The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The ...terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report.
This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction.
A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible.
A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
Introduction and hypothesis
Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a ...female-specific approach and clinically based consensus report.
Methods
This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus).
Results
A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible.
Conclusions
A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
Abstract
Aim The aim of the interdisciplinary S3-guideline Perimenopause and Postmenopause – Diagnosis and Interventions is to provide help to physicians as they inform women about the physiological ...changes which occur at this stage of life and the treatment options. The guideline should serve as a basis for decisions taken during routine medical care. This short version lists the statements and recommendations given in the long version of the guideline together with the evidence levels, the level of recommendation, and the strength of consensus.
Methods The statements and recommendations are largely based on methodologically high-quality publications. The literature was evaluated by experts and mandate holders using evidence-based medicine (EbM) criteria. The search for evidence was carried out by the Essen Research Institute for Medical Management (EsFoMed). To some extent, this guideline also draws on an evaluation of the evidence used in the NICE guideline on Menopause and the S3-guidelines of the AWMF and has adapted parts of these guidelines.
Recommendations Recommendations are given for the following subjects: diagnosis and therapeutic interventions for perimenopausal and postmenopausal women, urogynecology, cardiovascular disease, osteoporosis, dementia, depression, mood swings, hormone therapy and cancer risk, as well as primary ovarian insufficiency.
Zusammenfassung
Ziel Ziel der interdisziplinären S3-Leitlinie „Peri- und Postmenopause – Diagnostik und Interventionen“ ist es, Ärzte bei der Aufklärung von Frauen über die physiologischen Veränderungen in dieser Lebensphase sowie Therapiemöglichkeiten zu unterstützen. Die Leitlinie soll eine Entscheidungsgrundlage im ärztlichen Alltag darstellen. In der vorliegenden Kurzversion werden die Statements und Empfehlungen der Langversion mit Evidenzgrad, Empfehlungsgrad und Konsensusstärke aufgeführt.
Methoden Die Statements und Empfehlungen basieren überwiegend auf methodisch hochwertigen Publikationen. Es erfolgte eine Bewertung der Literatur nach den Kriterien der evidenzbasierten Medizin (EbM) durch Experten und Mandatsträger. Die Evidenzrecherchen wurden vom Essener Forschungsinstitut für Medizinmanagement GmbH (EsFoMed) durchgeführt. Teilweise wurde auf die Evidenzbewertung der NICE-Guideline Menopause und S3-Leitlinien der AWMF im Sinne einer Leitlinienadaptation zurückgegriffen.
Empfehlungen Es werden Empfehlungen zu folgenden Themen gegeben: Diagnostik und therapeutische Interventionen bei peri- und postmenopausalen Frauen, Urogynäkologie, kardiovaskuläre Erkrankungen, Osteoporose, Demenz, Depression, Stimmungsschwankungen, Hormontherapie und Krebsrisiko sowie prämature Ovarialinsuffizienz.
Pelvic organ prolapse represents a relatively frequent diagnosis that requires attention due to its detrimental effect on quality of life. Not surprisingly, it is one of the commonest indications for ...surgery in premenopausal and postmenopausal women, often requiring a complex multidisciplinary approach. Traditional vaginal procedures are being gradually replaced by laparoscopic techniques, offering anticipated benefits in reduced recurrence and complication rates, while respecting the trend towards uterus sparing if desirable. Recently, questions about the safety of alloplastic materials used in pelvic organ prolapse surgery were raised, leading to official restrictions in their use, particularly for transvaginal application. As a result, laparoscopic procedures might appear slightly favored but caution must be taken to assure proper technique of mesh placement while maintaining high awareness of possible long-term mesh-related complications that require close surveillance. Therefore, adequate education and training becomes even more important to achieve optimal results and to avoid possible serious medico-legal charges.
Burch colposuspension is still estimated as a 'gold standard' by the Cochrane Collaboration Group in the treatment of operative stress urinary incontinence (SUI) Some urogynecologists agree with this ...statement, some argue that Burch colposuspension should no longer be used.
The aim of this study was to evaluate mid-term effects and patient's satisfaction with standardized modified colposuspension performed in one centre.
Modified colposuspension was performed after standardization by 2 trained gynaecologists in 354 women. Data collected from 227 women were added to the final analysis of mid-term results. Average time from the operation to mid-term visit was 19 months (range 9-36 months).
At mid-term visit, 86.3% of patients were cured. There was no case of post-void urine residual over 100 ml. Pain near the operated region was reported by 1 woman from agricultural region. No one reported negative impact of modified colposuspension on sexual activity or dyspareunia.
Modified colposuspension according to the E. Petri technique seems to be an operation that is safe and well-tolerated by women with preoperative stress urinary incontinence and paravaginal defect without urodynamic signs of ISD in mid-term observation.
Necrotizing fasciitis after alloplastic slings Petri, Eckhard; Alwafai, Zaher
European journal of obstetrics & gynecology and reproductive biology,
March 2019, 2019-03-00, Letnik:
234
Journal Article
There has been a trend towards increased use of synthetic meshes and abdominal procedures with decreased use of sacrospinous fixation (SSF). A Medline search was performed for the MeSH terms ...‘sacrospinous ligament’, ‘sacrospinous fixation’, ‘sacrospinous ligament suspension’ and ‘sacrospinous colpopexy’. Published papers from 1996–2010 were selected for analysis. Outcome measures were assessed in terms of efficacy, complications and quality of life after sacrospinous vaginal fixation. Studies on bilateral SSF and fixing uterus to the sacrospinous ligament, use of concomitant anti‐incontinence procedures along with SSF were not included in this review. Sacrospinous vaginal fixation provides good long‐term objective and subjective outcomes and improves quality of life of women with pelvic organ prolapse. Further, complication rates of SSF are comparable to abdominal sacrocolpopexy and are much less than transvaginal mesh procedures and SSF is a cost‐effective procedure. SSF is a time‐tested surgical procedure with a reduction in surgical extent and has a definite place in modern pelvic reconstructive surgery.
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