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Medicina
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New Advances in Female Pelvic Floor Dysfunctions Management: 2nd Edition
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New Advances in Female Pelvic Floor Dysfunctions Management: 2nd Edition

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (15 February 2024) | Viewed by 3828

Special Issue Editor

Dr. Andrea Braga

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Ente Ospedaliere Cantonale, University of the Italian Switzerland, Mendrisio, Switzerland
Interests: urogynecology; urinary incontinence; pelvic reconstructive surgery; female urology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Female pelvic floor dysfunctions (PFDs) are common conditions that affect over 20% of the adult population. These disorders, which include urinary incontinence, anal incontinence, pelvic organ prolapse, and sexual dysfunction, represent serious health problems for the female population. In fact, in addition to physical discomfort, they could lead to psychological distress, such as anxiety and low self-esteem, leading to depression status.

The prevalence of PFDs increases with age, and it is estimated that the number of American women with at least one pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050. Considering the general aging of the global population, these problems could further increase. Additionally, due to the embarrassment of patients, the belief that PFDs are a normal and inevitable part of aging, and the lack of knowledge about treatment options, the prevalence is often underreported. Less than 20% of symptomatic women self-report their problems.

Furthermore, PFDs have a great impact on financial policy. In the USA, pelvic organ prolapse is thought to be the leading cause of more than 300,000 surgical procedures per year with 25% undergoing reoperations, for a total annual cost of more than USD 1 billion. Meanwhile, the annual direct cost of urinary incontinence in the USA alone is USD 16.3 billion, of which 3/4 is for the management of women who have this condition.

As women continue to live longer lives, understanding how to promote dialogues between clinicians and patients around these issues and finding therapies to reduce its effect on women’s quality of life should be a priority for future research. Moreover, it is important to develop the concept of a multidisciplinary approach to PFDs, which, in recent years, has led to the improvement of the condition for women.

In this Special Issue, we would like to provide a collection of papers, original articles, or clinical/systematic reviews aimed at providing a comprehensive overview of the recent advances in the diagnosis and treatment of PFDs.

This Special Issue is the continuation of the Special Issue "New Advances in Female Pelvic Floor Dysfunctions Management" (https://www.mdpi.com/journal/medicina/special_issues/Female_Pelvic_Floor_Dysfunctions).

Dr. Andrea Braga
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • female pelvic floor dysfunctions
  • urinary incontinence
  • anal incontinence
  • pelvic organ prolapse
  • sexual dysfunction

Published Papers (4 papers)

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Research

11 pages, 532 KiB  
Article
Quality of Life after Treatment for Pelvic Organ Prolapse in Real-World Study: Recommendations, Vaginal Pessary, and Surgery
by Dominyka Mančinskienė, Miglė Mikėnaitė, Mark Barakat, Justina Kačerauskienė, Dalia Regina Railaitė, Laima Maleckienė, Arnoldas Bartusevičius and Eglė Bartusevičienė
Medicina 2024, 60(4), 547; https://doi.org/10.3390/medicina60040547 - 28 Mar 2024
Viewed by 646
Abstract
Background and Objectives: Pelvic organ prolapse (POP) is a common condition in women, with its prevalence increasing with age, and can significantly impact the quality of life (QOL) of many individuals. The objective of this study was to assess the overall improvement, quality [...] Read more.
Background and Objectives: Pelvic organ prolapse (POP) is a common condition in women, with its prevalence increasing with age, and can significantly impact the quality of life (QOL) of many individuals. The objective of this study was to assess the overall improvement, quality of life, and continuation of primary treatment for POP over a 24-month period in a real-world setting. Materials and Methods: This is a prospective, observational, follow-up study of women with symptomatic POP who, as a primary treatment, opted for recommendations (lifestyle changes and pelvic floor muscle training), pessary therapy, or surgery. The primary outcome measure was a subjective improvement at the 24-month follow-up, measured with the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcome measures were the continuation rate of the primary treatment method, reason for discontinuation, and the quality of life evaluated with the P-QoL questionnaire. Results: We included 137 women, with 45 women (32.8%) in the recommendations group, 39 (28.5%) in the pessary group, and 53 women (38.7%) in the surgery group. After 24 months, surgery, in comparison with pessary treatment and recommendations, resulted in significantly more women reporting a subjective improvement: 89.6%, 66.7%, and 22.9% (p < 0.001), respectively. Overall, 52% of women from the recommendations group and 36.4% from the pessary group switched to another treatment or discontinued the primary treatment within 24 months. However, women who continued the primary treatment, pessary use, and surgery showed similar subjective improvements (90.5% and 89.6%, respectively) and quality-of-life improvement. Conclusions: The chance of significant improvement was higher following surgery. However, after 24 months, both vaginal pessaries and surgery showed an important quality-of life improvement and can be proposed as primary treatment methods for pelvic organ prolapse. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management: 2nd Edition)
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10 pages, 876 KiB  
Article
A Novel Method for the Measurement of the Vaginal Wall Thickness by Transvaginal Ultrasound: A Study of Inter- and Intra-Observer Reliability
by Sara Bosio, Marta Barba, Annalisa Vigna, Alice Cola, Desirèe De Vicari, Clarissa Costa, Silvia Volontè and Matteo Frigerio
Medicina 2024, 60(3), 370; https://doi.org/10.3390/medicina60030370 - 22 Feb 2024
Viewed by 584
Abstract
Background and Objectives: A consensus regarding the optimal sonographic technique for measuring vaginal wall thickness (VWT) is still absent in the literature. This study aims to validate a new method for measuring VWT using a biplanar transvaginal ultrasound probe and assess both [...] Read more.
Background and Objectives: A consensus regarding the optimal sonographic technique for measuring vaginal wall thickness (VWT) is still absent in the literature. This study aims to validate a new method for measuring VWT using a biplanar transvaginal ultrasound probe and assess both its intra-operator and inter-operator reproducibility. Material and Methods: This prospective study included patients with genitourinary syndrome of menopause-related symptoms. Women were scanned using a BK Medical Flex Focus 400 with the 65 × 5.5 mm linear longitudinal transducer of an endovaginal biplanar probe (BK Medical probe 8848, BK Ultrasound, Peabody, MA, USA). Vaginal wall thickness (VWT) measurements were acquired from the anterior and posterior vaginal wall at three levels. Results: An inter-observer analysis revealed good consistency between operators at every anatomical site, and the intra-class coefficient ranged from 0.931 to 0.987, indicating high reliability. An intra-observer analysis demonstrated robust consistency in vaginal wall thickness measurements, with an intra-class coefficient exceeding 0.9 for all anatomical sites. Conclusions: The measurement of vaginal wall thickness performed by transvaginal biplanar ultrasound was easy and demonstrated good intra- and inter-operator reliability. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management: 2nd Edition)
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9 pages, 1412 KiB  
Article
Radiofrequency as the New Opportunity in Treating Overactive Bladder and Urge Urinary Incontinence—A Single-Arm Pilot Study
by Damir Franić, Maja Franić Ivanišević and Ivan Verdenik
Medicina 2024, 60(2), 197; https://doi.org/10.3390/medicina60020197 - 24 Jan 2024
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Abstract
Background and Objectives: Until now, overactive bladder (OAB) with or without urge urinary incontinence (UUI) has been treated mainly in two ways: with behavioral methods and patient education, or using antimuscarinic drugs and/or beta-3 adrenergic receptor agonists. Unfortunately, these drugs may cause [...] Read more.
Background and Objectives: Until now, overactive bladder (OAB) with or without urge urinary incontinence (UUI) has been treated mainly in two ways: with behavioral methods and patient education, or using antimuscarinic drugs and/or beta-3 adrenergic receptor agonists. Unfortunately, these drugs may cause side effects in some women or are insufficiently effective, so patients abandon them. Therefore, in this pilot study, radiofrequency was evaluated as a new option in the treatment of OAB and UUI. Materials and Methods: Nineteen patients were enrolled in this pilot study using radiofrequency (RF), where the level of OAB and UUI was assessed using the validated ICIQ-OAB questionnaire. RF was applied four times for 20 min, once a week. Two weeks after treatment, the level of OAB and UUI was reassessed and processed statistically and the treatment effect evaluated. Results: Using the ICIQ-OAB, the severity of OAB and UUI was assessed: 0–3 mild symptoms; 4–7 moderate symptoms; 8–11 severe symptoms; 12–16 very severe symptoms. Before treatment, 10.5% of patients had mild symptoms, 21.1% moderate symptoms, 63.2% severe symptoms and 5.3% very severe symptoms. After treatment, 42.9% had mild symptoms, 50% moderate symptoms and 7% severe OAB and UUI symptoms. All four main symptoms—frequency, nocturia, urgency and incontinence—decreased statistically significantly, with the best results being found in urgency (p = 0.002). Conclusions: Based on this pilot study, RF seems a very promising method in the treatment of OAB and UUI. To extend our initial findings, it is necessary to perform a prospective, randomized and placebo-controlled study in order to obtain reliable results and to determine for how long one set of treatment maintains the results obtained immediately after the end of that treatment. In this way, we may determine how often the treatment needs to be repeated, if necessary, and when. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management: 2nd Edition)
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10 pages, 1571 KiB  
Article
Is Diastasis Recti Abdominis Rehabilitation after Childbirth Able to Prevent the Onset of Stress Urinary Incontinence? A Case-Control Study
by Andrea Braga, Livia Galli, Giorgio Caccia, Giulia Amato, Andrea Papadia, Marco Torella, Stefano Salvatore, Chiara Scancarello, Yoav Baruch and Maurizio Serati
Medicina 2023, 59(12), 2182; https://doi.org/10.3390/medicina59122182 - 15 Dec 2023
Viewed by 1377
Abstract
Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a [...] Read more.
Background and Objectives: Pelvic floor muscle training (PFMT) represent the first-line approach to pelvic floor dysfunctions (PFDs). Recently, studies have shown a synergy between the pelvic floor and abdominal muscles, hypothesizing that the anatomical and functional integrity of the abdominal wall plays a role in the prevention of pelvic floor disorders. Some studies have shown a significant correlation between diastasis recti abdominis (DRA) and stress urinary incontinence (SUI). Nevertheless, the evidence reported in the literature is controversial and based on low-quality data. The aim of the study is to clarify whether DRA-specific abdominal rehabilitation is needed in women with SUI after childbirth. Materials and Methods: All consecutive women who had at least one delivery and complained of symptoms of pure SUI that were urodynamically proven were considered for the study. The group of symptomatic patients was compared with a series of consecutive women, identified during the same study period, without any symptoms of SUI. In both groups, we measured the inter-rectal distance (IRD) with an ultrasound scanner above and below the navel. Results: A total of 102 women eligible for the study group and 100 women who did not report any symptoms of SUI were enrolled. The inter-rectal distance above the umbilicus showed no significant difference between the two groups (2.12 ± 0.98 vs. 2.1 ± 0.77; p = 0.94). In contrast, the data from the sub-umbilical measurements showed a significant difference. Surprisingly, the asymptomatic group showed significantly greater (0.98 ± 0.9 vs. 1.33 ± 0.87 p-value: 0.009) IRD compared to the symptomatic group. Conclusions: The study shows that DRA is not a risk factor for SUI in women after childbirth. Therefore, specific abdominal wall rehabilitation after childbirth does not seem to be indicated. Full article
(This article belongs to the Special Issue New Advances in Female Pelvic Floor Dysfunctions Management: 2nd Edition)
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