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Introduction: The quality of sleep is a crucial aspect of clinical health, and poor sleep quality is becoming more prevalent among individuals, particularly students. Therefore, this study was conducted to investigate the relationship between cognitive flexibility and self-compassion with sleep quality among students, taking into account the mediating role of emotion regulation.Method: This research is a descriptive correlational study. The statistical population for this study included all students at Guilan University. For this purpose, a sample of 384 people was selected using a non-random sampling method. In order to collect data, a researcher-made demographic questionnaire was used along with Pittsburgh Boyce et al.'s sleep quality questionnaire (1989), Neff's self-compassion questionnaire (2003), Dennis and Vander Wall's cognitive flexibility questionnaire (2010), and Gross and John's emotion regulation questionnaire (2003). Data analysis was conducted using the Pearson correlation method and path analysis with SPSS-27 and Amos-24 software. Results: The analysis revealed a significant relationship among the three variables of cognitive flexibility, self-compassion, and emotion regulation, particularly with the sleep quality re-evaluation subscale (p0.05). The variables of cognitive flexibility, self-compassion, and reappraisal could account for 14 percent of the variance in sleep quality.Discussion and Conclusion: The research results indicate that emotion regulation, particularly the reappraisal subscale, mediates the connection between cognitive flexibility and self-compassion with sleep quality. Therefore, leveraging emotion regulation abilities, especially the reappraisal subscale, can be an effective therapeutic approach to enhance the sleep quality of students.

Objective: Voiding Dysfunction (VD) is one of the most common disorders among women, which is characterized by a disorder in urination. Pelvic organ prolapse is one of the factors that can affect VD. In this study, the relationship between prolapse in the anterior, posterior, and apical areas and VD has been evaluated. Materials and methods: This is a cohort retrospective study. The participants in this study were women with VD, who referred to the pelvic floor disorders clinic of Imam Khomeini Hospital in Tehran in 2018-2020. Clinical information was obtained retrospectively from the hospital's electronic data system, also symptoms (intermittent stream, incomplete voiding, poor flow, post void dribble, straining to void, stage anterior, posterior and apical) and urodynamic parameters (including EMG, PVR100, Qmax12, and pdet20) were evaluated, which included detailed questionnaires (Urinary Distress Inventory 6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7)), pelvic examination, and complete urodynamic evaluation. Results: There was a direct relationship between the age of the patients and the stage of prolapse (p 100 had a significant relationship with the stage of prolapse in the apical area (p=0.001). Conclusion: Intermittent stream and straining to void were related to the stages of prolapse in the apical and anterior regions. It was also concluded that the greater the prolapse, the higher the value of PVR > 100.

Background & aim: A vaginal septum is a condition in which the wall of the tissue dividing vagina does not resolve completely. This complication can be transverse and longitudinal. Although the occurrence of a transverse vaginal septum is 2 per 100,000 births, the exact etiology of this anomaly remains still unidentified. In this study, a case of high transverse vaginal septum with vaginal and cervical agenesis is reported.Case report: A 13-year-old single and virgin girl presented with cyclic abdominal pain. On examination and magnetic resonance imaging, vaginal and cervical agenesis was diagnosed. Surgical therapy included an incision in the lower part of the uterus at the site of the bulging and the use of a hysterometer passing down the uterus. The cervix was not touched, cervical agenesis was diagnosed, and the patient underwent abdominal hysterectomy and bilateral tubal salpingectomy. The pathological results confirmed the cervical agenesis.Conclusion: It is recommended that in patients with high transverse vaginal septum, hysterectomy be performed for the treatment of cervical and vaginal agenesis. However, it may not be a suitable treatment choice for some cases, and it is better to decide based on the patient's condition.

Objective: Pericervical ring reconstruction through restoration of pubocervical and rectovaginal fascia is performed concomitantly with sacrospinous hysteropexy as a transvaginal native tissue procedure for vaginal apical prolapse.The main goal of this study was to assess subjective and objective outcomes of sacrospinous hysteropexy and additional pericervical ring reconstruction. Materials and methods: We conducted a prospective and observational study. All participants underwent sacrospinous hysteropexy and pericervical ring reconstruction and perineorrhaphy. Surgical complications, anatomical and functional efficacy were assessed. Results: 108 cases were included in this study. The mean follow-up timeframe was 18.62 ± 1.22 months (minimum 12 and maximum 26 months). All parameters of subjective outcomes were improved significantly. The overall anatomic success rate was 92.59%. Mean operation time was 50.64 ± 20.8 min. No major intraoperative or postoperative complications were found. There was no statistically significant difference in demographic characteristics including age, BMI, gravidity, medical comorbidities, menopausal status, sexual activity, pretreatment prolapse severity scores between subjects with failure, and good anatomical outcome. Recurrence was mostly observed in patients with higher prolapse stages of anterior and apical compartments. Baseline POP-Q parameters Ba, C, D were significantly higher in cases with failure. Conclusion: Our study disclosed sustainable anatomic and subjective outcomes of modified sacrospinous hysteropexy by means of additional pericervical ring reconstruction.

Introduction: Pelvic organ prolapse (POP) is the descent of pelvic organs beyond the vaginal walls which is associated with bothersome urinary, defecatory, sexual and vaginal mass protrusion symptoms. The present study was performed aimed to investigate the correlation of the symptoms and POP-Q stage. Methods: This cross-sectional study was performed on 335 women with pop symptoms referred to the pelvic floor clinic of Tehran Imam Khomeini hospital in 2018-2019. A checklist of detailed medical history which contains urinary, defecatory, sexual and bulging symptoms due to pelvic organ prolapse was completed by a gynecologist (fellowship of pelvic floor disorders) and the stage of POP was evaluated according to pelvic organ prolapse quantification (POPQ) system. The relationship between clinical symptoms and the stage of POP was assessed. Data were analyzed by SPSS software (version 23) and Chi-square, Fisher's exact test and multivariate regression. P0.05). There was significant correlation between vaginal noise and sexual dissatisfaction with lower stage of anterior compartment prolapse (p=0.014, p=0.025, respectively). Conclusion: Urinary symptoms especially stress and urgency urinary incontinence and sexual dissatisfaction were correlated with lower stage of POP. Also, due to the lack of relationship between defecation symptoms and prolapse stage, complaints of pelvic organ prolapse symptoms may not be related to the severity and stage of prolapse in clinical examination.

Introduction: To compare the modified McIndoe versus Davydov vaginoplasty techniques in terms of anatomical results, sexual performance, and satisfaction. Methods: From September 2019 to June 2021, a comparative study was conducted on 20 patients with MRKH syndrome who underwent either McIndoe vaginoplasty (McIndoe group, 10 cases) or Davydov vaginoplasty (Davydov group, 10 cases) in a university-based tertiary care hospital (Imam Khomeini Hospital) in terms of anatomical results, sexual performance, and satisfaction. Functional results were assessed using the Female Sexual Function Index (FSFI). Results: All surgical procedures (n = 20) were performed successfully. Patients in the modified McIndoe group were similar to those in the Davydov group in terms of hospital stay and intraoperative complications. However, postoperative complications were higher in the McIndoe group. There were no significant differences in the neovaginal length and width of the two groups at the 6-month follow-up (P > 0.05). Other parameters (duration of mold use and blood transfusion) were similar for all patients in the two groups. At 12 months after surgery, all patients had regular sexual activity. No significant differences were found in either group. Conclusions: In terms of anatomical results, sexual performance, and satisfaction, the two techniques were similar.

Background: Short children face many problems throughout their lives. Consumption of growth hormone and the drugs such as Letrozole, Oxandrolone, and Anastrozole can increase the growth of children and adolescents. There is not an overall estimate of the effects of Letrozole, Oxandrolone, and Anastrozole on the growth of children and adolescents with Idiopathic Short Stature (ISS). There are different estimates of the effect of growth hormone and the drugs Letrozole, Oxandrolone, and Anastrozole on growth in children and adolescents with Idiopathic Short Stature. Therefore, the aim of this study was to compare the efficacy of growth hormone, Letrozole, Oxandrolone, Anastrozole, and a combination of growth hormone and aromatase inhibitors on height gain in children and adolescents with idiopathic short stature using meta-analysis method. Methods: Search was done in databases such as; Scopus, Web of Science(ISI), and PubMed using keywords: Idiopathic, Short Stature, Body Height, Aromatase Inhibitors, Growth hormone, Letrozole, Oxandrolone, Anastrozole. Randomized clinical trial studies ,that have investigated the efficacy of growth hormone and aromatase inhibitors on height gain in children and adolescents with short stature, were selected. Height standard deviation score (HSDS) before intervention and after treatment has been used to measure the rate of height increase in various studies. This study was written based on the PRISMA checklist and the heterogeneity of this study was evaluated using the Q statistic and I2 index. Results: Height increase index (HSDS) was obtained with the use of growth hormone combined with one of the aromatase inhibitors (0.38-3.58=95%CI) (SMD=0.98), with the use of growth hormone (0.62-1.14=95%CI) (SMD=0.88), with the use of Letrozole (0.51-16.51=95%CI) (SMD=0.83), with the use of Oxandrolone (0.99-0.99=95%CI) (SMD=0.56), and with the use of Anastrozole (0.00-0.63=95%CI) (SMD=0.31), which shows that all these drugs have a significant effect on height increase. (P

Background: Transverse vaginal septum is a rare mullerian anomaly. Patients with a complete transverse vaginal septum generally complain of primary amenorrhea. Here, we presented a rare case of high transverse vaginal septum with abdominal mass during infancy in addition to chronic pelvic pain and cyclic hematuria during adulthood.Case presentation: The patient was a 26-year-old female with complain of severe abdominal and pelvic pain with significant weight loss. She had a history of surgery for correction of hydrometrocolpos (fluid accumulation in the uterus and vagina) because of transverse vaginal septum at infancy period. She had no gynecologic follow-up until the age of 26 years. At the last surgical evaluation, diffuse pelvic endometriosis with advanced metastatic colon cancer was noted.Conclusion: After diagnosis of transverse vaginal septum during infancy period, detailed counseling should be performed about the other treatment and follow-up which is needed to prevent severe complications that could affect the quality of life.

Introduction: Uterine prolapse has been traditionally treated with vaginal hysterectomy and cuff suspension. Recently there is renewed interest in uterine conservation during prolapse surgeries. This study was performed with aim to evaluate the success rate and quality of life in women following one of three types of uterine sparing prolapse surgery. Methods: This retrospective study was performed in Tehran Imam Khomeini Hospital in 2019. The data of 99 patients with uterine prolapse who underwent one of three types of uterine sparing surgery (Manchester, Sacrospinus Hysteropexy, Abdominal sacral Hysteropexy) during three years were reviewed and compared in terms of success rate and quality of life. 99 patients completed a valid questionnaire of quality of life after prolapse surgeries (Pelvic Floor Distress Inventory-20). The success rate after 12 months was evaluated as a primary outcome and the complications such as repeat surgery, using pessary and feeling mass were evaluated as secondary outcomes. Data were analyzed by SPSS software (version 22) and ANOVA, Kruskal-Wallis and Chi-square tests were used. P < 0.05 was considered statistically significant. Results: The success rate of sacral hysteropexy was higher than two other groups (about 94%).The highest recurrence was in sacrospinous, in the Ba point ( -2.06± 0.506) and C point (-2.1±1.084) (p

Introduction: Low knowledge of oral health in pregnant women can affect both mother and child’s health. This study was performed with aim to evaluate oral and dental health literacy and oral health behavior in pregnant women in south cities of Kerman province. Methods: This cross-sectional analytic study was done on 164 pregnant women who referred to health centers in south cities of Kerman province in 2018. Data was collected by demographic characteristic questionnaire (age, education, number of children, number of pregnancy, the economic situation) and the standard questionnaire of oral and dental health literacy )OHL-Q) (including 17 questions in four domains of hearing, comprehension, ability to read and decision -making), assessment of oral health behavior, self-report of oral and teeth health status and DMFT. Data were analyzed by SPSS software (version 21) and Chi-square and ANOVA tests. PResults: In the present study, 63 patients (43.4%) experienced the first pregnancy and most subjects 55 (33.7%) were diploma. 121 women (73.8%) had not dental examination before decision for pregnancy. The most frequent source of oral health information was dentists. Oral health literacy was insufficient in 122 (74.4%). There was significant difference between the level of oral health literacy and educational level(p=0.009),using tooth paste (p=0.005)and tooth brushing (p=0.001). Conclusion: Oral and dental health literacy in pregnant women is inadequate. Dentistry consultation and oral health education before decision for pregnancy are recommended.

Objective: Suicide is one of the most important health problems in the world. Financial, academic, social, and environmental difficulties along with genetic, physical, and mental disorders affect suicide attempts. This study aimed to find risk factors for completed suicide in Ilam province according to the suicide registry in Ilam province. Method: This was a prospective study and was performed based on suicide case registration data, pre-determined checklist data, and death registration data in Ilam province from March 2019 to September 2020. Logistic regression models and the Chi-square test were used to determine the relationship between completed suicide and its risk factors. Results: Among 1,410 attempted suicides, 66 (4.7 %) were executed. Rate of completed suicides was higher in men (6.5%) compared to women (4.5%), (p = 0.005), age groups over 65 years (P < 0.001), retirees and farmers (P = 0.009), illiterate people (P < 0.001), villagers (P = 0.02), people motivated due to physical problems (P = 0.016), suicide by physical methods (P < 0.001) and self-immolation (P < 0.001). Logistic regression showed that incidence of completed suicide was significantly higher in the age group over 65 years, illiterate people, people using physical methods, villagers, and men. Multivariate logistic regression also showed that men and individuals using physical methods of suicide were significantly more successful in suicide. Conclusion: Men, the elderly, illiterates, villagers, and people who used physical suicide methods were in high-risk groups. Despite lower prevalence of suicide, a higher rate of completed suicide was demonstrated. To decrease completed suicide rates, we must pay attention to these groups.

Background: A professional vision at education is necessary, because of the increasing development of technical education in the field of medical education. In the conventional methods, although mastering in the field and being up-to-date is necessary, today, the faculty member must be able to design and implement a group of learning experiences for the students in order to learn and to conduct valid exams. Methods: Our study was an interventional study, conducted on obstetrics and gynecology residents of the 3rd and 4th year at Tehran University of Medical Sciences in March, 2016. The number of participants was 66. The data collection was performed by a questionnaire. The included 19 questions about the anatomy of pelvic floor. At first, the questionnaires were administered to pre-test students to assess the amount of information before and then the theoretical and practical class about the anatomy of pelvic floor were held. At the end of classes, pre-test questionnaires were returned to residents. The responses to questions before and after the training were analyzed. Results: Our study was conducted on 66 obstetrics and gynecology residents. Of the 66 subjects, 30 were in the pre-test and 66 were in the post-test. The mean score of residences in the anatomy of the pelvic floor before intervention was 5.388±7.14 and after intervention was 12.57±2.181 (P=0.001). The difference in mean before and after education was significant at all levels of study. The general knowledge scores in the post-test, was significantly (P

Predicting survival time has many Effective implications in life quality management for the remainder of the patient's life. Also, survival data are highly variable and make accurate predictions difficult or impossible. Random Survival Forest by repeated tree construction on Bootstrap samples and averaging on the results of these trees reduce the prediction error and cause further generalization of these results. In this retrospective study, the records of 141 patients with epithelial ovarian cancer who were referred to the oncology and radiotherapy ward of Imam Hossein Hospital in Tehran from 2007 to 2018 were used. Random Survival Forest was fitted to the data to investigate the key factors affecting the first recurrence of epithelial ovarian cancer. The mean age of the patients in our study was 52 (23-82) years and the median time to the first recurrence in these was 17 (0.5-127) months, respectively. According to RSF results, using variable importance criterion (VIMP) metastatic tumor with relative importance 2.665 and also using minimal (MD) by depth 2.349, tumor stage with relative importance 1.993 and depth 2.678, and maximum platelet count with relative importance 2.132 and depth 2.683 were the most important variables affecting in the first recurrence of Epithelial Ovarian Cancer. One of the disadvantages of classical methods is the inappropriate fitting of many variables and the need for specific assumptions. More advanced methods such as RSF without the need for any specific assumptions with less prediction error can well explain event variations when exposed to high-dimensional data.

Introduction: Pelvic organ prolapse (POP) is the descend of pelvic organs including uterus, bladder, and rectum to the vaginal wall. Patients with POP may present with symptoms such as vaginal bulging with other symptoms like urinary, defecatory or sexual dysfunction. This study was conducted to evaluate the changes of POP symptoms one year after pessary fitting. Methods: Patients with symptomatic pelvic organ prolapse who presented to the pelvic floor clinic of an academic hospital between August 2016 and April 2019 were considered. Pelvic organ prolapse symptoms including urinary, defecatory, sexual and bulging symptoms were recorded before and one year after pessary fitting. pelvic floor distress inventory (PFDI)-20 and pelvic floor impact questionnaire-7 (PFIQ-7) were evaluated before and after treatment for all subjects. Results: We analyzed the characteristics of 110 patients who used the pessary for 12 months. At the baseline, the most common prolapse symptoms were vaginal bulging and pelvic pressure. All urinary, defecatory and sexual symptoms significantly improved one year after regular pessary use(P

Objective: Rapid technological advances in the last century and the large amount of information have made it difficult to analyze a large number of independent variables. In such circumstances, the existence of interactions of different degrees in the model is expected, in this case, the Cox model cannot be useful and the nonparametric method of random survival forest can be a useful alternative. This study compares the prediction error of random survival forest with Cox and Weibull models in predicting the time to the first recurrence in patients with epithelial ovarian cancer. Method: In this retrospective study, the records of patients with epithelial ovarian cancer who referred to Imam Hossein Hospital in Tehran from 2007 to 2018 were used. To investigate the factors affecting the first recurrence of these patients, RSF was fitted to the data. Finally, prediction error of Cox, Weibull and RSF were compared using C-Index and Brier score. Results: Brier score was calculated 0.16 for RSF, and 0.24 for Cox, also C-Index was calculated 0.34 for RSF and 0.42 for Cox. Brier score was calculated 0.092 for Cox and 0.089 for Weibull, so the prediction error of RSF was lower than both Cox and Weibull models. Conclusion: Random survival forest with a suitable fit on many variables and without the need for a special default with a prediction error less than the Weibull and Cox methods can predict the response variable when confronted with high-dimensional data.

Background: The Coronavirus 2019-nCOV (COVID-19) epidemic by SARS-CoV-2 is spreading worldwide, and by March 1, 2020, 67 countries, including Iran, have been affected. Many studies are being conducted at home and abroad to predict the outbreak of the disease so that they can make the necessary medical and health decisions in a timely manner. Methods: we used the SIR model to identify parameters to calculate epidemic features and some estimates of the new coronavirus. Data on the transmission of the novel coronavirus were extracted from the GitHub source in the covid19.analytics software package. Results: According to our model estimates, the rate of infection β = 1 and the rate of removal γ = 0.667 and index R0 = 1.497 were obtained. Because the value of R0 is more than one, it is still an epidemic disease. Given that tfinal~132 days was estimated, we can expect the transmission of this epidemic to stop in Iran after July 3, 2020, provided that existing quarantine measures and patient isolation rates continue as usual. In comparison with the global SIR model, we reached the peak of the infection earlierthan the global model, but in improved and susceptible cases, we performed better than the global model. The graph of recovered and susceptible cases in Iran earlier than the global model cut off themselves. Conclusion: Forecasts are set to be a useful guide for deciding whether to transfer COVID-19. According to the predictions and estimates made, more attention should be paid to control measures

Objective: The aim of this study was to evaluate the safety and efficacy of fractional CO2 laser for treatment of vulvovaginal atrophy. Materials and methods: In this clinical trial study, we evaluated the laser effect on vulvovaginal atrophy in 47 women aged 43-80 years. Each woman was treated with fractional CO2 laser, SmartXide2V2LR, DEKA, Monalisa Touch, vaginal 360o probe and cosmetic probe. The severity of vulvovaginal atrophy symptoms was evaluated before first session of laser and every 4 weeks after laser treatment until 12 weeks. Adverse effects including pain and itching were assessed at all visits. The statistical analysis was performed using SPSS version 23. Results: The response to laser therapy for vaginal dryness was significantly (p

Division of Female Pelvic Medicine and Surgery, Department of Obstetrics and Gynecology, Emam Khomeini Hospital, Tehran University of medical sciences proposed a clinically relevant algorithm to guide appropriate decision making based on underlying risk stratification and resource utilization in order to resume elective surgeries, following COVID-19 pandemic crisis. The consequence of standardized decision-making factors and transparency of the principles will provide more assurance, consistency, and reliability on both sides, care providers and the patient. It also will decrease ethical dilemmas and moral criticism for surgeons. Eventually, this approach is applicable in any other disaster preparedness as a logical stratification of surgical indications for the female pelvic floor surgical procedures.

The current evidence regarding the association between vitamin D status and pelvic floor disorder (PFD) are inconclusive. This meta-analysis was aimed to summarize existing data demonstrating the association between Vitamin D status and PFD using published observational studies. All national and international databases including Web of Science, PubMed, Google Scholar, and Scopus were searched up until January 30, 2018, and related published studies retrieved for meta-analysis. The effect sizes of Vitamin D status were presented as standardized mean difference (SMD) with 95% confidence interval (CI), using random-effect models and inverse variance method. The Cochran Q statistic and I2 tests were used to evaluate the heterogeneity across included studies. Seven studies with 3219 women were included our meta-analysis. There was heterogeneity existing among included studies (I2 = 96.4%, P < 0.001), so a random-effect model was used. The findings of this meta-analysis revealed that the mean serum Vitamin D levels in women with PFD were significantly lower than healthy women (SMD −0.60; 95% CI, −1.06, −0.13; P = 0.01). This meta-analysis demonstrates lower levels of serum Vitamin D in women with PFD rather than healthy women. Additional prospective studies regarding the association between Vitamin D status and PFD are required to confirm our findings.

Objective: To report the neglected pessary in a patient with pelvic organ prolapse. Pelvic organ prolapse (POP) is one of the most important medical challenges in women especially elderly. One of the conservative treatments of symptomatic POP is pessary placement. Case report: A 84-year-old woman, para 10 was referred to female pelvic floor clinic of an academic hospital for vaginal bleeding and neglected vaginal pessary. Vaginal examination in the pelvic floor clinic revealed an entrapped ring pessary in severely atrophic vaginal mucosa with purulent discharge. Conclusion: Although pessary is the first choice and one of the best conservative treatment for pelvic organ prolapse, it shouldn’t be used for poor cooperative patient who cannot comply with regular follow-up visits which may cause harmful complications.

Background: The differential efficacy between long GnRH agonist with antagonist can partly be due to the preexisting differences in the early antral follicles before ovarian stimulation.Objective: To compare the effect of pretreatment by estradiol with GnRH antagonist on antral follicular size coordination and basal hormone levels in GNRH antagonist protocol.Materials and Methods: On cycle day 3 (control/day 3), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones then were randomized to receive oral estradiol 4mg/day (n=15) or 3mg cetrorelix acetate (n=15) in luteal phase before subsequent antagonist protocol. Participants were re-evaluated as on control/day 3.Results: There was a significant reduction of mean follicular sizes in each group after medical intervention (7.63±2.11 Vs. 4.30±0.92 in group A and 8.73±1.96 Vs. 4.13±1.11 in group B) (p=0.0001). The magnitude of follicular size reduction was significantly higher in group B (-4.60±2.04 Vs. -3.33±2.28) (0.027). There was a non significant attenuation of follicular size discrepancies in two groups. FSH and inhibin B levels in the day 3 of the next cycle in both groups were significantly decreased but did not have significant difference between two groups.Conclusion: Both luteal E2 and premenstrual GnRH antagonist administration reduces the follicular sizes significantly and GnRH antagonist acts more potently than E2 in this way but attenuation of follicular size discrepancies in both treatment is not significant

Objective: The aim of this study was to compare the effects of the transverse muscle-cutting Maylard incision and the Pfannenstiel incision for hysterectomies, in terms of postoperative complications, pain, and quality of life. Materials and Methods: This randomized, double-blind study compared two laparotomy techniques. All hysterectomies were performed for benign conditions. Eighty cases were randomly assigned to receive either Pfannenstiel or Maylard incisions. Measured intraoperative variables included volume of blood loss and duration of surgery. Postoperative variables included abdominal distension, postoperative pain, and quality of life. Results: Postoperative abdominal distension was significantly lower in the Maylard group (p = 0.004). There were no differences in intraoperative characteristics and duration of hospitalization, hemorrhage volume, or duration of surgery between the two groups. Conclusion: Hysterectomy performed via the Maylard incision was associated with the use of fewer additional analgesics than hysterectomy performed via the Pfannenstiel incision.

Background & Objective: Overactive bladder (OAB) is a syndrome that has serious adverse effects on daily activities and therefore causes many economic burden and psychological consequences. The present study was conducted with aim to determine if there are differences between clinical symptoms and detrusor overactivity (DO) in patients with overactive bladder syndrome (OAB). Materials & Methods: This cross-sectional study was conducted on women with symptoms of overactive bladder referred to the urodynamic unit of pelvic floor clinic of Vali-E-Asr Reproductive Health Research Center between February 2018 and December 2022. Patients were divided into two groups with DO (DO group) and without DO (NDO group) based on urodynamic findings and then compared in terms of demographic characteristics and urodynamic variables in filling and voiding phase. Results: Among the 125 analyzed patients, DO was diagnosed in 36 patients (28%). DO group had older age (P=0.02), a greater number of menopause (P=0.03) and more disturbing urinary condition in the questionnaire (ICIQ-OAB) (P=0.02). Conclusion: As the results of this study showed, nearly one-third of OAB patients had DO. The presence of DO is associated with older age and has a greater effect on the quality of life. Also, they had lower first desire and maximal capacity in urodynamic study. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the quality of life, pelvic discomfort, and sexual function of patients who underwent posterior pericervical repair or level I to III surgical procedures for pelvic organ prolapse (POP) after 5 years of follow-up. This retrospective cohort study enrolled 107 women with POP who were referred to the Imam Khomeini Hospital Complex, an academic center affiliated with the Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2021. The patients underwent transvaginal surgery using native tissue, in which the rectovaginal fascia was attached to the pericervical ring. The Pelvic Floor Distress Inventory-20 (PFDI-20) and Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) questionnaires were completed by each patient before and 5 years after surgery. Of the 107 patients, only 78 completed the 5-year follow-up. The mean PFDI-20 scores before, 12 months, and 5 years after surgery were 141.87 ± 34.48, 100.87 ± 26.48, and 37.49 ± 56.39, respectively, indicating a significant improvement in the patients' symptoms after surgery (P < 0.001). The total mean score of ICIQ-FLUTSsex was 3.67 ± 3.63 (range, 0-10). In total, 22 (28.2%) women had an ICIQ-FLUTSsex score of 0, indicating no problems. The attachment of the rectovaginal fascia to the pericervical rings can be an effective surgical technique for correcting posterior vaginal wall prolapses, without significant morbidity. The PFDI-20 score improved significantly from before surgery to 12 months and 5 years after surgery. [ABSTRACT FROM AUTHOR]

Background & Objective: Defecatory dysfunction is a common problem among women who are referred for urogynecological care. Pelvic organs prolapse (POP) which is a downward displacement of pelvic organs is one of the common conditions among patients with defecatory problems. This study was planned to evaluate the correlation of obstructive defecatory symptoms with the site and severity of pelvic organ prolapse and the anorectal manometry results. Materials & Methods: This cross-sectional study was performed between Dec 2018 and Nov 2019. A total of 150 women with symptoms of defecatory problems were enrolled. Patients were classified in two groups according to each compartment prolapse staging and severity: stage =2 and stage >2. The correlation between defecatory symptoms and pelvic organ prolapse examination, anorectal examination and anal manometry were evaluated. Results: A total of 150 women were evaluated. There was a significant correlation between higher stage of anterior compartment prolapse (cystocele stage>2) and constipation (P=0.035). Although all the defecatory symptoms were more frequent in anterior prolapse stage>2, but the difference was not significant (P>0.05). There was no significant correlation between defecatory symptoms and severity of posterior compartment prolapse. There was a significant correlation between stage>2 of apical prolapse and all the defecatory symptoms (P=0.05). The abnormal anal resting and squeeze pressure and abnormal balloon expulsion test were more frequent in stage >2 of all compartments prolapse, but the difference was not significant (P>0.05). Conclusion: Obstructed defecation syndrome was more frequent in patients with higher stages of anterior and apical prolapse. Abnormal manometry results were more frequent in patients with defecatory dysfunction with advanced vaginal prolapse. [ABSTRACT FROM AUTHOR]

Introduction: Genitourinary syndrome of menopause (GSM) is a common complication secondary to estrogen depletion which leads to tissue changes in the female genitourinary tract. Here, we sought to investigate the short- and long-term effects of CO2 laser therapy on symptoms of GSM in postmenopausal women. Methods: In this clinical trial, 47 postmenopausal women with symptoms of GSM were included. Participants underwent vaginal and extra-vaginal CO2 fractional laser treatment in three sessions, with intervals of one month between each session. Symptom severity, including itching, dyspareunia, vaginal discharge, and dryness, was assessed at each session using a modified Vaginal Health Index (VHI), where the intensity was rated on a Visual Analog Scale (VAS) from 1 to 10 (1 indicating minimal symptoms and 10 representing maximum severity). Additionally, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was administered. Patients were followed for one to three years after the final laser treatment session. Results: The scores of all subscales, including itching, dyspareunia, urinary incontinence, vaginal discharge, and dryness, improved significantly following three sessions of CO2 fractional laser (P values < 0.001). However, except for the urinary incontinence domain (P = 0.058), none of the symptoms maintained improved after one to three years from the last intervention. Conclusion: CO2 fractional laser treatment is appropriate for treating symptoms related to GSM. But it seems that it needs to be used continuously for the maintenance effect on itching, dyspareunia, urinary incontinence, vaginal discharge, and dryness. The exact timing of laser sessions should be identified in further studies since the beneficial outcomes of the intervention seem temporary. [ABSTRACT FROM AUTHOR]

Constipation and obstructive bowel disorders are the most common symptoms of prolapse and posterior defects. Prolapse and obstructive defecation disorders are treated using various surgical techniques to repair posterior defects. This study aimed to evaluate the manometry results of patients before and after reconstructive surgery of the posterior compartment. This retrospective cohort study included 40 women with defecation disorders referred to the Imam Khomeini Hospital Complex, an academic center affiliated with Tehran University of Medical Sciences, Tehran, Iran, from 2020 to 2021. Data were collected through medical records and a checklist developed by the researcher before and after surgery. All analyses were performed using SPSS software (version 26), with significance at p<0.05. Forty women with a mean age of 49.47±9.66 years participated in this study. The manometry results showed significant differences in patients before and after surgery in parameters such as maximum resting pressure, push test, constipation, straining during defecation, finger support necessity, sensation of incomplete defecation, dyspareunia, and husband's sexual satisfaction (p<0.001). In addition, all patients had a grade 2 or higher posterior compartment prolapse, which improved in all cases after surgery (p<0.0001). Patients' symptoms significantly improved during the 12-month follow-up after DeLancey level 3 to 1 surgery. This type of surgery proved to be an effective surgical intervention without significant complications in the short-term follow-up. [ABSTRACT FROM AUTHOR]

Postoperative abscess after colpocleisis is rare. We reported a 67-year-old woman with an abscess after a month of Le Fort colpocleisis. Two abscesses of approximately 5 cm in size were drained. The injection of antibiotics continued up to 7 days after the surgery, and the drain was taken on the 4th day after the operation due to the improvement of the patient's general conditions and no discharge. It is recommended to consider pelvic abscess in patients suffering from fever, pain, pelvic pressure, and diarrhea after pelvic surgeries. Early diagnosis and treatment will reduce mortality and disability in patients. [ABSTRACT FROM AUTHOR]

Background & Objective: Pelvic organ prolapse (POP) is the herniation of the pelvic organs to or beyond the vaginal wall. Patients with POP may present with specific symptoms like vaginal bulge or pressure or associated symptoms including urinary, defecatory or sexual dysfunction, which could negatively affect the quality of life in these patients. This study aimed to assess the surgical outcomes of native-tissue apical suspension by sacrospinous ligament fixation (SSLF) versus uterosacral ligament suspension (ULS). Materials & Methods: This prospective cohort study was conducted to evaluate the outcomes of native-tissue apical suspension for pelvic organ prolapse within one year after the surgery from March 2017 to July 2019 at Imam Khomeini hospital, an academic hospital of Tehran University of Medical Sciences, Tehran, Iran. Inclusion criteria were patients with uterine prolapse at Stage 2 or 3 according to the Pelvic Organ Prolapse Quantification System (POP–Q) who planned for total vaginal hysterectomy and apical suspension using uterosacral ligament suspension (ULS) or sacrospinous ligament fixation (SSLF) with no history of pelvic organ prolapse surgery. The main outcome was surgical consequences within 1 year after surgery. Results: There was no significant difference between the two groups in terms of relapse of anterior, posterior, or apical compartment prolapse. According to the clinical recurrence, although vaginal bulging and pressure were more common in sacrospinous ligament fixation (SSLF) group, the difference was not significant. The number of patients with severe buttock and pelvic pain was significantly higher in the sacrospinous ligament fixation (SSLF) group. Conclusion: sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are both optimal procedures with the same complications and similar surgical outcomes; however, uterosacral ligament suspension (ULS) had lower post-operative pelvic pain, and also the number of retreatments was lower in this group. [ABSTRACT FROM AUTHOR]