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Latest Advances in Lower Urinary Tract Symptoms and Pelvic Floor...
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Latest Advances in Lower Urinary Tract Symptoms and Pelvic Floor Dysfunction Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 6 May 2025 | Viewed by 4069

Special Issue Editors

Dr. Marianne Koch

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Guest Editor
Department of Obstetrics and Gynecology, Clinical Division of General Gynecology and Gynecologic Oncology, Medical University of Vienna, 1090 Vienna, Austria
Interests: microbiome; urinary incontinence; overactive bladder syndrome; stress urinary incontinence; postpartum pelvic floor disorders
Dr. Rufus Cartwright

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Guest Editor
1. Department of Urogynaecology, LNWH NHS Trust, London, UK
2. Department of Epidemiology & Biostatistics, Imperial College London, London, UK
Interests: fibroids; heavy periods; gender affirmation surgery; incontinence; ovarian cysts; pelvic floor reconstructive surgery; prolapse; urinary tract infection
Dr. Kim W.M. Van Delft

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Guest Editor
Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
Interests: postpartum pelvic floor disorder; obstetric defaecation; obstetric anal sphincter

Special Issue Information

Dear Colleagues,

This Special Issue aims to address the pressing issues surrounding female lower urinary tract symptoms (LUTSs), including pelvic organ prolapse (POP) and urinary incontinence (UI). Despite significant advancements in research, there remain core problems to be solved, such as understanding the multifactorial etiology of these conditions, improving diagnostic accuracy and refining treatment modalities to enhance patient outcomes. In the current era in which women grow older, there will be more women suffering from pelvic floor disease. They will increasingly rely on healthcare as they are motivated to continue their work, informal care and leisure time. The increasing costs associated with healthcare and the reduction in the number of healthcare professionals mean that we need to treat all women in a suitable manner, including the need for prevention. The scope of this Special Issue encompasses a broad array of topics, including, but not limited to, epidemiology, pathophysiology, risk factors, diagnostic techniques, treatment strategies and patient outcomes related to female LUTSs. By mobilizing contributions from diverse research disciplines, including gynecology and obstetrics, urology, physiotherapy, general surgery and basic science, this Special Issue seeks to foster interdisciplinary collaboration and knowledge exchange, ultimately advancing our understanding and management of these complex and prevalent conditions in women.

Dr. Marianne Koch
Dr. Rufus Cartwright
Dr. Kim W.M. Van Delft
Guest Editors

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Keywords

  • pelvic organ prolapse
  • urinary incontinence
  • overactive bladder syndrome
  • stress urinary incontinence
  • postpartum pelvic floor dysfunction
  • bladder dysfunction
  • obstetric anal sphincter injury
  • lower urinary tract dysfunction

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Published Papers (4 papers)

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Research

17 pages, 5313 KiB  
Article
Evaluation of Perineal Descent Measurements on Pelvic Floor Imaging
by Isabelle M. A. van Gruting, Kirsten Kluivers, Aleksandra Stankiewicz, Joanna IntHout, Kim W. M. van Delft, Ranee Thakar and Abdul H. Sultan
J. Clin. Med. 2025, 14(2), 548; https://doi.org/10.3390/jcm14020548 - 16 Jan 2025
Viewed by 807
Abstract
Objectives: The aim of this study is to validate a uniform method for measuring perineal descent which can be used for different imaging methods, to establish cut-off values for this measurement, and to assess diagnostic test accuracy (DTA) of imaging techniques using these [...] Read more.
Objectives: The aim of this study is to validate a uniform method for measuring perineal descent which can be used for different imaging methods, to establish cut-off values for this measurement, and to assess diagnostic test accuracy (DTA) of imaging techniques using these cut-off values. Secondly, the study aims to correlate perineal descent to symptoms, signs and imaging findings in women with obstructed defaecation syndrome (ODS) to assess its clinical relevance. Methods: Cross-sectional study of 131 women with symptoms of ODS. Symptoms and signs were assessed using validated methods. These women underwent evacuation proctography (EP), magnetic resonance imaging (MRI), transperineal ultrasound (TPUS) and endovaginal ultrasound (EVUS). Perineal descent was measured on EP and MRI as the position of anorectal junction (ARJ) with respect to the pubococcygeal line (PCL) at rest (i.e., static descent) and during evacuation (i.e., descent at Valsalva). Dynamic perineal descent was measured on all four imaging techniques as the difference between the position of the ARJ at rest and Valsalva. DTA of dynamic perineal descent was estimated using Latent Class Analysis in the absence of a reference standard. Results: Interobserver agreement of dynamic perineal descent measurements was good for MRI and EVUS (ICC 0.86 and 0.85) and moderate for EP and TPUS (ICC 0.61 and 0.59). The systematic differences in measurements between imaging techniques show the need for individual cut-off values. New established cut-off values for dynamic descent are for EP 20 mm, MRI 35 mm, TPUS 15 mm and EVUS 15 mm. Sensitivity was moderate for EP (0.78) and MRI (0.74), fair for TPUS (0.65) and poor for EVUS (0.58). Specificity was similar for all imaging techniques (0.73–0.77). Static perineal descent correlated with symptoms of pelvic organ prolapse (POP) (r = 0.19), prolapse of all three compartments (r = 0.19–0.36), presence of levator ani muscle avulsion (p = 0.01) and increased hiatal area (r = 0.51). Dynamic perineal descent correlated with excessive straining (r = 0.24) and use of laxatives (r = 0.24). Classic symptoms of ODS (incomplete evacuation and digitation) did not correlate with perineal descent measurements. Static and dynamic perineal descent were associated with presence of rectocele, enterocele, intussusception, and absence of anismus. Conclusions: Dynamic perineal descent is a reliable measurement that can be applied to different imaging techniques to allow standardisation. Static descent is more often present in women with POP and dynamic descent is more often present in women with constipation. Perineal descent does not correlate with typical symptoms of ODS. Specificity of TPUS and EVUS is comparable to EP and MRI, hence ultrasound could be used for the initial assessment of pelvic floor dysfunction. Full article
(This article belongs to the Special Issue Latest Advances in Lower Urinary Tract Symptoms and Pelvic Floor Dysfunction Diseases)
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12 pages, 896 KiB  
Article
The External Validation of a Multivariable Prediction Model for Recurrent Pelvic Organ Prolapse After Native Tissue Repair: A Prospective Cohort Study
by Imke Kessels, Sander van Kuijk, Tineke Vergeldt, Iris van Gestel, Wilbert Spaans, Kim Notten, Roy Kruitwagen and Mirjam Weemhoff
J. Clin. Med. 2025, 14(2), 531; https://doi.org/10.3390/jcm14020531 - 15 Jan 2025
Viewed by 768
Abstract
Background/Objectives: A prediction model for anatomical cystocele recurrence after native tissue repair was developed and internally validated in 2016. This model estimates a patients’ individual risk of recurrence and can be used for counseling. Before implementation in urogynecological clinical practice, external validation [...] Read more.
Background/Objectives: A prediction model for anatomical cystocele recurrence after native tissue repair was developed and internally validated in 2016. This model estimates a patients’ individual risk of recurrence and can be used for counseling. Before implementation in urogynecological clinical practice, external validation is needed. The aim of this study was to assess the external validity of this previously developed prediction model. The secondary aim was to test the performance of this model with a composite and subjective outcome of pelvic organ prolapse (POP) recurrence. Furthermore, the aim was to investigate whether risk factors for POP recurrence were in line with the population in which the original model was developed. Methods: In this prospective multicenter cohort study, 246 patients who underwent anterior colporrhaphy were included. Inclusion criteria were patients scheduled to undergo a primary anterior colporrhaphy (with a POP Quantification (POPQ) stage ≥ 2 cystocele). A combination of a primary anterior colporrhaphy with other POP or incontinence surgery (without the use of vaginal or abdominal mesh material) was permitted. Patients with prolapse or incontinence surgery prior to index surgery could not participate. All patients filled in questionnaires, pelvic floor ultrasound was performed preoperatively, and data from the medical file concerning POPQ stage and obstetric and general history were obtained. Results: Thirty women (12.2%) were lost at follow up. Anatomical cystocele recurrence was present in 107/216 (49.5%), subjective recurrence in 19/208 (9.1%), and 39/219 (17.8%) patients met the criteria for composite outcome. The area under the receiver operating characteristic curves for anatomical, composite, and subjective recurrence were 65.5% (95% CI: 58.7–72.4), 55.8% (95% CI 47.3–64.3%, NS), and 55.1% (95% CI 45.1–65.2%), respectively. In the multivariable analysis, preoperative cystocele stage 3 or 4 and a complete levator defect on ultrasound were independent risk factors for anatomical recurrence. For composite recurrence, younger age and an active employment status were only risk factors in univariable analysis. No significant risk factors for subjective recurrence could be identified. Conclusions: This external validation study showed a moderate performance for a prediction model for anatomical recurrence. The model cannot be used for a composite or subjective outcome prediction because of poor performance. For composite and subjective recurrence, new prediction models need to be developed. Full article
(This article belongs to the Special Issue Latest Advances in Lower Urinary Tract Symptoms and Pelvic Floor Dysfunction Diseases)
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9 pages, 200 KiB  
Article
Opinions of Gynecologists About Indication and Technique of Perineoplasty
by Esther C. A. M. van Swieten, Karlijn J. van Stralen, Astrid Vollebregt and Jan-Paul W. R. Roovers
J. Clin. Med. 2024, 13(24), 7536; https://doi.org/10.3390/jcm13247536 - 11 Dec 2024
Viewed by 743
Abstract
Background. Perineoplasty is a frequently performed procedure as part of prolapse surgery. Despite its frequent use, there is a lack of evidence on the optimal indication, surgical technique and adverse outcomes. We intended to gain insight into the current opinions on indications and [...] Read more.
Background. Perineoplasty is a frequently performed procedure as part of prolapse surgery. Despite its frequent use, there is a lack of evidence on the optimal indication, surgical technique and adverse outcomes. We intended to gain insight into the current opinions on indications and techniques of perineoplasty among (uro)gynecologists worldwide. Methods. We conducted a survey among members of the International UroGynecological Association (IUGA) to objectify indications for perineoplasty and aspects of surgical technique. Results. A total of 114 urogynecologists responded, with 98% performing perineoplasty. A total of 85% of respondents aimed to approximate the bulbocavernosus muscle, whereas 27% aimed to include the puborectal muscle as well. A total of 86% of respondents used 1–4 resorbable sutures, especially vicryl 2/0 (39%) or vicryl 0 (52%). According to the respondents, a “wide genital hiatus at physical examination” (87%) and “subjective complaints of a wide genital hiatus” (84%) were considered good/excellent indications for perineoplasty, whereas “fecal incontinence”, “apical prolapse” and “perineal pain” were absolutely/mostly not a good indication. Reasons to not perform perineoplasty were pelvic pain (59%) and dyspareunia (64%). Most responders underlined the need for more research on this topic (8.5 out of 10). Conclusions. Perineoplasty is a frequently performed procedure. There is a wide variation in the indications for and surgical techniques of perineoplasty. Therefore, research is needed to identify which patients will benefit from perineoplasty and how to optimally perform this surgery. Full article
(This article belongs to the Special Issue Latest Advances in Lower Urinary Tract Symptoms and Pelvic Floor Dysfunction Diseases)
9 pages, 1009 KiB  
Article
Explorative Identification of Anatomical Parameters Associated with Successful Pessary Fitting in Pelvic Organ Prolapse Using Dynamic Magnetic Resonance Imaging
by Charlotte P. R. Triepels, Lars L. Boogaard, Jurgen J. Fütterer, Sander M. J. van Kuijk, Wilbert A. Spaans, Roy F. P. M. Kruitwagen, Mirjam Weemhoff and Kim J. B. Notten
J. Clin. Med. 2024, 13(16), 4819; https://doi.org/10.3390/jcm13164819 - 15 Aug 2024
Viewed by 1199
Abstract
Background: Pelvic organ prolapse (POP) affects many women and is often managed with pessary treatment, yet predicting the success of fitting remains challenging. This study aims to identify anatomical parameters associated with successful and unsuccessful pessary treatment using dynamic magnetic resonance imaging (dMRI). [...] Read more.
Background: Pelvic organ prolapse (POP) affects many women and is often managed with pessary treatment, yet predicting the success of fitting remains challenging. This study aims to identify anatomical parameters associated with successful and unsuccessful pessary treatment using dynamic magnetic resonance imaging (dMRI). Methods: A cross-sectional study in Maastricht University Medical Centre (MUMC+), the Netherlands. Sixteen women with a cystocele and/or descensus uteri minimal POP-Q stage 2, using pessary treatment, were included. All women underwent a dynamic MRI of the pelvic floor at rest, during contraction and on Valsalva. The anatomical parameters evaluated included various lengths and angles. The association between the anatomical parameters and pessary fitted is assessed using partial least squares regression. The predictive accuracy was tested using cross-validation based on the partial least squares model with the most important variables. Results: Seven of the sixteen women (43.8%) were in the non-fitting group (due to movement, rotation or expulsion of the pessary), and nine women (56.3%) were in the fitting group. Participants in the non-fitting group had a significantly lower body mass index (BMI). Variables such as total vaginal length (TVL) and certain angles were highly predictive of pessary fitting success, with variable importance of projection (VIP) scores indicating their importance. The prediction models showed accuracies ranging from 53.3% to 80.0%. Conclusions: In this explorative study, TVL, cervical length (CL), sacrococcygeal angle and pubococcygeal angle were key variables associated with pessary fitting success. These findings offer valuable insights for optimizing pessary fitting procedures and the development of new pessaries. Full article
(This article belongs to the Special Issue Latest Advances in Lower Urinary Tract Symptoms and Pelvic Floor Dysfunction Diseases)
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