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Clinical Challenges of Pelvic Floor Disorders Management
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Clinical Challenges of Pelvic Floor Disorders Management

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

Deadline for manuscript submissions: 27 June 2025 | Viewed by 2437

Special Issue Editor

Dr. Matteo Frigerio

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
Interests: urogynecology; pelvic floor; prolapse; incontinence; pelvic organ prolapse; pelvic floor surgery; stress incontinence; recurrent urinary tract infection; pelvic pain
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pelvic floor disorders are common in women of all ages, with different causes and expressions according to patient age and condition. For some women, the symptoms are ongoing and interfere with normal routine, impacting quality of life. Frequently these aspects combine with each other, leading to complex clinical presentations.

Many women never tell anyone about their symptoms and are reticent even with their gynecologist. Referral to a pelvic floor center is not usually required. On the other hand, the management of these conditions is never fulfilled by one single specialist but by a team of specialists who work together to ensure pelvic floor and urinary tract health.

This Special Issue of JCM is dedicated to offering an overview of complex pelvic floor disorders care. Groups from all specialties are encouraged to submit original research articles and reviews.

Dr. Matteo Frigerio
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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • pelvic floor disorders
  • pelvic organ prolapse
  • urinary incontinence
  • surgery
  • diagnostics
  • pelvic pain
  • vulvodynia
  • urinary tract symptoms
  • mesh-related complications

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Published Papers (3 papers)

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Research

18 pages, 4851 KiB  
Article
Comparison of Open Abdominal and Laparoscopic Bilateral Uterosacral Ligament Replacement: A One-Year Follow-Up Study
by Sebastian Ludwig, Mathieu Pfleiderer, Jodok Püchel, Constanze Amir-Kabirian, Janice Jeschke, Dominik Ratiu, Christian Eichler, Bernd Morgenstern, Peter Mallmann, Julia Radosa and Fabinshy Thangarajah
J. Clin. Med. 2025, 14(6), 1880; https://doi.org/10.3390/jcm14061880 - 11 Mar 2025
Viewed by 465
Abstract
Background: Pelvic organ prolapse significantly affects women’s health, often requiring surgery. Unilateral sacrocolpopexy (SCP) is the gold standard for apical prolapse repair. However, varied SCP techniques can lead to inconsistencies in clinical outcomes, with differences in synthetic materials, mesh dimensions, placement, and apical [...] Read more.
Background: Pelvic organ prolapse significantly affects women’s health, often requiring surgery. Unilateral sacrocolpopexy (SCP) is the gold standard for apical prolapse repair. However, varied SCP techniques can lead to inconsistencies in clinical outcomes, with differences in synthetic materials, mesh dimensions, placement, and apical tensioning. This variability may impact the comparability of clinical outcomes. Bilateral apical fixation has gained attention for its potential to provide effective apical support and restore anatomical integrity. Objective: To date there are not many studies on bilateral apical cervicosacropexy between the vaginal apex and the sacrum at the level of S1/promontory with one-year follow-up. Methods: This study presents a one-year follow-up comparing the clinical outcomes of open abdominal (CESA) and laparoscopic cervicosacropexy (laCESA) for bilateral apical suspension in women with pelvic floor disorders. A total of 145 women underwent either CESA (n = 75) or laCESA (n = 70) using a surgical technique with a designed polyvinylidene-fluoride (PVDF) mesh of defined shape replacing both uterosacral ligaments. Outcomes were efficacy, safety, and success rates of both surgical approaches in restoring apical vaginal support and pelvic floor functioning. Results: Both techniques demonstrated high efficacy of apical prolapse repair and a high level of safety. While comparable rates of urinary continence restoration were achieved, laCESA showed significant advantages in terms of operative time, hospital stay, and recovery time. Conclusions: These findings demonstrate the reproducibility of a surgical technique including clinical outcomes in the treatment of pelvic floor dysfunction. The standardization of mesh design and surgical methodology enhances reproducibility and may mitigate some of the variability associated with clinical outcomes in apical mesh fixation techniques. Full article
(This article belongs to the Special Issue Clinical Challenges of Pelvic Floor Disorders Management)
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8 pages, 212 KiB  
Article
The Role of Anterior Vaginal Prolapse in Co-Existent Underactive Overactive Bladder Syndrome—A Retrospective Cohort Study
by Yoav Baruch, Marta Barba, Alice Cola and Matteo Frigerio
J. Clin. Med. 2025, 14(2), 600; https://doi.org/10.3390/jcm14020600 - 17 Jan 2025
Viewed by 838
Abstract
Background: CUOB (co-existent underactive overactive bladder) syndrome is a clinical entity that embraces storage and emptying symptoms, not strictly correlated with urodynamic findings. We assessed the differences between patients diagnosed with CUOB with/without cystocele. Methods: The study group was allocated from 2000 women [...] Read more.
Background: CUOB (co-existent underactive overactive bladder) syndrome is a clinical entity that embraces storage and emptying symptoms, not strictly correlated with urodynamic findings. We assessed the differences between patients diagnosed with CUOB with/without cystocele. Methods: The study group was allocated from 2000 women who underwent urodynamic studies between 2008 and 2016. The demographic and clinical data of 369 patients with complaints consistent with CUOB were retrieved. The study group was subdivided using the Pelvic Organ Prolapse Quantification System. The International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) was used to quantify LUTS severity. Results: A total of 185 women had no or grade I cystocele (group 1), and 185 had grade II or III cystocele (group 2). No difference in mean age was computed. Patients from group 1 had a higher BMI (27 vs. 25, p = 0.02). Risk factors for prolapse, such as parity (1.7 vs. 2.1, p = 0.001) and maximal birthweight (3460 g vs. 3612 g, p = 0.049), were higher in group 2. Pelvic Organ Prolapse symptoms were 4.5 times more frequent in group 2 [n = 36/185 (19.5%) vs. n = 162/184 (88%) p < 0.001]. The rate of stress (70.8% vs. 55.4%, p = 0.002) and urge (64.9% vs. 50%, p = 0.04), urinary incontinence, and ICIQ-UI-SF scores (8 vs. 5, p < 0.001) were higher in group 1. Qmax measured lower in group 2 (17 vs. 15 mL/s, p = 0.008). Detrusor pressure at maximum flow was identical (24 cm H2O). The Bladder Contractility Index (BCI) was higher in group 1 (108 vs. 96.5, p = 0.017), and weak contraction (BCI < 100) was more common in group 2 (73/185; 39.5% vs. 95/184; 52.7%, p = 0.011). Conclusions: Based on our results, we assume that CUOB could be further subdivided based on its association with cystocele. The effect of prolapse repair in women with CUOB and cystocele remains to be evaluated in order to afford better counseling in the future. Full article
(This article belongs to the Special Issue Clinical Challenges of Pelvic Floor Disorders Management)
13 pages, 700 KiB  
Article
The Impact of Pelvic Organ Prolapse on the Long-Term Outcomes of Transobturator Tape (TOT) Procedures—A Retrospective Study
by Alessia Hillmeyer, Lieven N. Kennes, Mila Strauss, Katharina Lube, Elmar Stickeler and Laila Najjari
J. Clin. Med. 2025, 14(1), 159; https://doi.org/10.3390/jcm14010159 - 30 Dec 2024
Viewed by 781
Abstract
Objectives: Transobturator tape (TOT) procedures are a widely used and effective treatment for stress urinary incontinence (SUI), but there is limited research on mesh-related complications and revision surgeries. This study aimed to evaluate the incidence of revision surgeries and mesh-related complications following [...] Read more.
Objectives: Transobturator tape (TOT) procedures are a widely used and effective treatment for stress urinary incontinence (SUI), but there is limited research on mesh-related complications and revision surgeries. This study aimed to evaluate the incidence of revision surgeries and mesh-related complications following TOT procedures and identify potential risk factors influencing these outcomes. Methods: This retrospective study analyzed data from patients who underwent TOT procedures at the specialized incontinence center of University Hospital Aachen (UHA), Germany, between January 2010 and May 2023. Patients were divided into three groups: initial surgery without revision, initial surgery with revision, and external referrals requiring revision. Statistical analyses included multivariate logistic regression and predictive cross-validation to identify risk factors for revision and mesh-related complications. Results: Out of 265 TOT procedures performed, the revision rate was 8.7%, and the mesh-related complication rate was 2.6%. Mesh complications, including erosion and wound dehiscence, accounted for 30% of revisions, while 70% of revisions were caused by recurrent stress urinary incontinence (SUI). External referrals showed longer revision intervals compared to UHA patients (53 months vs. 5 months; p = 0.003). Multivariate analysis identified rectoceles as a protective factor against revisions (p = 0.0414), while pre-existing conditions significantly increased revision risk (p = 0.0100). Conclusions: The revision rate following TOT procedures was 8.7%, with mesh-related complications accounting for 2.6%. Pre-existing conditions significantly increased the risk of revision, while rectoceles were associated with improved outcomes. These findings emphasize the importance of identifying patient-specific risk factors to enhance the safety and success of TOT procedures. Full article
(This article belongs to the Special Issue Clinical Challenges of Pelvic Floor Disorders Management)
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