Vaginal pessaries are an effective nonsurgical treatment for pelvic organ prolapse, but routine pessary care can be associated with pain. Anxiety is known to influence pain perception in clinical procedures but its role in pessary care has not been studied. We hypothesised that anticipatory anxiety is present in women receiving continuous, non–self-managed pessary care and is associated with procedural pain. In this prospective observational cohort study, women with pelvic organ prolapse receiving continuous clinician-managed pessary care in a tertiary urogynaecology unit were included. Pain during pessary removal and insertion was assessed using the Numeric Rating Scale (NRS). Anticipatory anxiety regarding future pessary care was evaluated 4–6 weeks later using an adapted version of Corah’s Dental Anxiety Scale. Logistic regression was performed to identify factors associated with moderate to high anxiety. A total of 150 women were included, of whom 128 (85
Urethral leiomyomas are rare benign smooth-muscle tumors. Approximately 40 well-documented cases have been reported, most arising from the posterior urethral wall where exposure is relatively straightforward. Anterior wall lesions pose surgical difficulty because of proximity to the external urinary sphincter, periurethral fascia, and vestibular mucosa, all of which must be preserved to avoid urethrovaginal fistula and stress urinary incontinence. We hypothesized that a mucosa-sparing trans-vestibular approach would allow safe excision with preservation of urethral integrity and continence. A 39-year-old para-1 woman presented with a 6-month history of a tender peri-meatal urethral mass and intermittent post-coital spotting. Examination revealed a 3 cm anterior urethral mass distorting the external urethral meatus. Pelvic MRI demonstrated a 2.7 cm well-circumscribed anterior distal urethral mass with apparent urethral wall involvement. Examination under anesthesia, cystourethroscopy, and core biopsy confirmed leiomyoma. The lesion was excised via a mucosa-sparing trans-vestibular approach with intraoperative catheter palpation, capsular dissection, layered urethral reconstruction, and mid-urethral sphincter re-approximation. A 3 cm anterior urethral leiomyoma with focal urethral communication was excised. Blood loss was minimal; there were no intraoperative complications. A transurethral catheter was maintained for 21 days. Micturating cystourethrogram confirmed an intact urethra without fistula; the patient was continent. Histopathology confirmed benign leiomyoma (SMA-positive, desmin-positive, MIB-1 < 1
Menstrual cups are increasingly used as sustainable and cost-effective menstrual hygiene products, but their effects on pelvic floor function and genitourinary health remain unclear. We aimed to map evidence on pelvic floor–related symptoms and clinically relevant genitourinary outcomes associated with menstrual cup use. We conducted a scoping review following PRISMA-ScR and Joanna Briggs Institute guidance. Six databases were searched from inception to March 2026. Eligible studies included women or menstruating individuals using menstrual cups who reported pelvic floor–related symptoms or clinically relevant genitourinary outcomes. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Ten studies were included: one randomized controlled trial, one cross-sectional study, one prospective case series, and seven case reports. Evidence was synthesized into two conceptually distinct domains: functional pelvic floor and lower urinary tract outcomes and structural genitourinary complications. Reported functional outcomes included pain-related symptoms, initial vaginal discomfort, pelvic floor symptom burden, and exploratory changes in pelvic floor muscle parameters. The evidence was heterogeneous and insufficient to establish causality or clinically meaningful pelvic floor dysfunction. Rare structural complications consisted mainly of reversible ureteral obstruction or hydronephrosis reported in isolated cases, with resolution after cup removal. Current evidence does not support clinically established pelvic floor dysfunction attributable to menstrual cup use. The literature primarily identifies rare reversible mechanical complications and important knowledge gaps. Well-designed prospective studies using standardized objective pelvic floor assessments are needed.
Cystoscopy is a commonly performed invasive urological procedure often associated with pain and anxiety, negatively affecting patient compliance and satisfaction. Music has been proposed as a simple, low-cost, nonpharmacological intervention to reduce procedural discomfort and stress. This systematic review and meta-analysis evaluated the effectiveness of music during cystoscopy. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines, PubMed, Scopus, Web of Science, and the Cochrane Library were searched through 5 January 2026. Randomized controlled trials (RCTs) including male patients undergoing cystoscopy and comparing music with a placebo were eligible. Primary outcomes were changes in pain and anxiety scores; secondary outcomes were heart rate and systolic blood pressure. Data were pooled using a random-effects model, and study quality was assessed using the Cochrane Risk-of-Bias 2 tool. Thirteen RCTs comprising 1,347 participants were included. Music significantly reduced pain (MD = −1.39, 95
Sacrocolpopexy (SCP) is regarded as the gold-standard apical suspension procedure for vaginal vault prolapse; however, systematic reviews informing this reputation have largely included post-hysterectomy populations. Comparative evidence for primary uterovaginal prolapse (U-POP) remains limited. We aimed to evaluate failure and retreatment rates after hysterectomy with minimally invasive SCP compared with vaginal hysterectomy and native tissue repair (TVH + NTR). A systematic review and meta-analysis were conducted following PRISMA guidelines (PROSPERO CRD420251171050) as part of the 2026 U-POP Global Consensus Conference. MEDLINE and Embase were searched through October 31, 2025. Eligible studies included randomized trials and comparative cohort studies (≥ 30 participants) evaluating hysterectomy with minimally invasive SCP for primary U-POP, with or without a comparator group undergoing TVH + NTR. Outcomes included retreatment and failure. Pooled proportions of outcomes were estimated and between-group differences were evaluated using mixed-effects meta-regression. Study quality was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Of 5262 abstracts and 189 full texts screened, 24 studies met inclusion criteria: 6329 patients underwent hysterectomy with SCP and 681 underwent TVH + NTR. Compared with TVH + NTR, hysterectomy with SCP demonstrated significantly lower retreatment rates (1.59
To demonstrate the feasibility and technical approach of early robotic-assisted vesicovaginal fistula (VVF) repair in a patient with newly diagnosed colon cancer requiring timely initiation of chemotherapy following surgical resection. A stepwise robotic-assisted transperitoneal extravesical VVF repair was performed at a tertiary-care academic medical center through multidisciplinary collaboration between the Departments of Obstetrics and Gynecology and Urology. The procedure was conducted 6 weeks after the patient’s initial oncologic surgery and included identification and excision of the fistula tract, dissection of the vesicovaginal space, layered closure of the bladder and vagina and interposition of an omental flap. The surgery was completed robotically without intraoperative complications. Operative time was 4 h and 8 min with an estimated blood loss of 200 mL. The patient was discharged on postoperative day 3 in stable condition. Follow-up cystoscopic evaluation confirmed successful fistula closure without recurrence, allowing initiation of adjuvant chemotherapy. Early robotic-assisted VVF repair was technically feasible and resulted in successful fistula closure in this carefully selected patient requiring timely continuation of oncologic treatment. The repair incorporated careful patient selection, excision of devitalized tissue, tension-free multilayer closure and vascularized omental interposition, with no recurrence at 2 years. This case highlights the potential role of a multidisciplinary robotic approach in selected patients, while larger studies are needed to better define its safety, reproducibility and optimal indications.
We aimed to compare symptoms of pelvic floor disorders (PFDs) and surgery risk by mode of delivery 30 years after first childbirth and assess symptom changes over time. We also examined associations between PFDs and pelvic floor muscle injuries. Prospective cohort study in 2024 of women with first childbirth at Trondheim University Hospital, Norway in 1990–97. They responded to the pelvic floor distress inventory (PFDI-20) in 2013 and 2024. Ultrasound assessed pelvic floor muscle trauma in 2013–14. Outcomes included symptoms and surgery for PFDs and hysterectomy. Sixty percent of women (965/1606) responded 30.6 years after childbirth, with mean age 58.2 years; 140 (14.5
The Measure Yourself Medical Outcome Profile 2 (MYMOP2) is a patient-generated outcome measure allowing patients to describe their most important problems in their own words, scoring the severity of symptoms and scoring the effect these have on their quality of life (QoL). The objective of this study was to translate and validate a Dutch version of the MYMOP2 questionnaire for patients with non-neurogenic functional bladder disorders. The translation into the Dutch MYMOP2 questionnaire was performed according to standardized guidelines. Patients with non-neurogenic functional bladder disorders who visited a tertiary urology department were asked to fill in the Dutch MYMOP2, the Urogenital Distress Inventory 6 (UDI-6), and the European Quality of Life 5-Dimension 5-Level Questionnaire (EQ-5D-5L) at baseline (test) and 2 weeks later (retest). No reference group was included, as the MYMOP2 questionnaire is not symptom specific. The evaluated measurement properties were construct validity, reproducibility, content validity, criterion validity, and floor or ceiling effects of the Dutch version of the MYMOP2. Fifty-eight patients were included. Content validity was adequate, and the reproducibility was also adequate (intraclass correlation 0.88). Criterion and construct validity were also confirmed; MYMOP2 scores correlated significantly with the UDI-6 and EQ-5D-5L. The Dutch version of the MYMOP2 is a reliable outcome measure for non-neurogenic bladder patients as it indicates moderate-to-good measurement properties. We recommend using this questionnaire in clinical evaluation as it enables patients with multiple complaints to describe these in their own words.
Sexual dysfunction in postpartum women is common, yet the impact of intrapartum pelvic floor trauma (PFT) on domain-specific sexual recovery remains unclear, and pelvic floor physical therapy (PFPT) referral patterns in this population are poorly characterized. This study compared postpartum sexual function trajectories from 2 to 6 months in women with and without intrapartum PFT and examined PFPT referral and utilization. Participants were recruited from Midwest hospitals in the USA at discharge, postpartum visits, and well-baby checkups. Eligibility required age ≥18, vaginal delivery, English fluency, internet access, and follow-up availability. Women with ≥ grade 2 perineal tears were classified as having PFT. Baseline and follow-up surveys included the Carol Scale and FSFI-9, with Wilcoxon signed-rank and Mann–Whitney U tests used for analyses. Eighty-six women (45 PFT, 41 no-PFT) completed both timepoints. Overall sexual function, lubrication readiness, and vulvar caressing discomfort improved (all p ≤ .020), whereas libido worsened (p = 0.009). Penetration-related pain did not change. Groups did not differ at baseline; at follow-up, women with PFT reported poorer overall function, lubrication, penetration pain, and post-activity pain (p = 0.020 to 0.041). Recovery trajectories were parallel, with the only difference in change magnitude being greater improvement in intercourse pain in the PFT group (p = 0.039). Among participants reporting PFPT access, only 33.9
This scoping review aimed to explore the literature on pelvic floor physical therapy (PFPT) and document clinical outcomes in transgender and nonbinary patients following gender-affirming vaginoplasty. CINAHL, Embase, and Medline databases were searched from inception to February 5, 2025. Included studies focused on transgender and nonbinary patients undergoing vaginoplasty, who received PFMT and had pelvic floor dysfunctions evaluated. Studies were screened and critically appraised by two independent reviewers using the Mixed Methods Appraisal Tool. Eight studies were included. The literature was sparse and characterized by high methodological heterogeneity: seven studies lacked a control group (consisting of cohort, case series and single case studies), while one was a randomized control trial (RCT) comparing postoperative sham to a PFPT intervention group (subdivided into one receiving pre- and postoperative PFPT and one receiving postoperative PFPT only). Descriptive outcomes varied across the literature. For pain, the RCT found no significant difference between groups, one case series reported worsening, and three single case studies observed improvement. For urinary and anal function, the RCT found no significant difference between groups, whereas a case series and a cohort study observed improvement. For pelvic floor function, one cohort study, two case series, and three single case studies observed improvement following PFPT. For dilation, although there were no difference between active and sham PFTM in the RCT, participants receiving both pre- and postoperative PFPT reported significantly greater ease of dilation than those receiving postoperative PFPT only. Further, a case series and a single case study also observed easier dilation following PFPT. For sexual function, a case series and a single case study also found improvement. The RCT found no significant difference in participant-perceived improvement between groups. Finally, one cohort study found a satisfaction rate of 89.9
Endometriosis may contribute to the onset of pelvic floor dysfunction (PFD) but data on urologic and bowel symptoms in endometriosis patients are scant. The aim of this study is to determine the prevalence of PFD in women with endometriosis and their impact on quality of life. This is a cross-sectional study. A web survey was distributed throughout Italy from November 2022 to November 2023 to fertile age women with a self-reported diagnosis of endometriosis made by a specialist gynecologist or through surgery, assessing: medical history, pregnancies, endometriosis-related pain, urinary symptoms, bowel symptoms, sexual function, and quality of life. The informed consent was signed by 1149 women. Out of 820 eligible, 525 participants completed all questionnaires (64.0
Revision and explantation after permanent sacral neuromodulation (SNM) for overactive bladder (OAB) are important but inconsistently reported. We estimated rates of revision and explantation after permanent implantable pulse generator (IPG) implantation and summarized reasons for each outcome. This PROSPERO-registered review (CRD420261434099) searched PubMed, Embase, Web of Science, and CENTRAL until June 26, 2026. Eligible studies included adults with OAB undergoing SNM IPG implantation with extractable revision or explantation outcomes. Random-effects proportional meta-analysis estimated pooled proportions with 95
This study was aimed at evaluating the association between urinary incontinence awareness, bladder habits, and quality of life among health care professionals working in high-risk clinical units. This cross-sectional study was conducted with 520 health care professionals working in the emergency departments, intensive care units, and operating rooms of two state hospitals. Data were collected using a Descriptive Information Form, the Urinary Incontinence Awareness and Attitude Scale, the Urogenital Distress Inventory, and the 36-Item Short-Form Health Survey Quality of Life Scale. Data were analyzed using Statistical Product and Service Solutions version 27.0 and Statistical Analysis System version 9.4. Descriptive statistics, t tests, variance analyses, Fisher’s exact test, Pearson’s correlation analyses, and ANCOVA analyses were performed. Of the participants, 55.6
This study aimed to evaluate the association between autonomic symptom burden and urinary incontinence severity in women with type 2 diabetes. This cross-sectional study was conducted at a diabetes center in Istanbul, Türkiye, and women aged 18–65 years with type 2 diabetes were included. Autonomic symptoms were assessed using the Composite Autonomic Symptom Score-31, and urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire-Short Form. Urinary incontinence was analyzed both as a binary outcome and by severity categories. Multivariable logistic regression was used to examine whether autonomic dysfunction was independently associated with urinary incontinence after adjustment for age, body mass index, diabetes duration, HbA1c, menopausal status, number of deliveries, diabetic neuropathy, and diuretic use. The study included 391 women. Urinary incontinence was present in 282 out of 391 women (71.9
Laparoscopic lateral suspension (LLS) has emerged as an alternative to laparoscopic sacrocolpopexy (SCP) for apical pelvic organ prolapse (POP). Comparative patient-reported data remain limited, particularly at long-term follow-up. We compared the mid-to-long-term patient-reported and anatomical outcomes of the two procedures. Women who underwent LLS or SCP for symptomatic apical POP (2017–2024) were retrospectively reviewed; no baseline subjective scores were available. The primary outcome was subjective improvement on the Patient Global Impression of Improvement (PGI-I). Secondary outcomes were composite anatomical success (Ba < 0, Bp < 0, C ≤ −½ total vaginal length), PFDI-20, FSFI-6, de novo urinary incontinence, and perioperative parameters. Between-group comparisons and multivariable logistic regression analyses were performed. Of 115 patients (LLS 57; SCP 58), 84 completed subjective assessment at a median of 50 months. PGI-I–defined improvement was more frequent after LLS than SCP, though the difference was not statistically significant (84.8
Obstetric anal sphincter injury (OASI) is associated with pelvic floor dysfunction and long-term morbidity; however, its independent impact on global health-related quality of life (HRQoL) remains uncertain. We hypothesized that women with OASI would have a higher probability of impaired HRQoL than women without severe perineal trauma. We conducted a retrospective comparative cohort study at a tertiary referral center in Cali, Colombia. All women with documented OASI grade III–IV identified from the institutional delivery registry (n = 60) were compared with randomly selected women without OASI from the same source population and time period (n = 60; 1:1 ratio). HRQoL was assessed 24–36 months postpartum using the validated Spanish version of the Short Form Health Survey questionnaire. Impaired HRQoL was defined as a Physical Component Summary (PCS) or Mental Component Summary (MCS) score below 50. Adjusted odds ratios (OR) with 95
Pelvic organ prolapse (POP) remains underdiagnosed and undertreated worldwide, and pessaries are an effective yet underutilized conservative option. Digital platforms may play a key role in disseminating evidence-based guidance. This study analyzed long-term global engagement with an educational video on vaginal pessaries to understand patterns of access, audience characteristics, and informational needs. A mixed-methods design was used. Quantitative data were extracted from YouTube Analytics over a 9-year period (2017–2026), including views, watch time, audience demographics, traffic sources, devices, and geographic distribution. Qualitative content analysis was conducted on 107 valid user comments (43.1
INTRODUCTION AND HYPOTHESIS:OASIs affect 6.1% of primiparous and 1.7% of multiparous women in the UK. However, rates of OASI increased threefold between 2000 and 2012. This study aimed firstly to evaluate the current incidence and management of perineal trauma, including mode of birth, OASI and episiotomy in UK maternity units and secondly to monitor temporal trends since the previous national survey. METHODS:Freedom of information requests were sent to all UK maternity units requesting data on births between January 2024 and January 2025. Data from the 2009-2010 survey were re-analysed to compare the OASI, episiotomy, operative vaginal birth, and cesarean section (CS) rates at both time points. RESULTS:One hundred sixty-one of 268 units (59.7%) responded, including 469,744 births (78.9% of the total births). The median OASI rate was 3.1% (0-12.5%), affecting 6.4% of primiparous women and 1.2% of multiparous women (p < 0.001). Between 2009 and 2025, the odds of a forceps-assisted birth (OR 1.07 [95% CI 1.04-1.09]), OASI (OR 1.15 [95% CI 1.05-1.28]), and CS (OR 1.07 [95% CI 1.04-1.09]) increased in primiparous women. In multiparous women, the rate of CS alone increased (OR 1.04 [95% CI 1.02-1.06]). Overall, there was no change in vacuum-assisted births or episiotomy rates. CONCLUSIONS:This survey provides an update of the incidence of OASI in the UK, identifying an increase in forceps use and OASI incidence in primiparous women. This supports the need for further targeted strategies to reduce OASI, including enhanced training and support for vacuum-assisted births, and appropriate use of mediolateral episiotomy with forceps-assisted births.
Urinary incontinence (UI) is common among women Veterans in the USA and may be influenced by sleep health and psychological stress. Understanding relationships between aspects of sleep health and UI, and variation by stress level, may inform novel interventions. The objective was to examine associations between aspects of sleep health (sleep quality, sleep efficiency, daily disturbances) and UI severity, and explore differences by perceived stress level. We conducted an exploratory cross-sectional analysis of baseline data (April 2020) from women Veterans in the USA in a clinical trial of remote UI treatments. UI severity was measured with the International Consultation on Incontinence-UI Short Form. Sleep health was measured with the Pittsburgh Sleep Quality Index three-factor model to assess sleep quality, sleep efficiency, and daily disturbances. Stress was assessed with the Perceived Stress Scale-10. We used multivariable linear regression to examine associations between each aspect of sleep health and UI severity. We conducted stratified analyses by stress level (low, moderate, high). Overall, 246 women Veterans were included (mean age 53, SD 11.3). Most (211 out of 246, 85.8
The Manchester–Fothergill procedure has re-emerged as a uterus-preserving surgical option for pelvic organ prolapse, particularly in women with cervical elongation. However, postoperative anatomical changes may affect the cervical assessment and screening performance. This study aimed to evaluate the adequacy of cervical smears and the accessibility of the transformation zone after the Manchester procedure. This prospective cohort study was conducted at a tertiary center between May 2025 and February 2026. Women who underwent the Manchester procedure (n = 24) were compared with age- and menopausal status-matched controls (n = 51). The primary outcomes were smear adequacy and the presence of endocervical cells. The secondary outcomes included the transformation zone type, HPV DNA status, and colposcopic findings. Cytology was evaluated using the Bethesda System, and transformation zone classification followed International Federation for Cervical Pathology and Colposcopy criteria. Statistical analyses used chi-square or Fisher’s exact tests for categorical variables and Student’s t-test or the Mann–Whitney U test for continuous variables. Smear adequacy was high and comparable between the groups (95.8
