INTRODUCTION AND HYPOTHESIS:This global consensus conference was designed to define best practice for the controversial aspects of primary surgical management of uterovaginal pelvic organ prolapse (U-POP), to identify unanswered clinical questions, and to educate junior researchers on systematic review and meta-analysis methodology. METHODS:Eleven committees were created with geographically diverse representation and tasked with answering pragmatic questions specific to U-POP surgical decision making. A systematic search of MEDLINE, Embase, and ClinicalTrials.gov from 2000 through December 2025 was performed with specific search terms for each committee. Relevant abstracts and full texts were doubly screened and included articles were doubly extracted. Guided by literature, consensus statements were created and assigned high, moderate, and low levels of evidence. Statements with low levels of evidence were presented and voted upon in-person at a consensus conference, hosted by the Department of Urology at Wake Forest University School of Medicine in Winston Salem, NC, USA. RESULTS:Contributions from 154 participants (including 33 junior researchers) from 19 countries led to 29 systematic searches, screening of 51,143 abstracts and 3,869 full-text manuscripts. There were 133 consensus statements presented at the conference; 6 were supported by high-quality, 28 by moderate-quality, and 99 by low-quality or no evidence respectively, and required Delphi process consensus. Among expert opinion statements, 58 were accepted, 32 were rejected, and 9 were eligible for revision. CONCLUSIONS:A total of 92 statements are presented here to guide clinical decision making and best practices in surgical management of primary U-POP.
This is the second of two articles presenting the European Crohn's and Colitis Organisation [ECCO] evidence‑based consensus guidelines on the management of adult patients with ulcerative colitis [UC]. The first article covers the medical management of UC, including acute severe colitis. The present article addresses the surgical management of medically refractory UC, including the general surgical approach and perioperative optimisation, surgical strategies and techniques, and recommended levels of centre expertise and surgical specialisation. Together, these two articles aim to inform shared decision‑making and to guide clinicians and healthcare professionals involved in the care of patients with UC, drawing on the best available evidence.
BACKGROUND:Fracture risk in patients with chronic kidney disease (CKD) is excessively high. A recent European consensus provides guidance on the comprehensive screening for CKD-associated osteoporosis in patients with CKD stages G4-5D. However, data on the yield and therapeutic implications of this approach in patients with kidney failure is lacking. METHODS:All prevalent dialysis patients aged >50 years or postmenopausal with life expectancy >1 year at a single center were invited for comprehensive bone health assessment, including the evaluation of risk factors, calcium intake, mineral metabolism parameters, bone turnover markers, fracture history, bone mineral density and vertebral fractures by dual-energy X-ray absorptiometry (DXA), handgrip strength and self-reported physical activity. RESULTS:Of 203 patients screened, 121 (mean age 75 years, 55% male) were eligible, of whom 71 underwent comprehensive phenotyping including DXA. CKD-associated osteoporosis was identified in 73% of participants, based on a T-score ≤-2.5 at the hip or lumbar spine (65%), history of fragility fracture (41%) and/or finding of a vertebral fracture (13%). Vitamin D insufficiency (<30 ng/mL) and insufficient calcium intake (<800 mg/day) were observed in 35% and 29%, respectively. Despite bio-intact parathyroid hormone levels exceeding the KDIGO target range in only 17%, bone turnover markers suggested high bone turnover in 53% of patients. Handgrip strength was below sarcopenia threshold in 65%, while physical activity was low in 55% of participants. Only 21% of patients with CKD-associated osteoporosis were treated with bone targeting therapy. CONCLUSION:Comprehensive bone health assessment identified CKD-associated osteoporosis in 7 out of 10 patients with kidney failure and unveiled several therapeutic opportunities ranging from optimization of mineral metabolism to non-pharmacological and pharmacological bone-targeting interventions. The present single-center findings call for reflection and confirmation.
Cardiac damage correlates with adverse events in patients with severe aortic stenosis (AS). To evaluate the prognostic value of the cardiac damage staging system and the integrated use of cardiopulmonary exercise testing and echocardiography (CPET-echo) across the entire spectrum of aortic stenosis. A total of 519 patients (65% men; 74±10 years) with ≥mild AS and no other significant primary valvular disease underwent CPET-echo. On the basis of a cardiac damage staging scheme, patients were categorized into five independent stages: Stage 0 – no other cardiac damage detected; Stage 1 – LV damage (LV hypertrophy, diastolic or systolic dysfunction); Stage 2 – LA or mitral valve damage (enlarged LA; presence of atrial fibrillation or ≥moderate functional mitral regurgitation); Stage 3 – pulmonary hypertension or ≥moderate tricuspid regurgitation (TR) and Stage 4 – RV damage. Patients were subsequently evaluated for the occurrence of the combined endpoint heart failure (HF) death and HF hospitalizations. Severe, moderate and mild AS was present in 55% (40% low flow, low gradient), 26% and 19% of patients, respectively. Cardiac damage of any grade was observed in 79% of all patients. Among them, 31% had Stage 1 involvement, and an equal proportion presented with Stage 2. Stage 3 was identified in 3% of cases, while right ventricular damage (Stage 4) was found in 17% of patients. Remarkably, 80% of patients with mild AS had cardiac damage, most of them (56%) Stage 2 or higher. Over a median follow-up of 39 months [23-49], 71 patients reached the primary endpoint: 51 with severe AS (18%), 10 with moderate AS (7%) and 10 with mild AS (10%). In the multivariable Cox regression, with aortic valve replacement included as time-dependent covariate, cardiac damage stage, NT-proBNP, elevated left ventricular filling pressures at rest or exercise (positive diastolic stress test) and exercise induced pulmonary hypertension (exPHT) were independently associated with the adverse outcome (Figure 1). Incorporating cardiac damage and CPETecho derived parameters (exPHT and elevated left ventricular filling pressures at rest or exercise) to a baseline model (age, AS severity and NT-proBNP) significantly improved event prediction: likelihood χ2=51, p <0.001 and AUC 0.702 versus 0.766, p=0.03 (Figure 1). Figure 2 depicts event-free survival at 48 months stratified according to the cardiac damage stage. Cardiac damage is present in a significant proportion of patients with even mild AS. It is significantly associated with HF death and HF hospitalizations, independently of AS severity. CPET-echo may further refine risk stratification for HF across the entire spectrum of aortic stenosis.
