Use of Fermented Red Clover Isoflavones in the Treatment of Overactive Bladder in Postmenopausal Women: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Postmenopausal women are at risk of developing an overactive bladder (OAB). Conventional vaginal estrogen has shown promise for symptom relief. Isoflavones have proven effective as an alternative to estrogen treatment against menopause-related symptoms. However, its effect on OAB symptoms has not been studied. This study investigates if fermented red clover isoflavones reduce OAB symptoms in postmenopausal women. In this randomized, double-blinded, placebo-controlled trial, women were administered red clover extract (RCE) or a placebo twice daily for three months. Women filled out the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Urinary Incontinence Short Form (ICIQ-UI-SF), together with a fluid intake and voiding diary. A total of 33 women (16 in the RCE group and 17 in the placebo group) were included in the analysis. Baseline demographics and OAB characteristics were comparable across groups. Intake of RCE did not lead to significant relief in most urinary bladder symptom measures, although a significant reduction in the bother of urinary urgency (p = 0.033) and a tendency towards a decreased ICIQ-OAB score were observed (p = 0.056). In contrast, the placebo exhibited a significant decrease in the ICIQ-OAB score (p = 0.021) and in some diary outcomes. We found that an intake of isoflavones did not relieve OAB symptoms in postmenopausal women.

Impact on urinary incontinence after management of complications related to a retropubic midurethral sling.

INTRODUCTION AND HYPOTHESIS: The most common complications to midurethral sling (MUS) operations for stress urinary incontinence are postoperative urinary retention (POUR), vaginal MUS exposure, and urgency. They are well described but consensus regarding their management is missing. An evaluation of the treatment of POUR, exposure and urgency after the MUS procedure in our department was implemented. Incontinence status after treatment of complications was evaluated. METHODS: A review of the medical records of women undergoing MUS procedures from 1 January 2017 to 31 December 2021 (n = 329). RESULTS: A total of 279 women (85%) had no complications. Fifty women had one or more complications. Twenty-three women (7%) experienced POUR. Final treatment in 9 women was clean intermittent self-catheterization (CISC). All remained continent. Nine women had the MUS mobilized. This was successful in 8 women who remained continent. Six women had their MUS incised (one after unsuccessful mobilization). Four became incontinent again and 2 remained continent. Eight women had vaginal MUS exposure. Seven attempted recovering of the MUS. This was successful in 3 patients. The remaining had a partial MUS removal. Only 33% remained continent after removal. Ten patients developed de novo urge, but only 2 needed medication. CONCLUSIONS: Mobilization of the MUS must be considered the optimal treatment for POUR when CISC fails. It is the most effective intervention with the best effect on POUR and the lowest risk of incontinence. Concerning vaginal exposure, a trial of recovering should be attempted as the risk of incontinence when undergoing a partial removal of the MUS is considerable.

Does treatment of lichen sclerosus improve overactive bladder symptoms?

INTRODUCTION AND HYPOTHESIS: Lichen sclerosus (LS) is a chronic disease which mainly affects the vulvar area in women. A few studies have shown a possible relationship between LS and overactive bladder (OAB) symptoms, but no studies have investigated whether OAB symptoms improve after initiating treatment of LS. The aim of this study was to investigate whether the treatment of LS also improves OAB symptoms in women newly diagnosed with LS. METHODS: This was a prospective cohort pilot study based on questionnaires from women newly diagnosed with LS and with symptoms of OAB. Women above the age of 18 who were newly diagnosed with LS were included. The women completed two questionnaires on OAB at inclusion and after 3 months. The questionnaires consisted of the validated questionnaires OAB-q (33 questions, maximum score 198) and ICIQ-OAB (8 questions, maximum score 56). All women initiated treatment with local steroid by the time of the LS diagnosis. RESULTS: A total of 40 women were included, and 13 women dropped out during the data collection time. Comparing month 0 to month 3 for the remaining 27 women, a mean difference at 28.8 points was observed for OAB-q and a mean difference of 5.7 points was observed for ICIQ-OAB. Both results showed a statistically significant difference after 3 months (p < 0.05). A total of 92.6% (25/27) of the women improved their symptoms. CONCLUSION: Treatment with local steroid might improve OAB symptoms in women newly diagnosed with LS.

Treatment of stress urinary incontinence with polyacrylamide hydrogel in an office setting: patient perspectives.

INTRODUCTION AND HYPOTHESIS: The office setting provides the opportunity for surgeons to perform specific procedures more efficiently than in a day case operating theater. Consequently, health care systems are interested in altering surgical services from a day case operating theater to an office setting. The impact on patient's satisfaction is more challenging to estimate. The bulking procedure is an intervention for urinary stress incontinence. It was originally performed in the day case operating theater under general anesthesia or sedation. Today, the procedure is mostly done under local anesthesia. The aim of this study was to assess patient satisfaction changing from day case operating theater to office setting. Our hypothesis was that patients preferred the office setting. METHODS: A prospective cohort study was executed from 15 September 2020 to 1 June 2021. A total of 115 women underwent a bulking procedure in the office setting. A follow-up (phone questionnaire) 3 months post-operatively for quality assurance is mandatory. The office setting experience was assessed concurrently. RESULTS: A total of 95.6% (110 out of 115) preferred the bulking procedure performed in the office setting. The reasons were: a short waiting time (71 out of 110; 64.5%), less nervousness (47 out of 110; 42.7%), and they felt more secure (49 out of 110; 44.5%). On a visual analog scale (VAS) from 0 to 10, 37.4% (43 out of 115) considered a short waiting time important (VAS 10) and 81.7% (94 out of 115) rated a short waiting time ≥ VAS 5. CONCLUSIONS: The office setting provides a patient-friendly and comfortable place for the bulking procedure and is generally preferred by the patient over the day case operating theater. Important for the preference is the accessibility and minimal waiting time. The office setting is therefore both convenient and efficient for surgeon and patient.

Same-day surgery for pelvic organ prolapse and hospital contact within 30 days.

INTRODUCTION AND HYPOTHESIS: The practice of same-day surgery among urogynecologic surgeons is increasing worldwide, but the percentage fluctuates among nations. Our primary aim was to investigate the feasibility of same-day surgery for pelvic organ prolapse (POP) using native tissue repair and the reasons why same-day surgery was not possible. Secondarily, we aimed to investigate the cause of hospital contact within 30 days post surgery. METHODS: This is a case-control study including 803 women who underwent POP surgery performed by vaginal approach intended as same-day surgery during a 3-year period. No patients were excluded. Patients were divided into two groups: successful same-day surgery (SDSS) and same-day surgery failure (SDSF). RESULTS: Same-day surgery was performed successfully in 90.7% of the cases. Postoperative complications were the main cause of SDSF (76.0%), and most were caused by voiding dysfunction (VD) (42.7%). Patients receiving surgery in the apical compartment and/or surgery involving two compartments, receiving general anesthesia or having comorbidities equivalent to ASA score 3 had a greater tendency not to be able to complete same-day surgery. Regarding telephone contact with the hospital, the SDSS group was significantly less likely to call compared to the SDSF group (11.3% versus 26.7%) (p < 0.01) and the same regarding physical attendance in the department (8.9% and 24.0%) (p < 0.01). Only five patients were re-operated within 30 days because of bleeding. CONCLUSIONS: This study demonstrates that same-day surgery for POP has high feasibility and is safe. Complications, hospitalizations and reoperations immediately after surgery and within 30 days were found to be minimal.

Patient goals after operation in the posterior vaginal compartment.

OBJECTIVE: Success after operation for a pelvic organ prolapse in the posterior vaginal compartment is often related to restoration of anatomy, but success for the patient is linked to achievement of patient-reported goals. We investigated patient-reported goals after an operation in the posterior compartment and to which extent the goals had been achieved. STUDY DESIGN: A prospective case series study including 87 women undergoing operation in the posterior compartment at Aalborg University Hospital. The women were asked to list up to three goals they wished to fulfil with the operation. Three months after surgery a telephone interview was conducted in which the women were asked whether each single goal was fulfilled, partly fulfilled or not fulfilled and to estimate the extent to which the goals had been achieved on a VAS scale from 1 to 10. RESULTS: All patient-reported goals were divided into eight groups: 1: bulging, 2: bowel problems, 3: urinary problems, 4: sexual problems, 5: psychological problems, 6: physical activity, 7: pain and 8: others. A total of 233 goals were stated. Most goals were related to bowel problems (37.3%) and bulging (21.0%). Median total VAS score was 9. Overall 58.8% of all goals were categorized as fulfilled and 22.3% as partly fulfilled. Fulfilled goals were 83.7% in the group with bulging problems, sexuality problems 65%, and bowel problems 57.5%. Urinary problems had fewest fulfilled goals (18.5%). Bowel problems were further divided into evacuation problems, incontinence, constipation and others. Goals concerning evacuation problems were most often fulfilled (76.1%), and goals concerning anal incontinence were rarely fulfilled (25.0%). CONCLUSIONS: Approximately 80% of the patient-reported goals after posterior compartment operation were fulfilled or partly fulfilled. Most goals were related to bowel problems and bulging. Bowel problems in the form of evacuation problems were more often solved than incontinence and constipation, and women should be advised about this. All goals should be discussed with the patient prior to an operation.

Follow-up of patients after colpectomy or Le Fort colpocleisis: Single center experience.

OBJECTIVE: As the population ages, obliterative procedures (OP) are expected to become an increasingly important treatment option. The primary aim of this study was to evaluate vaginal and urinary symptoms 3 months after OP and peri- and postoperative complications. The secondary aim was to investigate long-term outcomes, including patient satisfaction, regret rate and the rate of symptomatic recurrent prolapse after OP. Another secondary aim was to evaluate the feasibility of performing OP under local anesthesia (LA) as increasingly more operations are performed under LA. STUDY DESIGN: Retrospective study of 43 women who underwent OP during a 10-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery, 3 months postoperatively and at long-term follow-up. Records were reviewed for complications, use of anesthetics, recurrences, patient satisfaction and regret. RESULTS: A Le Fort colpocleisis was performed in 31 (72 %) and a colpectomy in 12 (28 %) patients. At 3 months` follow-up, patients had a statistically significant improvement in vaginal symptoms. Twelve patients (46 %) became continent, compared with 14 (54 %) with remaining urinary incontinence (UI). There were no patients with de novo UI 3 months' after surgery. Total complication rate was 4,6% (2/43). A symptomatic recurrent prolapse occurred in 4 patients (9.3 %). The satisfaction rate was 86 %. No patients reported regret choosing to have vaginal closure surgery. Twenty one (49 %) of the procedures were performed under local anesthesia with intravenous sedation. CONCLUSION: Obliterative procedures are good surgical options for elderly women with a positive impact on vaginal and urinary symptoms, low complication and recurrence rate. Patients report high satisfaction and no regret over loss of sexual ability at longterm follow-up. OP under LA with intravenous sedation is a feasible and safe option.

Pre- and postmenopausal women have different core urinary microbiota.

Recent studies suggest that alterations in the female urinary microbiota is associated to development of bladder disease. However, the normal microbiota composition and variation in healthy women are poorly described. Moreover, the effects of hormonal changes on microbiota during menopause is not well understood. The aim of our study was to investigate the urinary microbiota in healthy pre- and postmenopausal women without urinary tract symptoms. Microbiota composition in catheterized urine samples was mapped using 16S rRNA gene sequencing. In total, 41 premenopausal and 42 postmenopausal women were initially included. Samples with first PCR amplification concentration below level of the negative control were excluded, resulting in 34 premenopausal and 20 postmenopausal women included in data analysis. Urine from postmenopausal women showed significantly higher alpha diversity compared to premenopausal women. Lactobacillus was the most abundant bacteria in both groups, however the relative abundance of Lactobacillus accounted for 77.8% in premenopausal versus 42.0% in postmenopausal women. In conclusion, urine from premenopausal mostly presented with Lactobacillus dominated urotypes, whereas urine from postmenopausal women presented a more diverse urinary microbiota with higher abundance of the genera Gardnerella and Prevotella. The clinical and pathophysiological implications of this difference remain to be elucidated.

TVT or TVT-O? - A systematic review and meta-analysis comparing efficacy, complications and re-operations.

OBJECTIVES: To compare the efficacy, complications and re-operations after bottom-up tension-free vaginal tape (TVT) and inside-out tension-free vaginal tape - obturator (TVT-O) in the treatment of stress urinary incontinence (SUI) in adult women. STUDY DESIGN: A systematic literature search and review was performed limited to randomized controlled trials. We searched Medline, Embase, Cochrane Library, Cinahl, Guideline International network (GIN), Trip Database and NICE (UK). The certainty in the estimates of the included outcomes was rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method. RESULTS AND CONCLUSIONS: We included 22 randomized controlled trials. The overall certainty in the evidence was moderate across all outcomes. TVT and TVT-O significantly improved the incontinence regarding number of incontinence episodes, subjective patient reported effect and incontinence related quality of life, and there was no difference between TVT and TVT-O. Leg or groin pain was significantly less common 6 months after TVT than TVT-O with RR 0.27 (CI 95 % 0.11 - 0.66), 9 studies, n = 1312. In absolute numbers 83 patients more developed chronic leg or groin pain per 1000 operations with TVT-O compared to TVT. We found no statistically significant differences between chronic pelvic or lower abdominal pain 6 months after TVT and TVT-O. Bladder perforations were significantly more common after TVT with RR 4.53 (CI 95 % 2.32-8.86), 21 studies, n = 3308. In absolute numbers this meant 5 more bladder perforations after TVT per 1000 operations. No statistically significant differences were noted in de novo urgency, re-operations, infection, hematoma, pain during sexual intercourse or sexual function. Bottom-up TVT and inside-out TVT-O showed equal efficacy, but leg and groin pain were much more common with TVT-O. The authors would recommend TVT instead of TVT-O as first line operation in patients who need surgery for SUI.

Complications and re-operations after tension-free vaginal tape operation in women with stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: We evaluate intraoperative and short-term postoperative (≤ 3 months) complications and long-term re-operations (up to 6 years) after tension-free vaginal tape (TVT) operation in women with stress urinary incontinence (SUI). METHODS: Data from 446 women undergoing TVT operation between 2012 and 2016 at a tertiary referral center was retrospectively collected. Data included patient baseline demographics, information from the TVT operation and the following postoperative period, and scores from patient questionnaires [the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Patient Global Impression of Improvement (PGI-I)]. Collected data were investigated for incidence of complications and re-operations, postoperative improvement in patient questionnaires, and association between complications and baseline patient demographics. RESULTS: The only intraoperative complication was bladder perforation (2.0%). Postoperative complications included: infection (0.7%), hematoma (0.9%), bleeding (0.2%), pain (0.9%), erosion of the vaginal mucosa (1.1%), persistent SUI (0.7%), and voiding dysfunction > 24 h (10.3%). Re-operations included: operation due to infections (0.4%), incontinence surgery for persistent SUI (0.4%), revision for tape erosion (1.1%), tape mobilization (3.6%), and tape division (0.2%). A significant reduction in urinary incontinence symptoms was observed in the ICIQ-UI SF and PGI-I. The reduction in ICIQ-UI SF did not vary significantly between patients with and without complications. No association between complications and baseline patient demographics was found. CONCLUSION: This study demonstrated high safety and efficacy of the TVT operation with only minor short-term complications and few long-term re-operations. The ICIQ-UI SF improved significantly postoperatively and was not statistically significantly affected by the occurrence of complications.

Acute colonic pseudo-obstruction after cesarean section and gastrointestinal symptoms⋆.

OBJECTIVE: To investigate whether women who developed acute colonic pseudo-obstruction (ACPO) after cesarean section have a higher degree of gastro-intestinal symptoms than women who did not develop ACPO after cesarean section. ACPO is a colonic dilatation without mechanical obstruction, and with an unknown pathophysiology. In younger people it is mostly seen in women after cesarean section. The hypothesis of the present study is that long-term consequences of gastrointestinal symptoms evolve after ACPO, due to the impact on the colon. STUDY DESIGN: 40 women who developed ACPO after cesarean section (cases) and 80 women, who did not develop ACPO after cesarean section (controls), were asked to participate in the study. The controls were matched based on time of cesarean section (± 14 days), age (±5 years), singleton or twin, parity, cesarean section grade, and ASA-group. Baseline characteristics and information regarding the cesarean section were collected from medical records. An electronic collection of surveys was distributed to the participants, including the following: Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS), Rome IV, Gastrointestinal Symptoms Rating Scale (GSRS), Visceral Sensitivity Index (VSI), Patient Health Questionnaire 15 (PHQ15), The MOS 36-item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The score from IBS-SSS after cesarean section was used as the primary outcome. RESULTS: 25 cases and 37 controls participated in the study. A difference in blood loss was found with a median of 600 mL in cases, compared to 400 mL in controls during cesarean section (p = 0.002). No difference was found between cases and controls in the IBS-SSS score after cesarean section. However, cases yielded a higher difference between IBS-SSS before and after cesarean section, indicating a higher degree of deterioration in gastrointestinal symptoms (p = 0.026). In addition, cases reported a higher degree of pain in everyday life (p = 0.039). No difference was found in the remaining surveys. CONCLUSION: Women undergoing cesarean section developed mild grade of irritable bowel syndrome. However, gastrointestinal symptoms did not seem to be more prevalent in women who developed ACPO, although women with ACPO had a higher degree of deterioration in gastrointestinal symptoms than controls.

First-line treatment of pelvic organ prolapse and discontinuation of pessary treatment.

INTRODUCTION: The primary objective of this study was to investigate the percentages of women choosing watchful waiting, pessary use or surgery as first-line treatment of pelvic organ prolapse (POP). Second, the rate and cause of discontinuation of pessary use were investigated. METHODS: A retrospective chart review was conducted on 794 patients referred with POP at a Danish tertiary center for urogynecology at Aalborg University Hospital between 1 January 2014 and 31 December 2015. The following data were registered: age, BMI, previous use of a pessary, total number of births, vaginal births, cesarean sections, previous hysterectomy, prolapse surgery and incontinence surgery, smoking, menopause, sexual status and POP-Q stage in the three vaginal compartments. Pessary treatments were evaluated after 3 months. Additional visits, reason for discontinuation and secondary treatment were noted. RESULTS: First-line treatment was surgery in 50%, watchful waiting in 33% and pessary use in 17% of patients. Characteristics associated with choosing surgery instead of a pessary were age < 65 years, previous prolapse surgery, prolapse in the anterior or posterior compartment, and POP-Q stage > 2. Characteristics associated with choosing watchful waiting instead of a pessary were age < 65 years and prolapse in the posterior compartment. A total of 33% discontinued pessary treatment within the first 3 months. Discontinuation was associated with age < 65 years, previous hysterectomy and pelvic surgery, and additional visits. Expulsion of the pessary and pain/discomfort were the main causes of discontinuation. CONCLUSION: This study showed that 50% of patients referred with POP were treated with conservative treatment (watchful waiting and pessary) and thus more women could probably be treated in primary care.

Treatment of urinary incontinence in overweight women by a multidisciplinary lifestyle intervention.

PURPOSE: Urinary incontinence (UI) is a frequent and complex condition that negatively affects women's quality of life (QoL). Weight loss and pelvic floor muscle training (PFMT) are first-line treatments of UI. The study aimed to reduce the symptoms of UI on QoL in overweight women by a multidisciplinary intervention including diet, physical exercise, and PFMT. METHODS: In this non-blinded prospective interventional study, women with stress or mixed UI were included in an intervention combining dietary counseling, physical exercise in groups, and individually planned PFMT. The primary outcome measure was the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). The Patient Global Impression of Improvement (PGI-I) was used at 12 and 36 weeks. Also, anthropometric measures, pelvic floor muscle strength (PFMS), and physical performance were measured at baseline, 12, and 36 weeks. The primary aim of this study was to reduce the ICIQ-UI SF score by minimum of 2.6 points. RESULTS: Thirty-three women participated in the study. Nine dropped out during the intervention. The ICIQ-UI SF score was reduced by 6.8 and 4.5 points at 12 and 36 weeks, respectively. PGI-I revealed satisfaction with the results. Furthermore, weight was reduced by 2.6 and 3.6 kg at 12 and 36 weeks, respectively, and PFMS improved significantly. CONCLUSION: Despite a limited mean weight loss of 3.6 kg, participants reported a significant decrease in the symptoms and the burden of UI. Using PFMT as an integrated part of the intervention might have contributed to the improvements and could be subject to future research.

Translation and validation of the International Consultation on Incontinence Questionnaire Vaginal Symptoms (ICIQ-VS): the Danish version.

INTRODUCTION: In the clinical evaluation of women with pelvic organ prolapse (POP), it is important to evaluate both objective and subjective presentations. The objective evaluation is done by gynecological examination, but the subjective presentation is more complex. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) is an important tool for subjective evaluation, and a Danish version was developed. MATERIALS AND METHODS: The English version was translated into Danish in accordance with guidelines. Eight women underwent a semistructured interview showing no misunderstandings. Women with and without prolapse completed the questionnaire and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. Three weeks later a retest was done. Women undergoing prolapse surgery completed the questionnaire 3 months postoperatively. RESULTS: Ninety-four women with and 98 without prolapse were included; 52 underwent surgery. Retest response rate was 88-95%. Mean time between test and retest was 24.5 and 92.2 days, respectively. Missing data ranged between 0 and 1%. Test-retest reliability was good to excellent (ICC 0.61-0.88) and internal consistency was acceptable (Cronbach's alpha 0.79-0.84). The questionnaire was excellent when distinguishing between women with and without prolapse (p < 0.001). Criterion validity (correlation between POP-Q stage and the questionnaire) was perfect (p < 0.001). Sensitivity to change was excellent for vaginal symptom score and quality of life (p < 0.001) but not for sexual matters (p = 0.059). CONCLUSIONS: The Danish version of ICIQ-VS was successfully translated and can be a valuable tool for prolapse research and daily evaluation of patients.

What happens to urinary incontinence after pelvic organ prolapse surgery?

INTRODUCTION AND HYPOTHESIS: The beneficial effect of pelvic organ prolapse (POP) surgery on urge urinary incontinence (UI) is well described in the literature, while effect on preoperative stress UI (SUI) is still unclear. The aim of this study was to investigate changes concerning UUI following POP surgery without concomitant anti-incontinence procedures and to identify possible factors influencing the changes. METHODS: We conducted a retrospective study of 678 women with prolapse surgery using native tissue repair during a 3-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) questionnaire and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 3 months postoperatively. Patients who scored >0 on the ICIQ-UI SF before surgery were included in the study. RESULTS: A total of 379 patients (55.9%) with POP had concomitant UI. At 3 months' follow-up, 174 patients (46%) became continent compared with 205 patients (54%) with UI. Patients with remaining UI had statistically significant higher mean preoperative ICIQ-UI SF score than patients who became dry. The risk of remaining UI after POP surgery was greater in patients with previous anti-incontinence repair. UI type was not a risk factor for its persistance. CONCLUSION: Almost half of the patients with UI before POP surgery became completely dry after prolapse surgery alone. Severity of incontinence and previous anti-incontinence surgery were identified as risk factors for persisting UI after POP surgery. We found a reduction of incontinence after an operation in any of the three compartments.

Patient goal achievement 2 years after a tension-free vaginal tape operation.

INTRODUCTION AND HYPOTHESIS: The primary aim of this study was to investigate long-term patient-reported goals after a tension-free vaginal tape (TVT) operation for stress urinary incontinence (SUI). METHODS: In this prospective study involving 67 women, patients completed the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) preoperatively and stated three goals for the operation. Postoperatively, a visual analog scale (VAS) ranging from zero (none) to ten (worst) estimated the extent to which goals were achieved. Goals were divided into five groups: symptoms, quality of life (QoL) (physical), QoL (emotional), sexual function, avoidance, and others. Short-term achievement of goal was estimated after 3 months and long-term achievement of goals after a mean of 28.2 months. RESULTS: A total of 201 goals were stated, most of which (38%) were in the group concerning QoL in physical domains. Mean VAS score for all goals was 9.1 after 3 months and 8.5 at long-term follow-up. ICIQ-UI SF preoperatively was mean 14.9; 3 months' postoperatively mean 1.4; and at long-term 3.8. The small rise in ICIQ-UI SF at long-term follow-up was statistically insignificant and due to urge urinary incontinence (UUI). CONCLUSIONS: Our study showed that patients achieved their goals to a high degree and maintained them at long-term follow-up. Most goals concerned QoL in physical domains. Although a proportion of women experienced episodes of UUI at the long-term follow-up, VAS score was not significantly changed.

Prospective evaluation of paravaginal defect repair with and without apical suspension: a 6-month postoperative follow-up with MRI, clinical examination, and questionnaires.

INTRODUCTION AND HYPOTHESIS: Paravaginal defect (PVD) has been suggested as one of the main contributors to the development of prolapse in the anterior vaginal wall (AVW). We aimed to evaluate the descent of pelvic organs, presence of vaginal H configuration, and pubococcygeus (PC) muscle defect by pelvic magnetic resonance imaging (MRI), together with subjective symptoms of prolapse, before and 6 months after PVD repair. We also aimed to evaluate risk factors of recurrence. METHODS: Fifty women with PVD diagnosed by gynecological examination and scheduled for vaginal PVD repair were planned for enrollment. Preoperatively and 6 months postoperatively, subjective symptoms were evaluated using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) together with MRI of the pelvis to evaluate defects in the PC muscle, vaginal shape, and pelvic organ descent. RESULTS: Forty-six women completed the study. Twenty had PVD repair alone, whereas 26 also had concomitant surgery performed. Prolapse grade, subjective symptoms, sexual problems, and quality of life (QoL) were significantly improved at follow-up. Missing vaginal H configuration was observed in 21 women before operation and was correlated with PC muscle defect. Recurrence rate was 39%, and significantly more women with recurrence had PC muscle defects and missing H configuration. CONCLUSION: Vaginal PVD repair alone or combined with concomitant surgery significantly reduces objective prolapse and subjective symptoms. We could not demonstrate MRI findings of missing H configuration to be a sign of PVD but, rather, a sign of defect in the PC muscle. Risk of recurrence is significantly higher in women with major PC muscle defects and missing H configuration.

Retrospective study on de novo postoperative urinary incontinence after pelvic organ prolapse surgery.

OBJECTIVE: Reported incidences of de novo urinary incontinence (UI) following pelvic organ prolapse (POP) surgery in preoperatively continent women vary between 2% and 43%. The aim of this study was to investigate the incidence and the types of de novo UI and differences between operations in different compartments. STUDY DESIGN: Retrospective study of 678 women with POP surgery using native tissue repair during a 3-year period. Patients completed three modified prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 3 months postoperatively. Patients who were totally dry and scored 0 on ICIQ-UI SF before surgery were included in the study (N=299). The patients developing new onset UI on ICIQ-UI SF postoperatively were interviewed by telephone after median 30 months. RESULTS: A total of 33 patients (11%) developed subjective de novo UI at 3 months follow-up. The majority of patients (N=16) reported stress UI. The risk of developing de novo UI increased with parity (p=0.03). We found no difference between operations in different compartments. At long-term follow-up 12 patients became continent without incontinence surgery or medical treatment leaving only 21 patients (7%) incontinent. CONCLUSION: The risk of developing de novo UI after prolapse surgery with native tissue repair is low and improves over time. Parity is significantly associated with the risk of developing de novo UI. There is no difference in the incidence of de novo incontinence between operations in different compartments.

Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life.

IMPORTANCE: In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. OBJECTIVE: To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life. DESIGN, SETTING, AND PARTICIPANTS: This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. EXPOSURE: Cesarean delivery. MAIN OUTCOMES AND MEASURES: Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy. RESULTS: Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having 2 or more cesarean deliveries had an adjusted odds ratio for receiving blood transfusion of 1.93 (95% CI, 1.21-3.07) compared with women having no previous cesarean delivery. CONCLUSIONS AND RELEVANCE: Women with at least 1 previous cesarean delivery face an increased risk of complications when undergoing a hysterectomy later in life. The results support policies and clinical efforts to prevent cesarean deliveries that are not medically indicated.

What are patient goals after an anterior colporrhaphy operation?

OBJECTIVES: The aim of this study was to describe patient-reported goals after an anterior colporrhaphy operation for anterior vaginal wall prolapse, the fulfilment of goals, and the correlation with subjective patient-reported outcomes. STUDY DESIGN: A prospective study involving 100 women. Preoperatively, patients completed three modified questions from the International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS) named ICIQ-VS short form (ICIQ-VS SF) and stated three goals for the operation. A telephone interview was performed 3 months postoperatively. RESULTS: A Visual Analogue Scale (VAS) score from one to 10 estimated the extent to which goals were achieved. Goals were divided into eight groups: 1: mechanical symptoms (bulging), 2: voiding symptoms, 3: quality of life (physical), 4: quality of life (emotional), 5: avoidance of urinary tract infection, 6: cure of incontinence, 7: sexual function and 8: others. ICIQ-VS SF preoperatively was mean 13.6 and postoperatively mean 1.7 (p<0.001). A total of 276 goals were stated, 63.4% of the goals were fulfilled with a VAS score of 10. The majority of the goals (27%) were in group 1 concerning symptoms of bulging. Mean VAS score for all goals was 8.6 (SD 2.5). Group 1 concerning mechanical symptoms of bulging had most goals fulfilled with a VAS of 10 (76%), and group 6 concerning cure of incontinence had fewest goals fulfilled with a VAS of 10 (31%). Forty patients (40%) fulfilled all their goals. CONCLUSIONS: Patient-described goal achievement was high. The majority of the fulfilled goals concerned mechanical symptoms of bulging, and goals concerning incontinence were the least fulfilled.