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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 25494

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Prof. Dr. Heinz Koelbl

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Guest Editor

Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
Interests: urogynaecology; gynaecological oncology; gynaecological surgery

Dr. Barbara Bodner-Adler

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Guest Editor

Department of General Gynecology and Gynecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
Interests: pelvic floor surgery; native tissue repair; basic science in urogynecology; incontinence treatment; objective outcome parameters and success definition in PFDs; risk factors for PFDs; urinary microbiota
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Special Issue Information

Dear Colleagues,

As pelvic floor disorders (PFDs) are very common, increasing with women's age, and can affect quality of life of concerned women, it is extremely important to continue and focus research on diagnosis and treatment of PDFs as well as on different risk factors.

Personalized approaches to treatment as well as the definition of various risk factors for PFDs such as pelvic organ prolapse or urinary incontinence over the last few decades have led to a significant improvements in treatment and preventive strategies in this group of patients. The aim of this Special Issue With the title “Clinical Research on Urogynecology” is to collect and publish original articles as well as reviews demonstrating advances in the diagnostic and therapeutic field of urogynecology.

Better understanding in this field could also help the clinician to better counsel and guide the patient to the right individual treatment decision.

Prof. Heinz Koelbl
Prof. Barbara Bodner-Adler
Guest Editors

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Keywords

pelvic organ prolapse
Urinary incontinence
conservative treatment
surgical procedures including mesh material
preventive strategy
quality of life

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Published Papers (10 papers)

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Research

12 pages, 632 KiB

Open AccessArticle

Assessment of the Effectiveness of the Sonofeedback Method in the Treatment of Stress Urinary Incontinence in Women—Preliminary Report

by Gabriela Kołodyńska, Maciej Zalewski, Anna Mucha and Waldemar Andrzejewski

J. Clin. Med. 2022, 11(3), 659; https://doi.org/10.3390/jcm11030659 - 27 Jan 2022

Viewed by 1841

Abstract

Urinary incontinence is a common problem that affects postmenopausal women. This ailment has a negative impact on many aspects of life, significantly limiting everyday functioning related to professional work, physical activity or the intimate sphere. The aim of the study was to assess the effectiveness of the sonofeedback method in reducing the severity of urinary incontinence in postmenopausal women with a urinary incontinence problem. A total of 60 patients aged 45–65 with stress urinary incontinence, confirmed by a gynecologist, were qualified for the study. All persons qualified for the study were randomly assigned to study group A (n = 20), comparative B (n = 20) and control C (n = 20). Patients from group A were treated with sonofeedback of the pelvic floor muscles. In group B, the combined electrostimulation method was used with biofeedback training. Group C was a control group in which only the measured parameters were measured at the same time interval as those carried out in groups A and B. In all patients, three times: before the therapy, after the fifth procedure and after the end of the therapy, the incidence and severity of stress urinary incontinence were assessed—Gaudenz questionnaire and the intensity of urinary incontinence—a modified 1 h pad test. The obtained results have an application value giving the possibility of using effective therapy with sonofeedback in women in whom the recommended electrostimulation method cannot be used due to health and behavioral reasons. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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11 pages, 253 KiB

Open AccessArticle

Sociodemographic Disparities and Parity in Relation to Urinary Incontinence: A Nationwide Primary Healthcare Cohort Study (1997–2018)

by Christoffer Sundqvist, Xinjun Li, Kristina Sundquist and Filip Jansåker

J. Clin. Med. 2022, 11(3), 496; https://doi.org/10.3390/jcm11030496 - 19 Jan 2022

Cited by 3 | Viewed by 1584

Abstract

Objectives: Urinary incontinence (UI) is a very common condition in the primary healthcare settings. Few studies have investigated whether sociodemographic factors are related to UI. This nationwide study aimed to investigate whether there is a relationship between sociodemographic factors and UI in women. Methods: A nationwide open cohort study included 2,044,065 women aged 15–50 years. Several national population-based (Sweden) databases including nationwide primary healthcare data were used. The outcome was the time to the first event of any UI diagnosis during the study period (1997–2018). Cox regression models were used to test for associations between individual sociodemographic factors and UI. Results: The study identified 44,250 UI events. These corresponded to 2.16% of the study population and an incidence rate (IR) per 1000 person-years of 1.85 (95% CI 1.84–1.87). In the fully adjusted model, a high age, low education level, and being born outside of Sweden were independently associated with a higher UI risk, while rural living was associated with a lower risk. The income level did not seem to have a large impact. Most notably, women born in the Middle East/North Africa and Latin America/Caribbean had a substantially higher risk of UI with HRs of 2.41 (95% CI 2.33–2.49) and 2.30 (95% CI 2.17–2.43), respectively. Parity was strongly and independently associated with UI. Conclusion: This study presents novel risk factors associated with UI. The findings provide new knowledge concerning the burden of this disease among women, which could be used to provide more equal healthcare for these patients in the future. Previous research allied with these findings suggests using a comprehensive approach targeting health disparities. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

11 pages, 1048 KiB

Open AccessArticle

Bladder Base Displacement during Abdominal Muscles Contraction and Functional Activities in Primiparous Women Assessed by Transabdominal Ultrasound: A Descriptive Study

by Beatriz Arranz-Martín, Patricia García-Gallego, Helena Romay-Barrero, Beatriz Navarro-Brazález, Carlos Martínez-Torres and María Torres-Lacomba

J. Clin. Med. 2022, 11(1), 25; https://doi.org/10.3390/jcm11010025 - 22 Dec 2021

Cited by 4 | Viewed by 3000

Abstract

This study described the response of the bladder base (BB) by transabdominal ultrasound in primiparous women during movements that activate the abdominopelvic cavity musculature and cause variations in intra-abdominal pressure (IAP). A descriptive cross-sectional study was conducted in 64 primiparous women at eight weeks after uncomplicated delivery. BB displacement was measured using a 5-MHz convex transducer in a suprapubic position. Participants were asked to perform the isolated contraction of pelvic floor musculature (PFM) and transverse abdominis (TrA), cough at high lung volume and trunk flexion with and without maximal voluntary contraction of PFM. PFM contraction elevated the BB in all but one participant, whereas TrA contraction caused the BB to ascend in 56% of the women and descend in the rest; their combined contraction rose the BB in 65% of the women although the effect was greater with only PFM contraction (p < 0.01). The BB descended in all participants during coughing and trunk flexion although the descent was inferior with the joint maximal voluntary contraction of PFM (p < 0.01). In conclusion, TrA contraction must be assessed individually in puerperal women since its effect on the BB varies among subjects. During movements increasing IAP, such as coughing or curl-ups, the anticipatory contraction of PFM reduces bladder descent although not sufficiently to counteract bladder displacement. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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10 pages, 379 KiB

Open AccessArticle

Association of Interstitial Cystitis/Bladder Pain Syndrome with Stress-Related Diseases: A Nationwide Population-Based Study

by Min-Hsin Yang, Jing-Yang Huang, Sung-Lang Chen and James Cheng-Chung Wei

J. Clin. Med. 2021, 10(23), 5669; https://doi.org/10.3390/jcm10235669 - 30 Nov 2021

Cited by 5 | Viewed by 3014

Abstract

Background: Stress-related diseases (SRDs) are adjustment disorders triggered by stressful life changes. There is a growing body of evidence showing that stress plays an important role in the pathophysiology of IC/BPS. In the present study, we investigated the association between SRDs and a subsequent association of interstitial cystitis/bladder pain syndrome (IC/BPS). Methods: We performed a nested case-control study from the Longitudinal Health Insurance Database (LHID) of Taiwan. The two-year time-varying association between SRDs and IC/BPS was explored to distinguish the short- or long-term effects of these factors. We then conducted multiple conditional logistic regressions to evaluate the adjusted odds ratio (OR) of IC/BPS in patients with a history of SRDs. Results: A total of 1103 IC/BPS patients and 4412 non-IC/BPS patients were analyzed. For all SRDs, the significantly increased risks were obtained in 2 years before IC/BPS diagnosis, and the higher OR was observed within 3 months before the diagnosis of IC/BPS. Multiple conditional logistic regressions showed that patients who had prior medical care for urinary tract infection (OR = 10.95, 95% CI = 9.07 to 13.22), chronic obstructive pulmonary disease (OR = 1.48, 95% CI = 1.13 to 1.93), peptic ulcer (OR = 1.69, 95% CI = 1.37 to 2.09), inflammatory bowel syndrome (OR = 1.66, 95% CI = 1.21 to 2.29), autoimmune diseases (OR = 1.48, 95% CI = 1.11 to 1.97), depression (OR = 1.54, 95% CI = 1.24 to 1.91), sleep disorders (OR = 1.45, 95% CI = 1.19 to 1.78), and allergic rhinitis (OR = 1.29, 95% CI = 1.03 to 1.62) within 2 years had a significant risk of IC/BPS. Conclusions: Our study demonstrates that the health care for SRDs within the previous 2 years is associated with an increased risk of subsequent IC/BPS. The time-varying association provides an important insight that helps us to identify cases with IC/BPS, especially among patients with repeated UTI visits. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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11 pages, 455 KiB

Open AccessArticle

Surgical Assessment of Tissue Quality during Pelvic Organ Prolapse Repair in Postmenopausal Women Pre-Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked, Placebo-Controlled, Multicenter Trial

by Marie-Louise Marschalek, Klaus Bodner, Oliver Kimberger, Raffaela Morgenbesser, Wolf Dietrich, Christian Obruca, Heinrich Husslein, Wolfgang Umek, Heinz Kölbl and Barbara Bodner-Adler

J. Clin. Med. 2021, 10(11), 2531; https://doi.org/10.3390/jcm10112531 - 7 Jun 2021

Cited by 3 | Viewed by 2136

Abstract

The aim of this prospective randomized, double-masked, placebo-controlled, multicenter study was to analyze the surgeon’s individual assessment of tissue quality during pelvic floor surgery in postmenopausal women pre-treated with local estrogen therapy (LET) or placebo cream. Secondary outcomes included intraoperative and early postoperative course of the two study groups. Surgeons, blinded to patient’s preoperative treatment, completed an 8-item questionnaire after each prolapse surgery to assess tissue quality as well as surgical conditions. Our hypothesis was that there is no significant difference in individual surgical assessment of tissue quality between local estrogen or placebo pre-treatment. Multivariate logistic regression analysis was performed to identify independent risk factors for intra- or early postoperative complications. Out of 120 randomized women, 103 (86%) remained for final analysis. Surgeons assessed the tissue quality similarity in cases with or without LET, representing no statistically significant differences concerning tissue perfusion, tissue atrophy, tissue consistency, difficulty of dissection and regular pelvic anatomy. Regarding pre-treatment, the rating of the surgeon correlated significantly with LET (r = 0.043), meaning a correct assumption of the surgeon. Operative time, intraoperative blood loss, occurrence of intraoperative complications, total length of stay, frequent use of analgesics and rate of readmission did not significantly differ between LET and placebo pre-treatment. The rate of defined postoperative complications and use of antibiotics was significantly more frequent in patients without LET (p = 0.045 and p = 0.003). Tissue quality was similarly assessed in cases with or without local estrogen pre-treatment, but it seems that LET prior to prolapse surgery may improve vaginal health as well as tissue-healing processes, protecting these patients from early postoperative complications. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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10 pages, 876 KiB

Open AccessArticle

Characteristics of the Urinary Proteome in Women with Overactive Bladder Syndrome: A Case-Control Study

by Marianne Koch, Pavel Lyatoshinsky, Goran Mitulovic, Barbara Bodner-Adler, Sören Lange, Engelbert Hanzal and Wolfgang Umek

J. Clin. Med. 2021, 10(11), 2446; https://doi.org/10.3390/jcm10112446 - 31 May 2021

Cited by 2 | Viewed by 2097

Abstract

Despite an estimated prevalence of 13% in women, the exact etiology of non-neurogenic overactive bladder syndrome is unclear. The aim of our study was to gain a better understanding of the pathophysiology of female overactive bladder syndrome by mapping the urinary proteomic profile. We collected urine samples of 20 patients with overactive bladder syndrome and of 20 controls. We used mass spectrometric analysis for label-free quantitation, Swissprot human database for data search, Scaffold for data allocation and the Reactome Knowledgebase for final pathway enrichment analysis. We identified 1897 proteins at a false discovery rate of 1% and significance level p < 0.001. Thirty-seven significant proteins of the case group and 53 of the control group met the criteria for further pathway analysis (p < 0.0003 and Log2 (fold change) >2). Significant proteins of the overactive bladder group were, according to the 25 most relevant pathways, mainly involved in cellular response to stress and apoptosis. In the control group, significant pathways mainly concerned immunological, microbial-protective processes and tissue- elasticity processes. These findings may suggest a loss of protective factors as well as increased cellular response to stress and apoptosis in overactive bladder syndrome. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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8 pages, 720 KiB

Open AccessArticle

Wide Variation in Post-Void Residual Management after Urogynecologic Surgery: A Survey of Urogynecologists’ Practices

by Marie-Louise Marschalek, Wolfgang Umek, Heinz Koelbl, Nikolaus Veit-Rubin, Barbara Bodner-Adler and Heinrich Husslein

J. Clin. Med. 2021, 10(9), 1946; https://doi.org/10.3390/jcm10091946 - 1 May 2021

Cited by 10 | Viewed by 2236

Abstract

To date there is no standardized regimen or evidence-based practical guideline concerning post-void residual (PVR) measurement after urogynecologic surgeries. This survey aimed to evaluate current practice patterns and the approach taken among urogynecologists surrounding PVR measurement. An online survey was sent to members of several urogynecologic societies assessing pre- and postoperative management of patients undergoing urogynecologic surgery. A total of 204 urogynecologists from 21 countries participated in the survey. The vast majority of urogynecologists perform some kind of voiding trial to assess voiding function postoperatively. The cut-off values to perform catheterization, the methods of measurement, and the number of successfully passed voiding showed strong differences. Only 34.4% of the respondents consider routine PVR measurement after urogynecologic surgery to be evidence-based. PVR measurement after urogynecologic surgeries is widely performed and if pathological, it almost always provokes invasive treatment. However, there is a wide variation of implemented strategies, methods, and cut-off values. Scientific societies are challenged to devise a standardized regimen based on evidence for the management of urinary retention after urogynecologic surgery. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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7 pages, 215 KiB

Open AccessArticle

Female Pelvic Floor Dysfunction Continues to Negatively Impact Quality-of-Life during the COVID-19 Lockdown

by Greta Lisa Carlin, Oliver Kimberger, Raffaela Morgenbesser, Wolfgang Umek, Heinz Kölbl, Klaus Bodner and Barbara Bodner-Adler

J. Clin. Med. 2021, 10(5), 1075; https://doi.org/10.3390/jcm10051075 - 5 Mar 2021

Cited by 8 | Viewed by 2803

Abstract

The COVID-19 pandemic led to dramatical changes in elective medical care. We analysed its impact on patients with female pelvic floor dysfunction during the 6 weeks of lockdown in Austria. A cross-sectional study was conducted: All 99 women who presented at the urogynaecologic outpatient clinic of the Medical University of Vienna with pelvic organ prolapse (POP) or urinary incontinence (UI) from December 2019 up to the lockdown in March 2020 were included and contacted. 97% of these women (96 participants) agreed to participate in the survey conducted to asses pelvic floor related quality of life (QoL) through telephone- interrogation. The mean age was 59 ± 14.8 years, the POP group consisted of 42 women while the UI group included 54 women. Most participants (83% of POP and 81% of UI cases) stated that their female pelvic floor dysfunction had remained equally relevant or had become even more significant during the lockdown. Associated symptoms and psychological strain also maintained their relevance during the lockdown (UI: p = 0.229; POP: p = 0.234). Furthermore, 97% of all interviewed women indicated to be strongly willing to continue their treatment. A generalised linear model regression revealed no clinical or demographic risk factors for psychological strain during the lockdown (p > 0.05). Our results demonstrate that women’s QoL remains significantly impaired by their pelvic-floor disorders even during a worldwide crisis such as COVID-19. Therefore, elective disciplines such as urogynaecology urgently require novel and innovative strategies for continued patient care even in times of a lockdown. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

11 pages, 3985 KiB

Open AccessArticle

Laparoscopic Pectopexy—CUSUM Learning Curve and Perioperative Complications Analysis

by Paulina Szymczak, Magdalena Emilia Grzybowska, Sambor Sawicki and Dariusz Grzegorz Wydra

J. Clin. Med. 2021, 10(5), 1052; https://doi.org/10.3390/jcm10051052 - 4 Mar 2021

Cited by 15 | Viewed by 2840

Abstract

The study aimed to examine the learning curve and perioperative complications for laparoscopic pectopexy (LP). A total of 60 women with stage II–IV apical prolapse who underwent LP were dichotomized into groups: LSH(+) with concomitant laparoscopic supracervical hysterectomy (LSH), LSH(−) after previous supracervical/total hysterectomy. Operative time, estimated blood loss and hospitalization length were evaluated with cumulative sum (CUSUM) analysis and the Kwiatkowski–Phillips–Schmidt–Shin (KPSS) test, separately for two surgeons (A and B). Intraoperative and perioperative complications according to the Clavien–Dindo (C–D) classification were analyzed. Mean operative time, change in hemoglobin level, and postoperative hospital stay were 143.5 ± 23.1 min—1.5 ± 0.5g/dL and 2.5 ± 0.9 days, respectively. LSH during pectopexy was associated with longer operative time (p = 0.01) but not with higher intraoperative bleeding or prolonged hospital stay. Severe complications rate was low (1.7%) with one bowel injury in LSH(−) (C–D grade IIIb). No C–D grade II, IV and V complications were found. Conversion to open pectopexy, return to the operating room or blood transfusion were not required. The KPSS test showed that a steady operative time for Surgeon A was achieved after 28 procedures. A proficiency for laparoscopic pectopexy based on CUSUM analysis was observed after 38–40 procedures. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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9 pages, 209 KiB

Open AccessArticle

Uterus Preservation in Case of Vaginal Prolapse Surgery Acts as a Protector against Postoperative Urinary Retention

by Christine Bekos, Raffaela Morgenbesser, Heinz Kölbl, Heinrich Husslein, Wolfgang Umek, Klaus Bodner and Barbara Bodner-Adler

J. Clin. Med. 2020, 9(11), 3773; https://doi.org/10.3390/jcm9113773 - 23 Nov 2020

Cited by 4 | Viewed by 2209

Abstract

Background: The aim of this study was to identify clinical risk factors for increased post-void residual (PVR) volumes in patients undergoing vaginal prolapse surgery and to find out whether uterus preservation or prolapse hysterectomy influences the incidence of postoperative urinary retention. Methods: This retrospective study included women who presented with pelvic organ prolapse (POP) and planned prolapse surgery between January 2017 and July 2019. PVR was assessed postoperatively and increased amounts were defined as incomplete voiding with residual urine volume greater than 150 mL. Results: Increased PVR at the first postoperative day occurred in 31.8% (56/176). Body mass index (BMI) was significantly lower in patients with increased PVR after pelvic floor surgery compared to patients with normal PVR amounts (p = 0.040). Furthermore, during multiple logistic regression analysis, low BMI (p = 0.009) as well as prolapse hysterectomy (p = 0.032) turned out to be the strongest risk factors associated with increased PVR volume. Conclusion: This is the first study identifying prolapse hysterectomy as an independent risk factor for increased PVR after surgical prolapse repair. Our results might be helpful in counseling patients prior to surgery and underline the option of uterus preservation during prolapse surgery in selected cases. Full article

(This article belongs to the Special Issue Clinical Researches on Urogynaecology)

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