Chronic pelvic pain (CPP) affects 5.7–26.6

Pelvic floor protection has a growing awareness and importance in long lasting strategies to provide female pelvic floor health. This state-of-the-art review article aims to summarize important future directions in this area. A literature search has been conducted within the last 20 years with pelvic floor protection-specific search terms. Four major work packages have been identified. (1) Epidemiology and risk stratification. (2) Mechanistic and translational research. (3) Diagnostic and preventive strategies. (4) Implementation and knowledge translation. A systematic literature search was performed and after assessing inclusion criteria and quality on expert opinion, 82 out of 1636 articles were included. The alignment for future research has been part of the analysis as well as ways of how to implement evidence based information to a day-to-day clinical routine.

The Postoperative Activity Instructions Following Urogynecologic Surgery Clinical Consensus Statement was generated by a group of multidisciplinary national and international experts from the American Urogynecologic Society. The objective of this document is to present evidence-supported statements related to postoperative activity after urogynecologic and reconstructive pelvic surgeries. The writing group generated a list of topic questions seeking to evaluate postoperative activity recommendations in women undergoing urogynecologic surgery. A literature search was completed with the aid of a librarian, and the 59 selected articles were used to create evidence-based topic statements. The writing group then utilized a modified Delphi process to approve the 26 final statements. Of the 26 topic statements, 26 reached consensus and none were omitted.

The growing awareness of pelvic floor protection, i.e., avoidance of diseases with a considerable long-term negative impact on quality of life, is a logical consequence of clinical and scientific improvements in the subspecialty of urogynecology. It is known today that vaginal birth is the most important risk factor for incontinence and prolapse. However, elective Cesarean section does not seem to be an alternative for pelvic floor protection in all women. This conclusion raises the necessity of thinking about specific aspects of pelvic floor protection to accompany expectant mothers during pregnancy and birth. Maternal-fetal medicine is undergoing a new phase of individualization aimed at reducing urogynecologic problems in a woman's life.

Laparoscopic sacrocolpopexy (SCP) is considered the gold standard for the correction of middle compartment (apical) prolapse. The extent to which simultaneous correction of the anterior compartment is necessary remains unclear. The aim of this study was to examine the anatomical and functional outcomes of the SCP on the anterior compartment with respect to the correction of central and lateral defects as well as stress urinary incontinence (SUI). This was a retrospective clinical follow-up with records of recurrences and complications as well as effects on SUI after laparoscopic SCP with and without simultaneous vaginal correction at Elisabeth Hospital, Essen, Germany, from 2014–2020 in 65 of 86 patients, with an average follow-up of 3.3 years. Without simultaneous vaginal correction of the anterior compartment, recurrence was more common in women with central defect POP-Q Ba > − 2.0 [4 of 8 patients without correction (50

The diagnostics of urinary incontinence represent an essential component for the development of a sustainably effective treatment to be obtained. In addition to well-planned instrumental diagnostics, a detailed medical history is not only essential but is frequently also decisive. In those cases where the situation remains unclear even after a detailed assessment of the medical history, specific urogynecological diagnostics can be helpful, which in various areas go beyond a classical gynecological evaluation. These include a compartment-specific vaginal speculum examination, pelvic floor sonography including sonography of residual urine and both kidneys as well as urodynamic testing and cystoscopy if necessary. Questionnaires can be helpful to verify the medical history. These comprehensive diagnostics enable the best possible treatment of patients.

Der Descensus genitalis stellt eine wichtige Erkrankung des weiblichen Beckenbodens dar. Im Zuge der demographischen Entwicklung unserer Gesellschaft werden uns die Herausforderungen in Bezug auf Diagnostik und Therapie der Beckenbodenfunktionsstörungen zunehmend beschäftigen. Eine sorgfältige Evaluation der Beschwerden kombiniert mit einer kompartimentspezifischen Diagnostik ist ein Schlüssel zur individuellen Erstellung eines Therapiekonzeptes. An unterschiedlichste Ansprüche der Patientin angepasst, kann dies uterus- oder fertilitätserhaltend sein, oder aber eine Hysterektomie beinhalten. Unterschiedliche operative Zugangswege – vaginal oder der endoskopisch – runden das Bild einer individualisierten operativen Urogynäkologie ab. Hierbei gilt es auch, den Einsatz alloplastischer Materialien sorgfältig abzuwägen, um die Beckenbodengesundheit unserer Patientinnen nachhaltig zu verbessern.

Introduction: Pelvic floor dysfunction (PFD), such as urinary or fecal incontinence or pelvic organ prolapse, is a common medical condition with increasing awareness in female athletes since they suffer more frequently from PFD than non-athletes. For female athletes PFD can be very disabling and stressful and may even lead to withdrawal from sport. Recently, a screening tool for PFD in female athletes was introduced (PFD-SENTINEL screening tool). In this study, we aimed to translate and culturally adapt the PFD-SENTINEL screening tool into German. Methods: Following an international guideline, forward and backtranslations of the screening tool were conducted throughout six progressive phases. A pre-final version of the PFD-SENTINEL screening tool for the German language was tested in a cohort of 27 potential users. Subsequently, a final version was adjusted and presented. Results: Twenty-two of the 27 potential users were female athletes (median age 24 years). Five of the potential users were healthcare professionals (median age 28 years). None of the participants had difficulties understanding the questionnaire, either linguistically or in terms of content. The final version was approved by the original developers. Conclusions: The PFD-SENTINEL screening tool holds promise to prompt specialist care and assessment, detecting potential PFD and helping to estimate the related prevalence in female athletes. Its successful translation and adaptation to the German language allows for future testing of its psychometric properties and application in German-speaking regions.

Introduction:Changes in surgical practice patterns to cure stress urinary incontinence (SUI) became evident after FDA warnings regarding vaginal mesh were issued. The primary aim was to describe nationwide numbers of suburethral alloplastic slings (SAS) inserted in 2010, 2015, 2018 and 2021 in Germany. Secondary, numbers were related to SUI specific non-alloplastic alternatives and bulking agents. Additionally, age distribution and overall inpatient surgeries in women were subject to analysis.Materials and Methods:Descriptive study utilizing data gathered from the German Federal Statistical Office ( www.destatis.de ). Included were the following procedures of inpatient surgery: A. SAS; B. non-allplastic slings; C. open/laparoscopic colposuspension; D. Bulking agents; overall changes and changes in age distribution (groups of 5-years intervals) are described.Results:Overall, n = 3599466 female inpatient procedures were analyzed. There was a considerable decrease of SAS surgeries of 28.49% between 2010 (n = 23464) and 2015 (n = 16778), and a decrease of 12.42% between 2015 and 2018 (n = 14695) and an additional decrease of 40.66% between 2018 and 2021 (n = 8720). Over time a 55.03% continuous decrease in non-alloplastic slings was observed (n = 725 in 2010 to n = 326 in 2021). Open and laparoscopic colposuspension numbers went down with a rate of 58.23% (n = 4415 in 2010, n = 1844 in 2021). Between 2010 and 2018, only bulking agent procedures increased with a rate of 5.89% from n = 1425 to n = 1509.Conclusions:There was a considerable decrease in inpatient surgical procedures using SAS. Alternatives not only failed to compensate, but experienced also a major decline.

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft fur Gynakologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft fur Urogynakologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k- guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the surgical treatment of female patients with stress urinary incontinence and urge incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of iatrogenic urogenital fistula are presented.

We sought to 1) test the hypothesis that young women (≤45 years) with pelvic organ prolapse have a higher prevalence of major levator ani muscle (LAM) defects than old women (≥70 years) with prolapse and 2) compare level II/III measurements between young and old women with prolapse and age-matched controls to evaluate age-related mechanistic differences in the disease process. A secondary analysis examined four groups of parous women: young prolapse (YPOP, n = 17); old prolapse (OPOP, n = 17); young controls (YC, n = 15); old controls, (OC, n = 13). Prolapse was defined as any compartment at or beyond the hymen with vaginal bulge symptoms. Genital hiatus (GH) was measured on clinical exam. Major LAM defects and level II/III measurements (UGH: urogenital hiatus, LA: levator area, and apex location) were assessed on MRI at rest and strain, and the difference (Δ) between measurements calculated. Principal component analysis was used to evaluate levator plate (LP) shape. Major LAM defects occurred in 42% of YPOP and 47% of OPOP (p > .99). GHrest was 1.5 cm larger in OPOP versus YPOP (p < .001) and 2 cm larger in OPOP versus OC (p < .001). Regardless of prolapse status, LArest and UGHrest on MRI increased with age. YPOP had larger ΔLA (p = .04), ΔUGH (p = .03), and Δapex than OPOP (p = .01). Resting LP shape was more dorsally oriented in OPOP versus YPOP (p = .02) and OC versus YC (p = .004). Prolapse in young women cannot be solely explained by a higher LAM defect prevalence. GH size and other measures of level II/III pelvic support worsen with age regardless of prolapse status.

Consideration of the potentially negative impact of pregnancy and childbirth on the female pelvic floor must be embedded into the broad context of advantages and disadvantages of elective Cesarean section. Other maternal and fetal morbidities must be taken into account and weighed up against each other. In case of an uncomplicated pregnancy and the absence of a risk profile for pelvic floor disorders, elective Cesarean does not represent an eligible alternative to vaginal birth for pelvic floor protection. Therefore, Cesarean does not have to be mentioned in the informed consent discussion in these cases. However, ongoing analyses of risk factors might help health care providers to identify women at a higher risk for pelvic floor disorders. In these cases, the potential negative impact of vaginal birth should be part of a risk-adapted consultation clearly focusing on restoring pelvic floor function after birth back to the antenatal status if possible, which may be more difficult than in women without risk factors. Elective Cesarean should be part of this consultation in these at-risk women, to support them in the sense of shared decision-making. Self-determination and long-term family planning issues are of major importance in this context.

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft fur Gynakologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft fur Urogynakologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary incontinence are discussed.

INTRODUCTION AND HYPOTHESIS:The aim of the study was to perform a systematic review and meta-analysis of the impact of pregnancy and childbirth (vaginal delivery [VD]) or cesarean section (CS) on the recurrence of pelvic floor disorders in women who had previously undergone pelvic floor reconstructive surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI), to facilitate future evidence-based counseling. METHODS:PubMed, Cochrane, Embase, BJOG, Scopus, etc. were screened, from 1990 to date. Inclusion criteria included cohort studies, case-control studies, case series, and case reports that reported on the primary outcome measure of the review. Exclusion criteria included studies on surgical procedures whose outcomes are unlikely to be impacted by pregnancy and childbirth or are obsolete. Meta-analysis was performed using Review Manager 5.3. RESULTS:Seven papers on midurethral slings (MUS; 181 women in both VD and CS groups respectively) and three papers on different hysteropexy techniques (47 and 29 women in the VD and CS groups respectively), were included in the meta-analysis. No difference was seen between the two groups regarding the recurrence of SUI in women who had previously undergone MUS surgery (OR: 1.18 [0.66, 2.09]; Z = 0.56; p = 0.58) or the recurrence of POP following hysteropexy using various apical suspension procedures (OR: 1.81 [0.04, 80.65]; Z = 0.31; p = 0.76). There are insufficient data to support meta-analyses for individual MUS sub-types or hysteropexy procedures. CONCLUSION:Current literature does not demonstrate a protective effect of CS in preventing recurrent SUI in women who had undergone MUS surgery for SUI. When hysteropexy is considered irrespective of the apical suspension procedure employed, the incidence of recurrent POP appears similar after CS and VD.

Introduction and hypothesis This narrative review describes the existing epidemiologic literature and identifies gaps regarding pelvic organ prolapse (POP) prevalence, incidence, natural history, and current and future service needs. Materials and Methods A PubMed search identified relevant citations published in 2000 or later. Pre-specified criteria were used to screen titles, abstracts, and manuscripts, including reference sections. Study findings were summarized to define what is known, identify gaps in current knowledge, and suggest priority areas for future research. Results The reported prevalence of POP varies widely (1-65%) based on whether its presence is ascertained by symptoms (1-31%), pelvic examination (10-50%), or both (20-65%). Most existing population-based surveys do not include physical examination data. White women from higher income countries are overrepresented in the existing literature. Incidence and natural history data are limited and consist mainly of cohorts that follow women after pregnancy or menopause. Given global increases in aging populations in well-resourced countries, the need for POP treatment is anticipated to increase in the coming decades. In lower and middle income countries (LMICs) where demographic trends are different, there is a dearth of information about anticipated POP service needs. Conclusion Future POP incidence, prevalence, and natural history studies should include non-white women from LMICs and should combine pelvic examination data with validated patient-reported outcome measures when feasible. Anticipated future service needs differ globally, with a greater demand for POP treatment services in well-resourced settings where aging populations are prevalent.

Zielsetzung Im Rahmen einer randomisiert kontrollierten Studie (RCT) wurden anatomische und funktionelle Ergebnisse sowie Komplikationen der nervenschonenden Kolposakropexie unter Verwendung von resorbierbarem (Vicryl) vs. nicht-resorbierbarem (Ethibond) Nahtmaterial erfasst und ausgewertet.

This case presents the work-up and management of a patient with a fibroid uterus and urinary incontinence. Five international experts also provide their evaluation and approach to this case. According to the literature, there is uncertainty surrounding the relationship between fibroids and urinary incontinence. The experts emphasize patient counseling and a staged approach.