpoint was treatment success, defined as a combined endpoint including the absence of a vaginal bulge symptom and no retreatment of apical prolapse. A validated questionnaire to evaluate quality-of-life and prolapse symptoms was utilized. Descriptive analysis was applied. Wilcoxon signed-rank test was performed to compare paired samples. The significance level was set at 5%., Results: A total of 103 women with a median age of 68.0 [IQR 11.5] years with a median apical POP-Q stage of 3 were included. The median surgery time was 22 [IQR 12] minutes and no intraoperative complication occurred. After a median follow-up time of 17 months, treatment success was achieved in 91 (89.2%) patients and quality of life and patient report outcomes improved significantly (p < 0.001). Mesh exposure occurred in 3 (2.9%) patients. Of these, two patients required surgical revision, and one patient was treated conservatively. One patient required partial mesh removal due to dyspareunia., Conclusion: Bilateral sacrospinous hysteropexy with Splentis offers an efficacious and safe alternative for apical compartment repair, incorporating the advantages of pelvic floor reconstruction via the vaginal route., (© 2022. The Author(s).)

Determine the prevalence of pelvic floor disorders (PFD) stratified by age, race, body mass index (BMI), and parity in adult women attending family medicine and general internal medicine clinics at an academic health system. The medical records of 25,425 adult women attending primary care clinics were queried using International Classification of Diseases-10th Revision codes (ICD-10 codes) for PFD [urinary incontinence (UI), pelvic organ prolapse (POP), and bowel dysfunction (anal incontinence (AI) and difficult defecation)]. Prevalence and odds ratios were calculated using univariate and multivariate analysis for age, race, BMI, and parity when available. Multivariate logistic regression models were used to assess the impact of age, race, BMI, and parity on the likelihood of being diagnosed with a PFD. A separate model was constructed for each of the three PFD categories (UI, POP, and bowel dysfunction) as well as a model assessing the likelihood of occurrence for any type of PFD. The percentage of women with at least one PFD was 32.0% with bowel dysfunction the most common (24.6%), followed by UI (11.1%) and POP (4.4%). 5.5% had exactly two PFD and 1.1% had all 3 categories of PFD. Older age and higher BMI were strongly and significantly associated with each of the three PFD categories, except for BMI and prolapse. Relative to White patients, Asian patients were at significantly lower risk for each category of PFD, while Black patients were at significantly lower risk for UI and POP, but at significantly greater risk for bowel dysfunction and the presence of any PFD. Higher parity was also significantly associated with pelvic organ prolapse. Using multivariate analyses, age, race, and BMI were all independently associated with PFD. PFD are highly prevalent in the primary care setting and should be screened for, especially in older and obese women. BMI may represent a modifiable risk factor., (© 2022. The Author(s).)

Introduction and Hypothesis: The aim of this study is to develop and validate a new integral parameter, the Biomechanical Integrity score (BI-score), for the characterization of the female pelvic floor., Methods: A total of 253 subjects with normal and pelvic organ prolapse (POP) conditions were included in the multi-site observational, case-control study; 125 subjects had normal pelvic floor conditions, and 128 subjects had POP stage II or higher. A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t-test, correlation) to identify the VTI parameters sensitive to the pelvic conditions., Results: Twenty-six parameters were identified as statistically sensitive to POP development. They were subdivided into five groups to characterize (1) tissue elasticity, (2) pelvic support, (3) pelvic muscle contraction, (4) involuntary muscle relaxation, and (5) pelvic muscle mobility. Every parameter was transformed to its standard deviation units against the patient age similar to T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups (1)-(5) and the BI-score in standard deviation units. The p-value for the BI-score has p = 4.3 × 10 -31 for POP versus normal conditions. A reference BI-score curve against age for normal pelvic floor conditions was defined., Conclusions: Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the BI-score in future research and practical applications., (© 2022. The Author(s).)

Background: Pregnancy and childbirth are thought to be the strongest environmental risk factors for pelvic organ prolapse, but prolapse does occur in nulliparae., Aim: To characterise prolapse in vaginal nulliparae., Material and Methods: This was a retrospective study using archived clinical and imaging data of 368 vaginally nulliparous women seen between 2006 and 2017 at two tertiary urogynaecological centres. Patients underwent a standardised interview, clinical examination and 3D/4D translabial ultrasound. Volume datasets were analysed by the second author, blinded against all clinical data, using post-processing software on a personal computer. Significant prolapse was defined as Pelvic Organ Prolapse Quantification system stage ≥2 for the anterior and posterior compartment, and stage ≥1 for the central compartment. On imaging, significant prolapse was defined as previously described., Results: Of 4297 women seen during the inclusion period, 409 were vaginally nulliparous, for whom 368 volume data sets could be retrieved. Mean age was 50 years (17-89) and mean body mass index 29 (16-64). Eighty-one (22%) presented with prolapse symptoms. On clinical examination, 106 women (29%) had significant prolapse, mostly of the posterior compartment (n = 70, 19%). On imaging 64 women showed evidence of significant prolapse (17%), again mostly posterior (n = 47, 13%). Rectovaginal septal defects were even more common in 69 (19%). On multivariate analysis we found no differences between true nulliparae (n = 184) and women delivered exclusively by caesarean section (n = 184)., Conclusions: Prolapse occurs in vaginal nulliparae, but it has distinct characteristics. Rectocele predominates, while cystocele and uterine prolapse are uncommon. Pregnancy and caesarean delivery seem to have little effect., (© 2022 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Numerous studies have investigated the influence of health disparities among women with pelvic floor disorders with varied results. Racial/ethnic disparities, in particular, inconsistently indicate differences in prevalence of disease, disease severity, and treatment outcomes. We aim to review the body of literature examining racial/ethnic disparities in pelvic floor disorders, including overactive bladder, stress urinary incontinence, pelvic organ prolapse, and interstitial cystitis. A better understanding of these disparities may help guide clinicians, researchers, and advocates in providing improved education, outreach opportunities, and access to care in minority women with pelvic floor disorders., (Copyright © 2021 Elsevier Inc. All rights reserved.)

This study was aimed at exploring the application value of ultrasound technology and rehabilitation training based on artificial intelligence algorithm in postpartum recovery of pelvic organ prolapse. Sixty patients diagnosed as mild and moderate pelvic organ prolapse by pelvic organ prolapse quantification evaluation were selected as the research objects. The patients were randomly divided into experimental group (30 cases) and control group (30 cases). The patients in the control group were given routine guidance and postpartum health education 42 days after delivery and given no pelvic floor rehabilitation training, waiting for natural recovery. 42 days after delivery, the patients in the experimental group received pelvic floor rehabilitation training based on the patients in the control group. All patients underwent ultrasonography, the convolution neural network (CNN) algorithm was used for image denoising and edge feature extraction, and the performance of the algorithm was evaluated by the Dice coefficient, positive predictive value, sensitivity, and Hausdorff distance. The thickness of levator ani muscle, anterior and posterior diameter of perineal hiatus, pelvic floor muscle strength, and imaging data were compared between the two groups. The results revealed that the thickness of levator ani muscle in the experimental group was significantly greater than that in the control group after one month and three months of treatment (0.633 ± 0.26 cm vs. 0.519 ± 0.234 cm, 0.7 ± 0.214 cm vs. 0.507 ± 0.168 cm, P < 0.05). After one month and three months of treatment, the anterior and posterior diameter of perineal fissure in the experimental group was obviously smaller than that in the control group (4.76 ± 0.513 cm vs. 5.002 ± 0.763 cm, 4.735 ± 0.614 cm vs. 4.987 ± 0.581 cm, P < 0.05). The pelvic floor muscle strength of the experimental group was remarkably higher than that of the control group after one month and three months of treatment (3.183 ± 1.47 vs. 2.41 ± 1.57, 3.365 ± 1.53 vs. 2.865 ± 1.69, P < 0.05). The ultrasonic image was clearer, the focus was more prominent, and the image quality was significantly improved after being processed by artificial intelligence algorithm. The Dice coefficient, positive predictive value, sensitivity, and Hausdorff distance of the proposed algorithm were better than those of the traditional algorithm. Thus, artificial intelligence algorithm had a good effect in ultrasonic image processing. Pelvic floor rehabilitation training had a good effect on postpartum nursing of patients with pelvic organ prolapse., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Ping Yin and Hongli Wang.)

Study Objective: To validate the use of an innovative navigation method for sacrospinous fixation in surgery-like conditions as a new teaching tool and surgical method., Design: Two-month experimental prospective pilot study between July and August 2021., Setting: Biomechanics laboratory academic research., Patients: A total of 29 participants took part in the study: 9 gynecological surgeons and 20 participants with no medical background., Interventions: All participants used the 2 mocks-up., Measurements and Main Results: The experiment was composed of 2 training phases dedicated to improving the hand-eye coordination and suture skills on a training mock-up and of a suturing phase on a pelvic mock-up designed to recreate the surgery-like conditions of a sacrospinous fixation. The surgeons provided qualitative feedback on the bio-accuracy of the mock-ups and evaluated the ease of use of the navigation software. Nonsurgeons were included to assess the progression of the suture performance between 2 experiments performed 1 week apart (session 1 and 2). The main objective for participants was to reach a virtual target and to stitch sacrospinous ligaments. For session 1, an overall comfort score of 7.2 of 10 was attributed to the tool; 14 (42%) surgeon suture attempts and 63 (65%) nonsurgeon suture attempts were accurate (i.e., below the 5-mm threshold). Twenty-two (67%) surgeon suture attempts and 28 (34%) nonsurgeon suture attempts were fast (i.e., in the first 2 quantiles of the duration dataset). An improvement in the nonsurgeon performance was observed between the 2 sessions in terms of duration (session 1: 46 ± 20 s; session 2: 37 ± 18 s; p = .047) and distance (session 1: 3.8 ± 1.3 mm; session 2: 3.2 ± 1.4 mm; p = 10 -5 ) for the last suturing exercise., Conclusion: This new motion capture-based navigation method for sacrospinous fixation tested under surgery-like conditions seemed to be accurate and effective. The next step will be to design a pelvis model more adapted to the constraints of a sacrospinous fixation and to validate the benefits of this method compared with current techniques., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Significant risk of bias and limitations in outcome selections in trials evaluating conservative treatments for the management of Pelvic Organ Prolapse (POP) have been highlighted and preclude comparability of outcomes, synthesis of primary studies and high quality evidence., Objectives: As systematic review of the reported outcomes is the first step in the process of development of a Core Outcome Set (COS), we aimed to systematically review reporting of outcomes and outcome measures in Randomised Control Trials (RCTs) on conservative treatments for POP and develop an inventory of them for consideration as core outcome and outcome measures sets. We evaluated methodological quality, outcome reporting quality and publication characteristics and their associations among published RCTs., Study Design: Systematic review of RCTs identified from the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and MEDLINE (Pubmed). RCTs evaluating the effectiveness of conservative interventions for the management of POP were considered for inclusion. Outcomes and outcome measures were obtained from the RCTs and an inventory was created. Outcomes were grouped in domains and themes. Methodological quality, outcome reporting quality and publication characteristics were evaluated and statistically analysed., Results: Twenty-five trials (3179 women) were included and reported 31 outcomes and 50 outcome measures. Reporting rates of the outcomes investigated ranged between 4% and 56%. The most commonly reported outcome domains were patient reported symptoms, stage of POP expressed as POP-Q stage, and quality of life. Univariate analysis demonstrated no significant correlations of methodological and outcome reporting parameters., Conclusions: There is a need to increase comparability of RCTs. Reporting standardized outcomes included in a COS for conservative interventions for POP will facilitate the comparability across RCTs. While the process of developing COS is in progress, we propose the interim use of the three most commonly reported outcomes in each domain: patient-reported outcomes (symptom distress including bowel and urinary symptoms, sexual function), stage of prolapse and quality of life parameters using validated questionnaires (Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire/Health related quality of life (PFIQ-7/HRQOL) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The objective of this study is to characterize an acceptable health state, using the patient acceptable symptom state (PASS) question, in adult women with urinary incontinence., Methods: This is a prospective multicenter cohort study determining PASS thresholds from condition-specific measures using an electronic research platform in English-speaking women seeking nonsurgical treatment of urinary incontinence between March 2019 and May 2020. Exclusions included pregnancy, isolated overactive bladder, and pelvic organ prolapse greater than stage II. The cohort was described and then grouped based on achievement of PASS. The PASS thresholds were determined using the 75th percentile and univariate regression methods. Multivariable regression modeling was used to understand the influence of covariates on PASS achievement., Results: The study was completed by 100 (80%) of the 125 enrolled subjects. Of these, 45% (n = 45) achieved PASS after a median of 7 weeks of treatment (range, 6-13 weeks). The corresponding questionnaire score for PASS was estimated to be 6 for the Incontinence Severity Index, 3 for the Patient Global Impression of Severity and Improvement, 37.5 using the Urinary Distress Inventory 6, and 33.3 using the Incontinence Impact Questionnaire 7. Increasing age was independently associated with achieving PASS after adjusting for treatment adherence and outcomes scores (adjusted odds ratio, 1.05 [95% confidence interval, 1.01-1.10]; P = 0.02)., Conclusions: PASS was achieved in 45% of women after conservative treatment of urinary incontinence. PASS offers a new perspective for analysis and interpretation of outcome measures used in pelvic floor disorders and can serve as a reference for future research and clinical care pathways., Competing Interests: D.J.S. is a consultant to InterPRO Urology. M.D.B. receives royalties from Elsevier and UpToDate. The other authors have declared they have no conflicts of interest., (Copyright © 2021 American Urogynecologic Society. All rights reserved.)

Objective: Investigate the impact of urinary incontinence (UI) on quality of life (QoL) in female CrossFit practitioners and to verify the strategies used by them to minimize the occurrence of urine leakage. In addition, to verify whether anthropometric and clinical characteristics increase the UI impact on QoL of female CrossFit practitioners., Study Design: This was an online cross-sectional survey. The impact of UI on QoL was investigated by International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Associations between the impact of UI on QoL and the clinical (age, BMI, gestations, mode of delivery, practice of other physical activities) and the others pelvic floor dysfunctions (PFD) related independent variables were tested using logistic regression analysis., Results: A total of 828 female CrossFit practitioners answered the questionnaire and 36% reported UI symptoms. The women who obtained the highest score on the ICIQ-SF have high UI interference in QoL. Previous history of two or more gestations and sexual dysfunctions (dyspareunia or vaginismus) or pelvic organ prolapse increase 2.65 and 1.82 times the risk of female CrossFit practitioners with UI having a high impact of UI on their QoL, respectively (OR = 2.65 95% CI 1.30-5.40, p = 0.01; and OR = 1.82 95% CI 1.04-3.21, p = 0.04, respectively). The most strategies used by them to minimize the occurrence of urine leakage were emptying the bladder before training (77.5%) and use absorbent (17.8%)., Conclusions: Women who had higher scores on the ICIQ-SF reported greater impact on QoL, and the previous history of two or more gestations and sexual dysfunction/pelvic organ prolapse increase the risk of women with UI who practice CrossFit to have a greater impact on QoL. Multigravida and women with sexual dysfunction/pelvic organ prolapse who practice CrossFit could have more attention on the UI symptoms due to the high impact on their QoL., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction and Hypothesis: The aim of this study was to clinically validate the French-translated PISQ-IR in a French-speaking population of women with pelvic floor disorders., Methods: We aimed to recruit 300 women to account for potential attrition secondary to failure to respond or loss to follow-up. Women were enrolled as part of an RCT and from a separate specific study. Both studies included surgically managed patients. Data were collected at recruitment, visit 1 (V1), V2 (9-12 months postoperatively) and V3 (V2 + 5-15 days). Participants also completed a PFDI 20, ICI-Q and FSFI and were assessed by POP-Q., Results: A total of 297 women were recruited between 18 January 2013 and 18 January 2016. Data were available for 291, 148 and 110 participants at V1, V2 and V3, respectively. The non-response rate for the NSA items varied from 5% to 30%, while for SA women, the non-response rate for the items varied from 0% to 15%. The tool was deemed reliable for five domains of the summary score. We also identified that several sections demonstrated acceptable to good temporal stability. A statistically significant score change was identified in different domains in the participants categorized as improved on either PGI-I or POP-Q. We also identified moderate to strong correlations between PISQ-IR and FSFI., Conclusions: The French translated PISQ-IR has several strengths in support of its validity. Our findings confirm the validity of the summary scores in addition to the item-based initial scoring system., (© 2021. The International Urogynecological Association.)

Introduction and Hypothesis: The aim of this study was to develop a Polish language version of the short form of the Pelvic Floor Impact Questionnaire 7 (PFIQ-7) and to validate it in a sample of Polish-speaking women with pelvic floor disorders (PFDs)., Methods: The PFIQ-7 was initially translated in a stepwise fashion as guided by the International Urogynecological Association (IUGA) Translation Protocol. First, two bilingual physicians in Poland and the USA performed a forward translation of the PFIQ-7. Next, a community review process was undertaken consisting of one-on-one cognitive interviews with 20 patients. The translated questionnaire was then back translated into English. The final Polish version of the PFIQ-7 was subsequently administered to Polish-speaking patients presenting with PFDs at university-based urogynecology clinics in Poland and the USA along with a Polish version of the Pelvic Floor Distress Inventory (PFDI-20). Internal consistency and criterion validity were assessed., Results: A total of 225 women with PFDs enrolled in this multicenter study. Complete data from 185 women in Poland and 40 primarily Polish-speaking women in the USA were analyzed. Participants had a mean age of 60.1 ± 11.1 years and mean body mass index (BMI) 27.9 ± 4.9. The Poland and United States cohorts did not vary significantly in age, BMI, or education level. PFIQ-7 internal consistency as measured by Cronbach's alpha was good (0.93). Criterion validity was adequate between responses on the PFIQ-7 and PFDI-20 prolapse, colorectal, and urinary subscales (0.62-0.69, p < 0.05)., Conclusions: The Polish version of the PFIQ-7 is a reliable tool for evaluating pelvic floor symptoms in Polish-speaking women with PFDs., (© 2020. The International Urogynecological Association.)

Introduction and Hypothesis: Our objectives were to describe the health literacy (HL) of urogynecology patients, characterize women with and without adequate HL, and compare errors made on the PFDI-20 and PFIQ-7., Methods: English-speaking women presenting to an academic urogynecology clinic in June-July 2018 were invited to complete questionnaires including the Newest Vital Sign™ (NVS), the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7). An NVS score > 4 indicated adequate HL. Descriptive analyses compared women with and without adequate HL and the rates and types of errors made on the PFDI-20 and PFIQ-7., Results: The mean age of participants (N = 115) was 65 + 15 years; 87% were white/Caucasian; 62% were college-educated. NVS scores indicated likely adequate HL in 61%. Participants at risk for limited HL (39%) were older, less educated, more likely to live alone, and more likely to require assistance to manage their healthcare (all p < 0.05). Those requesting help to complete the questionnaires (29%) had lower HL. Errors occurred more often on the PFDI-20 (44%) than PFIQ-7 (5%) regardless of HL status. Those who received help were less likely to make errors on the PFDI-20 (p < 0.05)., Conclusions: Overall 39% of patients were at risk for limited HL. Older age, living alone, less education, and requiring assistance to manage healthcare increased risk of limited HL. Errors were more common on the PFDI-20 than PFIQ-7 regardless of HL status and occurred even when participants received help completing the questionnaires, though less frequently., (© 2021. The International Urogynecological Association.)

Objectives: To determine the real-world effectiveness of pelvic floor muscle therapy (PFMT) recommendations for patients., Methods: We conducted a cross-sectional study of 70 women who were advised to undergo PFMT after their initial urogynaecology consultation for lower urinary tract symptoms and/or pelvic organ prolapse. About half (51%) of potential participants consented to answer our telephone survey. We calculated the proportion of patients who complied with the recommendation of PFMT, and we subjectively assessed whether these patients found PFMT to be helpful. We also collected demographic data and looked for reasons why patients did not attend PFMT. Chi-square, 2-tailed t, or Fisher exact tests were used to compare differences between patients who attended and those who did not., Results: During the 6-month period after their initial consultation, only 28 of 70 women (40%) followed the recommendation to attend PFMT. Sixteen of the 28 women who attended PFMT (57%) reported that they found it helpful. Therefore, the "real-world effectiveness" of the entire study sample was 23%, with only 16 of 70 women benefiting from PFMT. Time constraints (27%) and cost (18%) were the top 2 reasons given for not attending., Conclusions: Despite evidence-based recommendations in favour of PFMT for various pelvic floor disorders, its real-world effectiveness is quite low. A public health commitment to providing access to PFMT would be of significant benefit., (Copyright © 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Introduction and Hypothesis: Women with hereditary disorders of connective tissue (HDCT) are at increased risk of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). We hypothesized that patients would have increased incidence and severity of perioperative complications up to 6 weeks after surgeries for POP/SUI. Secondary objectives were to compare pre- and post-operative pelvic floor symptoms and anatomical support as well as pelvic floor disorder recurrence., Methods: In this multi-center retrospective cohort study, we identified patients with HDCTs by patient history and ICD-9 codes over an 11-year period. Controls without HDCTs were matched 2:1 to the primary POP or SUI procedure and surgeon. Demographic characteristics, perioperative pelvic floor information and complications were collected. A sample size of 65 HDCT patients and 130 controls was calculated to detect a 20% difference in complications with 80% power and alpha of 0.05., Results: We identified 59 HDCT patients and 118 controls. Of the women with HDCTs, 49% had Ehlers-Danlos, 22% joint hypermobility syndrome, 15% Marfan syndrome, and 14% had others. Compared with controls, HDCT patients had more total perioperative complications (46% vs 22%, p = 0.002); an age-adjusted relative risk of complications was 1.4 (CI 0.7-2.6). HDCT patients had more Clavien-Dindo grades I and II complications (p = 0.02, 0.03) and more hospital readmissions (14% vs 3%, p = 0.01) than controls. There was no difference in the incidence of specific complications nor was there a difference in recurrence of POP (10%) or SUI (11%) between groups., Conclusions: Patients with HDCTs had more Clavien-Dindo grade I and II complications following pelvic floor reconstructive surgery and more readmissions., (© 2021. The International Urogynecological Association.)

Background: Sarcopenia is a determinant of age-related skeletal muscle weakness. In this sense, it is believed that there may be a pathophysiological association between pelvic floor dysfunction (PFD) and sarcopenia; however, few articles investigating an association between these two pathologies have been published., Objectives: To identify the prevalence of sarcopenia in older women with PFD and verify the association between the severity of PFD and the severity of sarcopenia., Methods: This cross-sectional study was undertaken in urogynaecology outpatient clinics in Fortaleza, Ceará, Brazil. Women with PFD aged ≥ 60 years were included. Women with cognitive impairments, amputations and/or limb fractures were excluded. Sociodemographic, anthropometric and PFD data were evaluated, and tests for measuring muscle strength, muscle mass and physical performance were performed., Results: In total, 217 women were included in this study; of these, 121 (55.8%) presented without sarcopenia, 71 (32.7%) presented with probable sarcopenia, 23 (10.6%) presented with confirmed sarcopenia, and two (0.9%) presented with severe sarcopenia. Regarding sarcopenia related to PFD, a higher prevalence of probable sarcopenia was observed in women with urinary incontinence (UI) (n = 55, 77.5%). Confirmed sarcopenia was more prevalent in women with pelvic organ prolapse (POP) (n = 19, 82.6%); among these cases, most women had POP of the anterior, posterior and apical compartments (n = 8, 42.1%). All the women with severe sarcopenia had UI and POP and, considering the specific types of these dysfunctions, the prevalence of severe sarcopenia was 50.0% in the women with UI and POP of the anterior and apical wall. The most severe stages of POP were associated with sarcopenia (p = 0.002)., Conclusion: The prevalence of sarcopenia in women with PFD was high. Healthcare providers who assist women with PFD should consider the possibility of assessing sarcopenia, especially when faced with more extensive POP in older women. The evaluation of sarcopenia may play a role in the management of women with PFD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)