搜索结果：Gynecology and pelvic medicine

Endometriosis affects approximately 10% of women of reproductive age globally and is a leading cause of chronic pelvic pain and infertility. Accurate classification is essential for preoperative diagnosis, surgical planning, and research. However, systems like the revised American Society for Reproductive Medicine (r-ASRM) rely on intraoperative findings and are not applicable preoperatively. This narrative review addresses this gap by examining three emerging classification systems-#Enzian, American Association of Gynecologic Laparoscopists (AAGL) 2021, and Numerical Multi-Scoring System of Endometriosis (NMS-E)-with a focus on their utility in pre-surgical assessment. We conducted a narrative literature review using PubMed, Embase, and Scopus covering the period from January 2015 to January 2025. A total of 66 articles related to the #Enzian classification and 19 articles on the AAGL 2021 classification were initially identified. Among them, 7 articles on #Enzian (3 original research articles and 4 reviews) and 5 articles on AAGL (2 original studies and 3 reviews) were selected based on their clinical relevance and methodological rigor. In addition, 5 original studies on the NMS-E system conducted at our institution were included. Further literature related to surgical planning, imaging techniques, and classification validation was also reviewed to support the comparative analysis. The r-ASRM system remains widely used but lacks correlation with deep endometriosis and is not applicable preoperatively. The #Enzian system provides detailed anatomical mapping and is compatible with imaging but lacks scoring for pain and adhesions. It also does not offer a composite severity score or a specific evaluation of pouch of Douglas obliteration. Similarly, the AAGL 2021 classification introduces a surgical complexity score but does not assess pain or adhesions in detail and lacks specific evaluation of uterosacral ligament involvement. The NMS-E system uniquely integrates pelvic examination and ultrasound findings into an E-score reflecting lesion, pain, and adhesion severity. Validation studies demonstrate a strong correlation with surgical duration (r=0.724, P<0.01). Patients with lower NMS-E adhesion scores had better postoperative fertility outcomes (P<0.05). While #Enzian and AAGL 2021 are gaining international adoption, NMS-E remains in the early stages of clinical uptake. Each system contributes to improved preoperative assessment but has limitations. NMS-E adds value by incorporating symptoms and adhesion scoring. No system is yet ideal; further integration and validation across diverse clinical settings are needed. This review provides comparative insights to support classification system refinement and practical application.

Rehabilitation training methods for stress urinary incontinence (SUI) need to be based on a global postural exercise, involving overall core muscle strength, core stability, and balance of the pelvis and spine. The pelvic floor workout (PEFLOW) program was developed to promote in-pregnancy pelvic floor muscle training to prevent postpartum SUI. To assess the effectiveness of PEFLOW in preventing postpartum SUI. This multicenter randomized clinical trial was conducted across 9 hospitals in China. Eligibility criteria were primiparous women aged 20 to 40 years, with singleton pregnancy of less than 16 weeks' gestation, and who visited the outpatient obstetric department of 1 of the 9 hospitals from August 1, 2020, to June 6, 2022. Participants, who were followed up through January 17, 2024, were randomly assigned to the exercise group or the control group and were followed up at 37 weeks' gestation and 6 weeks, 3 months, 6 months, and 12 months post partum. Primiparous women with severe complications; SUI or pelvic organ prolapse; and/or a history of cervical insufficiency, recurrent miscarriage, or induced labor were excluded. Intention-to-treat (ITT) analysis was conducted between May 1 and July 1, 2024. Participants in the exercise group were trained to practice PEFLOW from 28 weeks' gestation to delivery, with checkups and guidance provided every 2 weeks. Participants in the control group were provided usual medical care. The primary outcome was the incidence of SUI at 6 weeks post partum among participants in the exercise and control groups. SUI was diagnosed based on urinary leakage when abdominal pressure increased or detected from a stress test. Symptomatic SUI and the Modified Oxford Scale (MOS) score were recorded. A total of 764 women (median [IQR] age, 29 [27-32] years) were randomized into the exercise group (n = 382) and the control group (n = 382). ITT analysis showed that the incidence of SUI at 6 weeks post partum was significantly lower in the exercise group than the control group (8.7% [32 of 367] vs 13.9% [50 of 360]), with a risk difference of 5.17 (95% CI, 0.36-10.03) percentage points (P&#x2009;=&#x2009;.03). The proportion of women with an MOS score of 4 or higher at 6 weeks post partum was significantly higher in the exercise group than the control group (17.8% [68 of 382] vs 7.9% [30 of 382]), with a risk difference of 9.95 (95% CI, 5.05-14.87) percentage points (P&#x2009;<&#x2009;.001). In this multicenter randomized clinical trial, PEFLOW effectively reduced SUI incidence at 6 weeks post partum. This finding suggests that PEFLOW is effective in preventing SUI in pregnancy. Chinese Clinical Trial Registry Identifier: ChiCTR2000029618.

The application of radiofrequency (RF) therapy in pelvic floor disorders (PFDs) has been on the rise. However, its efficacy and safety remain a subject of debate. This narrative review aims to synthesize the current evidence from randomized controlled trials (RCTs) on the application of RF therapy in PFDs, including vaginal laxity syndrome (VLS), stress urinary incontinence (SUI), chronic pelvic pain (CPP), and fecal incontinence (FI). This narrative review was conducted to synthesize the current evidence on the application of RF therapy in PFDs, with a specific focus on RCTs to ensure the robustness and reliability of the included evidence. We conducted a narrative literature review using PubMed, Embase, and Scopus covering the period from January 2002 to July 2025. RCTs investigating the efficacy, safety, and mechanisms of RF therapy in PFDs were included. Non-randomized studies and reviews were referenced for contextual support but not as primary evidence. RF technology, a non-invasive/minimally invasive energy-based modality, shows potential in managing PFDs. For VLS, limited RCTs confirm its efficacy in improving symptoms and sexual function with good safety, though treatment protocols and efficacy duration need further study. In SUI, RF works as an effective adjunct to pelvic floor muscle training, but its standalone efficacy and comparison with other modalities require more high-quality research. For CPP and FI, RF's efficacy and safety remain controversial, lacking sufficient evidence-based support for widespread use, with relevant guidelines not recommending it currently. Overall, the application of RF therapy in PFDs is still in the exploratory stage, with numerous unresolved issues such as inconsistent treatment parameters, short follow-up periods, small sample sizes, and a predominance of single-center studies. Future research should focus on designing rigorous multi-center, large-sample RCTs, optimizing treatment protocols, clarifying the mechanisms of action, establishing scientific efficacy evaluation systems, and conducting stratified analyses based on individual differences. This will promote the precise, safe, and effective application of RF therapy in PFDs, providing more high-quality treatment options for patients with PFDs.

Maximal sports performance requires sustained physical effort that challenges the structures and functions of the pelvic floor (PF), particularly in high-impact disciplines such as track and field. Despite the specific daily demands faced by female athletes, no studies to date have explored the influence of these habits on PF symptoms. This study aimed to describe the most frequent toileting and training habits related to the PF and to evaluate their association with pelvic floor dysfunctions (PFD) in female athletes. A total of 281 female track and field athletes participated in this cross-sectional observational study. Between May and August 2023, participants completed an online questionnaire assessing urinary, fecal, and sports training habits, as well as sociodemographic data and symptoms related to PFD. Validated and adapted scales, along with ad hoc items, were used. The most frequent toileting habits were related to premature voiding, such as attempting to urinate before training (>60%) or trying to defecate at home (>75%). During sports training, the most common habit was a healthy practice, being mindful of posture to protect the PF (38.4%). Unhealthy habits related to straining during voiding or defecation, and preferences for specific toileting locations, were more prevalent among athletes with urinary and anal incontinence (AI). However, associations between sports training habits and PFD symptoms were unclear. A high proportion of female athletes report toileting habits considered potentially harmful to PF, mainly involving premature voiding and location preferences. Healthy habits during sports training are infrequent. Habits involving straining and location preferences were more common among athletes with PFD symptoms. Further research is needed to investigate the role of sports-related habits in PF health.

To assess the potential value of the Natural birth prediction system (NBPS) on predicting cephalopelvic disproportion (CPD) and compare the value with a pelvimetry model and the foetal-pelvic index. A multicentre prospective study was conducted between November 2023 and September 2024 in three hospitals in China. Singleton nulliparas suspected with CPD and willing to attempt vaginal delivery were included. Patients were categorised according to NBPS results (absence CPD, borderline CPD, and presence CPD). The software results were compared with actual delivery modes. Receiver operating characteristic (ROC) curve analysis was employed to compare the predictive value of NBPS with a pelvimetry-based nomogram model and foetal-pelvic index. The final analysis included 303 patients. Among the 14 women identified as presence CPD by NBPS, 12 underwent emergency CS, while the rest two delivered vaginally with forceps. Of the 213 patients deemed absence CPD by NBPS, 190 had normal vaginal deliveries, 22 delivered with forceps, and only one required an emergency CS. The area under the ROC curve (AUC) for NBPS was 0.908, with a sensitivity of 97.0% and specificity of 78.5%. The PPV was 35.6%, and the NPV was 99.5%. In comparison, the AUC for the pelvimetry model was 0.827, with a sensitivity of 81.8% and specificity of 70.2%. The PPV was 28.4%, and the NPV was 96.4%. For the foetal-pelvic index, the sensitivity and specificity were 72.7% and 42.6%, and the PPV and NPV were 13.4% and 92.7%, respectively. This study demonstrates that NBPS shows promise for clinically predicting CPD among those suspected of CPD and willing to attempt vaginal delivery. Our findings support its utility as an objective assessment tool in this specific population to help manage labour and anticipate the risk of dystocia.

The pelvic structures are anatomically and functionally interconnected, forming an integrated system. The diagnosis and management of multi-compartment pelvic organ prolapse (POP) often require multidisciplinary collaboration among urogynecologists, colorectal surgeons, and radiologists. Individualized surgical planning should be tailored according to the patient's condition and preferences, aiming to correct all compartmental defects in a single procedure whenever possible. In this study, we report a case of a patient presenting with rectal prolapse, anterior vaginal wall prolapse, and uterine prolapse accompanied by severe constipation, who achieved satisfactory outcomes following laparoscopic lateral suspension (uterus preservation) combined with ventral mesh rectopexy. This combined surgical approach is particularly suitable for patients with multi-compartment POP presenting with rectal prolapse and anterior vaginal or apical prolapse, who also express a desire for uterine preservation and report symptoms of constipation. The key technical considerations involve utilizing lateral suspension to correct anterior vaginal and/or apical prolapse, while employing ventral mesh rectopexy to address rectal prolapse. Compared to the combination of ventral mesh rectopexy and sacrocolpopexy, this procedure is technically simpler and maintains appropriate independence between the posterior vaginal wall and the rectum. It not only achieves favorable outcomes in correcting prolapse across all pelvic compartments but also reduces the risks of mesh-related complications and postoperative constipation. The purpose of this video is to share our experience and insights into the multidisciplinary management of multi-compartment POP.

Pelvic organ prolapse (POP) is commonly managed with transvaginal hysterectomy (TVH) and pelvic floor repair. As the population ages, the need for POP surgery continues to increase, typically under either spinal or general anesthesia. Although spinal anesthesia is associated with fewer postoperative complications, concerns regarding postoperative urinary retention (POUR) remain. This study was designed to investigate whether the type of anesthesia influences the incidence of POUR in POP surgery. This retrospective cohort study analyzed 350 patients who underwent TVH with anterior and posterior repair for POP at the Chonnam National University Hospital between January 2018 and June 2023. Patients were divided into spinal anesthesia (n&#x2005;=&#x2005;167) and general anesthesia (n&#x2005;=&#x2005;183) groups. Primary outcomes were POUR, catheter reinsertion, length of hospital stay, and urinary symptoms. Multivariable logistic regression was used to identify independent predictors of post-discharge urinary tract infection symptoms. A total of 350 patients were analyzed (spinal anesthesia, n&#x2005;=&#x2005;167; general anesthesia, n&#x2005;=&#x2005;183). The baseline characteristics, including age, body mass index, parity, and comorbidities, were comparable between the groups. No significant differences were observed in POP quantification stage or perioperative variables. Postoperatively, catheter reinsertion was required in 9.0% of the spinal group and 2.2% of the general group (P&#x2005;=&#x2005;.182). Urinary symptoms at 1 week occurred in 1.8% and 7.2% of the spinal anesthesia and general anesthesia group, respectively (P&#x2005;=&#x2005;.176). Multivariate logistic regression identified no independent predictors of post-discharge urinary tract infection symptoms. Both anesthesia types demonstrated comparable safety, voiding function, and recovery outcomes after TVH with anterior and posterior repair for POP. POUR rates were comparable between the spinal and general anesthesia groups, supporting their similar safety and recovery profiles, consistent with the principles of enhanced recovery after surgery.

The pelvic examination is essential in gynecologic care but often causes discomfort and anxiety. Choice of plastic or metal speculums may influence patient comfort and adherence to screening, yet patient preferences and environmental considerations remain underexplored. To assess patient preferences between plastic and metal speculums, identify factors influencing these preferences, and evaluate environmental concerns related to speculum use. A cross-sectional survey was conducted among 203 patients receiving care at West Virginia University's Obstetrics and Gynecology clinics between September 15, 2024 and June 16, 2025. Participants completed an anonymous online questionnaire assessing speculum preference, comfort factors, sanitation perceptions, and environmental awareness. Data were analyzed using descriptive statistics and chi-square tests. Plastic speculums were preferred by 49.8% of respondents, followed by no preference (32.5%) and metal speculums (17.7%). Younger participants (ages 18-35) showed a stronger preference for plastic. The speculum was identified as the most uncomfortable aspect of the exam by 34.4% of respondents, with temperature and positioning also frequently cited. Plastic was perceived as more sanitary by 45.8%. Environmental concern about plastic waste was higher among younger respondents and those preferring metal speculums. Despite ecological awareness, comfort during the exam was the predominant factor influencing preference. Patient discomfort remains a primary barrier to maintaining consistent patient care in the field of obstetrics and gynecology, and this research found that the majority favor plastic speculums due to comfort despite environmental concerns in their lack of reusability. Efforts to improve pelvic exam experiences should address both comfort and sustainability, including innovations in speculum design, patient education on reusable options, and alternative screening methods. Further research is warranted to balance patient-centered care with environmental stewardship.

Ring pessary therapy is a widely used conservative treatment for pelvic organ prolapse (POP). In Japan, pessary self-management (SM) is recognized as a management option that may reduce adverse events; however, its adoption in routine clinical practice remains limited, and clinical data are scarce. This study aimed to identify factors associated with successful fitting and continuation of ring pessary therapy, focusing on the role of SM. We retrospectively reviewed the medical records of 90 patients with POP who initiated ring pessary therapy at our institution between 2010 and 2020. Patient characteristics, anatomical parameters, pessary management methods (SM or clinic management [CM]), and reasons for discontinuation were analyzed. Kaplan-Meier analysis, multivariate logistic regression, and Cox proportional hazards models were used to evaluate factors associated with fitting success and continuation. Among the 90 patients, 66 (73.3%) selected SM and 24 (26.7%) CM. Successful fitting was achieved in 62 patients (93.9%) in the SM group and in 8 patients (33.3%) in the CM group. SM was independently associated with successful fitting and longer continuation. Among patients with successful fitting, continuation rates were significantly higher in the SM group than in the CM group (p&#x2009;<&#x2009;0.0001). The median pessary size among successfully fitted patients was 62&#x2009;mm. In exploratory analyses, patients who discontinued therapy due to pain or discomfort tended to have shorter total vaginal length (TVL) and lower TVL/height ratios. Ring pessary therapy is a useful conservative treatment option for Japanese women with POP. SM may facilitate successful fitting and prolonged continuation when appropriate patient instruction and follow-up are provided.

Pelvic organ prolapse (POP) impairs quality of life in aging women. Vaginal hysterectomy (VH) is a standard approach for advanced POP, yet large single-center series are limited. We evaluated concomitant procedures and perioperative outcomes of VH and explored associations of age, parity, and concomitant adnexal or reconstructive surgery with perioperative measures. This retrospective cohort included 416 patients who underwent VH for POP between 2017 and 2025. Demographics, prolapse stage, concomitant procedures, perioperative complications, length of hospital stay, perioperative hemoglobin change, and pathological/specimen characteristics were recorded. Subgroup analyses compared patients undergoing additional reconstructive and/or adnexal surgery. Statistical analyses included t-test/ANOVA and Spearman correlation, with p&#xa0;<&#xa0;0.05 considered statistically significant. Mean age was 62.6&#xa0;&#xb1;&#xa0;9.2&#xa0;years and mean parity 3.2&#xa0;&#xb1;&#xa0;1.7. POP was stage 3 in 41.6% and stage 4 in 34.6%. Anterior colporrhaphy was performed in 69.7%. Apical suspension accompanied VH in 72.4% of cases, including McCall culdoplasty (52.4%) and sacrospinous fixation (20.2%). Increasing age was associated with higher prolapse stage (p&#xa0;=&#xa0;0.033). Vaginal deliveries were associated with cystocele and rectocele (p&#xa0;=&#xa0;0.027 and p&#xa0;=&#xa0;0.028). Concomitant adnexal surgery was associated with longer hospitalization and lower postoperative hemoglobin (p&#xa0;<&#xa0;0.001 and p&#xa0;=&#xa0;0.03). Postoperative complications occurred in 1.4% and were associated with lower mean age (p&#xa0;=&#xa0;0.038). VH for advanced POP demonstrated favorable perioperative outcomes with a low complication rate. Age, parity, and concomitant procedures influenced perioperative measures, supporting VH with apical suspension as a reliable real-world surgical option.

To review the evolution, outcomes and safety of transvaginal mesh (TVM) use for pelvic organ prolapse (POP) repair in Taiwan from January 2004 to May 2025. A systematic literature search in PubMed using MeSH terms "transvaginal mesh" AND "Pelvic organ prolapse", yielding 856 articles. Of these 96 Taiwanese studies were included, comprising 10 prospective trials, 1 meta-analysis, and the remainder retrospective studies. A total of 88 study cases involving various mesh types were analyzed. Objective cure rates exceeded 90% at 1-year across most mesh types, with significant improvements in quality of life measured by validated questionnaires (POPDI-6, IIQ-7, UDI-6, PISQ-12). Mesh extrusion rates with newer generation meshes (2019-2023) ranged from 0.8% to 4.8%. Most complications, such as urinary tract infections and voiding dysfunction, were minor and manageable. Surelift, Calistar-S and MIPS, the only currently approved meshes for transvaginal use in Asia, showed promising one-year cure rates, all exceeding 92%. Surelift demonstrated superiority more than native tissue repair at 5 years, with success rates of 89.1% vs. 64.4% (p = 0.002). Older age was associated with increased risk of voiding dysfunction and recurrence (HR 1.07, if > 64 years). Obesity did not increase mesh-related complications but has greater postoperative symptom burden. Concomitant MUS effectively reduced de novo stress urinary incontinence from 31.2% to 5%. TVM continues to be a reliable and effective option for POP management. Taiwan's experience highlights the importance of proper training, patient selection, and surgical refinement in minimizing complications. Long-term follow-up and awareness of red-flag symptoms remains essential.

Ovarian mature teratoma (OMT) is a common benign gynecological tumor, with surgical resection being the primary treatment. Laparoendoscopic single-site surgery (LESS) has been widely used in various surgical procedures due to its advantages of minimal invasiveness and faster recovery. However, there is limited research on LESS for OMT in adolescents. This study aims to evaluate the safety and efficacy of LESS in children and adolescents aged 18 years or younger. Patients who underwent LESS cystectomy or laparotomic cystectomy in West China Second Hospital, Sichuan University, from 01/01/2019 to 31/12/2023, were enrolled in this retrospective cohort study. They were divided into LESS group and open surgery group based on the surgical approaches. We collected surgical conditions, postoperative conditions and complications to evaluate the safety and efficacy. Patients were followed up one month and one year after surgery by phone-call and recurrence was recorded. A t-test or chi-square test was performed according to the data type characteristics. We included 169 pediatric and adolescent girls (151 LESS cases and 18 open cases) in this study. The average age, body mass index, and menstrual history were not statistically different (P=0.84, 0.93, 0.93, retrospectively). Compared with open group, the tumors in LESS group were smaller and the difference was statistically significant (6.5&#xb1;0.2 vs. 18.9&#xb1;1.0 cm, P<0.001). The surgical outcomes and recovery in LESS group were better and difference was statistically significant (surgical duration, P<0.001; estimated blood loss, P=0.02; complications, P<0.001; exhaust time, P<0.001; hospital stays, P<0.001). LESS is a safe and effective method for female children and adolescents with OMT. A tumor diameter <15 cm may serve as one of the factors favoring LESS, but the final surgical approach should be determined through comprehensive consideration of tumor characteristics, the patient's general condition, and fertility requirements.

Urinary incontinence (UI) is a prevalent yet under-recognized condition among women in China, impairing quality of life and imposing socioeconomic burden. Primary care providers are pivotal for early detection and first-line management. Unlike Western systems dominated by general practitioners, China' s primary women' s health care is largely provided by gynecologists in county-level or lower-tier institutions. Evidence on their UI-related knowledge and practices is limited, hampering targeted training and policy efforts. We conducted a cross-sectional survey (March 2023-September 2024) among gynecologists in Fujian primary healthcare institutions recruited via professional WeChat groups. A structured, expert-developed questionnaire assessed demographics, UI-related awareness/perceptions (nine items, max score 18) and clinical practice (12 items, max score 24) on three-point Likert scales. Additional items explored barriers, preferred assessment methods, and factors influencing pelvic floor and bladder training. Reliability and construct validity were tested using Cronbach's &#x3b1;, KMO and Bartlett's tests. Multivariate linear regression identified factors associated with scores. A total of 1,427 gynecologists responded (urban 75.5%; mean age 36.6&#xa0;&#xb1;&#xa0;9.3 years; 81.7% female). The questionnaire showed high reliability (&#x3b1;&#xa0;=&#xa0;0.84) and good validity (KMO = 0.88; Bartlett's P&#xa0;<&#xa0;0.001). Mean awareness/perception and clinical practice scores were 12.24&#xa0;&#xb1;&#xa0;3.07/18 and 12.63&#xa0;&#xb1;&#xa0;5.41/24. Only 20.3% routinely screened for UI symptoms and 10.5% felt confident managing UI. Female gender and higher education were associated with better awareness; older age and female gender were associated with better practice (all P&#xa0;<&#xa0;0.05). Lack of UI training and infrequent literature reading correlated with lower scores. Urban physicians cited time constraints, whereas rural physicians cited limited space, lack of feedback mechanisms for exercises, and lower use of pelvic floor ultrasound or pad tests. This first large-scale evaluation of UI-related knowledge and practice among Chinese primary care gynecologists reveals substantial gaps, especially in rural areas. Incorporating UI into continuing medical education, promoting routine screening, updating diagnostic knowledge, and applying digital tools for real-time monitoring of pelvic floor training may improve early detection and care. Tailored interventions addressing urban-rural disparities are essential to strengthen UI management at the primary care level.

Minimally invasive surgery (MIS) has changed the surgical approach of many gynecologic malignancies, offering benefits such as reduced blood loss, shorter hospitalization and quicker recovery. While laparoscopic and robotic-assisted approaches are well established in the treatment of endometrial cancer, their role in cervical and ovarian cancer remain less clear. This review discusses the evolution and key controversies of MIS in gynecologic oncology. We will evaluate recent data and ongoing clinical trials that examine the use of MIS across cervical, endometrial, and epithelial ovarian cancers. A literature review was conducted using PubMed from January 2000 through April 2025 to identify relevant peer-reviewed studies. Only English language publications were included. Randomized controlled trials and retrospective cohort studies focused on MIS in gynecologic oncology were included. Ongoing clinical trials were identified through ClinicalTrials.gov. Studies were selected based on relevance, methodological rigor and impact on clinical practice. The Laparoscopic Approach to Cervical Cancer (LACC) trial and subsequent population-based studies raised concerns of inferior survival outcomes with minimally invasive hysterectomy for early-stage cervical cancer. This prompted a shift in clinical practice to abdominal radical hysterectomy for cervical cancer, and also led to new randomized trials, such as Robotic versus Open RadicalHysterectomy for Cervical Cancer (ROCC) and Robotic-assisted Approach to Cervical Cancer (RACC), to reassess oncologic safety. The Laparoscopic Approach to Carcinoma of the Endometrium (LAP2) and Laparoscopic Approach to Cancer of the Endometrium (LACE) trials established MIS as the standard of care for early-stage endometrial cancer, demonstrating comparable survival outcomes and fewer complications. In advanced ovarian cancer, the LANCE trial and multiple retrospective series suggest that MIS is feasible and safe for interval cytoreductive surgery in specific patient populations, however more data is needed for clinical generalizability. MIS is an important tool in modern gynecologic oncology. Its use continues to evolve, particularly in the context of cervical and ovarian cancers. Ongoing trials will clarify its role in oncologic outcomes.

A uterine niche (cesarean section scar defect), defined as an indentation&#x2009;&#x2265;&#x2009;2&#xa0;mm in the myometrium at the site of a previous cesarean scar, reflects impaired myometrial healing after cesarean delivery. Its prevalence increases with the number of cesarean deliveries and is associated with abnormal uterine bleeding, pelvic pain, secondary infertility, cesarean scar ectopic pregnancy, placenta accreta spectrum disorders, and uterine rupture in subsequent pregnancies. While secondary surgical correction may alleviate symptoms, preventive strategies implemented at the time of repeat cesarean delivery remain insufficiently studied. This trial evaluated whether resection of the previous cesarean scar during repeat cesarean delivery reduces uterine niche formation and related morbidity without increasing operative risk. This single-center, prospective, parallel-group, randomized controlled superiority trial was conducted at a tertiary university hospital between February and November 2025. A total of 170 multigravida women aged 18-45 years with &#x2265;&#x2009;1 prior cesarean delivery undergoing elective or urgent repeat cesarean section were randomized (1:1) to either repeat cesarean delivery with resection of the previous cesarean scar (scar-resection group, n&#x2009;=&#x2009;85) or standard repeat cesarean section without scar resection (control group, n&#x2009;=&#x2009;85). Outcome assessors were blinded to group allocation. The primary outcome was the incidence of uterine niche (&#x2265;&#x2009;2&#xa0;mm) at 6 months postpartum, assessed using saline-infusion sonohysterography. Secondary outcomes included operative time, additional hemostatic sutures, estimated blood loss, niche dimensions, residual myometrial thickness, and cyclic menstrual bleeding abnormalities at 6 months postpartum. Analyses were conducted on a modified intention-to-treat basis excluding participants lost before outcome assessment. A total of 160 participants (80 per group) completed the 6-month assessment. Operative outcomes, including total operative time, number of additional hemostatic sutures, and estimated intraoperative blood loss were comparable between groups (all P&#x2009;>&#x2009;0.05). At 6 months postpartum, the incidence of uterine niche was significantly lower in the scar-resection group than in the control group (45.0% vs. 78.8%; relative risk 0.57, 95% CI 0.44-0.75; P&#x2009;<&#x2009;0.001), corresponding to an absolute risk reduction of 33.8% and a number needed to treat of 3. These results remained significant after adjustment for number of previous cesarean deliveries. Among women who developed a niche, scar resection was associated with significantly smaller niche depth, length, and width, greater residual myometrial thickness, and significantly fewer postmenstrual or intermenstrual spotting days and total bleeding days per cycle (all P&#x2009;<&#x2009;0.0001). Resection of the previous cesarean scar during repeat cesarean delivery significantly reduces the incidence and severity of uterine niche formation, improves residual myometrial thickness, and decreases niche-related menstrual morbidity, without increasing operative time or blood loss. This standardized surgical modification represents a feasible preventive strategy to reduce cesarean scar-related morbidity. ClinicalTrials.gov, NCT07228858. Registered 20 December 2025 (retrospectively registered).

Pelvic inflammatory disease (PID), also referred to as pelvic inflammatory disorder, is a group of inflammatory conditions affecting the upper female reproductive tract and its surrounding tissues, including the uterus, fallopian tubes, ovaries, and pelvic peritoneum. The incidence of PID is ubiquitous among young sexually active women, and is rare among women who are not sexually active. However, there is a lack of relevant cross-sectional studies about this. Data in this study were collected and screened from the National Health And Nutrition Examination Surveys from 2013 to 2016. The variables were extracted from interviews and compared between the age of first sexual experience and the PID. The data was analyzed by weighted multivariate logistic regression. After excluding individuals who were not eligible and had invalid data, we finally identified 3437 participants for inclusion in this study. We found a positive association between the age of first sexual experience and the PID (P&#x2005;<&#x2005;.05). In conclusion, a positive correlation between the age of first sexual experience and PID was found. The results can help us developing more effective strategies to prevent and manage both of these important health issues. Our findings provide a better understanding to improve young female adolescents' correct understanding of premature sexual behavior and advise them against engaging in it prematurely.

Ovarian cancer is a highly lethal gynecological malignancy, with epithelial ovarian cancer (EOC) being its most common form. Surgery combined with chemotherapy is the standard treatment. Resection completeness significantly impacts patient prognosis and survival. Lymphatic, hematogenous, and transcoelomic routes are potential pathways for EOC metastasis, and the infundibulopelvic (IP) ligament is considered a possible route for cancer cells to reach para-aortic and pelvic lymph nodes. This study aimed to evaluate the necessity and clinical significance of high-level resection (HLR) (&#x2265;10 cm) of the IP ligament during EOC surgery. This retrospective comparative study included 80 EOC patients [Federation International of Gynecology and Obstetrics (FIGO) stages I-IV] who underwent bilateral HLR (ligation &#x2265;10 cm from the ovarian margin) of the IP ligament during cytoreductive surgery at West China Second University Hospital from October 2019 to June 2023. A control group of 93 EOC patients (same FIGO stages) without HLR (WHLR) during the same period was randomly selected. IP ligament metastasis was confirmed histopathologically. Post-operative data were collected mainly through a combination of outpatient clinic visits and computed tomography (CT) imaging to assess para-aortic lymph node metastasis. Statistical analysis used SPSS 26.0, with quantitative data analyzed by t-tests and qualitative data by &#x3c7;2 test or Fisher's exact test. P<0.05 indicated statistical significance. In the HLR group, IP ligament metastasis was detected in 19/80 patients (23.8%). The in vivo length of resected IP ligaments averaged 11.6 cm (range, 10-15 cm) and 7.48 cm (range, 6-10 cm) in fixed specimens. Baseline characteristics and intraoperative complication rates (e.g., ureteral or vascular injuries) were comparable between groups. IP ligament metastasis was significantly correlated with para-aortic lymph node metastasis (P=0.005). Postoperative follow-up CT scans revealed the incidence of postoperative para-aortic lymph node metastasis was higher in the WHLR group compared to the HLR group, with this difference becoming more pronounced over extended follow-up. The median follow-up time was 30 months (range, 24-36 months). In EOC patients, our study suggests that HLR (&#x2265;10 cm) of the IP ligament may reduce the risk of postoperative para-aortic lymph node metastasis by eliminating potential cancer sites and metastatic pathways. These findings imply that high-level IP ligament resection could be a valuable component of cytoreductive surgery. However, due to the study's small sample size and short follow-up, larger prospective trials are needed to confirm these results and determine the optimal resection length for improved patient outcomes.

To describe diagnostic and triage pitfalls in patients with CT-imaged, STI-confirmed pelvic inflammatory disease (PID) in the emergency department (ED) settings, and to identify factors associated with missed diagnosis and non-gynecologic admission. Single-center, retrospective cohort (2016-2024) of women who underwent computed tomography (CT) scan during ED evaluation, tested positive for Chlamydia trachomatis and/or Neisseria gonorrhoeae, and clinically diagnosed with PID. Missed PID diagnosis was defined as (i) discharge after the initial gynecologic ED evaluation without a PID diagnosis or (ii) admission to Internal Medicine/General Surgery rather than Gynecology among hospitalized patients. Univariable comparisons used Chi-square and Mann-Whitney U tests. Forty-four women were included (mean age 32.7&#xa0;years). GI symptoms were common (nausea 52.3%, vomiting 34.1%), while fever >38&#xa0;&#xb0;C was uncommon (6.8%). CT was interpreted as suggestive of PID in 52.3% of cases. Overall, 68.2% were discharged after the initial gynecologic ED evaluation without a diagnosis of PID. Among twenty-nine hospitalized patients, 51.7% were admitted to Gynecology and 48.3% to Internal Medicine/General Surgery. Correct PID diagnosis at initial evaluation was associated with CT interpreted as PID (78.6% vs 40.0%, p&#xa0;=&#xa0;0.02). Non-gynecologic admission was associated with nausea (85.7% vs 33.3%, p&#xa0;=&#xa0;0.004), fewer specific ultrasound findings (14.3% vs 57.1%, p&#xa0;=&#xa0;0.02), and higher white blood cell count (15.8 vs 11.0&#xa0;K/&#x3bc;L, p&#xa0;=&#xa0;0.02). In CT-imaged, STI-confirmed PID, missed diagnosis, and non-gynecologic triage were frequent, particularly in gastrointestinal-dominant presentations and when imaging lacked specific PID features. Integrating PID more explicitly into acute abdominal pain pathways may improve the timely recognition and treatment of PID.

Pelvic organ prolapse (POP) is a common condition in women that negatively impacts the quality of life, including symptoms and effects on body image and sexuality. Robotic-assisted sacrocolpopexy (RASC) is established as a gold-standard treatment for POP, and most published evidence concerns the da Vinci robotic platform. New robotic systems are expanding the technological landscape; the Hugo-RAS platform is one of the most popular of them. Published experience with Hugo-RAS has focus mainly on prostate cancer and typically comes from centers with previous da Vinci experience. RASC articles with Hugo-RAS are very few. Moreover, the implementation of Hugo-RAS in an inexperienced robotics scenario remains unclear. We present our initial series of Hugo-RAS RASC performed by surgeons without prior robotic surgery experience to evaluate the safety, feasibility, and clinical outcomes. Between November 2023 and March 2024, eight consecutive patients with symptomatic POP underwent RASC using Hugo-RAS system. The women included have a POP of &#x2265;3 stage based on the POP-quantification (POP-Q). Perioperative parameters, complications, and functional outcomes were prospectively collected. Procedures were performed by a standardized technique including dissection, mesh placement, fixation to the cervix or vaginal vault and promontory, and peritonealization. A gynecological examination was carried out at discharge and at 45 days using the POP-Q system and the Patient Global Impression of Improvement (PGI-I) scale. The median operative time was 230 [interquartile range (IQR), 190-272] minutes, and the median estimated blood loss was 275 (IQR, 147.5-387.5) cc. The intraoperative complications occurred in one patient (opening of the vagina). The postoperative complications occurred in 2 patients and were Clavien-Dindo grade I-II. Median hospital stay was 3 days. At a median follow-up of 15.5 months, all patients showed objective anatomical improvement without recurrences and reported satisfaction with the surgery. In our preliminary series RASC using Hugo-RAS for the treatment of POP is safe, feasible, and provides satisfactory short-term outcomes even by robotic-naive surgeons. More robust and comparative studies are needed to support these results and determine their definitive role in urogynecologic surgery.