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Medicina
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New Advances in Female Pelvic Floor Dysfunctions Management
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New Advances in Female Pelvic Floor Dysfunctions Management

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (20 January 2023) | Viewed by 24586

Special Issue Editor

Dr. Andrea Braga

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Ente Ospedaliere Cantonale, University of the Italian Switzerland, Mendrisio, Switzerland
Interests: urogynecology; urinary incontinence; pelvic reconstructive surgery; female urology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Female pelvic floor dysfunctions (PFDs) are common conditions affecting over 20% of the adult population. These disorders, which include urinary incontinence, anal incontinence, pelvic organ prolapse and sexual dysfunction, represent serious health problems for the female population. In fact, in addition to physical discomfort, they could lead to psychological distress, such as anxiety and low self-esteem, until depression status.

The prevalence of PFDs increases with age and it is estimated that the number of American women with at least one pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050. Considering the general aging of the global population, these problems could further increase. Besides, due to the embarrassment of patients, the belief that PFDs are a normal and inevitable part of aging and the lack of knowledge about treatment options, the prevalence is often underreported. Less than 20% of symptomatic women self-report their problems.

Furthermore, PFDs have a great impact on financial policy. In the USA, pelvic organ prolapse is thought to be the leading cause of more than 300,000 surgical procedures per year with 25% undergoing reoperations, for a total annual cost of more than 1 billion dollars. Meanwhile, the annual direct cost of urinary incontinence in the USA alone is USD 16.3 billion, of which 3/4 is for the management of women who have this condition.

As women continue to live longer lives, understanding how to promote dialogues between clinicians and patients around these issues and finding therapies to reduce its effect on women’s quality of life, should be a priority for future research. Moreover, it is important to develop the concept of a multidisciplinary approach to PFDs, that in recent years, has led to the improvement of the condition for women.

In this Special Issue, we would like to provide a collection of papers, original articles or clinical/systematic reviews, aimed at providing a comprehensive overview of the recent advances on the diagnosis and treatment of PFDs.

Dr. Andrea Braga
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • female pelvic floor dysfunctions
  • urinary incontinence
  • anal incontinence
  • pelvic organ prolapse
  • sexual dysfunction

Published Papers (7 papers)

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Editorial

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3 pages, 241 KiB  
Editorial
New Advances in Female Pelvic Floor Dysfunction Management
by Andrea Braga and Maurizio Serati
Medicina 2023, 59(6), 1010; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59061010 - 24 May 2023
Viewed by 1277
Abstract
Pelvic floor dysfunctions (PFDs), which include various disorders such as urinary and anal incontinence, pelvic organ prolapse, and sexual disorders, are widespread amongst females, so much so that they affect one fifth of adult women [...] Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)

Research

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9 pages, 1932 KiB  
Article
A Comparative Study on the Clinical Efficacy of Simple Transobturator Midurethal Sling and Posterior Pelvic Floor Reconstruction
by Daoming Tian, Zhenhua Gao, Hang Zhou, Han Lin, Xingqi Wang, Ling Li, Xunguo Yang, Yubin Wen, Quan Zhang and Jihong Shen
Medicina 2023, 59(1), 155; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59010155 - 12 Jan 2023
Cited by 3 | Viewed by 3168
Abstract
Background and Objectives: The purpose of this study was to compare the complications, success rate and satisfaction of pelvic floor reconstruction after transobturator midurethral sling (TOT) and TOT combined with pelvic floor reconstruction in the treatment of female stress urinary incontinence. To explore [...] Read more.
Background and Objectives: The purpose of this study was to compare the complications, success rate and satisfaction of pelvic floor reconstruction after transobturator midurethral sling (TOT) and TOT combined with pelvic floor reconstruction in the treatment of female stress urinary incontinence. To explore the pathogenesis of stress urinary incontinence after pelvic floor stress injury and improve the surgical treatment strategy. Materials and Methods: From 15 August 2018 to 24 February 2022, patients diagnosed with stress urinary incontinence (SUI) and secondary prolapse of the anterior pelvis were selected to receive surgically. Participants were followed up and evaluated at 2 months, 6 months and 1 year after treatment. According to the patient’s chief complaint, the patient can urinate automatically without incontinence. The number of urinary incontinence and urine leakage was significantly reduced compared with those before operation. Urinary incontinence symptoms did not improve or worsen as ineffective, observing the efficacy and complications. Results: We included 191 patients in the TOT group and 151 patients in the pelvic floor reconstruction group after TOT was combined. The operation time and hospital stay in the TOT group were short, but the TOT group needed a second operation to treat recurrent SUI. Perioperative complications were mostly dysuria, and the incidence of postoperative complications in the group of TOT combined with pelvic floor reconstruction was low. The complete success rate and effective rate of pelvic floor reconstruction after TOT in the merger group were significantly higher than those in the TOT group, and the patient satisfaction and complete success rate were also higher. Conclusions: TOT combined with posterior pelvic floor reconstruction has a definite short-term effect on patients with SUI and anterior pelvic secondary prolapse. The operation design should pay attention to the support of the posterior wall of the perineum to the bladder neck and the middle and proximal end of the urethra. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)
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8 pages, 905 KiB  
Communication
Pulsed Magnetic Stimulation for Stress Urinary Incontinence and Its Impact on Sexuality and Health
by Pablo González-Isaza, Rafael Sánchez-Borrego, Félix Lugo Salcedo, Nuria Rodríguez, Diana Vélez Rizo, Irene Fusco and Silvia Callarelli
Medicina 2022, 58(12), 1721; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58121721 - 24 Nov 2022
Cited by 6 | Viewed by 1773
Abstract
It is becoming increasingly common that patients’ preferences move towards non-surgical approaches, such as pulsed magnetic stimulation, for female stress urinary incontinence. Objective: We evaluated the efficacy and safety of a device that uses electromagnetic technology to treat urinary incontinence, with an emphasis [...] Read more.
It is becoming increasingly common that patients’ preferences move towards non-surgical approaches, such as pulsed magnetic stimulation, for female stress urinary incontinence. Objective: We evaluated the efficacy and safety of a device that uses electromagnetic technology to treat urinary incontinence, with an emphasis on health-related quality of life. Methods: A total of 47 female subjects from 18 to 80 years old were enrolled. After block randomization, treatment consisted of 2 pulsed planar magnetic stimulation sessions per week for 4 weeks (8 sessions). Validated questionnaires: Female Sexual Function Index, International Consultation on Incontinence Questionnaire for Urinary Incontinence: Short Form, and Pelvic Floor Bothersome. Follow-ups were performed at weeks 1, 9, and 14. Results: The present study is one of the first clinical trials published evaluating the efficacy and safety of the electromagnetism-based device with flat configuration in patients with stress urinary incontinence, showing a reduction in PFBQ, ICQSF, and Oxford test scores during follow-up, and significantly at week 14 of follow-up, which implied a favorable impact on clinical outcomes, quality of life, and sexuality. Conclusions: The improved results in the treatment group compared with the simulated group show that pulsed magnetic stimulation is a safe and attractive non-invasive alternative for patients who prefer non-surgical treatments. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)
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8 pages, 304 KiB  
Article
Medium Term Outcomes of TVT-Abbrevo for the Treatment of Stress Urinary Incontinence: Efficacy and Safety at 5-Year Follow-Up
by Andrea Braga, Fabiana Castronovo, Anna Ottone, Marco Torella, Stefano Salvatore, Alessandro Ferdinando Ruffolo, Matteo Frigerio, Chiara Scancarello, Andrea De Rosa, Fabio Ghezzi, Andrea Papadia, Giorgio Caccia and Maurizio Serati
Medicina 2022, 58(10), 1412; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58101412 - 08 Oct 2022
Cited by 6 | Viewed by 2044
Abstract
Background and objectives: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting approximately 46% of adult women. After failure of conservative treatment, the mid-urethral sling (MUS) is considered the most effective and safe surgical procedure for SUI. In [...] Read more.
Background and objectives: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting approximately 46% of adult women. After failure of conservative treatment, the mid-urethral sling (MUS) is considered the most effective and safe surgical procedure for SUI. In 2012, Waltregny et al. introduced a new trans-obturator tension-free vaginal tape (TVT) procedure, named TVT-abbrevo (TVT-A). The aim of the present study is to evaluate the efficacy and safety of the TVT-A procedure in women with pure SUI at 5-year follow-up. Materials and Methods: All women who complained of pure SUI symptoms with concomitant urodynamic stress incontinence (USI) were prospectively enrolled and treated with the TVT-A procedure. Postoperative subjective outcome measures included: International Consultation on Incontinence Questionnaire–Short Form (ICI-Q SF), Patient Global Impression of Improvement (PGI-I) scale, and patient degree of satisfaction scale. A PGI-I score ≤ 2 and a patient-satisfaction score ≥8 were used to define subjective success. Objective success was defined as the absence of urine leakage during a cough stress test. Adverse events were collected according to the Clavien–Dindo classification during follow-up. Results: Univariable analysis was used to investigate outcomes. Fifty women who met the inclusion criteria underwent TVT-A implantation. At 5 years after TVT-A implantation, 38 out of 45 (84.4%) patients were subjectively cured (p for trend 0.05), and 40 out of 45 (88.9%) patients were objectively cured (p for trend 0.04). A significant trend of de novo OAB symptoms was reported (22.2% [10/45]) at the 5-year follow-up. No serious early or late complications such as urethral/bladder injury, persistent groin-thigh pain, and sexual dysfunction that required mesh removal were detected. The univariate analysis did not reveal any risk factors (i.e., age, body mass index (BMI), menopause, obstetric factors, and preoperative ICIQ- SF questionnaire) statistically associated with failure of the TVT-A procedure. Conclusions: In conclusion, the 5-year follow-up results of this study demonstrated that TVT-A is a safe and effective option for treatment of SUI with a very low rate of post-operative groin–thigh pain Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)
11 pages, 1903 KiB  
Article
Low Intensity Extracorporeal Shock Wave Therapy as a Novel Treatment for Stress Urinary Incontinence: A Randomized-Controlled Clinical Study
by Kun-Ling Lin, Kuang-Shun Chueh, Jian-He Lu, Shu-Mien Chuang, Bin-Nan Wu, Yung-Chin Lee, Yi-Hsuan Wu, Mei-Chen Shen, Ting-Wei Sun, Cheng-Yu Long and Yung-Shun Juan
Medicina 2021, 57(9), 947; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57090947 - 08 Sep 2021
Cited by 5 | Viewed by 4168
Abstract
Background and Objectives: To evaluate the effects of low intensity extracorporeal shock wave therapy (LiESWT) on stress urinary incontinence (SUI). Materials and Methods: This investigation was a multicenter, single-blind, randomized-controlled trial study. Sixty female SUI patients were randomly assigned to receive [...] Read more.
Background and Objectives: To evaluate the effects of low intensity extracorporeal shock wave therapy (LiESWT) on stress urinary incontinence (SUI). Materials and Methods: This investigation was a multicenter, single-blind, randomized-controlled trial study. Sixty female SUI patients were randomly assigned to receive LiESWT with 0.25 mJ/mm2 intensity, 3000 pulses, and 3 pulses/s, once weekly for a 4-week (W4) and 8-week (W8) period, or an identical sham LiESWT treatment without energy transmission. The primary endpoint was the changes in urine leakage as measured by a pad test and validated standardized questionnaires, while the secondary endpoint was the changes in a 3-day urinary diary among the baseline (W0), the W4 and W8 of LiESWT, and 1-month (F1), 3-month (F3), and 6-month (F6) follow-up after LiESWT. Results: The results showed that 4 weeks of LiESWT could significantly decrease urine leakage based on the pad test and validated standardized questionnaire scores, as compared to the sham group. Moreover, 8 weeks of LiESWT could significantly reduce urine leakage but increase urine volume and attenuate urgency symptoms, which showed meaningful and persistent improvement at W8, F1, F3, and F6. Furthermore, validated standardized questionnaire scores were significantly improved at W8, F1, F3, and F6 as compared to the baseline (W0). Conclusions: Eight weeks of LiESWT attenuated SUI symptoms upon physical activity, reduced urine leakage, and ameliorated overactive bladder symptoms, which implied that LiESWT significantly improved the quality of life. Our findings suggested that LiESWT could serve as a potentially novel and non-invasive treatment for SUI. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)
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Review

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11 pages, 2350 KiB  
Review
The Anatomical Pathogenesis of Stress Urinary Incontinence in Women
by Xunguo Yang, Xingqi Wang, Zhenhua Gao, Ling Li, Han Lin, Haifeng Wang, Hang Zhou, Daoming Tian, Quan Zhang and Jihong Shen
Medicina 2023, 59(1), 5; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina59010005 - 20 Dec 2022
Cited by 8 | Viewed by 6353
Abstract
Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. For this reason, researchers have carried out a large number of studies on stress urinary incontinence. At present, it is [...] Read more.
Stress urinary incontinence is a common disease in middle-aged and elderly women, which seriously affects the physical and mental health of the patients. For this reason, researchers have carried out a large number of studies on stress urinary incontinence. At present, it is believed that the pathogenesis of the disease is mainly due to changes related to age, childbirth, obesity, constipation and other risk factors that induce changes in the urinary control anatomy, including the anatomical factors of the urethra itself, the anatomical factors around the urethra and the anatomical factors of the pelvic nerve. The combined actions of a variety of factors lead to the occurrence of stress urinary incontinence. This review aims to summarize the anatomical pathogenesis of stress urinary incontinence from the above three perspectives. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)
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Other

11 pages, 560 KiB  
Systematic Review
Effects of Non-Invasive Radiofrequency Diathermy in Pelvic Floor Disorders: A Systematic Review
by María Dolores González-Gutiérrez, Álvaro López-Garrido, Irene Cortés-Pérez, Esteban Obrero-Gaitán, Felipe León-Morillas and Alfonso Javier Ibáñez-Vera
Medicina 2022, 58(3), 437; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58030437 - 17 Mar 2022
Cited by 7 | Viewed by 4556
Abstract
Background and Objectives: In recent years, the use of radiofrequency diathermy in pelvic floor disorders has grown proportionally to the interest in this specialty. Despite the common use of this therapy among pelvic floor physiotherapists, little is known about its effects and [...] Read more.
Background and Objectives: In recent years, the use of radiofrequency diathermy in pelvic floor disorders has grown proportionally to the interest in this specialty. Despite the common use of this therapy among pelvic floor physiotherapists, little is known about its effects and effectiveness in pelvic floor disorders. For this reason, the aim of the present review is to assess the effects of non-invasive 300 kHz–1 MHz radiofrequency diathermy in the treatment of pelvic floor disorders. Materials and Methods: A literature search was performed in PubMed, Scopus and Web of Science, searching for any type of study that included pelvic floor disorder participants and an experimental group treated with non-invasive nor ablative radiofrequency diathermy. Results: There were a total of 578 studies after removing duplicates. The inclusion and exclusion criteria were applied, resulting in a total of 15 studies, which were methodologically assessed with PEDro and the Newcastle and Ottawa scale. Conclusions: Despite the low quality of most of them, the studies showed improvements in urinary incontinence, pelvic pain conditions, pelvic floor muscles strength and sexual function. These findings must be considered with caution until more randomized clinical trials are performed to solve the biases detected. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management)
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