Analyze, design, develop, implement, and evaluate approach to develop a pelvic floor muscle training guidebook to treat stress urinary incontinence in women.

Objective: Stress urinary incontinence (SUI) is a common problem that affects the quality of life of women worldwide. Pelvic floor muscle training (PFMT) is an effective conservative first-line treatment for SUI. However, low compliance with PFMT is one of the main reasons for therapeutic failure. Indirect supervision using a guidebook may improve PFMT outcomes. To develop a PFMT guidebook using the analyze, design, development, implementation, and evaluation (ADDIE) method. Methods: A guidebook was developed from July 2020 to April 2021 using the ADDIE method. This prospective study used mixed methods, namely qualitative analysis, focus group discussions, and in-depth interviews, and involved various experts from urogynecology, urology, medical rehabilitation, and physiotherapy departments. A pilot study was conducted on patients with SUI to evaluate the effectiveness of the guidebook. Results: The ADDIE method was successfully implemented to develop the PFMT guidebook. The formative evaluation of the ADDIE steps mainly focused on the PFMT technique, content clarity, illustration, design, and color choice of the book. After the pilot study, the guidebook significantly improved IIQ-7, 1-hour pad test, and perineometer scores. However, the pilot study showed no significant improvement in UDI-6 scores. Conclusion: The PFMT guidebook developed using the ADDIE method improved outcomes in patients with SUI.

Selecting the best surgical approach in various cases of prolapsed pedunculated submucosal fibroids: A case series.

INTRODUCTION: The pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty. PRESENTATION OF CASES: The first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure. DISCUSSION: Vaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances. CONCLUSION: Customised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.

Diagnostic capabilities of transperineal ultrasound (TPUS) to evaluate anal sphincter defect post obstetric anal sphincter injury (OASIS)? A systematic review.

INTRODUCTION: Endoanal ultrasound (3D-EAUS) is the gold standard imaging investigation for evaluating the anal sphincter; unfortunately, it is not universally available in most obstetric units. This study aims to appraise the ability of transperineal ultrasound (TPUS) compared with 3D-EAUS as the gold standard to identify anal sphincter defects after primary repair of OASIS. METHODS: A systematic search of major databases to identify diagnostic accuracy of 3D-TPUS in evaluating anal sphincter defects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were designed for this systematic review. The risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Our eligibility criteria are patients with a history of primary repair of anal sphincter injuries (OASIS). They were followed up after the primary repair to detect the anal sphincter defect using 3D-TPUS vs. 3D-EAUS as a gold standard. RESULTS: Two eligible observational studies were included and assessed for risk of bias using the QUADAS-2 tool and showed a low risk of bias and a low risk of concerns. 3D-TPUS had various sensitivity to detect external anal sphincter defects in two studies; meanwhile, the specificity was around 67-70%. For detecting the internal anal sphincter defects, 3D-TPUS had low sensitivity but high specificity (93-94%). CONCLUSION: 3D-TPUS had various sensitivity to detect external anal sphincter defects and low sensitivity to detect internal anal sphincter defects. On the other hand, 3D-TPUS had low specificity for detecting external anal sphincter defects and high specificity for detecting internal anal sphincter defects.

Mesh-Tissue Integration of Platelet-Rich Plasma-Decellularized Amnion Scaffold-Polypropylene Mesh Sandwiches Implanted in the Vesicovaginal Spaces of Hypoestrogenic Rabbit Models: Protocol for a Randomized Controlled Trial.

BACKGROUND: Mesh-augmented surgery with polypropylene meshes (PPMs) is often used in urogynecology and pelvic reconstructive surgery. However, the various complications that arise from its integration process have resulted in a decrease in the number of mesh-augmented surgeries performed worldwide. An approach to improving mesh-tissue integration is coating PPMs with anti-inflammatory and wound-healing molecules, such as platelet-rich plasma (PRP), which is a component of biotechnologies that are capable of accelerating wound healing. Estrogen is also known to have a beneficial effect on wound remodeling; therefore, a hypoestrogenic status may have negative implications for wound healing. The mechanism of how PRP plays a role in wound remodeling, especially among individuals in a hypoestrogenic state, has not been fully described until now. OBJECTIVE: Our aim is to investigate the impact of applying PRP to PPMs in hypoestrogenic rabbit models. METHODS: Our study will be a randomized controlled trial involving hypoestrogenic rabbit models. Samples were categorized into either the PRP group or the PPM group (1:1 ratio), with a minimum sample size of 16 in each arm, via simple random sampling. All samples were put into a hypoestrogenic state via bilateral oophorectomy. After confirming a decrease in estradiol level, the meshes were implanted in the vesicovaginal space. The samples were euthanized on the 14th, 28th, or 90th day of the surgery. The mesh-tissue integration process will be analyzed based on inflammatory parameters (inflammatory infiltrate, interleukin-17, and interleukin-1B expression); angiogenesis (CD31 expression); and collagen deposition, which will be assessed by using Masson trichrome staining. RESULTS: Our study is in the protocol development stage. A preliminary study regarding its feasibility, including the feasibility of the preparation of hypoestrogenic rabbit models, mesh implantation in the rabbits' vesicovaginal spaces, the PRP and amnion scaffold, started in February 2022. The results of our study are expected to be available by the end of 2022. CONCLUSIONS: Our randomized controlled trial is designed to provide high-quality evidence on the effect of applying a PRP-decellularized amnion scaffold to PPMs in the vesicovaginal spaces of hypoestrogenic rabbit models. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37942.

Does freeze dried amnion useful as scaffold for mesenchymal stem cell for repair of vesicovaginal fistula? An overview of proliferative and remodeling phase in the wound healing process.

BACKGROUND: Surgery is still the main solution for vesicovaginal fistula, but postoperative wound healing represents a challenge, and the recurrence rate remains high. There is a need to develop therapeutic methods to increase the success of therapy and women's quality of life. OBJECTIVE: To explore whether human freeze-dried amnion is useful as a mesenchymal stem cell scaffold for repair of vesicovaginal fistula through assessment of the proliferative and remodelling phases. METHODS: This experiment was undertaken using a New Zealand rabbit model. The research was divided into two stages: (1) an experiment to create a model of a vesicovaginal fistula; and (2) a laboratory experiment to close a vesicovaginal fistula as a result of the first stage. The second stage used a post-test-only control group design. The wound-healing process was assessed based on the expression of platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), occludin and claudin-4. Data were analysed descriptively and statistically. RESULTS: Expression of PDGF, VEGF, FGF, occludin and claudin-4 in vesicovaginal fistula models sutured with human freeze-dried amnion was higher compared with models without human freeze-dried amnion. Significant differences were found in average expression of PDGF, VEGF, FGF, occludin and claudin-4. CONCLUSION: Human freeze-dried amnion plays a role in the wound-healing process in vesicovaginal fistula repair models. It is hoped that this research will improve urogynaecological services.

Genital self-image as predictor of sexual dysfunction in women with pelvic organ prolapse in Indonesia.

BACKGROUND: The incidence of sexual dysfunction increases in women with pelvic organ prolapse. In addition to physical factors, other important components that influence each other in sexual dysfunction are psychological aspects and genital self-image. Sociocultural factors also affect individual sexuality and sexual behavior. Until now, there are no data and the relationship between genital self-image and sexual dysfunction in pelvic organ prolapse is not known in Indonesia. OBJECTIVE: This study aims to analyze the correlation of genital self-image with sexual dysfunction in women with pelvic organ prolapse. METHODS: In this cross-sectional study, 113 consecutive women with pelvic organ prolapse were selected in urogynecology referral centers in Jakarta. Demographic data, physical examination, and guided interviews were filled in to complete the Female Sexual Function Index and Female Genital Self-Image Scale-7 questionnaires. Preliminary research has been carried out in the form of language translation and cultural validation of the Indonesian version of the Female Genital Self-Image Scale-7 questionnaires. RESULTS: There is a significant correlation between genital self-image and sexual dysfunction, where the lower Female Genital Self-Image Scale-7 score significantly predicts the lower Female Sexual Function Index score (p < 0.000; odds ratio: 14.17). CONCLUSION: Genital self-image is the main variable that affects sexual function in women with pelvic organ prolapse. It is necessary to evaluate and treat genital self-image because sexual function is an integrated component of quality of life.

Cervical elongation caused by big cervical fibroid resembling malignant cervical prolapse? Management via vaginal surgery.

INTRODUCTION: Cervical elongation could lead to cervical elongation thus worsen the descent of uterine prolapse. In certain cases, this hypertrophic and hyperplastic mass could have fragile surface with some bleeding and necrotic, resembling cervical cancer. As case of cervical elongation due to cervical fibroid is quite rare, such cases are valuable to be reported. We present two cases of cervical fibroid with cervical elongation resembling cervical malignancy. PRESENTATION OF CASE: First case was A 59-year-old lady with intractable vaginal mass since one day before admission. Bleeding from the mass was positive. We found a bulky vaginal mass exceeding hymenal ring, 14 × 7 × 6 cm sized, with some necrotic and discharge, foul smelling, and some bleeding area. Ultrasound evaluation revealed a cervical fibroid with differential diagnosis cervical malignancy. The second case was Mrs 53-year-old with vaginal mass since last year. For the last 7 months the mass has been bigger and could not be inserted into vagina, with some bleeding. We found globular vaginal mass 12 × 9 × 6 cm exceeding hymenal ring, with some necrotic and reddish surface, foul smelling, discharge, and some blood. Ultrasound evaluation revealed cervical mass on anterior lip with elongated cervices. Both cases have been menopaused. As the clinical presentation resembling malignancy, we did biopsy. The biopsy results were no evidence of malignancy, then we did Manchester fothergill, and colporaphy as needed. DISCUSSION: Length between internal to external cervical ostium ≥ 5 cm correlated to cervical elongation. Growing cervical mass could drag the cervix, predisposing to cervical elongation and prolapse. Cervical fibroids protruded through vagina was usually pedunculated. But in our cases, the fibroids were not pedunculated but manifested as a bulky mass on the cervical tissue with some bleeding and necrotics, mimicking cervical malignancy. The most important initial management besides ultrasound evaluation was mass biopsy. CONCLUSION: In such cervical fibroids with cervical elongation resembling cervical malignancy, biopsy is compulsory to determine the diagnosis and to lead the management.

Hydration status of pregnant women in West Jakarta.

BACKGROUND AND OBJECTIVES: During pregnancy, the body exhibits dynamic changes in fluid composition. More than 50%of women experience nausea and vomiting during the first trimester. Studies of hydration status in pregnant women are limited, and not in tropical countries, like in Indonesia. The objective of this study was to investigate the hydration status and appropriate biomarkers for determination of hydration status in pregnant women in West Jakarta. METHODS AND STUDY DESIGN: This study was cross-sectional. A total of 35 pregnant women aged (19-35 years) at the early second trimester of pregnancy was recruited. Urine osmolality, urine specific gravity, and serum osmolality were used to determine hydration status. Subjects then were divided into a hydration group (HG) and a dehydration group (DG). We used independent t tests, chi-square and Spearman rank correlation coefficient to analyse the data. RESULTS: The population was comparably divided between dehydration and hydration groups (57.1% and 42.9%, respectively). The proportions by age, parity, gestational age, height, weight, upper arm circumference, waist circumference, pelvic circumference, body temperature, blood pressure, and fundal height did not differ between groups (p>=0.05). There was a relationship between urine colour and hydration status (p<0.05). Differences in hydration biomarker status (urine osmolality and urine specific gravity) were noted between the groups (p<0.05). CONCLUSIONS: Dehydration may be common during pregnancy in tropical Indonesia and can be confirmed by the hydration biomarkers of urinary specific gravity and osmolality. Fluid balance is necessary to prevent health problems and intrauterine growth restriction in pregnant women.

Estimating the annual cost of overactive bladder in Indonesia.

AIM: to estimate the annual economic cost and quality of life related to OAB in Indonesia population by taking into account the direct cost, value of lost productivity and cost consequences associated with OAB. METHODS: cross sectional study was done in Geriatric Clinic and Urogynaecology Clinic in Dr. Cipto Mangunkusumo Hospital Jakarta from July 2005 to March 2006. Primary outcome of this study was annual cost of OAB, symptom and quality of life of OAB patients. Cost data related to personal routine care of OAB and transportation expenditures were obtained by using questionnaires modified from Dowell Bryant incontinence cost index validated questioner. Data related to quality of life were obtained by OAB-q questioner. Subjects included 30 male and female OAB patients aged 18-100 years. RESULTS: most of patients were female (96.7%). Median of age was 62.5 (30-93) years old, 56.7% patients were elderly (age more than 60 years). Median of total annual cost of OAB was Rp. 2,850,000,-. Median of total personal cost which consist of routine personal care costs and treatment costs were Rp. 2,850,000. Median of total cost which is expended by government for routine personal and treatment of OAB was Rp.2,500,000,- . Median score of symptom severity was 62.5. Quality of life score was divided into coping, concern, sleep, and social item. Median of coping score was 50.0, concern score was 43.1, sleep score was 50.8, and social score was 38.8. Median of total quality of life score was 44.7. Maximum score of symptom severity and quality of life should be 98.8. The higher the score, the more severe the symptom, but the better is the quality of life. CONCLUSION: total annual cost of OAB was Rp. 2,850,000, Quality of life of OAB patient was somewhat poor.

Randomized trial of one versus two transcervical insertions of quinacrine pellets for sterilization.

OBJECTIVE: To determine the relative effectiveness of single vs. two transcervical monthly insertions of 252 mg of quinacrine for female sterilization. DESIGN: Controlled clinical study. SETTING: Family planning clinics of 6 academic centers. PATIENT(S): Sexually active reproductive-age women requesting sterilization. INTERVENTION(S): At each of six centers 70 and 30 women were randomly assigned to receive either one or two, respectively, monthly transcervical insertions to the fundus of 252 mg of quinacrine and 75 mg of diclofenac as pellets and they were followed for 1 year. MAIN OUTCOME MEASURE(S): Complications, side effects, and pregnancy failures. RESULT(S): There were no serious complications and side effects were transient and easily treated. There were 31 (7.4%) pregnancy failures in the single insertions group and 2 (1.1%) in the two insertions group, but with marked center variation. CONCLUSION(S): Quinacrine sterilization using two monthly insertions of 252 mg of quinacrine appears safe and reasonably effective.