A Pilot Randomized Controlled Trial of Vaginal Cryotherapy for the Treatment of Pelvic Floor Myofascial Pain.

Introduction And Hypothesis: Pelvic floor myofascial pain (PFMP) is a common but underrecognized component of chronic pelvic pain and pelvic floor disorders symptoms with limited, well-studied treatment modalities. Our objective was to determine the effect of vaginal cryotherapy on PFMP with palpation.

Methods: Following a standardized PFMP screening examination, individuals with a pain score ≥4/10 in ≥1 of four muscle groups were invited to participate in a randomized controlled trial comparing patients undergoing vaginal cryotherapy with controls.

d-Mannose for Recurrent Urinary Tract Infection Prevention in Postmenopausal Women Using Vaginal Estrogen: A Randomized Controlled Trial.

Importance: Further research is needed to determine whether d-mannose plus vaginal estrogen therapy (VET) is beneficial over VET alone for recurrent urinary tract infection (rUTI) prevention.

Objective: The aim of this study was to evaluate d-mannose efficacy for rUTI prevention in postmenopausal women using VET.

Study Design: We conducted a randomized controlled trial comparing d-mannose (2 g/d) with control.

A pilot trial of movement-based pelvic floor physical therapy to address pelvic floor myofascial pain and lower urinary tract symptoms.

Introduction And Hypothesis: Pelvic floor myofascial pain (PFMP) is associated with lower urinary tract symptoms (LUTS). The objective of this study was to test movement-based pelvic floor physical therapy (PT) for patients with PFMP and LUTS. We hypothesized that movement-based PT designed to target PFMP would result in significant improvement in both PFMP and concomitant LUTS.

Pelvic Floor Mobility measured by Transperineal Ultrasound Imaging in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms.

Background: Women with urgency/frequency predominant lower urinary tract symptoms (UF-LUTS) may have elevated pelvic floor muscle (PFM) position at rest and limited mobility with PFM contraction and bearing down, but this has not been quantified.

Objectives: To compare PFM position and mobility using transperineal ultrasound (TPUS) at rest, maximal PFM contraction (perineal elevation), and bearing down (perineal descent) in women with and without UF-LUTS. We hypothesized that women with UF-LUTS would demonstrate elevated resting position and decreased excursion of pelvic landmarks during contraction and bearing down as compared to women without UF-LUTS.

Feasibility and Research Insights From a Randomized Controlled Trial for Recurrent Urinary Tract Infection Prevention in Postmenopausal Women Using Vaginal Estrogen Therapy.

Objective: The aim of the study was to inform feasibility parameters (eligibility, enrollment, and retention) for a recurrent urinary tract infection (rUTI) prevention randomized controlled trial (RCT).

Methods: We assessed feasibility parameters of an RCT of postmenopausal women with uncomplicated rUTIs using vaginal estrogen. Participants were randomized to either d-mannose or a control arm.

Telemedicine: The New "Virtual Reality" of Female Pelvic Medicine and Reconstructive Surgery?

Importance: Understanding women's acceptance of telemedicine as a model of care for pelvic floor disorders (PFDs) allows for a more patient-centered approach to widespread implementation in female pelvic medicine and reconstructive surgery.

Objectives: The pandemic sparked rapid and widespread implementation of telemedicine. Our goal was to assess acceptance, satisfaction, and desire for future use of telemedicine among women seeking care for PFDs.

International Urogynaecology Consultation chapter 1 committee 4: patients' perception of disease burden of pelvic organ prolapse.

Introduction And Hypothesis: This manuscript from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reports on the patients' perception of disease burden associated with pelvic organ prolapse.

Materials And Methods: An international group containing a team of eight urogynaecologists, a physiotherapist and a statistician performed a search of the literature using pre-specified search terms in PubMed and Embase (January 2000 to August 2020). The division of sections within this report includes: (1) perception of POP and the relationship with body image and poor health; (2) a vaginal bulge as it impacts health and wellbeing in women; (3) the impact of POP on sexual life; (4) body image and pelvic floor disorders; (5) POP and mood; (6) appropriate use of treatment goals to better meet patients' expected benefits; (7) using health-related quality of life questionnaires to quantify patients' perception of POP; (8) The financial burden of POP to patients and society.

Hip and Pelvic Floor Muscle Strength in Women with and without Urgency and Frequency Predominant Lower Urinary Tract Symptoms.

Background: Urgency and frequency are common lower urinary tract symptoms (UF-LUTS) in women. There is limited evidence to guide physical therapist-led treatment.

Objectives: To compare hip and pelvic floor muscle strength between women with and without UF-LUTS.

Adult female urinary incontinence guidelines: a systematic review of evaluation guidelines across clinical specialties.

Introduction And Hypothesis: To systematically review evaluation guidelines of uncomplicated urinary incontinence (UI) in community-dwelling adult women to assess guidance available to the full range of providers treating UI.

Methods: Systematic literature search of eight bibliographic databases. We included UI evaluation guidelines written for medical providers in English after January 1, 2008.

Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: is there a correlation?

Background: Pelvic floor myofascial pain, which is predominantly identified in the muscles of the levator ani and obturator internus, has been observed in women with chronic pelvic pain and other pelvic floor disorder symptoms, and is hypothesized to contribute to their symptoms.

Objectives: To describe the prevalence of pelvic floor myofascial pain in patients presenting with pelvic floor disorder symptoms and to investigate whether severity of pelvic floor myofascial pain on examination correlates with degree of pelvic floor disorder symptom bother.

Study Design: All new patients seen at 1 tertiary referral center between 2014 and 2016 were included in this retrospectively assembled cross-sectional study.

Development of a standardized, reproducible screening examination for assessment of pelvic floor myofascial pain.

Background: Pelvic floor myofascial pain is common, but physical examination methods to assess pelvic floor muscles are defined poorly. We hypothesized that a simple, transvaginal pelvic floor examination could be developed that would be highly reproducible among providers and would adequately screen for the presence of pelvic floor myofascial pain.

Objective: The purpose of this study was to develop a simple, reproducible pelvic floor examination to screen for pelvic floor myofascial pain.

Supporting Clinicians After Adverse Events: Development of a Clinician Peer Support Program.

Background: Many healthcare organizations have developed processes for supporting the emotional needs of patients and their families after medical errors or adverse events. However, the clinicians involved in such events may become "second victims" and frequently experience emotional harm that impacts their personal and professional lives. Many "second victims," particularly physicians, do not receive adequate support by their organizations.

Genital hiatus size is associated with and predictive of apical vaginal support loss.

Background: Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse. There are several reasons that this is likely: (1) Although the Pelvic Organ Prolapse-Quantification examination is the standard prolapse staging system used in the Female Pelvic Medicine and Reconstructive Surgery field for reporting outcomes, this assessment is not used commonly in clinical care outside the subspecialty; (2) no clinically useful and accepted definition of apical support loss exists, and (3) no consensus or guidelines address the degree of apical support loss at which an apical support procedure should be performed routinely.

Objective: The purpose of this study was to identify a simple screening measure for significant loss of apical vaginal support.

The Emotional Burden of Pelvic Organ Prolapse in Women Seeking Treatment: A Qualitative Study.

Objective: We aimed to qualitatively describe the emotional burden experienced by women seeking treatment for prolapse. We hypothesized that the condition of prolapse would have an impact on women's emotional well-being.

Methods: Women with stage II or greater symptomatic prolapse participated in focus groups or individual phone interviews.

Sleep quality in women seeking care for pelvic organ prolapse.

Objectives: To identify the prevalence of sleep disturbance in women seeking treatment for pelvic organ prolapse (POP) and identify correlates of poor sleep quality in this population by using a validated sleep scale.

Study Design: This is a cohort study of female patients with pelvic organ prolapse.

Main Outcome Measures: Pittsburgh Sleep Quality Index (PSQI), Pelvic Floor Disorders Inventory (PFDI), and Pelvic Floor Impact Questionnaire (PFIQ) measures were completed.

Most older women recover baseline functional status following pelvic organ prolapse surgery.

Introduction And Hypothesis: To evaluate postoperative functional status changes in older women undergoing pelvic organ prolapse (POP) surgery and determine predictors for nonrecovery of baseline status.

Methods: We enrolled women ≥ 65 years in whom POP surgery was planned and measured functional status using the Katz Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living (IADL) scales at baseline, 1 week, 2 weeks, and 3 months postoperatively. We used logistic regression modeling to identify predictors of postoperative nonrecovery of functional status (score < baseline) and calculated score change over time.

Body image in the Pelvic Organ Prolapse Questionnaire: development and validation.

Objective: The purpose of this study was to develop and validate a prolapse-specific body image questionnaire.

Study Design: Prolapse-specific body image themes that were identified in our previous work served as a framework for the development of a question pool. After review for face and content validity and reading level, the question pool was reduced to 21 items that represent predominant themes and that form the initial Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire.

Inpatient procedures in elderly women: an analysis over time.

Objectives: To describe inpatient surgical and diagnostic/therapeutic procedures in women ≥65 years old and assess procedure trends over time.

Study Design: Procedure data for all women ≥65 years was collected using the National Hospital Discharge Survey, a federal dataset drawn from a representative sampling of U.S.

Long-term efficacy and safety of questionnaire-based initiation of urgency urinary incontinence treatment.

Objective: The objective of the study was to determine the longer-term efficacy and safety of initiating treatment for urgency-predominant urinary incontinence (UUI) in women diagnosed using a simple questionnaire rather than an extensive evaluation.

Study Design: Women completing a 12 week randomized controlled trial of fesoterodine therapy for UUI diagnosed by questionnaire were invited to participate in a 9 month, open-label continuation study. UUI and voiding episodes were collected using voiding diaries.

Effect of a preoperative self-catheterization video on anxiety: a randomized controlled trial.

Introduction And Hypothesis: The purpose of this study was to determine if a clean intermittent self-catheterization (CISC) instructional video could improve anxiety in women undergoing prolapse and/or incontinence surgery.

Methods: A total of 199 women were randomized to preoperative CISC video or routine counseling prior to prolapse/incontinence surgery. Patient anxiety, satisfaction, and concerns about CISC were evaluated using the State-Trait Anxiety Inventory-State (STAI-S) and study-specific visual analog scale (VAS) questions at four perioperative time points.

Body image perceptions in women with pelvic organ prolapse: a qualitative study.

Objective: To describe perceptions of prolapse-specific body image in women with symptomatic prolapse.

Study Design: Women with symptomatic pelvic organ prolapse quantification stage ≥ II prolapse participated in semistructured focus groups or self-report questionnaire. Transcripts were independently reviewed and body image themes were identified and confirmed by consensus.

Normative data for commonly used validated pelvic floor disorder questionnaires in women.

Objective: : To report measures of central tendency for Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), and 12-item short form Pelvic Organ Prolapse-Incontinence-Sexual Function Questionnaire (PISQ-12) in women with POPQ stage ≤I.

Methods: : An analysis was conducted of 67 women participating as controls in a body image in prolapse study who were recruited from a general gynecology setting. Following are the inclusion criteria: (1) presenting complaint was not prolapse/incontinence symptoms; (2) answered "no" to questions, (a) "Do you usually have a sensation of bulging protrusion from the vaginal area?" and (b) "Do you usually have a bulge or something falling out that you can see or feel in the vaginal area?" (3) POPQ stage ≤I; and (4) no prior surgery for prolapse/incontinence.

Retropubic versus transobturator midurethral slings for stress incontinence.

Background: Midurethral slings are increasingly used for the treatment of stress incontinence, but there are limited data comparing types of slings and associated complications.

Methods: We performed a multicenter, randomized equivalence trial comparing outcomes with retropubic and transobturator midurethral slings in women with stress incontinence. The primary outcome was treatment success at 12 months according to both objective criteria (a negative stress test, a negative pad test, and no retreatment) and subjective criteria (self-reported absence of symptoms, no leakage episodes recorded, and no retreatment).

Body image in women before and after reconstructive surgery for pelvic organ prolapse.

Introduction And Hypothesis: This study seeks to determine the impact of prolapse surgery on body image in women with pelvic organ prolapse.

Methods: Case-control study of 76 sexually active women with greater than or equal to stage II prolapse planning reconstructive surgery and 67 women with lesser than or equal to stage I prolapse. Questionnaires/examinations were completed at baseline and 6 months postoperatively for cases and at baseline for controls: Body Exposure During Sexual Activity Questionnaire (BESAQ), Body Image Quality of Life Inventory (BIQLI), Pelvic Floor Distress Inventory (PFDI)/Pelvic Floor Impact Questionnaire (PFIQ), and Pelvic Organ Prolapse-Incontinence Sexual Function Questionnaire-12 (PISQ-12), and the Pelvic Organ Prolapse Quantification (POPQ) examination.