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Yount-Tavener SM, Fay RA. Maintaining A Long-Term Practice of Daily Pelvic Floor Muscle Exercises: What Do Childbearing Women Think? J Midwifery Womens Health 2024; 69:567-576. [PMID: 38520694 DOI: 10.1111/jmwh.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/02/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION To be effective, pelvic floor muscle therapy (PFMT) exercises should be intense, be practiced consistently, and include clinical support. Many women do not adhere to a consistent PFMT program, compromising the resolution or prevention of urinary incontinence (UI). This study aimed to answer 2 key questions: What prevents women from performing PFMT long term, and what can health care providers do to support women to perform them? METHODS Postpartum women from 4 sites in the United States completed a questionnaire about experiences with PFMT or Kegel exercises during and after pregnancy. This study focused on one of the 7 open-ended questions: What would prevent you from performing Kegels lifelong? Thematic analysis was implemented via an inductive approach using Braun and Clarke's 6-phase process. RESULTS Three salient themes emerged that help explain factors that prevent women from adhering to a daily PFMT routine: (1) life gets in the way, (2) inadequate PFMT education and instruction, and (3) disconnect exists about long-term consequences. The sample included 368 participants. DISCUSSION The themes were congruent with the limited body of qualitative literature on experience with PFMT exercises. This study was able to identify areas of need in the US maternal health care system to help childbearing people adopt daily PFMT, such as (1) inadequate parental leave and childcare support, (2) no formalized education related to UI and PFMT and a lack of pelvic health promotion, (3) lacking prioritization of long-term PFMT, and (4) the need to dispel the acceptance that UI postbirth is normal. Health care providers should prioritize interactive education, emphasizing how to correctly perform PFMT and the importance and effectiveness of integrating clinical support. To adequately encompass pelvic floor health care and education up to one year postbirth, changes are needed to the US perinatal health care system, providing sufficient insurance reimbursement and parental social support programs.
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Affiliation(s)
- Susan M Yount-Tavener
- Department of Midwifery and Women's Health, Frontier Nursing University, Lexington, Kentucky
| | - Rebecca A Fay
- Department of Midwifery and Women's Health, Frontier Nursing University, Lexington, Kentucky
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Aleissa M, Osumah T, Drelichman E, Mittal V, Bhullar J. Current Status and Role of Artificial Intelligence in Anorectal Diseases and Pelvic Floor Disorders. JSLS 2024; 28:e2024.00007. [PMID: 38910957 PMCID: PMC11189024 DOI: 10.4293/jsls.2024.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background Anorectal diseases and pelvic floor disorders are prevalent among the general population. Patients may present with overlapping symptoms, delaying diagnosis, and lowering quality of life. Treating physicians encounter numerous challenges attributed to the complex nature of pelvic anatomy, limitations of diagnostic techniques, and lack of available resources. This article is an overview of the current state of artificial intelligence (AI) in tackling the difficulties of managing benign anorectal disorders and pelvic floor disorders. Methods A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed database to identify all potentially relevant studies published from January 2000 to August 2023. Search queries were built using the following terms: AI, machine learning, deep learning, benign anorectal disease, pelvic floor disorder, fecal incontinence, obstructive defecation, anal fistula, rectal prolapse, and anorectal manometry. Malignant anorectal articles and abstracts were excluded. Data from selected articles were analyzed. Results 139 articles were found, 15 of which met our inclusion and exclusion criteria. The most common AI module was convolutional neural network. researchers were able to develop AI modules to optimize imaging studies for pelvis, fistula, and abscess anatomy, facilitated anorectal manometry interpretation, and improved high-definition anoscope use. None of the modules were validated in an external cohort. Conclusion There is potential for AI to enhance the management of pelvic floor and benign anorectal diseases. Ongoing research necessitates the use of multidisciplinary approaches and collaboration between physicians and AI programmers to tackle pressing challenges.
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Affiliation(s)
- Maryam Aleissa
- Fellow of Colorectal Surgery, Ascension Providence Hospital - Michigan State University, College of Human Medicine, Southfield, Michigan, USA
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Tijani Osumah
- Fellow of Colorectal Surgery, Ascension Providence Hospital - Michigan State University, College of Human Medicine, Southfield, Michigan, USA
| | - Ernesto Drelichman
- Assistant Program Director of Colorectal Surgery Fellowship, Department of Surgery, College of Human Medicine, Ascension Providence Hospital-Michigan State University, Southfield, Michigan, USA
| | - Vijay Mittal
- Associate DIO Medical Education, Past Program Director, General Surgery, Department of Surgery, College of Human Medicine, Ascension Providence Hospital-Michigan State University, Southfield, Michigan, USA
| | - Jasneet Bhullar
- Program Director of Colorectal Surgery Fellowship, Clinical Assistant Professor WSUCOM/MSUCHM, Department of Surgery, College of Human Medicine, Ascension Providence Hospital-Michigan State University, Southfield, Michigan, USA
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Kalev G, Marquardt C, Schmerer M, Ulrich A, Heyl W, Schiedeck T. Resection rectopexy as part of the multidisciplinary approach in the management of complex pelvic floor disorders. Innov Surg Sci 2023; 8:29-36. [PMID: 37842195 PMCID: PMC10576551 DOI: 10.1515/iss-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/22/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required. Methods All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications. Results Two hundred and eighty seven patients were assigned to one of the following groups: PG1 - patient group one: after resection rectopexy (n=141); PG2 - after ventral rectopexy (n=8); PG3 - after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4 - after combined resection rectopexy and trans-vaginal pelvic floor repair (n=76). The duration of follow-up was 14 months for PG1 (median, IQR 37 months), 11 months for PG2 (mean, SD 9 months), 7 months for PG 3 (median, IQR 33 months), and 12 months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. "De novo" constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade ≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499). Conclusions Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.
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Affiliation(s)
- Georgi Kalev
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Christoph Marquardt
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Marten Schmerer
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Anja Ulrich
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Wolfgang Heyl
- Department of Obstetrics and Gynecology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Thomas Schiedeck
- Department of General, Visceral, Thoracic and Pediatric Surgery, Ludwigsburg Hospital, Ludwigsburg, Germany
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Alborzi Avanaki F, Rafiee S, Aldin Varpaei H, Taher M, Aletaha N, Allameh F. Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study. Middle East J Dig Dis 2023; 15:45-52. [PMID: 37547159 PMCID: PMC10404073 DOI: 10.34172/mejdd.2023.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/02/2022] [Indexed: 08/08/2023] Open
Abstract
Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Methods: This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Results: Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 ± 11.4. The average resting pressure decreased in response to treatment; however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion: Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.
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Affiliation(s)
- Foroogh Alborzi Avanaki
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Rafiee
- Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Taher
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Aletaha
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Allameh
- Department of Gastroenterology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Derrar SL, Dallak FH, Alfaifi A, Alessa RM, Abbas KA, Zurayyir AJ, Altraifi AA, Gosadi I. Knowledge, Attitude, and Practice of Pregnant Women in Jazan, Saudi Arabia Concerning Pelvic Floor Muscle Exercises. Cureus 2022; 14:e28819. [PMID: 36105894 PMCID: PMC9445776 DOI: 10.7759/cureus.28819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
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Jin J, Wang M. Effects of Pelvic Floor Muscle Training Combined with Estriol on Pelvic Floor Dysfunction after Total Hysterectomy Applied in Perimenopause. Appl Bionics Biomech 2022; 2022:6962542. [PMID: 35898602 PMCID: PMC9314174 DOI: 10.1155/2022/6962542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Total hysterectomy (TH) is becoming more and more common in clinical practice, and many patients suffer from postoperative complications such as pelvic floor dysfunction (PFD). How to prevent and treat PFD is an important part of the current clinical work, and it is important to improve patients' postoperative quality of life. This study was to investigate the effect of pelvic floor muscle training (PFMT) combined with estriol on PFD after TH in perimenopause. Methods Totally, 95 patients who developed PFD receiving TH in our hospital between January 2020 and June 2021 were selected. They were randomly divided into a PFMT+ET (estriol therapy) group (n = 49) and CT group (conventional treatment, n = 46). After treatment, the two groups were compared in terms of pelvic floor muscle tension (systolic pressure and resting pressure of the vagina), female sexual function index (pain, satisfaction, orgasm, sexual arousal, sexual desire, and lubrication), and the degree of PFD (persistent time of vaginal muscle contraction, 1-hour pad test, residual urine volume, and frequency of urinary incontinence). Results After 4 months of treatment, vaginal systolic pressure and resting pressure were significantly increased in both groups, with higher levels in the PFMT+ET group. Also, the improvement in female sexual function index score and persistent time of vaginal muscle contraction was observed to be greater in the PFMT+ET group than in the CT group. Additionally, PFMT combined with estriol resulted in lower levels of urinary leakage in the 1-hour pad test, residual urine volume, and frequency of urinary incontinence. Conclusions The postoperative intervention of PFMT combined with estriol in perimenopausal patients with TH can significantly improve vaginal muscle contraction, improve the quality of sexual life, and reduce the degree of PFD, which has a good application prospect.
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Affiliation(s)
- Jichao Jin
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, Taizhou, Zhejiang 317500, China
| | - Minyuan Wang
- Department of Obstetrics and Gynecology, The First People's Hospital of Wenling, Taizhou, Zhejiang 317500, China
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Validation of the Sinhala translations of the Pelvic Floor Distress Inventory and the Pelvic Floor Impact Questionnaire in a Sri Lankan population. Int Urogynecol J 2021; 32:3235-3248. [PMID: 33779797 DOI: 10.1007/s00192-021-04695-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was to translate and validate self-reported questionnaires, the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) into Sinhala, the language spoken by the majority of Sri Lankans. METHODS A total of 270 patients were enrolled in this study. Two groups were selected with pelvic organ prolapse (POP)-cases and without POP-controls in a ratio of 1:2 respectively. Psychometric properties of the questionnaires were assessed using content validity, face validity, convergent validity, construct validity, internal consistency, and reliability. Pelvic Organ Prolapse Quantification (POP-Q) was used as the test to quantify POP. RESULTS Excellent content validity was demonstrated by a content validity ratio for all items by experts. Face validity was confirmed by non-experts using a five-point Likert scale and Mann-Whitney U test for all items. Internal consistency was found to be high for both questionnaires (Cronbach's alpha >0.8) in all items. Construct validity was assessed by receiver-operating characteristic curves and the area under the curve is above 0.5 in all items in both questionnaires. Convergent validity was assessed using Pearson coefficient correlation, which was above 0.8 for all subscales. Reliability was low for all subscales in the paired t test. CONCLUSIONS The Sinhala versions of PFDI-20 and PFIQ-7 were valid, consistent, responsive, but have low reliability in the Sri Lankan setting.
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Sánchez-Sánchez B, Arranz-Martín B, Navarro-Brazález B, Vergara-Pérez F, Bailón-Cerezo J, Torres-Lacomba M. How Do We Assess Patient Skills in a Competence-Based Program? Assessment of Patient Competences Using the Spanish Version of the Prolapse and Incontinence Knowledge Questionnaire and Real Practical Cases in Women with Pelvic Floor Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052377. [PMID: 33804379 PMCID: PMC7967754 DOI: 10.3390/ijerph18052377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 02/03/2023]
Abstract
Therapeutic patient education programs must assess the competences that patients achieve. Evaluation in the pedagogical domain ensures that learning has taken place among patients. The Prolapse and Incontinence Knowledge Questionnaire (PIKQ) is a tool for assessing patient knowledge about urinary (UI) and pelvic organ prolapse (POP) conditions. The aim of this study was to translate the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) into Spanish and test its measurement properties, as well as propose real practical cases as a competence assessment tool. The cross-cultural adaptation was conducted by a standardized translation/back-translation method. Measurement properties analysis was performed by assessing the validity, reliability, responsiveness, and interpretability. A total of 275 women were recruited. The discriminant validity showed statistically significant differences in the PIKQ scores between patients and expert groups. Cronbach's alpha revealed good internal consistency. The test-retest reliability showed excellent correlation with UI and POP scales. Regarding responsiveness, the effect size, and standardized response mean demonstrated excellent values. No floor or ceiling effects were shown. In addition, three "real practical cases" evaluating skills in identifying and analyzing, decision making, and problem-solving were developed and tested. The Spanish PIKQ is a comprehensible, valid, reliable, and responsive tool for the Spanish population. Real practical cases are useful competence assessment tools that are well accepted by women with pelvic floor disorders (PFD), improving their understanding and their decision-making regarding PFD.
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Affiliation(s)
- Beatriz Sánchez-Sánchez
- Physiotherapy in Women’s Health Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain; (B.S.-S.); (B.A.-M.); (F.V.-P.); (J.B.-C.); (M.T.-L.)
| | - Beatriz Arranz-Martín
- Physiotherapy in Women’s Health Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain; (B.S.-S.); (B.A.-M.); (F.V.-P.); (J.B.-C.); (M.T.-L.)
| | - Beatriz Navarro-Brazález
- Physiotherapy in Women’s Health Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain; (B.S.-S.); (B.A.-M.); (F.V.-P.); (J.B.-C.); (M.T.-L.)
- Correspondence:
| | - Fernando Vergara-Pérez
- Physiotherapy in Women’s Health Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain; (B.S.-S.); (B.A.-M.); (F.V.-P.); (J.B.-C.); (M.T.-L.)
| | - Javier Bailón-Cerezo
- Physiotherapy in Women’s Health Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain; (B.S.-S.); (B.A.-M.); (F.V.-P.); (J.B.-C.); (M.T.-L.)
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain; (B.S.-S.); (B.A.-M.); (F.V.-P.); (J.B.-C.); (M.T.-L.)
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Chen H, Li Z, Lin M, Lv X, Wang J, Wei Q, Zhang Z, Li L. MicroRNA-124-3p affects myogenic differentiation of adipose-derived stem cells by targeting Caveolin-1 during pelvic floor dysfunction in Sprague Dawley rats. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:161. [PMID: 33569463 PMCID: PMC7867888 DOI: 10.21037/atm-20-8212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The aim of this study was to investigate using myogenic differentiation of adipose stem cells for the treatment of female pelvic floor dysfunction (PFD) and aimed to further study the influences of microRNA-124-3p (miR-124-3p) in the process of myogenic differentiation of adipose-derived stem cells (ADSCs) through targeting Caveolin-1 (Cav1) during PFD in Sprague Dawley (SD) rats. Methods The ADSCs were separated from 6–8-week-old female SD rats (n=25) and were cultivated. Then, we observed the cell status and conducted fat and osteogenic experiments. We then constructed an ADSC-green fluorescent protein (GFP) stable transfer strain. Flow cytometry was used to identify the positive rates of CD44, CD90, and CD45 in ADSCs and ADSC-GFP. Real-time quantitative polymerase chain reaction (qRT-PCR) and western blotting were used to mRNA and protein expression levels. Myogenic differentiation of ADSCs was measured with immunofluorescence methods. A dual-luciferase reporter assay was executed to affirm whether Cav1 was a target of miR-124-3p. Results The isolated ADSCs cells were in good condition under the microscope. The results of flow cytometry showed that the positive rate of CD44 and CD90 was high, and the positive rate of CD45 was low in ADSCs and ADSC-GFP. Under normal culture conditions, ADSCs-GFP cells can be massively adipated and osteogenic. After 5-Aza induced ADSC-GFP myogenic differentiation, the level of miR-124-3p was significantly increased. We found that MiR-124-3p mimics promoted the myogenic differentiation of ADSCs. Moreover, we discovered that Cav1 was a target gene of miR-124-3p and was negatively regulated by miR-124-3p. The results of leak point pressure (LPP), hematoxylin and eosin (HE), and Masson showed that the collagen fiber content of the PFD group was lower than that of the control group; the collagen fiber content of ADSC-GFP, 5-Aza, or miR-124-3p mimics were increased after intervention. Furthermore, the outcomes qRT-PCR, western blotting, and immunofluorescence suggested that miR-124-3p facilitated the survival ADSC-GFP fat transplantation by regulating many key factors in vivo. Conclusions These results proofed that miR-124-3p could accelerate myogenic differentiation of ADSCs by down-regulating Cav1 to improve PFD in SD rats, which will pave the way for therapeutic delivery of miRNA targeting PFD disease.
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Affiliation(s)
- Hao Chen
- Department of Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zihao Li
- Hangzhou Medical College, Hangzhou, China
| | - Ming Lin
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuling Lv
- Department of Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingping Wang
- Department of Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing Wei
- Department of Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zikai Zhang
- Department of Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liqun Li
- Department of Plastic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Kasper-Jędrzejewska M, Jędrzejewski G, Ptaszkowska L, Ptaszkowski K, Schleip R, Halski T. The Rolf Method of Structural Integration and Pelvic Floor Muscle Facilitation: Preliminary Results of a Randomized, Interventional Study. J Clin Med 2020; 9:jcm9123981. [PMID: 33316903 PMCID: PMC7764274 DOI: 10.3390/jcm9123981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/29/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
The management of pelvic floor dysfunctions might need to be based on a comprehensive neuro-musculoskeletal therapy such as The Rolf Method of Structural Integration (SI). The aim of the study was to evaluate the pelvic floor muscle (PFM) after the tenth session of SI by using surface electromyography (sEMG). This was a randomized, interventional study. Thirty-three healthy women were randomly assigned to the experimental (SI) or control group. The outcome measures included PFM bioelectrical activity, assessed using sEMG and endovaginal probes. An intervention in the SI group included 60 min of SI once a week, and teaching on how to contract and relax PFMs; in the control group, only the teaching was carried out. In the SI group, a significant difference was found between the PFM sEMG activity during “pre-baseline rest” (p < 0.014) and that during “rest after tonic contraction” (p = 0.021) in the supine position, as were significant increases in “phasic contraction” in the standing position (p = 0.014). In the intergroup comparison, higher PFM sEMG activity after the intervention “phasic contraction” (p = 0.037) and “pre-baseline rest” (p = 0.028) was observed in the SI group. The SI intervention significantly changes some functional bioelectrical activity of PFMs, providing a basis for further research on a new approach to PFM facilitation, particularly in clinical populations.
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Affiliation(s)
- Martyna Kasper-Jędrzejewska
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
- Correspondence:
| | - Grzegorz Jędrzejewski
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
| | - Lucyna Ptaszkowska
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
| | - Kuba Ptaszkowski
- Department of Clinical Biomechanics and Physiotherapy in Motor System Disorders, Faculty of Health Science, Wroclaw Medical University, Grunwaldzka 2, 50-355 Wroclaw, Poland;
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Georg Brauchle Ring 60/62, 80992 München, Germany;
- Diploma University of Applied Sciences, Am Hegeberg 2, 37242 Bad Sooden-Allendorf, Germany
| | - Tomasz Halski
- Institute of Health Sciences, Opole University, Plac Kopernika 11a, 45-040 Opole, Poland; (G.J.); (L.P.); (T.H.)
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Kizilkan Y, Tohma YA, Senel S, Gunakan E, Oguzulgen AI, Aktas BK, Bulut S, Gokkaya CS, Ozden C, Ozkardes H, Ayhan A. The Effects of Transobturator Tape Surgery on Sexual Functions in Women With Stress Urinary Incontinence. Sex Med 2020; 8:777-782. [PMID: 32891593 PMCID: PMC7691869 DOI: 10.1016/j.esxm.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Stress urinary incontinence (SUI) can adversely affect the patient's sexual function. Aim To evaluate the sexual functions in women who underwent transobturator tape (TOT) surgery because of stress urinary incontinence and factors affecting the treatment results. Methods The study was conducted in 2 tertiary level clinics between 2013 and 2019 and included sexually active patients with a diagnosis of SUI who underwent TOT operation. The preoperative and postoperative (6 months after surgery) Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores of the patients were evaluated. The patients were evaluated according to the score changes of an increased score (benefited) and the same or lower score (did not benefit). The PISQ-12 questionnaire has 3 subdomains of behavioral-emotive (Q: 1–4), physical (Q: 5–9), and partner-related (Q: 10–12). Each question is scored from 0 to 4, giving a total ranging from 0 to 48. A higher PISQ-12 score indicates better sexual function. Main Outcome Measure PISQ-12. Results The study included 117 patients with a median age of 52 years (range, 32–67 years), and 51.3% of the patients were postmenopausal. When the preoperative and postoperative PISQ-12 scores were evaluated in the whole group, there was a statistically significant improvement (from 24.66 to 26.52, P = .001). In the analysis of domains, there was a statistically significant improvement in physical score (from 11.68 to 13.53, P < .001), whereas behavioral-emotive and partner-related scores did not significantly change. In the multivariate analysis of menopausal status, parity and presence of diabetes mellitus were all independently and significantly associated with poor PISQ-12 outcome (OR: 2.60, 95% CI: 1.41–4.81, P = .002; OR: 1.59, 95% CI: 1.03–2.47, P = .034; and OR: 2.42, 95% CI: 1.28–4.58, P = .007, respectively). Conclusion Both physical and psychological statuses should be taken into consideration when planning treatment in patients with urinary incontinence, and it should be noted that postsurgical sexual function status may not be positively affected in postmenopausal, multiparous, and diabetic patients. Kizilkan Y, Tohma YA, Senel S, et al. The Effects of Transobturator Tape Surgery on Sexual Functions in Women With Stress Urinary Incontinence. Sex Med 2020;8:777–782.
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Affiliation(s)
- Yalcin Kizilkan
- Department of Urology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Yusuf Aytac Tohma
- Department of Obstetrics and Gynecology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Samet Senel
- Department of Urology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Emre Gunakan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | | | - Binhan Kagan Aktas
- Department of Urology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Suleyman Bulut
- Department of Urology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | | | - Cuneyt Ozden
- Department of Urology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hakan Ozkardes
- Department of Urology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Ali Ayhan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Başkent University, Ankara, Turkey
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12
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Khowailed IA, Disney H, Lee H. Gender-specific differences of normative values of pelvic floor muscle function in healthy adults population: an observational analytical study. Women Health 2020; 60:1185-1195. [PMID: 32854597 DOI: 10.1080/03630242.2020.1807449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Females and males differ significantly in gross anatomy and physiology of the pelvic floor muscle, and these differences are commonly discussed in the scientific literature. However, less attention is dedicated to investigating the normative values of pelvic floor muscle (PFM) function between females and males. Our study aims to describe the normal reference values of PFM function in females and males of a healthy adult population using transabdominal ultrasound (TAUS). A total of 200 healthy adults, including 71 males and 129 females consented to participate in this study. Bladder base displacement was measured using a sagittal curved linear array 2-5 MHz transducer over the suprapubic region. The amount of bladder base movement on ultrasound was measured in all subjects from freeze frame ultrasound images and considered as an indicator of PFM function. The average age of subjects was (26.1 ± 2.6 years), (24.4 ± 3.7 BMI). Statistical analysis revealed a significant difference in transabdominal ultrasound measurement for PFM function (p = .00000). The bladder base displacement was significantly greater in males compared to females (0.65 ± 0.42 vs. 0.38 ± 0.35, p <.001, 95% CI:0.16-0.38). The present study provides evidence of a gender-related PFM functional differences creating a baseline for the clinic to establish the normal percentile values of PFM function.
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Affiliation(s)
- Iman Akef Khowailed
- Department of Physical Therapy, College of Rehabilitative Sciences, University of St Augustine for Health Sciences , San Marcos, California, USA
| | - Heather Disney
- Department of Physical Therapy, College of Rehabilitative Sciences, University of St Augustine for Health Sciences , San Marcos, California, USA
| | - Haneul Lee
- Department of Physical Therapy, Gachon University , Incheon, Korea
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Xu L, Fu C, Zhang Q, Xiong F, Peng L, Liang Z, Chen L, He C, Wei Q. Efficacy of biofeedback, repetitive transcranial magnetic stimulation and pelvic floor muscle training for female neurogenic bladder dysfunction after spinal cord injury: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034582. [PMID: 32759239 PMCID: PMC7409967 DOI: 10.1136/bmjopen-2019-034582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Neurogenic bladder dysfunction is prevalent in female patients with spinal cord injury (SCI), and previous guidelines have recommended pelvic floor muscle training (PFMT) for first-line conservative treatment. However, the actual regimen of PFMT varies widely and the single treatment does not satisfy the need of some patients. Therefore, this study aims to provide a detailed rationale and methodology for comparing the effectiveness of PFMT, biofeedback and repetitive transcranial magnetic stimulation (rTMS) as adjunct treatments for neurogenic bladder dysfunction. METHODS AND ANALYSIS This trial is a single-centre randomised controlled trial for female patients with urinary incontinence (UI) in phase of chronic SCI. Eligible participants will be randomised to one of four arms: (1) PFMT, (2) PFMT with biofeedback, (3) PFMT and rTMS and (4) PFMT with biofeedback and rTMS. There will be 44 participants in each arm and all the subjects will undergo 20 treatment sessions, five times a week for 4 weeks. The outcomes will be evaluated at 4 weeks, 3 months and 6 months after randomisation. The primary outcome is the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, and the secondary outcomes include bladder diary, pelvic floor muscle function and the International Spinal Cord Injury Quality of Life Basic Data Set. ETHICS AND DISSEMINATION The Clinical Research and Biomedical Ethics Committee of the West China Hospital, Sichuan University has approved this trial and the approval number is 2019-885. All participants will be provided written informed consent after verification of the eligibility criteria. The results of this study will be accessible in peer-reviewed publications and be presented at academic conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900026126).
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Affiliation(s)
- Lin Xu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Qing Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Feng Xiong
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Zejun Liang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Li Chen
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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Saei Ghare Naz M, Ramezani Tehrani F, Behroozi-Lak T, Mohammadzadeh F, Kholosi Badr F, Ozgoli G. Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review. Res Rep Urol 2020; 12:179-185. [PMID: 32440514 PMCID: PMC7213900 DOI: 10.2147/rru.s249611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/14/2020] [Indexed: 01/06/2023] Open
Abstract
Pelvic floor dysfunction is one of the most common disorders in women that is associated with social and economic consequences. In general, this disorder imposes direct and indirect costs on the economy of various societies. This review aimed to investigate pelvic floor dysfunction in women with polycystic ovary syndrome (PCOS). In this narrative review, the published articles on pelvic floor dysfunction were examined in PubMed, Scopus, Web of Sciences and Google Scholar. We searched for terms related to polycystic ovary syndrome and pelvic floor dysfunction. Inclusion criteria of this research were observational, experimental, and review studies. In this investigation, the complications associated with polycystic ovary syndrome were examined as risk factors for pelvic floor dysfunction. In this narrative review, we discuss about changes in hormone levels, obesity and overweight, hormonal medications and complications such as diabetes and metabolic disorders and obstetric complications of PCOS can be involved in the pathophysiology of pelvic floor dysfunctions, including stress urinary incontinence and pelvic organ prolapse in women with PCOS. This review highlights knowledge gaps about protective effect of hyperandrogenism on pelvic floor dysfunction as well as destructive effect of metabolic changes on pelvic floor dysfunction in women with PCOS. Further cohort and prospective studies are recommended in women with PCOS to investigate the concept of pelvic organ dysfunction in these women.
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Affiliation(s)
- Marzieh Saei Ghare Naz
- Student Research Committee, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Behroozi-Lak
- Reproductive Health Research Center, Department of Infertility, Urmia University of Medical Sciences, Urmia, Iran
| | - Farnaz Mohammadzadeh
- Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhnaz Kholosi Badr
- Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Giti Ozgoli
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sakin Ö, Uzun SB, Koyuncu K, Giray B, Akalın EE, Anğın AD. Cervix human papilloma virus positivity: Does it cause sexual dysfunction? Turk J Obstet Gynecol 2020; 16:235-241. [PMID: 32231854 PMCID: PMC7090267 DOI: 10.4274/tjod.galenos.2019.18853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/10/2019] [Indexed: 01/23/2023] Open
Abstract
Objective: To investigate whether testing positive for human papilloma virus (HPV) in cervical screening has an impact on female sexual functioning. Materials and Methods: This study was designed as a single-center, prospective, descriptive-cross-sectional study and 300 women who received HPV testing in our hospital [HPV-positive (n=187) or HPV-negative (n=113)]. The Arizona Sexual Experiences (ASEX) scale and Female Sexual Functioning index (FSFI) were administered to study participants during face-to-face interviews. Results: No significant differences were found between women who were HPV-positive and HPV-negative in sexual functions as assessed using the ASEX and FSFI scales (p=0.343 and p=0.604, respectively). In addition, the analyses addressing whether sexual functioning was affected by a positive test result, at diagnosis or during the follow-up (before 2 weeks, 2 weeks-1 month, 1-3 months, 3-6 months, 6 months-1 year and over 1 year) revealed no significant differences between HPV-positive and HPV-negative women in sexual functioning (p>0.05). Sexual dysfunction was less common in married women than in the ASEX scale (p=0.03), and this difference was not detected when the FSFI scale was applied. The incidence of dysfunction was more frequent in working women than in retirees (p=0.006, p=0.01). Conclusion: Educational attainment, socioeconomic status, age, employment status, and marital status were found to have statistically significant effects on sexual functioning. Sexual functioning was affected by neither HPV test results (positive/negative) nor time from diagnosis.
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Affiliation(s)
- Önder Sakin
- University of Health Sciences, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Sakine Betül Uzun
- University of Health Sciences, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Family Medicine, İstanbul, Turkey
| | - Kazibe Koyuncu
- University of Health Sciences, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Burak Giray
- University of Health Sciences, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Emine Eda Akalın
- University of Health Sciences, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
| | - Ali Doğukan Anğın
- University of Health Sciences, İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital, Clinic of Obstetrics and Gynecology, İstanbul, Turkey
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Prentice A, Bazzi AA, Aslam MF. Treatment patterns of primary care physicians vs specialists prior to subspecialty urogynaecology referral for women suffering from pelvic floor disorders. World J Methodol 2019; 9:26-31. [PMID: 31367545 PMCID: PMC6658364 DOI: 10.5662/wjm.v9.i2.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral.
AIM To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns.
METHODS This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist vs primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics.
RESULTS There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51% (n = 26) of the PCP compared to 48% (n = 88) of the specialist referrals prior to FPMRS referral (P = 0.6). There was no significant difference in length of treatment prior to referral for PCPs vs specialists (14 mo vs 16 mo, respectively, P = 0.88). However, there was a significant difference in the patient’s average time with the condition prior to referral (35 mo vs 58 mo for PCP compared to specialist referrals) (P = 0.02).
CONCLUSION One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.
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Affiliation(s)
- Abigail Prentice
- Department of Family Medicine, Marquette Health System, Marquette, MI 49855, United States
| | - Ali Ahmad Bazzi
- Department of Obstetrics and Gynaecology, St. John Hospital and Medical Center, MI 48236, United States
| | - Muhammad Faisal Aslam
- Department of Family Medicine, Marquette Health System, Marquette, MI 49855, United States
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Abstract
PURPOSE OF REVIEW Patient-reported outcome measures (PROMs) are tools that are widely used by clinicians and researchers across different medical specialties. In this review, we examine the use of PROMs in the evaluation of female pelvic floor disorders (PFD). RECENT FINDINGS PROM development in the assessment of urinary incontinence is more advanced than other pelvic disorders. Work is ongoing in the scientific community to improve currently available measures and create new robust tools where needed. Hundreds of PROMs are available for use in the evaluation of PFD, some more rigorously validated than others. They are used to screen for diseases, evaluate their impact on quality of life, determine the results of treatment, and measure patient's satisfaction with treatment. Careful consideration is required to choose the appropriate PROMs to care for a patient or include in a research study. The topic was reviewed in the Textbook of Female Urology and Urogynecology published in 2017. We reviewed recent literature (2015-2018) on the topic and summarized our findings.
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Affiliation(s)
- Engy Habashy
- Department of Surgery, Division of Urology, University of Cincinnati, 231 Albert Sabin Way, ML 0589, Room#2511, Cincinnati, OH, 45267, USA.
| | - Ayman E Mahdy
- Department of Surgery, Division of Urology, University of Cincinnati, 231 Albert Sabin Way, ML 0589, Room#2511, Cincinnati, OH, 45267, USA
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Zhang L, Luo X. Clinical Significance of Neuropeptide Y Expression in Pelvic Tissue in Patients with Pelvic Floor Dysfunction. Open Life Sci 2019; 14:126-132. [PMID: 33817144 PMCID: PMC7874799 DOI: 10.1515/biol-2019-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To investigate the neuropeptide Y (NPY) expression in the tissue of pelvic floor ligament and anterior vaginal wall in female patients with pelvic organ prolapse (POP) and stress urinary incontinence (SUI). METHOD Seventeen patients with POP, 6 with SUI, 13 with POP and SUI (POP&SUI), and 10 controls were included in this study from First Affiliated Hospital of JiNan University. Immunohistochemical assay was used to examine NPY expression in the tissue of round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall. NPY expression were compared between POP, SUI, POP&SUI and controls. RESULTS NPY was positive expressed in the round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal subepithelial connective tissue. Compared with the control group, NPY expression in the round, cardinal, and uterosacral ligaments in patients with POP&SUI group was decreased with significant statistical difference (p<0.05). NPY expression in anterior vaginal wall was significantly decreased in POP, SUI, and POP&SUI groups compared to normal group (p<0.05). Compared to POP group, NPY expression in SUI and POP&SUI groups were significantly decreased (p<0.05), however the difference was not statistical different between SUI and POP&SUI groups (p>0.05). In POP and POP&SUI groups, the NPY expression in the cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall were negatively correlated with age (p<0.05), however, was not correlated with number of pregnancy, number of delivery, and BMI (p>0.05). CONCLUSIONS NPY expression was reduced in the round ligament, cardinal ligament of uterus, Uterosacral ligament, and vaginal anterior wall of the patients with POP and SUI. The decreased NPY expression may play an important role in the development of pelvic floordysfunction.
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Affiliation(s)
- Limin Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Fujian Medical University, Fuzhou350005 PRChina
| | - Xin Luo
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Jinan510632 PRChina
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Han W, Wang Y, Qi S, Li T, Cao J, Zheng T, Su Y. Observation of the effect of physical rehabilitation therapy combined with the medication on pelvic floor dysfunction. Exp Ther Med 2017; 15:1211-1216. [PMID: 29399117 PMCID: PMC5774529 DOI: 10.3892/etm.2017.5583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/18/2017] [Indexed: 12/13/2022] Open
Abstract
We observed the effects of physical rehabilitation therapy combined with medication on pelvic floor dysfunction (PFD). We collected the medical records of 84 maternal patients with PFD who received treatment at the Affiliated Hospital of Hebei University between May 2015 and October 2016. These patients were randomly divided into two groups, the control group (n=42) and observation group (n=42). In the control group, patients received conventional physical rehabilitation therapy while in observation group, patients received the shixiao powder combined with siwu decoction in addition to the physical rehabilitation. The therapeutic effects were compared between the two groups. The total effective rate of the observation group was 97.6%, which was significantly higher than 78.6% in the control group (P<0.05). In observation group, the index scores of pelvic floor function under rest state, such as electromyo-graphy amplitude, contraction force, coordinate strength and urine flow rate, were significantly higher than those in control group (P<0.05). The rate of Grade II perineal muscle strength in the observation group was 7.32%, which was significantly lower than 47.62% in control group (P<0.05). In observation group, the rates of Grade III and Grade IV muscle strength were respectively 43.91 and 29.26%, which were significantly higher than those in control group (P<0.05). Before the administration of treatment, there were no significant differences in the comparison of the urinary incontinence and sexual life quality of patients between the two groups (P>0.05). In observation group, after treatment, the rehabilitation effects of urinary incontinence and sexual life quality at 3 months post-delivery were significantly better than those in control group (P<0.05). Before treatment, there were no significant differences in the comparison of levels of C-reactive protein (CRP) and interleukin-10 (IL-10) between the two groups (P>0.05), however, after treatment, the levels of CRP and IL-10 of patients in observation group were significantly lower than those in control group (P<0.05). In the observation group, the incidence rate of complications (7.14%) were significantly lower than that in control group (23.81%; P<0.05). Therefore, physical rehabilitation therapy combined with the shixiao powder and siwu decoction exhibits significant efficacy in the treatment of PFD by effectively improving the pelvic floor functions, increasing perineal muscle strength, and decreasing expression levels of inflammatory factors, which can significantly ameliorate life quality and reduce the incidence rate of complications. Thus, this treatment method shows great application value in clinical practice.
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Affiliation(s)
- Wei Han
- Maternity and Child Care Among Perinatal Care Clinic, Tangshan, Hebei 063000, P.R. China
| | - Yongmei Wang
- Department of Gynecology and Obstetrics, The Fourth Hospital of Hebei Medical University (Tumor Hospital of Hebei) Shijiazhuang, Hebei 050011, P.R. China
| | - Shengbo Qi
- Hospital of Gastrointestinal Surgery, Weifang, Shandong 261042, P.R. China
| | - Tingting Li
- Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, Hebei 071000, P.R. China
| | - Jiang Cao
- Hospital of Gastrointestinal Surgery, Weifang, Shandong 261042, P.R. China
| | - Tinghua Zheng
- Maternity and Child Care Department of Obstetrics and Gynecology, Tangshan, Hebei 063000, P.R. China
| | - Yan Su
- Maternal and Child Health Care Medicine, Tangshan, Hebei 063000, P.R. China
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Abstract
There has been an overall increase in pelvic organ prolapse due to demographic changes (increased life expectancy). Increasing sociocultural demands of women require treatments that are more effective with methods that are more successful. In the treatment of pelvic floor insufficiency and uterovaginal prolapse, pelvic floor reconstructions with mesh implants have proven to be superior to conventional methods such as the classic colporrhaphy, reconstructions with biomaterial, and native tissue repair in appropriately selected patients and when applying exact operation techniques, especially because of good long-term results and low recurrence rates. When making a systematic therapy plan, one should adhere to certain steps, for example, a pelvic floor reconstruction should be undertaken before performing the corrective procedure for incontinence. The approach, if vaginal, laparoscopic, or abdominal should be chosen wisely, taking into consideration the required space of action, in such a way that none or only minimal collateral damage related to the operation occurs. The use of instrumental suturing techniques and operation robots are advantageous in the case of difficult approaches and limited anatomical spaces. In principle, the surgeon who implants meshes should be able to explant them! The surgical concept of mesh-related interventions in the pelvis must meet established rules. "Implant as little mesh as possible and only as much suitable (!) mesh as absolutely necessary!" In the case of apical direct fixations, a therapeutically relevant target variable is the elevation angle of vagina (EAV). Established anatomical fixation points are preferable. A safe distance between implants and vulnerable tissue is to be maintained. Mesh-based prolapse repairs are indicated in recurrences, in primary situations, in combined defects of the anterior compartment, in central defects of multimorbid and elderly patients, and above all, when organ preservation is wanted. Native connective tissue structures are to be preserved, strengthened and reconstructed to restore altered functions. Practical skills for highly specialized mesh-based operations as well as effective techniques for complication management should be taught in interdisciplinary specialist courses.
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Assessing exercises recommended for women at risk of pelvic floor disorders using multivariate statistical techniques. Int Urogynecol J 2017; 29:1447-1454. [PMID: 28905083 DOI: 10.1007/s00192-017-3473-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is a widely held, but untested, belief that certain exercises and activities generate intraabdominal pressure (IAP) that may compromise the function of the pelvic floor muscles. Women with, or at risk of, pelvic floor disorders are advised therefore to refrain from these exercises and activities in order to theoretically protect their pelvic floor. The aim of this study was to compare IAPs generated during exercises of different types that are recommended to women as pelvic floor "safe" with those generated during the corresponding conventional exercises that women are typically cautioned against. METHODS This was a cross-sectional cohort study. All participants were guided by a trained exercise practitioner through a series of ten exercise pairs, one version recommended to women as pelvic floor "safe" and one conventional version which women are cautioned against. IAP components were extracted from the pressure traces from a wireless intravaginal pressure sensor and used in multivariate linear regression modelling, canonical discriminant analysis, and linear mixed modelling. RESULTS A total of 53 participants were recruited. After adjusting for age, body mass index and parity, there was an exercise type-version effect (p < 0.01). After taking into account all pressure components of the IAP trace, there was a significant difference in IAP between the recommended and discouraged versions of the same exercise for five of the ten exercise types. Coughing and the Valsalva manoeuvre generated IAPs that were distinct from those generated by the exercises. CONCLUSIONS No differences in IAPs were found between the recommended and discouraged versions of the same exercise for all exercise types. In particular, the IAPs generated during the two versions of ball rotations, lunges, core, push-ups and squats did not differ significantly. Performing the recommended pelvic floor "safe" version instead of the discouraged conventional version of these exercises may not necessarily protect the pelvic floor and vice versa.
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Ghorat F, Esfehani RJ, Sharifzadeh M, Tabarraei Y, Aghahosseini SS. Long term effect of vaginal delivery and cesarean section on female sexual function in primipara mothers. Electron Physician 2017; 9:3991-3996. [PMID: 28461875 PMCID: PMC5407233 DOI: 10.19082/3991] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/30/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction Pregnancy and birth giving are two of the most important and common effective factors influencing female sexual function. Sexual dysfunction can affect women’s quality of life and marriage. This research tried to determine the relation between labor type and long term sexual function in primipara women of Sabzevar, Iran. Methods This cross-sectional study took place in Sabzevar healthcare system in 2014. Study population was chosen by random sampling from every primipara woman who had delivered 2 years ago, in Sabzevar Hospitals. A total number of 177 primipara women were enrolled in this study after signing an informed contest. Sexual function of mothers was determined by validated Persian version of female sexual function index (FSFI). SPSS statistical software version 19 and descriptive and inferential statistics such as percentage, mean, standard deviation, Chi square, student t-test and fisher exact test were used to analyze data. Results Among the study population, 69.5% had natural vaginal delivery (NVD) and 30.5% had caesarean section (C/S). The overall FSFI score was not significantly different in women undergoing NVD or C/S (p=0.23). Also, no significant relation was found between delivery method and urinary (p=0.07) and fecal incontinency (p=0.6). Female sexual function was prominent in women with urinary (p=0.015) and fecal incontinency (p=0.018). Conclusion The results of present study showed that delivery method has no long-term effect on female sexual function and appropriate education about the sexual issues after delivery and effect of birth giving on sexual function are necessary for this group of society.
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Affiliation(s)
- Fereshteh Ghorat
- Ph.D. Candidate of Traditional Medicine, Traditional and Complementary Medicine Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Reza Jafarzadeh Esfehani
- MD-Ph.D. student, Department of Medical Genetics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sharifzadeh
- M.Sc. Student of Counseling in Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Yaser Tabarraei
- M.Sc., Traditional and Complementary Medicine Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Shima Sadat Aghahosseini
- Ph.D. Candidate of Nursing, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Peschers U. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:212. [PMID: 27118723 PMCID: PMC5400037 DOI: 10.3238/arztebl.2016.0012b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Jäger W. Broadened View. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:211. [PMID: 27118720 PMCID: PMC5400035 DOI: 10.3238/arztebl.2016.0011b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Wolfram Jäger
- *Urogynäkologie der Universitäts-Frauenklinik Köln, Germany
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Jongen J, Kahlke V, Schimmelpenning H. Proctologists Omitted. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:211. [PMID: 27118719 PMCID: PMC5400034 DOI: 10.3238/arztebl.2016.0011a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Johannes Jongen
- *Proktologische Praxis, Kiel, Abteilung Proktologische Chirurgie, Park-Klinik, Kiel, Germany,
| | - Volker Kahlke
- *Proktologische Praxis, Kiel, Abteilung Proktologische Chirurgie, Park-Klinik, Kiel, Germany,
| | - Hendrik Schimmelpenning
- **Klinik für Chirurgie, Fachzentrum Viszeralchirurgie, Koloproktologie, Gefäß- und Unfallchirurgie, Schön Klinik Neustadt, Germany
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Materna F. NPH Among the Potential Causes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:212. [PMID: 27118722 PMCID: PMC4980300 DOI: 10.3238/arztebl.2016.0012a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Wenderlein MJ. Vaginal Delivery as Leading Risk Factor. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:211-2. [PMID: 27118721 DOI: 10.3238/arztebl.2016.0011c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Peschers U. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016. [PMID: 27118723 PMCID: PMC5400037 DOI: 10.3238/arztebl.2016.0212b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Wenderlein JM. Vaginal Delivery as Leading Risk Factor. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016. [PMID: 27118721 PMCID: PMC5400036 DOI: 10.3238/arztebl.2016.0211c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Jäger W. Broadened View. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016. [PMID: 27118720 PMCID: PMC5400035 DOI: 10.3238/arztebl.2016.0211b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Wolfram Jäger
- *Urogynäkologie der Universitäts-Frauenklinik Köln, Germany
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Materna F. NPH Among the Potential Causes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016. [PMID: 27118722 PMCID: PMC4980300 DOI: 10.3238/arztebl.2016.0212a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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