During the last 2 decades, ultrasonography has been proposed for the morphologic evaluation of the urethral rhabdosphincter. The aims of this study were to evaluate the feasibility of a simple ...sonographic technique for the assessment of the urethral rhabdosphincter morphology by using a 2-dimensional (2D) transvaginal transducer and to evaluate any associations between the sonographic parameters of rhabdosphincter morphology with the presence of urodynamic stress incontinence (USI).
This was a prospective study of women who underwent urodynamic studies and an introital 2D ultrasonography and divided in 2 groups based on the presence or absence of USI. Measurements included rhabdosphincter thickness at the 3-o'clock (right) and 9-o'clock (left) positions and the rhabdosphincter outer (Π) and inner circumference (π). Based on these values, the mean thickness of the rhabdosphincter (R + L / 2), the rhabdosphincter differential perimeter (Π - π), and area (A - α) were also calculated.
Statistical analysis showed that women with a rhabdosphincter area of less than 0.65 cm, mean thickness of less than 0.24 cm, and differential perimeter of less than 1.08 cm had 3.98, 5.67, and 5.41 times greater odds for USI, respectively. Receiver operating characteristic curve analysis results showed that the optimal cutoff values for the prediction of USI from rhabdosphincter thickness, differential perimeter. and surface area were 0.24 cm (79.6% sensitivity, 63.4% specificity), 1.08 cm (70.8% sensitivity and 69.1% specificity), and 0.65 cm (71.9% sensitivity, 57.1% specificity), respectively.
Introital ultrasonography with a 2D transvaginal probe allowed the visualization of the urethral rhabdosphincter morphology in greater than 90% of the cases. Sonographic measurements showed that patients with USI had a thinner urethral rhabdosphincter than did women with a normal sphincteric mechanism.
Abstract Objective To assess current preferences regarding episiotomy and management of obstetric perineal injuries used by obstetricians in Greece, and to assess the impact of evidence-based ...information on everyday practices. Methods A questionnaire survey of obstetricians regarding episiotomy use and the management of obstetric perineal injuries. Results Fifty-one percent of obstetricians reported routinely performing an episiotomy during a normal vaginal delivery in primiparous women and 89% reported performing an episiotomy during vacuum-assisted deliveries. Forty-two percent of the respondents performed lateral, 44% mediolateral, and 14% midline episiotomies. Following an obstetric anal sphincter tear, half of the respondents recommended a vaginal delivery, regardless of bowel symptoms. There was significant heterogeneity of practices regarding the repair techniques of all obstetric perineal injuries. Conclusion The majority of obstetricians prefer to perform routine mediolateral and lateral episiotomies, for both normal and operative vaginal deliveries. The adoption of evidence-based information should be implemented while considering working and cultural backgrounds.
Occult stress urinary incontinence (SUI, OSUI) is defined as the demonstration of SUI after pelvic organ prolapse (POP) reduction. The aim of this study was to evaluate the effectiveness and ...complication rates of the 1-step surgical approach for treating women with POP and OSUI.
Retrospective study of women with POP and OSUI who underwent a concomitant prolapse and midurethral sling procedure was conducted. Main outcome measures were absence of postoperative urodynamic stress incontinence (USI) and absence of postoperative SUI at 12 months. Secondary outcome measures included evaluation of objective and subjective parameters related to the lower urinary tract function and assessment of the quality of life.
Of the 244 women, 205 women (84%) attended the 12-month postoperative follow-up visit and were included in the study. Overall, 87.8% (180/205) of the patients had absence of postoperative urodynamic stress incontinence, whereas 95.1% (195/205) did not report postoperative SUI. Evaluation of parameters related to the postoperative lower urinary tract dysfunction showed that (a) 43% of women with preexisting urgency symptoms continued to have urgency, (b) 16.7% of patients presented de novo urgency, (c) de novo detrusor overactivity occurred in 9.3% of patients, and (d) 4.9% of women with preoperative obstructive voiding symptoms continued to have obstructive voiding symptoms after combined surgery. King's Health Questionnaire data analysis showed a statistically significant improvement in all domains.
This 1-step approach is both safe and effective and could be offered as a valid operative choice for those women who wish or should avoid a repeat surgical procedure for postoperative SUI.
This retrospective case-control study aimed to compare 30 versus 40 W power of CO
laser for the therapy of genitourinary syndrome of menopause (GSM). Postmenopausal women with severe intensity of ...dyspareunia and dryness were eligible to be included in this study. Primary outcomes were dyspareunia and dryness. Secondary outcomes were itching/burning, dysuria, frequency and urgency, Female Sexual Function Index (FSFI), vaginal maturation value (VMV), and Vaginal Health Index Score (VHIS). One laser therapy was applied every month for 3 months. Outcomes were evaluated at baseline and 1 month following the 3rd therapy. Fifty (25 per group) women were included in this study. In the 30-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.0 ± 1.9, 5.9 ± 2.0, 16.6 ± 6.7, 29.9 ± 13.0, and 11.0 ± 2.9, respectively (within group comparisons all p < 0.001). In the 40-W group, mean improvement of dyspareunia, dryness, itching/burning, FSFI, VMV, and VHIS was 6.1 ± 1.7, 6.5 ± 2.0, 5.2 ± 2.5, 14.8 ± 7.1, 25.0 ± 13.4, and 10.5 ± 4.1, respectively (within-group comparisons, all p ≤ 0.001). Comparison between 30 and 40 W revealed that mean improvement or presence of all GSM symptoms and clinical signs was not statistically significant different. CO
laser therapy may improve GSM symptoms and clinical signs. This improvement did not seem to associate to power of 30 or 40 W.
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