IMPORTANCE:In women with pelvic floor disorders, pelvic floor myofascial pain with palpation is associated with lower urinary tract symptoms, but the prevalence in community-dwelling women is unknown. OBJECTIVES:Our study describes the prevalence of pelvic pain with palpation in community-dwelling women and its association with bladder health and symptoms. STUDY DESIGN:A subset of adult women from a large population-based, regionally representative cohort across 8 geographic regions of the United States was examined for pain with palpation of the obturator internus and levator ani muscles. Participants were not excluded on the basis of pain or urinary symptoms at baseline. Bladder health and urinary symptoms were measured using validated questionnaires. Linear and Poisson regression were used to examine associations between baseline pain and changes in bladder health and symptoms at follow-up. RESULTS:Of 502 participants, 56% had pain (46% mild [1-3/10], 8% moderate [4-6/10], 2% severe [7-10]; mean 1.1±1.6) on examination. At baseline, higher pain scores were associated with worse bladder function (β, -1.4, CI, -2.6, -0.1), and greater urinary symptoms (β, 0.4, CI, 0.1, 0.8). Baseline pain on palpation was associated with the development of new bothersome urinary symptoms (β, 1.1, CI, 1.0, 1.2) and painful urinary symptoms (β, 1.2, CI, 1.0, 1.3) over 1-2 years. CONCLUSION:Pain with palpation of the pelvic floor musculature is common in community-dwelling women and is significantly associated with urinary symptoms at baseline and with new-onset urinary symptoms over time. Pelvic muscle pain with palpation may be important to consider in the assessment of factors associated with urinary symptoms and as a precursor to bladder pain.

The objective of this study was to explore if vaginal angle is associated with pelvic organ prolapse (POP) stage and predominant compartment utilizing a simple physical examination measurement as a possible screening tool for POP. We conducted an exploratory cross-sectional analysis of women from our urogynecology clinics who underwent POP Quantification (POP-Q) examination and vaginal-angle measurements. Angle at rest and with Valsalva were measured using a POP-Q stick placed in the vaginal apex and a goniometer with attached line level (0° reference = horizontal). Angle change was calculated (resting – Valsalva). Reproducibility of angle measurements between examiners was assessed (r = 0.92–0.95, p < 0.0001). Associations for vaginal angle with POP stage and predominant compartment were estimated using linear regression, adjusting for age, parity, body mass index, hysterectomy status, and prior POP surgery. Data from 477 women were included, 78 with POP-Q stage 0 support, 156 with stage 1, 111 with stage 2, and 132 with stages 3–4. A total of 241 patients had anterior-predominant, 35 apical-predominant, 83 posterior-predominant, and 40 equal anterior/posterior POP. Resting angle was higher for POP-Q stage 1 than 0 (adjusted β = 3.6, 95

Recurrent urinary tract infections (rUTIs) are a common and vexing problem for women and clinicians alike. Adherence to clinical guidelines for evaluation and antibiotic management is poor and the need for antibiotic stewardship is paramount. For these reasons, there is a growing interest in nonantibiotic prevention strategies for recurrent urinary tract infections (rUTIs). Our objective is to provide a focused, pragmatic review of the latest evidence. Adherence to current clinical guidelines reduces the misdiagnosis and mis- and overtreatment of rUTIs. A better understanding and clinical recognition of asymptomatic bacteriuria (ASB) will also lead to a reduction in the mistreatment of positive urine cultures in asymptomatic women or those with other conditions that cause UTI-like symptoms. Vaginal estrogen is well tolerated and effective for preventing rUTI in postmenopausal women. Cranberry supplements at sufficient doses and methenamine hippurate are effective in preventing uncomplicated rUTI. D-mannose has evidence to support use, although the evidence is of somewhat variable quality. Adherence to current rUTI clinical guidelines is paramount to minimize mis- and overtreatment of rUTIs and maximize antibiotic stewardship. ASB is a common cause of positive urine cultures in post-menopausal women, often confused for rUTIs, and does not need treatment. There is sufficient evidence to recommend vaginal estrogen, cranberry and methenamine hippurate as first-line rUTI prevention strategies, particularly in postmenopausal women. Prevention strategies can be used in series or in tandem, based on patient preference and tolerance for side effects, to create effective nonantibiotic rUTI prevention strategies.

OBJECTIVE:To compare the long-term pelvic floor subjective and objective outcomes of immediate and delayed pushing in the second stage of labor. METHODS:This was a multicenter randomized controlled trial that included nulliparous patients at 37 weeks of gestation or more in labor with neuraxial analgesia. Participants were randomized in the second stage of labor to immediate pushing or pushing after a 60-minute delay. Pelvic floor assessments were performed 1-5 days, 4-8 weeks, and 2-3 years postpartum. Pelvic organ prolapse quantification (POP-Q) measurements and validated questionnaire score (PFDI-20 [Pelvic Floor Distress Inventory], PFIQ-7 [Pelvic Floor Impact Questionnaire], FISI [Fecal Incontinence Severity Index], and MMHQ [Modified Manchester Health Questionnaire]) assessments were compared within and between the immediate and delayed pushing groups. Pelvic floor questionnaire assessments were performed 1-5 days and 2-3 years postpartum. The POP-Q examinations were performed at 4-8 weeks and 2-3 years postpartum. Changes in questionnaire scores were adjusted for birth weight exceeding 4,000 g and duration of pushing. RESULTS:A total of 2,414 participants were randomized between 2014 and 2017. Three hundred fifty-six women (14.7%) completed pelvic floor assessments at 2-3 years, 175 in the immediate pushing group and 181 in the delayed pushing group. Patients with an interval pregnancy were excluded (n=236). There was no significant difference in POP-Q stage at 2-3 years postpartum. Intergroup and intragroup changes in total and subscale scores for the PFIQ, FISI, and MMHQ were not significantly different at 2-3 years postpartum (-12.8±47.2 vs -22.0±58.7, P =.09; -1.2±8.0 vs -0.6±7.7, P =.56; and 3.1±22.5 vs -0.1±20.2, P =.53, respectively). The changes in PFDI-20 score were not significantly different (3.4±29.1 vs 0.4±36.2, P=.40). However, the Colorectal-Anal Distress Inventory subscale score change was significantly different (2.4±16.0 vs -5.7±15.7, P =.01). CONCLUSION:Among nulliparous patients in the second stage of labor with neuraxial analgesia, immediate compared with delayed pushing did not result in significant differences in POP-Q measures and most pelvic floor symptoms at 2-3 years. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov , NCT02137200.

ObjectiveTo investigate the association between hormonal contraception (HC) and lower urinary tract symptoms (LUTS) and recurrent urinary tract infections (rUTIs) among premenopausal women in the Boston Area Community Health Survey.MethodsAt baseline in 2002-2005 and 5 years later, participants provided information on contraception use, 14 LUTS, and rUTIs. We used this information to investigate HC use (ever, past, current, and ever systemic) in relation to the prevalence and risk of urinary incontinence, other storage symptoms, voiding/emptying symptoms, lower urinary tract pain, and rUTIs. Associations were estimated using Poisson regression with robust variance estimation, adjusting for age, race/ethnicity, vaginal parity, body mass index, waist circumference, cigarette smoking, diabetes, and sexual activity (rUTI analyses only).ResultsIn both prevalent (n = 881) and incident analyses (n = 608-867, depending on the LUTS), no associations were observed for HC use with urinary incontinence, other storage LUTS, voiding/emptying LUTS, or lower urinary tract pain. In contrast, positive associations were observed for rUTIs in prevalent analyses (ever [adjusted prevalence ratio (aPR) 6.4, 95% confidence interval (CI) 1.0-41.3] and current use [aPR 16.3, 95% CI 1.8-152.1] compared to never use), with similar suggestive positive associations in incident analyses (ever use [adjusted relative risk = 4.4, 95% CI 0.9-21.2] and current use [aPR 5.9, 95% CI 0.7-53.5]).ConclusionsOur prospective findings do not support associations between HC use and risk of most LUTS or conditions, except for rUTIs. Future studies should explore this association further to determine whether it is explained by residual confounding by sexual activity or the possible influence of HC use on the hormonal genitourinary tract milieu.

BACKGROUND:Vaginal dilators use inflatable balloons that can be gently increased in size to dilate the vagina at a controlled rate before or during delivery. OBJECTIVE:The primary objective of this study was to assess if antenatal use of vaginal dilator devices reduces the incidence of the following outcomes: episiotomy, perineal lacerations, anal sphincter injury, and levator ani avulsion. SEARCH STRATEGY:We identified studies using Embase, Ovid-Medline All, Scopus, Web of Science, and ClinicalTrials.gov from inception to August 28, 2024. We searched for concepts of vaginal dilators or birth training devices, episiotomy, and injuries to the vagina, perineum, pelvic floor musculature, or obstetric anal sphincter. SELECTION CRITERIA:We included randomized and non-randomized studies that reported outcomes of interest in participants who used any vaginal dilator device during pregnancy/delivery compared to those who did not. Inclusion criteria were: (1) original clinical research, (2) use of any vaginal dilator device during pregnancy compared to a non-dilator control group and (3) provision of data on at least one of the four outcomes. Exclusion criteria were: (1) publications in languages other than English and French, (2) not peer-reviewed original research and (3) studies that combined dilator use with a second intervention. For meta-analyses, studies were included in each subgroup if they included relevant data. DATA COLLECTION AND ANALYSIS:Two independent readers screened studies for inclusion/exclusion criteria and independently performed data extraction. Primary outcomes included episiotomies, perineal lacerations, anal sphincter injury, and levator ani avulsion. These outcomes were analyzed separately and combined. The Cochrane Q Test and Higgin's I2 were used to assess study heterogeneity. Random effects models were used to obtain pooled risk ratios and 95% confidence intervals. Subanalyses were also performed limited to higher-quality studies (i.e., randomized controlled trials with or without birth attendant and outcome assessor blinding) and for each device separately. MAIN RESULTS:Of 64 screened studies, six were included in the meta-analyses. Antenatal vaginal dilator device reduced incidence of episiotomy compared to no treatment in all studies combined (n = 1262; pooled risk ratio = 0.82 [95% CI: 0.69, 0.98]), but not higher-quality studies (n = 862; pooled risk ratio = 0.90 [95% CI: 0.73, 1.11]). No associations were observed for perineal lacerations, obstetric anal sphincter injury, and levator ani injury in all studies combined or in higher-quality studies. No association was also observed when all outcomes were combined. CONCLUSIONS:Results from our systematic review and meta-analysis do not support a protective effect of antenatal vaginal dilator device use on perineal trauma, especially when limited to the highest-quality studies. However, as our findings were based on the results of only two randomized controlled trials that included birth attendant blinding, additional rigorous studies including birth attendant and outcome assessor blinding are warranted to address this question conclusively.

BACKGROUND:Bladder health encompasses total bladder well-being and not merely the absence of urinary symptoms. While much is known about the prevalence of urinary symptoms in women, little is known about the distribution of bladder health (eg, optimal to poor). OBJECTIVE:We report the distributions of multiple dimensions of bladder health and function in a population-based sample of community-dwelling women, overall and separately in women without urinary symptoms to begin to explore bladder health dimensions that may precede the onset of symptoms. STUDY DESIGN:RISE FOR HEALTH is a regionally-representative cohort study of US women aged 18 and older. Baseline surveys included the validated Bladder Health Scales/Bladder Function Indices, the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and additional study items. Bladder well-being was assessed across 10 scales and bladder function across 6 indices. Bladder Health Scale scores were adjusted for adaptive/coping behaviors (eg, using/carrying pads, staying close to a toilet) to account for the perceived impact of urinary symptoms on well-being. Scores for scales and indices ranged from 0 (poor well-being/function) to 100 (optimal well-being/function). We calculated summary statistics for each scale (with and without adaptive behavior adjustment) and each index in the full study population and subset of women without urinary symptoms. RESULTS:The mean age of 3027 eligible participants was 49.8 years (standard deviation 17.9). The median global Bladder Health Scale score was 72 (interquartile range: 56, 84) before adjustment for adaptive/coping behaviors and 55 (interquartile range: 34, 78) after adjustment. Median scores for the other scales ranged from 75 to 100 before and 61 to 72 after adjustment. Sixty-nine percent of participants reported using adaptive/coping behaviors, including using pads (40%), toilet mapping (58%), and staying close to a toilet (3%). The median overall Bladder Function Index score was 77 (interquartile range: 63, 89); individual median scores ranged from 63 to 68 for frequency, sensation, continence, and emptying indices to 100 for biosis/urinary tract infection and comfort indices. Among participants without reported urinary symptoms (n=700), scores were higher across all scales (unadjusted medians=88-100 and adjusted medians=82-100) and indices (medians=93-100), indicating better, but not optimal health; however, 38% of asymptomatic women reported using adaptive/coping behaviors: 11% using pads, 30% toilet mapping, and 2% staying close to a toilet. CONCLUSION:We observed a wide range of bladder well-being and function in RISE participants and high utilization of adaptive/coping behaviors. Bladder health variability and utilization of adaptive/coping behaviors was also observed in women without urinary symptoms, highlighting bladder health dimensions not captured by traditional urinary symptom tools and potentially identifying a group of women with "subclinical" symptoms who may be at greater risk of developing urinary symptoms. Future prospective analyses should investigate this novel group of women further.

IMPORTANCE:Genitourinary fistula is a rare complication of obstetric cerclage with limited evidence to guide prevention and management. OBJECTIVE:The aim of the study was to describe 5 new cases of vesicovaginal fistula (VVF) after cerclage and evaluate existing cases, including shared features, to generate hypothesis for future etiologic research. STUDY DESIGN:Case series and scoping review. RESULTS:Five patients presented with VVF symptoms after cerclage placement; 4 were diagnosed during pregnancy, 1 postpartum. Two patients had prior cervical procedures and were noted to have difficult cerclage placements. Three cerclages remained until delivery, 1 was removed antepartum, and another was replaced. All VVFs were diagnosed by cystoscopy and were repaired postpartum transvaginally. In the scoping review, 14 studies met inclusion criteria, and 19 cases were identified. Compiled cases had a history of cervical procedure(s), shortened cervix, McDonald technique, anterior knot placement, and Mersilene tape use. Fistulas were identified by cystoscopy when performed. Most reports described VVFs near the bladder trigone and midline of the vagina. All VVFs required surgical repair. CONCLUSIONS:Genitourinary fistula after cerclage is rare but may be more common after prior cervical surgery, shortened cervix, and McDonald cerclage. Methods to mitigate morbidity associated with fistula after cerclage placement include cystoscopy if bladder injury is suspected at the time of cerclage placement and consideration of abdominal cerclage when intravaginal access to the cervix is limited. Patients with urinary leakage after cerclage should be evaluated for genitourinary fistula, not just incontinence. Postpartum surgical repair remains the primary treatment for VVF, ideally by a vaginal approach.

OBJECTIVE:To facilitate research on interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) symptom variability or flares, we reviewed the published literature to document existing data collection instruments (e.g., questionnaires and diaries), and to identify those relevant for flare research. METHODS:Seven databases were searched systematically for articles describing the development of instruments: (1) specific for IC/BPS, CP/CPPS, or both; and (2) intended for use by investigators beyond the development team. In total, 1216 abstracts and 79 full-text articles were reviewed, and data were extracted in duplicate. RESULTS:We identified 17 instruments, 11 for IC/BPS, 5 for CP/CPPS, and 1 for both. In total, 13 instruments (12 questionnaires and 1 electronic diary) assessed symptoms for diagnostic, symptom evaluation, and/or symptom monitoring purposes, and included items assessing the presence, location, intensity (mostly typical intensity), and/or amount of time experienced pelvic pain and/or urinary symptoms. No instruments included items related to symptom variability or flares. CONCLUSION:In addition to describing existing instruments for future urologic CPPS research, our review identified a lack of validated instruments for flares. Future studies should address this gap to facilitate rigorous research on this understudied topic.

Introduction and HypothesisWomen with vulvovaginal or genital pain more commonly experience interstitial cystitis/bladder pain syndrome (IC/BPS) and urinary tract infections. However, the relationship between genital pain and bladder health is lacking.MethodsWomen in the Prevention of Lower Urinary Tract Symptoms Consortium's RISE FOR HEALTH population-based study answered questions about bladder health globally, and across nine bladder health domains of holding, efficacy, social-occupation, physical activity, intimacy, travel, emotion, perception, and freedom. Bladder function was assessed across six indices including urinary frequency, sensation, continence, comfort, emptying, and dysbiosis (e.g., urinary tract infections). Participants were grouped by no pain beyond transitory events (i.e., minor headaches, toothaches, or sprains), nongenital-related pain only, and any genital pain using a validated pain diagram. Mean adjusted scores and indices were compared using general linear modelling.ResultsOf 1,973 eligible women, 250 (12.7%) reported genital pain, 609 (30.9%) reported nongenital pain only, and 1,114 (56.5%) reported no pain. Women with any genital pain had lower (worse) adjusted mean scores across all bladder health scales (BHS; BHS global adjusted mean 47.5; 95% CI 40.8-54.1), compared with those with nongenital pain only (53.7; 95% CI 47.6-59.8), and no pain (59.3; 95% CI 53.3-65.4). Similarly, adjusted mean total Bladder Functional Index scores were lower for those with genital pain (63.1; 95% CI 58.4-67.9) compared with nongenital pain (72.1; 95% CI 67.7-76.5) and no pain (77.4; 95% CI 73.0-81.8).ConclusionsHeightened awareness of the relationship between genital pain and bladder health should prompt clinicians caring for women with genital pain to assess bladder health and function.

To determine intrapartum factors associated with perineal laceration at delivery. This was a planned secondary analysis of a multicenter randomized clinical trial of delayed versus immediate pushing among term nulliparous women in labor with neuraxial analgesia conducted in the United States. Intrapartum characteristics were extracted from the medical charts. The primary outcome was perineal laceration, defined as second degree or above, characterized at delivery in women participating in longer term pelvic floor assessments post-delivery. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, birth weight, and maternal age. Among the 941 women participating in the pelvic floor follow-up, 40.6

IMPORTANCE:Feasibility of home urogenital microbiome specimen collection is unknown. OBJECTIVES:This study aimed to evaluate successful sample collection rates from home and clinical research centers. STUDY DESIGN:Adult women participants enrolled in a multicentered cohort study were recruited to an in-person research center evaluation, including self-collected urogenital samples. A nested feasibility substudy evaluated home biospecimen collection prior to the scheduled in-person evaluation using a home collection kit with written instructions, sample collection supplies, and a Peezy™ urine collection device. Participants self-collected samples at home and shipped them to a central laboratory 1 day prior to and the day of the in-person evaluation. We defined successful collection as receipt of at least one urine specimen that was visibly viable for sequencing. RESULTS:Of 156 participants invited to the feasibility substudy, 134 were enrolled and sent collection kits with 89% (119/134) returning at least 1 home urine specimen; the laboratory determined that 79% (106/134) of these urine samples were visually viable for analysis. The laboratory received self-collected urine from the research center visit in 97% (115/119); 76% (91/119) were visually viable for sequencing. Among 401 women who did not participate in the feasibility home collection substudy, 98% (394/401) self-collected urine at the research center with 80% (321/401) returned and visibly viable for sequencing. CONCLUSIONS:Home collection of urogenital microbiome samples for research is feasible, with comparable success to clinical research center collection. Sample size adjustment should plan for technical and logistical difficulties, regardless of specimen collection site.

BACKGROUND:The gold-standard treatment for advanced pelvic organ prolapse is sacrocolpopexy. However, the preoperative features of prolapse that predict optimal outcomes are unknown. OBJECTIVE:This study aimed to develop a clinical prediction model that uses preoperative scores on the Pelvic Organ Prolapse Quantification examination to predict outcomes after minimally invasive sacrocolpopexy for stages 2, 3, and 4 uterovaginal prolapse and vaginal vault prolapse. STUDY DESIGN:A 2-institution database of pre- and postoperative variables from 881 cases of minimally invasive sacrocolpopexy was analyzed. Data from patients were analyzed in the following 4 groups: stage 2 uterovaginal prolapse, stage 3 to 4 uterovaginal prolapse, stage 2 vaginal vault prolapse, and stage 3 to 4 vaginal vault prolapse. Unsupervised machine learning was used to identify clusters and investigate associations between clusters and outcome. The k-means clustering analysis was performed with preoperative Pelvic Organ Prolapse Quantification points and stratified by previous hysterectomy status. The "optimal" surgical outcome was defined as postoperative Pelvic Organ Prolapse Quantification stage <2. Demographic variables were compared by cluster with Student t and chi-square tests. Odds ratios were calculated to determine whether clusters could predict the outcome. Age at surgery, body mass index, and previous prolapse surgery were used for adjusted odds ratios. RESULTS:Five statistically distinct prolapse clusters (phenotypes C, A, A>P, P, and P>A) were found. These phenotypes reflected the predominant region of prolapse (apical, anterior, or posterior) and whether support was preserved in the nonpredominant region. Phenotype A (anterior compartment prolapse predominant, posterior support preserved) was found in all 4 groups of patients and was considered the reference in the analysis. In 111 patients with stage 2 uterovaginal prolapse, phenotypes A and A>P (greater anterior prolapse than posterior prolapse) were found, and patients with phenotype A were more likely than those with phenotype A>P to have an optimal surgical outcome. In 401 patients with stage 3 to 4 uterovaginal prolapse, phenotypes C (apical compartment predominant, prolapse in all compartments), A, and A>P were found, and patients with phenotype A>P were more likely than those with phenotype A to have ideal surgical outcome. In 72 patients with stage 2 vaginal vault prolapse, phenotypes A, A>P, and P (posterior compartment predominant, anterior support preserved) were found, and those with phenotype A>P were less likely to have an ideal outcome than patients with phenotype A. In 297 patients with stage 3 to 4 vaginal vault prolapse, phenotypes C, A, and P>A (prolapse greater in posterior than in anterior compartment) were found, but there were no significant differences in rate of ideal outcome between phenotypes. CONCLUSION:Five anatomic phenotypes based on preoperative Pelvic Organ Prolapse Quantification scores were present in patients with stages 2 and 3 to 4 uterovaginal prolapse and vaginal vault prolapse. These phenotypes are predictive of surgical outcome after minimally invasive sacrocolpopexy. Further work needs to confirm the presence and predictive nature of these phenotypes. In addition, whether the phenotypes represent a progression of prolapse or discrete prolapse presentations resulting from different anatomic and life course risk profiles is unknown. These phenotypes may be useful in surgical counseling and planning.

ABSTRACTIntroductionUroflowmetry is often used to assess lower urinary tract symptoms (LUTS). Criteria for characterization of flow patterns are not well established, and subjective interpretation is the most common approach for flow curve classification. We assessed the reliability of uroflowmetry curve interpretation in adult women.Materials and MethodsUroflowmetry studies were obtained in 296 women who participated in an observational cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for interrater reliability. A random subset of 50 tracings was re‐reviewed by each investigator for intrarater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous fluctuating, interrupted, and prolonged. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters is summarized with kappa (k) statistics and percentage where at least three raters agreed.ResultsThe mean age of participants was 44.8 ± 18.3 years. Participant age categories were 18–24 years: 20%; 25–34 years: 17%; 35–64 years: 42%; 65+ years: 18%. Nine percent described their race as Asian, 31% Black, 62% White, and 89% were of non‐Hispanic ethnicity. The interrater reliability was highest for the continuous flow category (k = 0.65), 0.47 for prolonged, 0.41 for continuous fluctuating, and 0.39 for interrupted flow curves. Agreement among at least three raters occurred in 74.3% of uroflow curves (69% for continuous, 33% for continuous fluctuating, 23% for interrupted, and 25% for prolonged). For intrarater reliability, the mean k was 0.72 with a range of 0.57–0.85.ConclusionsCurrently accepted uroflowmetry pattern categories have fair to moderate interrater reliability, which is lower for flow curves that do not meet “continuous” criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use in research and as a screening tool for LUTS and voiding dysfunction.Trial RegistrationParent trial: Validation of Bladder Health Instrument for Evaluation in Women (VIEW); ClinicalTrials.gov ID: NCT04016298.

The purpose of this document is to update the 2013 AUGS Position Statement based on subsequent decisions made by the U.S. Food and Drug Administration, published clinical data, and relevant society and national guidelines related to the use of surgical mesh. Urogynecologists specialize in treating pelvic floor disorders, such as pelvic organ prolapse (POP) and urinary incontinence, and have been actively involved and engaged in the national and international discussions and research on the use of surgical mesh in the treatment of POP and stress urinary incontinence. In 2019, the U.S. Food and Drug Administration ordered manufacturers of transvaginally placed mesh kits for prolapse to stop selling and distributing their devices, stating that the data submitted did not provide a reasonable assurance of safety and effectiveness. Evidence supports the use of mesh in synthetic midurethral sling and abdominal sacrocolpopexy. The American Urogynecologic Society (AUGS) remains opposed to any restrictions that ban currently available surgical options performed by qualified and credentialed surgeons on appropriately informed patients with pelvic floor disorders. The AUGS supports the U.S. Food and Drug Administration's recommendations that surgeons thoroughly inform patients seeking treatment for POP about the risks and benefits of all potential treatment options, including nonsurgical options, native tissue vaginal repairs, or abdominally placed mesh. There are certain clinical situations where surgeons may assert that the use and potential benefit of transvaginal mesh for prolapse outweighs the risk of other routes/types of surgery or of not using mesh. The AUGS recommends that surgeons utilize a shared decision-making model in the decision-making process regarding surgical options, including use of transvaginally placed mesh.

PURPOSE:We aimed to estimate the prevalence of a wide range of lower urinary tract symptoms (LUTS) in US women, and explore associations with bother and discussion with health care providers, friends, and family. MATERIALS AND METHODS:We analyzed baseline data collected from May 2022 to December 2023 in the RISE FOR HEALTH study-a large, regionally representative cohort study of adult female community members. LUTS and related bother were measured by the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and discussion was assessed by a study-specific item. RESULTS:Of the 3000 eligible participants, 73% (95% CI 71%-74%) reported any storage symptoms, 52% (95% CI 50%-53%) any voiding or emptying symptoms, and 11% (95% CI 10%-13%) any pain with bladder filling, for an overall LUTS prevalence of 79% (95% CI 78%-81%). This prevalence estimate included 43% (95% CI 41%-45%) of participants with mild to moderate symptoms and 37% (95% CI 35%-38%) with moderate to severe symptoms. Over one-third of participants reported LUTS-related bother (38%, 95% CI 36%-39%) and discussion (38%, 95% CI 36%-40%), whereas only 7.1% (95% CI 6.2%-8.1%) reported treatment. Urgency and incontinence (including urgency and stress incontinence) were associated with the greatest likelihood of bother and/or discussion (adjusted prevalence ratios = 1.3-2.3), even at mild to moderate levels. They were also the most commonly treated LUTS. CONCLUSIONS:LUTS, particularly storage LUTS such as urgency and incontinence, were common and bothersome in the RISE study population, yet often untreated. Given this large burden, both prevention and treatment-related interventions are warranted to reduce the high prevalence and bother of LUTS.

(Abstracted from Urogynecology (Phila) 2023;29:367–377 Up to 25% of women experience recurring urinary tract infections, which are typically managed through long-term antibiotic prophylaxis intended for common urogenital pathogens. Unfortunately, prolonged use of antibiotics can lead to several adverse effects such as allergic reactions, sequelae from microbiome alterations, drug interactions/toxicities, and antibiotic resistance. One commonly prescribed prophylactic therapy, vaginal estrogen therapy (VET), is used as a first-line nonantibiotic therapy for rUTIs.