Die seit 3 Jahren öffentlich verfügbaren und leistungsstarken Anwendungen der künstlichen Intelligenz (KI) wie ChatGPT eröffnen auch der Urogynäkologie neue Wege der medizinischen Versorgung. Die Digitalisierung des Gesundheitswesens, das sogenannte E‑Health, wird Diagnostik, Therapie und Kommunikation weiterentwickeln. Gleichzeitig wird deren zunehmende technologische Komplexität alle beteiligten Akteure vor Herausforderungen in Bezug auf Datenschutz und ethische Fragestellungen stellen. Akzeptanz und Erfolg von E‑Health hängen entscheidend davon ab, ob seine Lösungen auf die unterschiedlichen Bedürfnisse und digitalen Kompetenzen der verschiedenen Altersgruppen von Patienten und Ärzten zugeschnitten sind. Mit anderen Worten: E‑Health muss diese digitale Kluft überbrücken können.

Abstract Background Idiopathic vulvodynia is a chronic vulvar pain condition that occurs with a high burden of disease and frustratingly low therapeutic success. Psychosomatic factors are discussed to be involved in the onset and presentation of the disease. Sexual abuse has been positively associated with vulvar pain in general; similarly, patients suffering from vulvar pain are discussed to carry certain personality characteristics. Our aim was to examine two psychosomatic aspects: sexual violence/abuse and specific personality traits as associated factors for this particular patient cohort of idiopathic vulvodynia. Methods This cross-sectional single-center study recruited 85 previously diagnosed vulvar pain patients (34 idiopathic vulvodynia, 31 eczema and 20 lichen patients) that visited the vulva clinic and 30 asymptomatic women that consulted the contraception or dysplasia consultation clinic at university hospital Zürich. Underage women and patients with vulvar pain due to other somatic diseases were excluded. All participants completed the Big Five Inventory-42 (BFI-42) questionnaire and the 3 vulvar pain groups additionally completed a customised questionnaire regarding vulvar pain symptoms and history of sexual violence/abuse. In the statistical analysis, the idiopathic vulvodynia patients were compared to the other vulvar pain groups in terms of history of sexual violence/abuse, vulvar pain symptom severity and personality traits. For the latter analysis, the asymptomatic control group was also included. Furthermore, an age-adjusted logistic regression was performed as confounder-control in the sexual violence/abuse analysis and Wilcoxon rank-sum tests included in the personality analysis. Results In total, 25% of all vulvar pain patients had a history of sexual abuse, with a prevalence of 17.7% in the idiopathic vulvodynia group. Symptom severity results were similar in idiopathic vulvodynia and other vulvar pain patients, whether they had experienced sexual violence/abuse or not. Also, the logistic regression analysis did not find any age-dependent association of sexual violence/abuse history and vulvodynia. Furthermore, no distinctive divergence in personality traits could be detected in idiopathic vulvodynia patients, neither in comparison to genital eczema or lichen patients, nor to control women. A finding that was further emphasised by Wilcoxon rank-sum testing. Median neuroticism scores in idiopathic vulvodynia patients were, however, highest in patients that reported the least or medium symptom severity. Conclusions Sexual violence/abuse rates of all vulvar pain groups were higher than the estimated rate in the general female population. However, our findings did not suggest a higher prevalence of history of sexual violence/abuse in the idiopathic vulvodynia patients compared to the other vulvar pain groups and no specific personality profile could be demonstrated in idiopathic vulvodynia patients. Furthermore, the subgroup analyses did not show particularly high rates of sexual violence/abuse history or a distinct personality profile in idiopathic vulvodynia patients with more severe symptoms. Due to limited sample size in the present study, such correlations might, however, only be visible in larger patient cohorts. Also, other psychosomatic factors might be of more relevance in distinguishing the disease of idiopathic vulvodynia from other vulvar pain conditions.

Stress urinary incontinence (SUI) significantly affects women’s quality of life (QoL). Patient-reported outcome measures (PROMs) are widely used to assess QoL; however, the content validity of many instruments has not been systematically evaluated in women with SUI. This study aimed to evaluate the content validity of PROMs used to assess QoL in women with SUI. EMBASE, MEDLINE and PsycINFO were searched from database inception to December 2025. Additional records were identified through hand-searching Google Scholar. Selection criteria: Studies describing PROM development or evaluating content validity of PROMs assessing QoL or the impact of urinary symptoms in women with SUI were included. Two reviewers independently screened studies, extracted data using a standardised form, and assessed methodological quality using the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Evidence for relevance, comprehensiveness and comprehensibility was synthesised, and quality of evidence graded using a modified GRADE approach. Nineteen studies describing 22 PROMs were included. Methodological quality of PROM development was rated as inadequate for 21 instruments. Only one PROM had been developed specifically for women with SUI. Concept elicitation was inadequate for most instruments and patient involvement in development was limited. Evidence supporting content validity varied across PROMs. Evidence supporting the content validity of PROMs used in women with SUI is heterogeneous and often limited. Greater adherence to COSMIN guidance is needed to ensure instruments adequately capture patient-relevant outcomes.

Uterine scar defects after cesarean sections are increasingly common and elevate the risk of life-threatening complications in subsequent pregnancies. From various sonomorphological measurement parameters, the residual myometrial thickness (RMT) is crucial for predicting an obstetric complication in a subsequent pregnancy. A low RMT can be improved by surgical correction. The purpose of this paper is to present our technique for robotic-assisted laparoscopic niche repair (RALNR), to sonomorphologically characterize the niches pre- and postoperatively and to surveil subsequent symptoms and pregnancies. A cohort study of 35 patients with a niche and the wish to conceive, who had undergone RALNR between 05/2019 and 09/2023 at the university hospital of Zurich, was conducted. Sonomorphological parameters before and 6 weeks after surgery, as well as surgical, clinical and obstetrical outcomes were assessed. The mean widths and depths of the niche were significantly reduced (p < 0.001), width from 10.0 ± 3.5 mm preoperatively to 2.6 ± 3.4 mm postoperatively, and depths from 9.1 ± 3.7 mm preoperatively to 1.8 ± 2.6 mm postoperatively. RMT was significantly improved after RALNR (p < 0.001) with mean 1.5 ± 1.5 mm preoperatively compared to 8.3 ± 2.9 mm postoperatively. The pregnancy rate was 13 of 18 (77

Vulvar diseases have a serious impact on women’s quality of life and can be challenging to diagnose. Correct diagnosis is, however, mandatory for appropriate treatment. Therefore, the aim of this study was to evaluate diagnostic quality regarding the classification of disease symptoms, the suspected diagnosis of referring doctors, the agreement of suspected diagnosis with final diagnosis and the latencies from onset of symptoms to final diagnosis, thereby identifying potential resources for improvement. Retrospective data from the electronic medical charts of 325 patients attending the interdisciplinary vulva clinic at the University Hospital Zurich between January 2016 and December 2020 were analyzed. The consistency between suspected diagnosis at referral and the definitive diagnosis was investigated against the background of vulvar pathology, disease symptoms, specialization of the referring physicians involved, diagnostic steps and time until diagnosis. Referral diagnoses were inconsistent with final diagnoses in 96 (43.8

Background Considerable variations exist in the selection and reporting of outcomes and outcome measures across randomized controlled trials (RCTs) evaluating surgical treatments for pelvic organ prolapse (POP). These variations hinder the ability to conduct comprehensive analyses and limit the comparability of results regarding safety and efficacy. Objective To create an inventory of selected and reported outcomes and outcome measures in published RCTs evaluating laparoscopic and robotic surgical treatments for POP and to assess their variations. Additionally, we aimed to investigate methodological parameters and quality of outcome reporting in these studies. Methods A comprehensive search was conducted across EMBASE, the Cochrane Central Register of Controlled Trials, and PubMed from inception to May 2025 to identify relevant RCTs. Data on study characteristics and reported outcomes were extracted and compiled. Outcomes were organized into overarching domains and sub-categorized into specific themes. We considered all RCTs on adult women in English language. Results Forty-five RCTs involving a total of 4566 female participants were included. Across these studies, 83 outcomes and 59 different outcome measures were identified. The most reported outcomes were duration of operation (65%), postoperative pain (45%), quality of life (45%), intraoperative blood loss (40%), and anatomical correction (40%). Twelve outcome domains were recognized, with “intraoperative technical aspects and observations” being the most comprehensive, containing 11 unique outcomes. Less frequently reported outcomes included financial cost (20%), sexual function (10%), and the cosmetic appearance of surgical wounds (5%). Outcome measures were grouped into six domains, with quality of life representing the most diverse, encompassing 24 different measures. The Pelvic Organ Prolapse Quantification (POP-Q) system emerged as the most consistently utilized outcome measure.

To date, levator ani muscle (LAM) morphometry has been classified descriptively and semi-quantitatively. New MRI techniques enabling detailed visualization with the 3D pelvic inclination correction system (3D PICS) could offer a one-stop-shop diagnostic modality for quantitative assessment of LAM subdivisions. The aim of this controlled MRI study was to assess morphometric LAM subdivision characteristics in two distinct groups of premenopausal women, namely nulliparous asymptomatic controls and symptomatic patients (Pelvic Organ Prolapse Quantification [POP-Q] ≥ II). Magnetic resonance imaging scans of the 22 women in each group were analyzed applying the 3D PICS coordinate system. A second reading of MRI was used to calculate interrater reliability (IRR). Origins and insertions were expressed in the 3D-Cartesian coordinate system in relation to point 0/0/0 (inferior pubic point). Distances and angles between muscles and planes were described using mean and standard deviation or median with first and third quartiles for all LAM subdivisions. Moderate to good IRR was reported except for points close to point 0/0/0. Origins showed no difference between groups. Insertions differed notably in the vertically oriented pubovaginal, puboperineal, and puboanal muscles, with patients exhibiting lower positions along the superior–inferior axis by 6.1–7.7, 8.8, and 8.0–8.2 mm respectively. In contrast, the insertions of the horizontally oriented puborectal muscle showed a smaller difference of 1.8 mm. Muscle lengths were also 4

Background:The susceptibility to acute mountain sickness (AMS) in relation to sexual hormones in women remains elusive, partly because hormones could not be conveniently measured. We evaluated a novel kit for self-monitoring sexual hormones in women and recorded AMS incidence during high-altitude sojourns. Methods:Two groups of healthy, premenopausal women, mean ± SD age 23.1 ± 2.3 years, residing <1,000 m underwent baseline evaluations at 760 m before travelling to and staying for 2 days and nights (48 h) at 3,100 m or 3,600 m, respectively. Participants self-monitored morning urine sexual hormone concentrations (estrone-1-glucuronide, E1G, pregnanediol-3-alpha-glucuronide, PdG, and luteinizing hormone, LH) daily for 30d including altitude sojourns using the simple "Proov" kit (MFB Fertility Inc). Follicular and luteal menstrual cycle phases detected by LH peak, altitude-related adverse health effects (ARAHE), AMS [Lake Louise score 2018 (LLS) ≥ 3 points including headache] and pulse oximetry (SpO2) were assessed. Results:1,172 of 1,250 (93.8%) hormone measurements were successful, 78 of 1,250 (6.2%) failed due to nonadherence or technical failure. At 3,600 m, mean differences in urinary PdG concentration were 3.8 mcg/ml (95% CI, 0.6-7.1) between luteal and follicular cycle phases. At 3,100 m, corresponding difference was 8.5 mcg/ml (95% CI, 5.0-12.0). At 3,100 m, 9 of 21 (43%) women were diagnosed with AMS with SpO2 of 93.0 ± 1.6% and LLS of 0.3 ± 1.4 in the morning after the first night. At 3,600 m, 12 of 21 (57%) women had AMS (p = 0.355 vs. 3,100 m) with SpO2 of 86.8 ± 1.8% (p < 0.05 vs. 3,100 m) and LLS of 1.9 ± 1.4 (p < 0.05 vs. 3,100 m). Conclusion:Self-monitoring female sexual hormones during high-altitude field studies with the employed kit is feasible and provides physiologically plausible trends of hormone levels over the menstrual cycle. Our data provide a valuable basis for designing further studies to evaluate AMS susceptibility in women.

Background: The levator ani muscle (LAM) is crucial for pelvic floor stability, yet its quantitative MRI assessment is only a recent focus. Our study aims to standardize the quantitative analysis of the LAM morphology within the 3D Pelvic Inclination Correction System (3D-PICS). Methods: We analyzed 35 static MR datasets from nulliparous women examining the pubovisceral (PVM), iliococcygeal (ICM), coccygeal (COC), and puborectal muscle (PRM). The PVM consists of three origin-insertion pairs, namely the puboanal (PAM), puboperineal (PPM) and pubovaginal muscle (PVaM). The analysis included a quantitative examination of the morphology of LAM, focusing on the median location (x/y/z) (x: anterior–posterior, y: superior–inferior, z: left–right) of the origin and insertion points (a), angles (b) and lengths (c) of LAM. Inter-rater reliability was calculated. Results: Interindividual variations in 3D coordinates among muscle subdivisions were shown. In all, 93% of all origin and insertion points were found within an SD of <8 mm. Angles to the xz-plane range between −15.4° (right PRM) and 40.7° (left PAM). The PRM is the largest pelvic muscle in static MRI. The ICC indicated moderate-to-good agreement between raters. Conclusions: The accurate morphometry of the LAM and its subdivisions, along with reliable inter-rater agreement, was demonstrated, enhancing the understanding of normal pelvic anatomy in young nulliparous women.

Background: Genital pain treatment regimens range from local or systemic pharmacological to non-pharmacological, manual and psychosexual therapies with poor to moderate evidence for their efficiency. The aim of this study was to evaluate the subjective therapeutic response (genital pain relief) of different treatment modalities for vulvodynia and the most prevalent other vulvar pathologies, chronic vulvar eczema and lichen sclerosus by means of a cross-sectional survey. Material and Methods: A questionnaire-based cohort study that included 128 vulvodynia, 116 eczema and 79 lichen sclerosus patients was used. All patients attended the vulvar clinic at the University Hospital of Zurich. The patients who had been treated were surveyed from January to October 2022, using a customized online questionnaire consisting of 37 questions on symptoms and treatment outcomes for guideline-recommended treatment modalities. The study was approved by the Cantonal Ethics Review Board Results: Altogether, 41 patients with vulvodynia, 37 with vulvar eczema and 23 with lichen sclerosus returned the questionnaire. The three groups were similar regarding pain characteristics and comorbidities. All three patient groups reported having benefited from non-pharmacological treatment (improvement rate vulvodynia 54%; eczema 51%; lichen sclerosus 58%), from topical (55%; 55%; 75%) and from locally invasive (46%; 66%; 50%) treatments. Overall, there was no significant difference in subjective treatment outcome between non-pharmacological, locally invasive, and topical treatments for vulvodynia, eczema, and lichen sclerosus. However, the use of oral medication was reported to be significantly less effective (p-value 0.050). Conclusion: In conclusion, we found that in the patients' perception, topical, invasive and non-pharmacological treatments, but not oral medications, are helpful for genital pain relief in women with vulvodynia, vulvar eczema, and lichen sclerosus. Therefore, we recommend an escalating therapy approach with first-line non-pharmacological treatments together with topical therapies.

Main outcome(s) sonographically thickened endometrium, need for biopsy, postmenopausal bleeding, endometrial hyperplasia, endometrial cancerQuality assessment / Risk of bias analysis Randomization, blinding, inclusion and exclusion criteria, reporting of dropouts and explanation, intention to treat vs per protocol.

Main outcome(s) breast cancer incidence, mammographic or sonographic features, need for breast biopsies, findings on palpation, serum level of estrogens and gonadotropins. Quality assessment / Risk of bias analysisRandomization, blinding, inclusion and exclusion criteria, reporting of dropouts and explanation, intention to treat vs per protocol. Strategy of data synthesis Descriptive analysis. Subgroup analysisNo subgroup analysis intended. Sensitivity analysisNo sensitivity analysis intended.

Purpose: The aim of the MRI-study was to evaluate the visibility of the pelvic floor ligaments and to analyze the ligament morphometry in 3D space. Methods: Twenty-two nulliparous women underwent MRI with a ligament specific protocol. MR datasets were evaluated using the 3D Pelvic Inclination Correction System (3D-PICS). The round ligament (RL), sacrospinous ligament (SSL), sacrotuberous ligament (STL), urogenital diaphragm (UGD) and uterosacral ligament (USL) were analyzed. Qualitative and quantitative analysis was performed. 3D coordinates for origin and insertion points were determined relative to the symphysis; subsequently lengths and angles were calculated. Interrater reliability was calculated to validate the point determination method. Results: Moderate to good visibility was reported for the RL, the SSL, the STL and the UGD. Standard deviation of the points analyzed in the different dimensions vary from 1.5 mm to 21.3 mm. Origin and insertion points of the ligaments are found within a mean standard distance of 10.7 mm. The highest variability was seen in insertion points of RL, with a standard distance of 25.4 mm. The interrater reliability was good to very good (range of intraclass correlation coefficients (ICC) from 0.58 to 0.96), except for the UGD ventral points (ICC from 0.27 to 0.55). Conclusions: This in -vivo MRI technique development study offers first exact data describing the pelvic floor ligaments in nulliparous women in 3D-PICS. Visibility, exact 3D coordinates of the origin and insertion points, lengths, angles and interrater reliability assessed for all parameters were evaluated morphometrically.

INTRODUCTION:Urinary incontinence is a common complaint of both general practitioners and specialists. An accurate basic diagnosis with a structured medical history and bladder diary, urine analysis, gynaecological examination including pelvic floor assessment and a full bladder cough test can be supplemented by sonography, cystoscopy and urodynamic testing. This will help to differentiate between the different types of urinary incontinence, such as urge incontinence, stress incontinence and overflow incontinence. Treatment should be based on the type of urinary incontinence. Conservative treatments such as pelvic floor physiotherapy and pessaries can be supplemented by electrical stimulation for OAB and overflow incontinence, and various procedures such as TVT or bulking agents for stress incontinence, sacral neurostimulation for OAB and overflow incontinence.

Purpose To define the normal range and threshold values for pathologic prolapse on MRI using the PICS line and assess its correlation with the pubococcygeal line (PCL). Methods This prospective, IRB-approved study included 20 nulliparous volunteers and 18 prolapse patients (POP-Q Stage ≥ 2). Organ positions (bladder, cervix, anorectal junction) relative to PICS and PCL were measured on dynamic MRI. Differences in organ position were compared. Receiver-operating characteristic (ROC) analysis was performed to identify cutoff values for prolapse using the PICS line. The correlation between PICS and PCL measurements was tested with Spearman’s rank correlation. Results In volunteers, median bladder and cervix positions measured to the PICS at rest were − 2.7 cm and − 5.3 cm compared to − 1.9 cm and − 2.7 cm in patients ( p < 0.001). During straining, bladder and cervix were at − 0.9 cm and − 3.2 cm in volunteers versus + 2.5 cm and + 2.5 cm in patients ( p < 0.001). Correlation was strong for PICS and PCL measurements for all three compartments ( δ = 0.883–0.970, p ≤ 0.001). AUCs of PICS for the anterior and middle compartment were 0.98 (95% confidence interval [CI] 0.96–1.00, p < 0.001) and 0.96 (95% CI 0.89–1.00, p < 0.001) for differentiating patients from healthy volunteers. AUC for the posterior compartment was 0.76 (95% CI 0.57–0.96, p = 0.034). Conclusion PICS measurements reliably differentiate patients from volunteers in the anterior and middle compartment. Future studies need to identify a reliable threshold for the posterior compartment. PICS and PCL measurements are strongly correlated. Graphical abstract