Prevalence of pelvic floor disorders in adult women being seen in a primary care setting and associated risk factors

Pelvic Floor Dysfunction Among Persons With Marfan and Loeys-Dietz Syndrome

IMPORTANCE

Connective tissue disorders are proposed in the literature to be predisposing risk factors for pelvic floor disorders. Prior data characterizing the prevalence of and symptom burden related to pelvic floor disorders are limited for individuals with Marfan syndrome and are nonexistent for those with Loeys-Dietz syndrome.

OBJECTIVE

The objective of this study was to determine the prevalence and severity of symptoms related to pelvic floor disorders among individuals with Marfan syndrome and Loeys-Dietz syndrome using the Pelvic Floor Distress Inventory-20 (PFDI-20).

STUDY DESIGN

In this cross-sectional study, a survey including the PFDI-20 was administered to biologically female individuals older than 18 years with a confirmed diagnosis of Marfan syndrome or Loeys-Dietz Syndrome. Respondents were solicited through the websites, email lists, and social media forums of The Marfan Foundation and The Loeys-Dietz syndrome Foundation.

RESULTS

A total of 286 respondents were included in the final analysis, 213 with Marfan syndrome and 73 with Loeys-Dietz syndrome. The median PFDI-20 score of the cohort was 43.8. Individuals with Loeys-Dietz syndrome had higher PFDI-20 scores and were more likely to have established risk factors for pelvic floor disorders that correlated with their PFDI-20 scores compared with those with Marfan syndrome.

CONCLUSIONS

Respondents with Marfan syndrome and Loeys-Dietz syndrome experience a high burden of symptoms related to pelvic floor disorders. Despite the similar pathophysiology and clinical manifestations of these disorders, there were differences in PFDI-20 responses that may suggest that these diseases differ in the ways they affect the pelvic floor.

Association Between Physical Activity and Pelvic Floor Disorders in Parous Ugandan Women

INTRODUCTION AND HYPOTHESIS

The aim was to assess the association between the degree of physical activity (PA) and the presence of pelvic floor disorders (PFDs) in a cohort of parous Ugandan women.

METHODS

In this cross-sectional study, PFDs were measured using symptom assessment, standardized questionnaires (Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire), and a standardized physical examination (POP-Q and cough stress test [CST]). Degree of PA was assessed using the International Physical Activity Questionnaire. Interquartile ranges were used to describe the age, parity, and body mass index (BMI) of participants. To examine the association between PA and PFDs, a log transformation was applied to the weekly minutes of PA variable and a logistic regression model was constructed with weekly minutes of moderate/vigorous PA, age, BMI, and parity as the predictors.

RESULTS

A total of 159 women were enrolled. Median age was 35 (IQR 32-37), median parity 4 (IQR 3-5), and median BMI 29.0 (IQR 24-33). The prevalence of PFD as determined by symptom assessment was 28% (n=44). The most frequent stage of prolapse identified by POP-Q was stage II (57%, n=91). Thirty-six percent of the women (n=58) reported vigorous PA. Ninety-nine percent of the cohort (n=158) reported moderate PA. When controlling for age, parity, and BMI there was a significant positive association between PFD (defined as a combination of stage II prolapse, positive CST, and urinary incontinence (UI)) and moderate PA (OR 2.20, 95% CI 1.08-5.14, p value 0.045).

CONCLUSIONS

Pelvic floor disorders are common among parous Ugandan women and are associated with moderate PA when controlling for age, BMI, and parity. Understanding the risk factors associated with PFD in this population may better equip providers to screen and care for individuals.

Race and ethnicity expression in reproductive endocrinology and infertility research studies compared with other obstetrics and gynecology subspecialty studies

Objective

To compare the percentage of patients per race and ethnicity group in the most cited reproductive endocrinology and infertility studies with the most cited studies in 3 other obstetrics and gynecology (OBGYN) subspecialties: gynecologic oncology, urogynecology (URO), and maternal-fetal medicine.

Design

Retrospective cohort study.

Setting

Not applicable.

Patients

Patients previously recruited in research studies.

Interventions

None.

Main Outcome Measures

Expression of minorities in research studies.

Results

Individual searches were conducted for the most cited articles in OBGYN subspecialties until 50 studies met the inclusion criteria for each OBGYN subspecialty. A total of 29,821,148 patients were included and compared between subspecialty and US Census data. Reproductive endocrinology and infertility studies had the highest percentage of White patients (80.5%), although URO studies had fewer Black patients (6.6%) compared with other subspecialties. Reproductive endocrinology and infertility studies had the lowest percentage of Hispanic patients (4.9%), yet more Asian patients were present in URO studies (3.3%) than in other subspecialties. Gynecologic oncology studies were most likely to have missing data in race expression (19.3%). Comparing study types, retrospective studies had the highest percentage of White patients (61.9%), although randomized controlled trials had the lowest expression of Hispanic patients (8.8%).

Conclusions

Reproductive endocrinology and infertility studies featured the highest rates of White patients compared with other OBGYN subspecialty studies, although URO studies had the lowest rates of Black patients. Randomized controlled trials featured higher rates of White patients and lower levels of Hispanic patients compared with US Census data.

Pelvic Floor Muscle Training for Stress Urinary Incontinence, Fecal Incontinence, and Pelvic Organ Prolapse: A Health Technology Assessment

Background

Stress urinary incontinence, fecal incontinence, and pelvic organ prolapse are common forms of pelvic floor dysfunction. Pelvic floor muscle training is used to improve pelvic floor function, through a program of exercises. We conducted a health technology assessment of pelvic floor muscle training for people with stress urinary incontinence, fecal incontinence, or pelvic organ prolapse, which included an evaluation of effectiveness, safety, and the budget impact of publicly funding pelvic floor muscle training, and patient preferences and values.

Methods

We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of included studies using the ROBIS tool, for systematic reviews, and the Cochrane Risk of Bias tool, for randomized controlled trials, and we assessed the quality of the body of evidence according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search but did not conduct a primary economic evaluation. We also analyzed the budget impact of publicly funding pelvic floor muscle training in adults with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse in Ontario. To contextualize the potential value of pelvic floor muscle training as a treatment, we spoke with people with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse.

Results

We included 6 studies (4 systematic reviews and 2 randomized controlled trials) in the clinical evidence review. In comparison with no treatment, pelvic floor muscle training significantly improved symptom severity and increased patient satisfaction in women with stress urinary incontinence or pelvic organ prolapse (GRADE: Moderate). For men with stress urinary incontinence after prostatectomy, pelvic floor muscle training yielded mixed results for symptom improvement (GRADE: Very low). For adults with fecal incontinence, pelvic floor muscle training did not improve symptoms in comparison with standard care (GRADE: Very low).In the economic literature review, we included 6 cost-utility analyses that had evaluated the cost-effectiveness of pelvic floor muscle training as a treatment for people with pelvic organ prolapse or urinary incontinence. We did not identify any economic studies on pelvic floor muscle training for women or men with fecal incontinence or men with pelvic organ prolapse. The analyses included in our review found that, for women with stress urinary incontinence, pelvic floor muscle training was likely cost-effective in comparison with other nonsurgical interventions. For men with urinary incontinence after prostate surgery, pelvic floor muscle training was likely not cost-effective in comparison with standard care. For women with pelvic organ prolapse, the cost-effectiveness of pelvic floor muscle training in comparison with no active treatment was uncertain.The average cost of pelvic floor muscle training was approximately $763 per patient. Publicly funding pelvic floor muscle training for women with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse would result in additional costs over 5 years of $185.3 million, $275.6 million, and $85.8 million, respectively. Publicly funding pelvic floor muscle training for men with stress urinary incontinence and fecal incontinence would result in additional costs over 5 years of $10.8 million and $131.1 million, respectively. The people we spoke with reported that stress urinary incontinence, fecal incontinence, and pelvic organ prolapse limited their social and physical activities, taking a huge emotional toll. Many were hesitant or even fearful of surgery, and most people with experience of pelvic floor muscle training reported that it relieved most or all of their symptoms and allowed them to return to normal daily activities.

Conclusions

Pelvic floor muscle training is likely more effective (with respect to symptom improvement and patient satisfaction) than no treatment for women with stress urinary incontinence or pelvic organ prolapse. Pelvic floor muscle training may yield mixed results with respect to symptom improvement for men with stress urinary incontinence after prostatectomy and have little to no effect on symptom improvement for adults with fecal incontinence. We estimate that publicly funding pelvic floor muscle training for adults with pelvic floor dysfunction (stress urinary incontinence, fecal incontinence, and pelvic organ prolapse) in Ontario would result in a substantial budget increase over the next 5 years. People with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse shared the negative impact these conditions have on their social and physical life and valued pelvic floor muscle training as a nonsurgical treatment option.

Race/Ethnicity and Incidence of Pelvic Organ Prolapse in Midlife Women: The Study of Women's Health Across the Nation

Background: Pelvic organ prolapse (POP) affects a considerable proportion of women. Limited information exists regarding the incidence of POP as women transition through menopause. Using data from the Study of Women's Health Across the Nation (SWAN), this diverse community-based longitudinal cohort study assessed the incidence of symptomatic POP and risk by race/ethnicity. Methods: Self-reported POP was ascertained by questionnaire at 11 approximately annual SWAN visits over a median of 13.3 years of follow-up. We estimated probabilities for reporting POP using interval-censored Kaplan-Meier survival plots. We estimated hazard ratios (HR) and 95% confidence intervals (CI) using interval-censored Cox proportional hazards models. Results: The estimated cumulative probability of POP increased linearly from 2.1% at age 45 to 10.1% by age 65 (4.0% per decade). At age 65, the probability was 4.2%, 4.8%, 8.9%, 9.7%, and 33.9% for Japanese, Chinese, Black, White, and Hispanic women, respectively. Compared with White women, the unadjusted HR for POP was 3.09 (95% CI = 2.18-4.39), 0.96 (0.71-1.31), 0.43 (0.22-0.85), and 0.48 (0.26-0.88) for Hispanic, Black, Chinese, and Japanese women, respectively. After adjustment for financial strain and vaginal birth, the low hazards among Chinese and Japanese women and the high hazard for Hispanic women remained significant. Conclusion: Incidence of symptomatic POP increased as women aged through midlife. Risks varied by race and ethnicity and were not accounted for by population differences in socioeconomic life contexts or the probability of having had a vaginal birth. Although not associated with menopause, health providers should incorporate screening for and information about POP when treating menopausal symptoms and health needs of midlife women. Research on pathophysiological factors associated with increasing POP in midlife is warranted.

The beneficial effects of conservative treatment with biofeedback and electrostimulation on pelvic floor disorders

Objectives

Pelvic floor disorders (PFDs) such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can be managed through conservative treatments, such as conservative management involving biofeedback (BF) and electrostimulation. This study aimed to investigate the therapeutic effects of conservative treatments on PFDs.

Materials and Methods

A retrospective cohort study was conducted. Women with PFD who underwent 1-3 months of BF and electrostimulation between January 1, 2020, and January 31, 2021, were included in the study. BF treatment was administered using three sensors to monitor pelvic floor muscle activity, providing patients with immediate feedback and guidance on muscle exercises. One session lasted for 5-10 min. Electrostimulation treatment utilized a specially made pelvic belt with electrode sheets to stimulate and contract pelvic floor muscles passively. One session lasted for 15 min. Six therapies in 1 month were prescribed. Pre- and post-treatment Pelvic Floor Distress Inventory (PFDI-20) scores, including POP distress inventory 6 (POPDI-6), colorectal-anal distress inventory (CRAD-8), and urinary distress inventory 6 (UDI-6) scores, were compared. Subgroup analysis by age, menopause, body mass index (BMI), and child delivery mode was performed.

Results

The study included 51 women with PFDs (SUI, POP, frequency or urgency or nocturia, and pain) treated with BF and electrostimulation, with a mean age of 49.94 ± 13.63 years. Sixteen patients (37.1%) were menopausal, with a mean menopause age of 50 ± 5.20 years. Twenty-six patients (68.4%) had a history of normal vaginal delivery. The mean PFDI-20 scores before and after treatment were 32.67 (standard deviation [SD] 10.05) and 25.99 (SD 9.61), respectively (P < 0.001). This decrease in scores reflected an improvement in subjective perceptions of symptoms and quality of life. The POPDI-6, CRAD-8, and UDI-6 scores significantly decreased after treatment. Subgroup analysis of scores change regarding age, menopause, BMI, and child delivery mode was not statistically significant.

Conclusion

The study demonstrated the effectiveness of BF and electrostimulation for treating women with PFDs. The findings contributed to the understanding of treatment duration, patient characteristics, and the potential benefits of a multimodal approach. Moreover, the study's diverse participant population and the use of validated outcome measures enhance the generalizability and scientific rigor of the findings.

Clinical Trial Racial and Ethnic Disparities in Minimally Invasive Gynecologic Surgery

STUDY OBJECTIVE

To study racial and ethnic disparities in randomized controlled trials (RCTs) in minimally invasive gynecologic surgery (MIGS).

DESIGN

Cross-sectional study.

SETTING

Online review of all published MIGS RCTs in high-impact journals from 2012 to 2023.

PATIENTS

Journals included all first quartile obstetrics and gynecology journals, as well as The New England Journal of Medicine, The Lancet, The British Medical Journal, and The Journal of the American Medical Association. The National Institutes of Health's PubMed and the ClinicalTrials.gov websites were queried using the following search terms from the American Board of Obstetrics and Gynecology's certifying examination bulletin 2022 to obtain relevant trials: adenomyosis, adnexal surgery, abnormal uterine bleeding, cystectomy, endometriosis, fibroids, gynecology, hysterectomy, hysteroscopy, laparoscopy, leiomyoma, minimally invasive gynecology, myomectomy, ovarian cyst, and robotic surgery.

INTERVENTIONS

The US Census Bureau data were used to estimate the expected number of participants. We calculated the enrollment ratio (ER) of actual to expected participants for US trials with available race and ethnicity data.

MEASUREMENTS AND MAIN RESULTS

A total of 352 RCTs were identified. Of these, race and/or ethnicity data were available in 65 studies (18.5%). We analyzed the 46 studies that originated in the United States, with a total of 4645 participants. Of these RCTs, only 8 (17.4%) reported ethnicity in addition to race. When comparing published RCT data with expected proportions of participants, White participants were overrepresented (70.8% vs. 59.6%; ER, 1.66; 95% confidence interval [CI], 1.52-1.81), as well as Black or African American participants (15.4% vs. 13.7%; ER, 1.15; 95% CI, 1.03-1.29). Hispanic (6.7% vs. 19.0%; ER, 0.31; 95% CI, 0.27-0.35), Asian (1.7% vs. 6.1%; ER, 0.26; 95% CI, 0.20-0.34), Native Hawaiian or other Pacific Islander (0.1% vs. 0.3%; ER, 0.21; 95% CI, 0.06-0.74), and Indian or Alaska Native participants (0.2% vs. 1.3%; ER, 0.16; 95% CI, 0.08-0.32) were underrepresented. When comparing race/ethnicity proportions in the 20 states where the RCTs were conducted, Black or African American participants were underrepresented.

CONCLUSION

In MIGS RCTs conducted in the United States, White and Black or African American participants are overrepresented compared with other races, and ethnicity is characterized in fewer than one-fifth of trials. Efforts should be made to improve racial and ethnic recruitment equity and reporting in future MIGS RCTs.

Pelvic Floor Dysfunction among Reproductive-Age Women in Israel: Prevalence and Attitudes-A Cross-Sectional Study

Objectives: Our study aimed to investigate the prevalence of female pelvic floor dysfunction (PFD) in Israeli women who experienced vaginal delivery and are in their reproductive years (premenopausal), as well as to understand their attitudes and health-seeking behavior and barriers towards treating this problem. Methods: In this cross-sectional study, we conducted a questionnaire-based Internet survey. The surveys were sent to Israeli women in their fertile years (18-50 years old). We asked the women about their PFD symptoms, attitudes, and help-seeking behaviors. We used two validated questionnaires, including the USIQ and the PFDI-20. The combined questionnaire was submitted in both Hebrew and Arabic. We assessed the prevalence of PFD symptoms in the study population. Symptomatic women were asked about their help-seeking behaviors and their beliefs, desires, and barriers regarding the clinical management of symptoms. Results: Between July and September 2020, 524 women completed the questionnaire (response rate 44%). In total, 95% reported at least one symptom (mostly urinary-related) at any grade of severeness in at least one category, and 66.8% suffered from at least one moderate to severe symptom in at least one category. Most women (93.7%) reported that they wanted to be asked and offered voluntary information about PFD from physicians and nurses; however, only 16.6% reported receiving such information. Barriers to seeking treatment were mainly related to low awareness. The study's main limitation was selection bias due to the questionnaire's design. Conclusions: These findings show the importance of raising awareness of the different therapeutic solutions to PFD symptoms and designing more available services for this common problem.

Pelvic floor dysfunction survivorship needs and referrals in the gynecologic oncology population: a narrative review

The population of survivors of gynecologic malignancies continues to grow. The population of gynecologic oncology survivors has a high prevalence of pelvic floor disorders. Gynecologic oncology patients identify several survivorship needs, including a need for more focused pelvic floor disorder sequelae care. The increasing focus on patient needs following cancer treatment has led to the development of survivorship care plans and other strategies for addressing post-treatment transitions and sequelae. Common themes in patient survivorship care are patient needs for flexible and integrated care, and it is unclear if survivorship care plans in their current state improve patient outcomes. Patient referrals, specifically to urogynecologists, may help address the gaps in survivorship care of pelvic floor dysfunction.The objective of this review is to discuss the burden of pelvic floor disorders in the gynecologic population and to contextualize these needs within broader survivorship needs. The review will then discuss current strategies of survivorship care, including a discussion of whether these methods meet survivorship pelvic floor disorder needs. This review addresses several gaps in the literature by contextualizing pelvic floor disorder needs within other survivorship needs and providing a critical discussion of current survivorship care strategies with a focus on pelvic floor disorders.

Psychometric evaluation and cross-cultural adaptation of the Australian Pelvic Floor Questionnaire (APFQ-IR) in Iranian reproductive age women

Pelvic floor disorders (PFDs), as a silent alert, is one of the pervasive debilitating health concerns among women all over the world, such that in developed countries, one in four women, suffers from PFDs. Validity and reliability of the Australian Pelvic Floor Questionnaire (APFQ) has not been determined in Iran, so to determine APFQ's psychometric characteristics, we decided to conduct this study on women of reproductive age in Tabriz city, Iran. This methodological cross-sectional study was intended to determine the psychometric properties of the Persian version of the APFQ-IR in 5 steps including "translation process, content validity, face validity, construct validity (exploratory and confirmatory factor analyses and examination of ceiling and floor effects) and reliability" on 400 reproductive age women referring to health centers in Tabriz city, Iran, with cluster random sampling method in the period between May 2022 to September 2022. The translation process was done based on two approaches, Dual panel, and Beaton et al.'s five steps. Then, in order to evaluate content validity, face validity, and construct validity, 10 instrument and PFDs experts, 10 women from the target group investigated the instrument's items, and 400 eligible women completed the instrument. Finally, to determine the reliability, two internal consistency methods, (Cronbach's alpha and McDonald's omega) and test-retest method (ICC) were used. In the present study, content validity assessment of APFQ-IR, showed a good level of validity (CVR = 0.96, CVI = 0.94). To assess construct validity, exploratory factor analysis results on 36 items, led to the identification of 4 factors including bladder function, bowel function, prolapse symptom and sexual function, which explained 45.53% of the cumulative variance and indicated the sufficiency of the sample size (Kaiser-Meyer-Olkin = 0.750). Implementing confirmatory factor analysis, (RMSEA = 0.08, SRMR = 0.08, TLI = 0.90, CFI = 0.93, χ2/df = 3.52) confirmed the model fit indices. Finally the internal consistency and reliability was high for the entire instrument (Cronbach's alpha = 0.85; McDonald's omega (95% CI) = 0.85 (0.83-0.87) and Intraclass Correlation Coefficient (95% CI) = 0.88 (0.74-0.94)). The Persian version of the APFQ-IR, has a good validity and reliability and has acceptable psychometric properties, thus can be used both for research purposes and for clinical evaluation of pelvic floor disorders symptoms in health centers.

Impact of parity on pelvic floor morphology and function: A retrospective study

To analyze the effect of parity on pelvic floor morphology and function during the postpartum period. A total of 971 participants, who attended the Fujian Maternity and Child Health Hospital (Fuzhou, China) between December 2019 and August 2021, were included. All participants were assessed using the modified Oxford scale (MOS), pelvic floor surface electromyography, and 3-dimensional pelvic floor ultrasound to assess pelvic floor morphology and function. Multivariate analysis revealed no differences among primipara, deuteripara, and tertipara in pre-baseline rest, phasic contraction, endurance contraction, post-baseline rest, and MOS, except for tonic contraction (P = .020), the amplitude of which was lower in primipara than in deuteripara in post hoc comparison (P = .008). Differences in bladder neck presentation and bladder neck descent were statistically significant in multivariate analysis (P = .002, P = .001, respectively), with the value of bladder neck presentation in primiparas being greater than that of deuteriparas and tertipara (P = .002, P = .008, respectively), and the value of bladder neck descent was lower than that of deuteripara and tertipara in further post hoc comparisons (P = .002, P = .003, respectively). Functional impairment was not statistically associated with parity according to the MOS score or surface electromyography. However, parity was significantly correlated with descent of the bladder neck, and most of the effects appeared to occur during the first delivery.

[Dynamic magnetic resonance imaging of the pelvic floor: clinical application]

BACKGROUND

Dynamic magnetic resonance imaging (MRI) of the pelvic floor plays a key role in imaging complex pelvic floor dysfunction. The simultaneous detection of multiple findings in a complex anatomic setting renders correct analysis and clinical interpretation challenging.

OBJECTIVES

The most important aspects (anatomy of the pelvic floor, three compartment model, morphological and functional analysis, reporting) for a successful clinical use of dynamic MRI of the pelvic floor are summarized.

MATERIALS AND METHODS

Review of the scientific literature on dynamic pelvic MR imaging with special consideration of the joint recommendations provided by the expert panel of ESUR/ESGAR in 2016.

RESULTS

The pelvic floor is a complex anatomic structure, mainly formed by the levator ani muscle, the urethral support system and the endopelvic fascia. Firstly, morphological changes of these structures are analysed on the static sequences. Secondly, the functional analysis using the three compartment model is performed on the dynamic sequences during squeezing, straining and defecation. Pelvic organ mobility, pelvic organ prolapse, the anorectal angle and pelvic floor relaxation are measured and graded. The diagnosis of cystoceles, enteroceles, rectoceles, the uterovaginal as well as anorectal decent, intussusceptions and dyssynergic defecation should be reported using a structured report form.

CONCLUSIONS

A comprehensive analysis of all morphological and functional findings during dynamic MRI of the pelvic floor can provide information missed by other imaging modalities and hence alter therapeutic strategies.

Prevalence and Severity of Pelvic Floor Disorders during Pregnancy: Does the Trimester Make a Difference?

(1) Background: Women experience pelvic floor dysfunction symptoms during pregnancy. This study is the first to investigate and compare variances in the prevalence and severity of pelvic floor symptoms between trimesters using a valid pregnancy-targeted questionnaire. (2) Methods: A retrospective cohort study was conducted between August 2020 to January 2021 at two university-affiliated tertiary medical centers. Pregnant women (n = 306) anonymously completed the Pelvic Floor Questionnaire for Pregnancy and Postpartum with its four domains (bladder, bowel, prolapse, and sexual). (3) Results: Thirty-six women (11.7%) were in the 1st trimester, eighty-three (27.1%) were in the 2nd trimester, and one hundred and eighty-seven (61.1%) were in the 3rd trimester. The groups were similar in age, pregestational weight, and smoking habits. A total of 104 (34%) had bladder dysfunction, 112 (36.3%) had bowel dysfunction, and 132 (40.4%) reported sexual inactivity and/or sexual dysfunction. Least prevalent (33/306; 10.8%) were prolapse symptoms. Increased awareness of prolapse and significantly higher rates of nocturia and the need to use pads due to incontinence were recorded in the 3rd trimester. Sexual dysfunction or abstinence were equally distributed in all three trimesters. (4) Conclusions: Bladder and prolapse symptoms, equally frequent throughout pregnancy, significantly intensified in the 3rd trimester. Bowel and sexual symptoms, equally frequent throughout pregnancy, did not intensify in the third trimester.

Platelet rich plasma for the management of urogynecological disorders: the current evidence

PURPOSE OF REVIEW

Our objective is to review the currently available literature on the use of platelet-rich plasma (PRP) in patients with pelvic floor disorders and to critically appraise the latest evidence on the safety and efficacy of the PRP application.

RECENT FINDINGS

The evidence on the use of PRP for the treatment of stress urinary incontinence (SUI) appears promising, although limited to case series, case reports and animal studies. PRP has also been proposed to enhance the surgical outcomes of pelvic organ prolapse (POP) by native tissue repair with promising success rates. The application of PRP in other PFDs including vaginal fistulas, genitourinary syndrome of menopause (GSM), mesh exposure and lichen sclerosus has been also associated with beneficial outcomes and a favorable safety profile.

SUMMARY

The currently available literature indicates that PRP could have a beneficial effect as a single or adjuvant treatment in patients with SUI, POP, GSM, vaginal fistula and genital lichen sclerosus with minimal adverse events. However, valid evidence is still lacking and further well-designed studies are warranted in the field to confirm the validity of the so far reported outcomes.