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The impact of surgery on pelvic floor muscle (PFM) function remains uncertain. There is a pressure differential along the length of the vagina, influenced by surrounding active and passive tissue structures, giving rise to a pressure profile. The aim of this study is to determine if an intravaginal pressure sensor, femfit®, can measure differences in pressure profiles before and after surgery for pelvic organ prolapse (POP). This pilot study includes 22 women undergoing POP surgery. Intravaginal pressure profiles were measured with femfit® pre- and post-surgery and differences tested using paired Student’s t-tests. Patients completed validated questionnaires for vaginal, bowel, and urinary incontinence symptoms pre- and post-POP surgery and a femfit® usability questionnaire. Sixteen sets of vaginal pressure data were analysed. The highest pressure generated was identified as the peak PFM pressure, whilst all sensor measurements provided a pressure profile. Intra-abdominal pressure (IAP) was measured by the most distal sensor, 8. On average, the difference between peak PFM pressure and IAP was significantly greater post-surgery (p

This case presents the work-up and management of a patient with a fibroid uterus and urinary incontinence. Five international experts also provide their evaluation and approach to this case. According to the literature, there is uncertainty surrounding the relationship between fibroids and urinary incontinence. The experts emphasize patient counseling and a staged approach.

With conflicting evidence in the literature, we hypothesised that the long-term subjective outcomes of the retropubic midurethral sling (MUS) are the same in the severely obese and non-obese populations. A retrospective matched cohort study was performed on women with a BMI ≥ 35 and

There has been a scarcity of long-term published data comparing lightweight versus heavier weight transvaginal mesh for prolapse repair. The aim was to ascertain the long-term rates of recurrent prolapse and mesh exposure in a cohort of vaginal repairs utilizing two different weights of transvaginal mesh. Data were prospectively collected on all mesh-augmented vaginal prolapse repairs performed with Apogee® or Perigee® mesh kits (IntePro® or IntePro Lite®) at a single centre over an 11-year period, with patients receiving ongoing annual follow-up. A sequential stepwise univariate and multivariate Cox regression analysis was performed to identify variables that were significantly associated with mesh exposure. Eighty-eight women with 113 mesh kits were reviewed from the original cohort of 158 women. The median length of follow-up was 6.4 years (range 1.1–12.5 years). Mesh exposure rate per implant in the IntePro® group was 16/40 (40%) versus 4/73 (5.5%) in the IntePro Lite® group (p < 0.0001). A hazard ratio of 4.2 was identified for mesh exposure for IntePro® versus IntePro Lite® (95% CI 3.0–6.8). There was no difference in rates of recurrent prolapse between the heavy- and lightweight mesh groups. Lightweight transvaginal mesh is associated with lower mesh exposure rates than heavyweight mesh at a median follow-up of 6.4 years, with no difference in rates of recurrent prolapse.

Introduction and hypothesis This narrative review describes the existing epidemiologic literature and identifies gaps regarding pelvic organ prolapse (POP) prevalence, incidence, natural history, and current and future service needs. Materials and Methods A PubMed search identified relevant citations published in 2000 or later. Pre-specified criteria were used to screen titles, abstracts, and manuscripts, including reference sections. Study findings were summarized to define what is known, identify gaps in current knowledge, and suggest priority areas for future research. Results The reported prevalence of POP varies widely (1-65%) based on whether its presence is ascertained by symptoms (1-31%), pelvic examination (10-50%), or both (20-65%). Most existing population-based surveys do not include physical examination data. White women from higher income countries are overrepresented in the existing literature. Incidence and natural history data are limited and consist mainly of cohorts that follow women after pregnancy or menopause. Given global increases in aging populations in well-resourced countries, the need for POP treatment is anticipated to increase in the coming decades. In lower and middle income countries (LMICs) where demographic trends are different, there is a dearth of information about anticipated POP service needs. Conclusion Future POP incidence, prevalence, and natural history studies should include non-white women from LMICs and should combine pelvic examination data with validated patient-reported outcome measures when feasible. Anticipated future service needs differ globally, with a greater demand for POP treatment services in well-resourced settings where aging populations are prevalent.

Introduction Pelvic floor disorders (PFD) are extremely common; 1 in 3 parous women will experience urinary incontinence, 1 in 2 will develop pelvic organ prolapse, whereas 1 in 10 experience fecal incontinence. PFD are often associated with a significant reduction in women’s psychological, social, and sexual well-being. Aim To review the current literature on sexual dysfunction related to PFD. Methods A literature search was conducted using PubMed and key words including sexual dysfunction, prolapse, incontinence, pelvic floor dysfunction, and surgical repair. Main Outcome Measure The outcome was to identify the nature and severity of sexual dysfunction in women with PFD. Results The prevalence of sexual dysfunction is estimated to be around 30–50% in the general population, whereas in women with PFD, the reported incidence rises to 50–83%. The leading factors cited for the reduction in a woman’s sexual experience included worries about the image of their vagina for women with pelvic organ prolapse, dyspareunia and coital incontinence in women with urinary incontinence, and fear of soiling when dealing with anal incontinence. Pelvic floor muscle training has been associated with an improvement in sexual function. 11% of parous women will have surgery for pelvic organ prolapse, yet limited data are available on the impact of surgical intervention on sexual function. Native tissue repair of pelvic organ prolapse is associated with an improvement in sexual function, whereas posterior repair with levatorplasty and vaginal mesh repair can increase the risk of postsurgical dyspareunia. Subtotal hysterectomy is not associated with improved sexual function compared with traditional total hysterectomy. Conclusion It is clear there is an urgent need for further research on the effects of surgery for PFD on sexual function. To date, most studies have focused on anatomic rather than functional outcomes. Verbeek M, Hayward L. Pelvic Floor Dysfunction and Its Effect on Quality of Sexual Life. Sex Med Rev 2019;7:559–564.

This case presents the work-up and management of a patient with a fibroid uterus and urinary incontinence. Five international experts also provide their evaluation and approach to this case. According to the literature, there is uncertainty surrounding the relationship between fibroids and urinary incontinence. The experts emphasize patient counseling and a staged approach.

There is a widely held, but untested, belief that certain exercises and activities generate intraabdominal pressure (IAP) that may compromise the function of the pelvic floor muscles. Women with, or at risk of, pelvic floor disorders are advised therefore to refrain from these exercises and activities in order to theoretically protect their pelvic floor. The aim of this study was to compare IAPs generated during exercises of different types that are recommended to women as pelvic floor “safe” with those generated during the corresponding conventional exercises that women are typically cautioned against. This was a cross-sectional cohort study. All participants were guided by a trained exercise practitioner through a series of ten exercise pairs, one version recommended to women as pelvic floor “safe” and one conventional version which women are cautioned against. IAP components were extracted from the pressure traces from a wireless intravaginal pressure sensor and used in multivariate linear regression modelling, canonical discriminant analysis, and linear mixed modelling. A total of 53 participants were recruited. After adjusting for age, body mass index and parity, there was an exercise type–version effect (p

Outcomes on pelvic floor function after pelvic floor surgery are difficult to quantify. Urinary incontinence affects 25% of women, with 12% of these women requiring surgical intervention to relieve symptoms. However, quantitative measurement of pelvic floor function following surgery is not currently available. This work considers the use of an intra-vaginal pressure sensor array to measure the vaginal pressure profile as a means to quantify surgical outcomes. An observational cohort study is underway to evaluate changes in vaginal pressure profiles pre and post pelvic organ prolapse surgery.

Introduction The influence of levator-ani muscles on second-stage labor is poorly understood. The ability of these muscles to stretch without damage may affect birth outcomes, but little is known about material properties, effects of pregnancy and/or ethnicity on levator-ani stiffness. There are strong associations between muscle damage and subsequent pelvic floor disorders. This study aimed to quantify levator-ani muscle stiffness during the third trimester of pregnancy and postpartum in European and Polynesian women. Associations between stiffness, obstetric variables, and the risk of intrapartum levator-ani injury (avulsion) were investigated. Material and methods This was a prospective observational pilot study. A total of 167 (106 European and 61 Polynesian) nulliparous women were recruited antenatally; 129 returned postnatally. Participants were assessed between 36 and 38 weeks' gestation and three to five months postpartum. Assessments included pelvic floor ultrasound, elastometry testing, and validated questionnaires on pelvic floor function. Logistic regression, Student t-, Chi-square and Mann–Whitney tests were used as appropriate. Results There are significant differences between antenatal and postnatal muscle stiffness measurements (p < 0.01). Stiffness was significantly higher in the European cohort (p = 0.03). There were more avulsion injuries in European (20%) than in Polynesian (9%) women. There were no significant differences in antenatal stiffness between women with and without avulsion, but change in stiffness (antenatal to postnatal) was significantly less in the avulsion group. There were no associations between stiffness, and other obstetric variables, epidural anaesthesia seemed protective (p = 0.03). Conclusions Quantification of levator-ani muscle stiffness is feasible. Muscle stiffness is significantly different before and after birth.

A wireless intravaginal pressure sensor (IVPS) has been developed to quantify abdominal pressure (Pabd) changes during exercise and activities of daily living to guide post-operative advice given to women. In this pilot study, we aimed to compare IVPS performance, comfort, retention, and acceptability to a standard fluid-filled intrarectal pressure catheter currently used to measure Pabd during routine urodynamics. A Life-Tech 3-mm urodynamic intrarectal catheter and IVPS were inserted concurrently in volunteers attending a urodynamics clinic. The IVPS was positioned above the levator plate and the intrarectal catheter positioned in routine fashion well above the anal sphincter. Routine urodynamics was undertaken, with women asked to perform star jumps if coughing or Valsalva did not invoke leakage. Subjects rated device comfort using a visual analogue scale (0–10). Repeated measures Bland-Altman analysis determined level of agreement (LOA) between the two devices for peak pressures for each activity. Twenty-seven women were recruited, 67 % of the participants preferred the IVPS, 18 % the intrarectal catheter, while 15 % had no preference. Mean comfort score was 0.9 ± 1.7 and 2.1 ± 2.6 (p = 0.049) for the IVPS and intrarectal catheter respectively. Bland-Altman analysis demonstrated minimal bias for cough and Valsalva, however LOA were wide. Differences were more prominent during star jumps where rapid dynamic pressure changes occurred. The IVPS had a higher comfort score and was well retained. The LOA between the two systems was moderate, but the high sampling rate and lower susceptibility to motion artefacts of the IVPS may provide more accurate information that will be important clinically.

Item does not contain fulltext OBJECTIVE: In an unselected group of women with signs of preterm labour, maintenance tocolysis is not effective in the prevention of preterm birth and does not improve neonatal outcome. Among women with signs of preterm labour, those who are fetal fibronectin positive have an increased risk of preterm birth. We investigated whether maintenance tocolysis with nifedipine would delay delivery and improve neonatal outcome in women with threatened preterm labour and a positive fetal fibronectin status. STUDY DESIGN: Women with a singleton pregnancy in threatened preterm labour (24(+0) to 33(+6) weeks) with a positive fetal fibronectin test were randomised to nifedipine or placebo. Study medication was continued until 36 completed weeks' gestation. The primary endpoint was prolongation of pregnancy of seven days. Secondary endpoints were gestational age at delivery and length of NICU admission. RESULTS: Of the 60 participants, 29 received nifedipine and 31 placebo. Prolongation of pregnancy by >7 days occurred in 22/29 (76%) in the nifedipine group and 25/31 (81%) in the placebo group (relative risks, RR 0.94 [0.72-1.2]). Gestational age at delivery was 36.1 +/- 5.1 weeks for nifedipine and 36.8 +/- 3.6 weeks for placebo (P = 0.027). Length of NICU admission [median (interquartile ranges, IQR)] was 27 (24-41) days and 16 (8-37) days in nifedipine and placebo groups, respectively (P = 0.17). CONCLUSION: In women with threatened preterm labour who are fetal fibronectin positive, maintenance tocolysis with nifedipine does not seem to prolong pregnancy, nor reduce length of NICU admission.