This study was aimed at translating and validating the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Russian and assessing its clinical validity within a Russian-speaking population. The PISQ-IR was translated into Russian following the PISQ-IR Translation Protocol of the International Urogynecological Association. Internal consistency was measured using Cronbach's alpha, whereas external consistency was evaluated by administering the Female Sexual Function Index-Short Form (FSFI-SF), the Pelvic Floor Distress Inventory Questionnaire, the International Consultation on Incontinence Questionnaire (ICIQ), and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. Clinical data were collected, and the PISQ-IR subscales were compared with the Pelvic Organ Prolapse Quantification (POP-Q) stage, pelvic floor muscle tone, and the Oxford Grading Scale. The PISQ-IR was completed by 220 women, 76 (34.5%) of whom identified as not sexually active (NSA) and 144 (65.5%) as sexually active (SA). In both the SA and NSA groups, most subscales demonstrated acceptable internal consistency (Cronbach's alpha ranging from 0.60 to 0.92). Significant correlations were observed between the PISQ-IR scores, POP-Q stage, and ICIQ in the NSA group, as well as between the PISQ-IR scores and the FSFI-SF in the SA group. The Russian-language PISQ-IR is a reliable and easily administered tool for assessing sexual function in SA women with pelvic organ prolapse and urinary incontinence. Nevertheless, the nonsexually active Partner-Related subscale displayed weak consistency in the NSA cohort, possibly attributable to cultural sensitivity surrounding the disclosure of partner-specific sexual matters.
Large language models (LLMs) such as ChatGPT-4 are increasingly utilized in clinical medicine, yet their performance in subspecialties requiring personalized decision-making, including urogynecology, remains insufficiently understood. Comparing the clinical acceptability of management recommendations generated by ChatGPT-4 with those of board-certified urogynecologist using standardized clinical case scenarios. Twelve outpatient urogynecology vignettes were developed by senior subspecialists. Three fellowship-trained urogynecologists and ChatGPT-4 independently generated management recommendations. Twenty senior urogynecology evaluators, blinded to authorship, assessed each response using a 10-point scale. Primary analysis compared median human versus AI scores. Secondary analyses evaluated score distributions, geographic differences, and response patterns in guideline-based versus clinical reasoning scenarios. 960 evaluations were completed. Median scores did not differ between human (5.8; 95% CI, 4.4-9.0) and AI-generated responses (6.1; 95% CI, 4.0-9.4; p = 0.39). Evaluator-level analysis similarly showed no difference. GPT -4 outperformed human responders in all six guideline-based cases (average advantage + 99 points), while human specialists generally outperformed GPT -4 in clinical reasoning cases. Score distributions differed significantly: human responses showed a near-normal distribution, whereas GPT -4 responses displayed a U-shaped pattern (D = 0.262, p < 0.001). International evaluators rated GPT -4 higher than Israeli evaluators (p = 0.031). ChatGPT-4 generated management recommendations that were rated similarly to those of board-certified urogynecologists. However, AI responses demonstrated greater variability and a more polarized distribution of ratings. These findings suggest that large language models may function as adjunct decision-support tools in structured scenarios, while complex clinical reasoning still requires specialist oversight.
High-quality patient education materials are essential in urogynecology. We hypothesized that patient handouts generated by different large language models (LLMs) would vary in quality and readability and would differ from an established society-produced leaflet. Twelve leaflets on bladder training and pelvic floor muscle therapy from six origins: GPT-4, Gemini-2.5 Pro, Sonnet-4, Llama-4, Perplexity, and The International Urogynecological Association (IUGA), were produced or obtained and standardized into plain text. Three blinded reviewers assessed completeness, information quality (DISCERN), and the Patient Education Materials Assessment Tool (PEMAT-A: actionability; PEMAT-U: understandability). The statistical plan included ordinary least squares fixed-effects per metric with type II analysis of variance for source effects; estimated marginal means with Holm-adjusted pairwise comparisons; a crossed mixed-effects model for topic groups; and inter-rater reliability was measured. Readability and text analyses used standard indices. Origins varied in completeness (p < 0.001), DISCERN (p < 0.001), and PEMAT-A (p = 0.0018); PEMAT-U showed a trend (p = 0.063). Llama-4 scored significantly lower on completeness and DISCERN, and lower than GPT-4, IUGA, and Perplexity on PEMAT-A; Sonnet4 outperformed Llama-4 on PEMAT-U. No single origin dominated all metrics. Readability varied greatly: GPT-4 had an average Flesch-Kincaid grade level ≈ 6.6, Gemini ≈ 7.4; Sonnet4 ≈ 15; Llama-4 ≈ 17. IUGA leaflets were the longest, with grade levels around 9-10. Bladder-training materials were modestly more complete than pelvic muscle materials (p = 0.045). Inter-rater reliability was high (ICC ≥ 0.87). Patient education quality varies substantially across AI tools and compared with society materials. AI-generated content can meet readability targets but requires expert review to ensure completeness and reliability before clinical use.
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by bladder pain and lower urinary tract symptoms, predominantly affecting women and significantly impairing quality of life. Particularly in the absence of reliable knowledge about etiology and appropriate treatment of IC/BPS, clinical practice guidelines (CPGs) emphasize self-management as a key element of care. This review was aimed at comparing recommendations from CPGs, focusing on interventions to facilitate the self-management of women with IC/BPS. A systematic review was conducted following a preregistered protocol. Databases and libraries MEDLINE, Guidelines International Network, Cochrane Library, National Institute for Health and Care Excellence, and Scottish Intercollegiate Guidelines Network were searched. Data extraction focused on interventions facilitating self-management, following the definition according to Corbin and Strauss. Recommendations were categorized and presented with grade of recommendation and level of evidence. CPG quality was appraised using the Appraisal of Guidelines for Research & Evaluation II instrument. Eight CPGs from Europe, North America, and Asia were included. All emphasized self-management as essential for IC/BPS care and contained recommendations across ten core categories, including dietary modification, bladder training, multimodal pain management, stress management, sexual health, and others. Although certain interventions such as physiotherapy referral and bladder diaries were frequently recommended, overall consistency and strength of evidence were limited. Although some consensus exists, recommendations vary in focus and often lack strong evidence. Gender-specific aspects are rarely addressed. These findings highlight the need for more consistent, evidence-informed, and patient-centered CPGs that explicitly account for the gendered and biographical dimensions of living with IC/BPS.
This exploratory pilot study provided initial evidence of the effectiveness of the digital therapeutic (DTx) FEMANEA® for the conservative treatment of stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with a predominant stress component in women and is intended to prepare a further, more in-depth subsequent randomized controlled trial (RCT). Between May and October 2024, 81 patients (women at least 18 years old; SUI or MUI) were enrolled at five centers and randomized into an intervention group (IG, n = 34) or a control group (CG, n = 40). Both groups received standard conservative treatments (i.e., reality of care), the IG additionally had immediate access to the DTx FEMANEA®. Outcome parameters were assessed at baseline, mid-treatment (45 days), and post-treatment (90 days) using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), King's Health Questionnaire (KHQ), bladder diary, 24-h pad test, Patient Activation Measure (PAM-13), and app usage metrics. Data collection was carried out electronically with eCRFs (electronic case report forms) and ePROs (electronic patient reported outcomes). The final analysis included 74 patients (dropout rate 6.2%). At baseline, symptom burden was slightly higher in the IG than in the CG (ICIQ-UI SF: T0 IG 10.7 ± 4.3, CG 9.2 ± 3.0; p = 0.09). The CG showed no significant improvement in symptoms (T2 8.3 ± 2.7; Δ = -0.9, p = 0.051), whereas the IG demonstrated a significant and clinically relevant reduction in symptoms (T2 8.2 ± 4.7; Δ = -2.2; p = 0.001), exceeding the minimal important difference (MID) of 1.46 points. Additionally, the KHQ subscale 2 "incontinence impact on life" observed a significant improvement (IG -19.8 ± 18.7 vs. CG -5.3 ± 19.8; p = 0.002), with IG improvements also being clinically relevant and surpassing the MID by a factor of four. Daily incontinence episodes decreased by 79.7% in the IG versus 48.3% in the CG (each group p < 0.01). Urinary loss volume revealed a 44.0% reduction in the IG, whereas CG values slightly increased. The mean app use in the IG was 2.6 ± 1.9 days per week per patient. Use of the DTx FEMANEA® resulted in clinically and statistically significant improvements in UI symptom burden (ICIQ-UI SF) and quality of life (KHQ subscale 2). These initial clinical data are intended to provide preliminary indications and prepare for the subsequent trial to be conducted.
The aims of the study were the translation, cultural adaptation, and validation of the Incontinence Severity Index (ISI) for a Russian population. Following a forward- and back-translation of the original English ISI questionnaire into Russian (ISI-R), the translated questionnaire was reviewed by a group of patients as well as an expert panel. Women with urinary incontinence over 18 who gave informed consent were recruited in a validation study. They completed ISI-R and International Consultation on Incontinence Questionnaire ICIQ-UI Short Form (ICIQ-UI SF), as well as a sociodemographic checklist, and performed the 1-h pad weight (pad) test to measure urine leakage using pre-weighed absorbent pads. The psychometric properties of ISI-R were assessed. A total of 213 women with urinary incontinence were included in the study. Satisfactory content validity of the ISI-R was shown: content validity indices for comprehensibility were 0.90 for patients and 1.0 for clinicians. Acceptable internal consistency was observed: a Cronbach's alpha value of 0.62 and an interclass correlation coefficient of 0.70. Spearman's correlation coefficient was 0.42 between ISI-R score and pad test results, and 0.41 between four-level severity index and pad test results (p < 0.001). Strong significant positive correlation between the ISI-R score and the total ICIQ-UI SF score was obtained (0.82, p < 0.001). Moderate agreement between the pad test and the ISI-R was shown-quadratic weighted Kappa coefficient 0.425 (p < 0.01). Significant sensitivity to changes was demonstrated by assessing the changes in ISI-R scores before and 12 weeks after surgery. The ISI-R is an informative instrument to be used in clinical practice and research to assess and document the severity of stress urinary incontinence in women, particularly those undergoing surgery.
Vaginal delivery may impact both the structures and function of the pelvic floor, including the levator ani muscle (LAM). In addition to urinary incontinence and prolapse, sexual dysfunction and pelvic pain may occur. We aimed to systematically review the literature on a potential association between LAM avulsion or hiatal dimensions and sexual dysfunction after childbirth. We systematically searched the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science Core Collection, CENTRAL (Cochrane), Clinicaltrials.gov, and databases. The principal aim was to identify reports studying the association between LAM avulsion or hiatal dimensions and sexual dysfunction within 24 months of childbirth. LAM had to be determined by imaging, and the latter had to be documented through questionnaires. Risk-of-bias assessment was evaluated using the Risk of Bias in Non-randomized Studies of Interventions tool. A meta-analysis was intended but not performed due to methodological differences among the studies. Of 7621 studies identified, 9 were eventually included, reporting on 1623 women. For LAM assessment, 8 studies used transperineal ultrasound and 1 study utilized magnetic resonance imaging. Sexual function was evaluated using eight different questionnaires. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms was used twice; all others used a variety of methods. Two studies demonstrated an adverse relationship between LAM avulsion and sexual dysfunction; in the other studies no such relationship was present. The current data are scarce and methods diverse. Little evidence was found to suggest an association between LAM-avulsion and sexual dysfunction in women within 24 months after vaginal delivery.
Interstitial cystitis/bladder pain syndrome (IC/BPS) has been recognized as a chronic, debilitating disorder characterized by pelvic pain and urinary dysfunction, for which current therapies have offered limited long-term effectiveness. Recently, platelet-rich plasma (PRP), a biologic therapy rich in growth factors, has been investigated as a regenerative treatment option. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251084131). Eight studies evaluating intravesical PRP for IC/BPS were included. Data were extracted from PubMed, Web of Science, CINAHL, and Cochrane Central Register of Controlled Trials. Risk of bias was evaluated using the RoB 2.0 tool for randomized controlled trial (RCTs) and the Newcastle-Ottawa Scale for observational studies. Platelet-rich plasma therapy led to significant improvements in patient-reported outcomes. Pain scores (visual analog scale) showed a pooled standardized mean difference (SMD) of -0.78 (95% CI -1.15 to -0.41; p < 0.0001), whereas Interstitial Cystitis Symptom Index, Interstitial Cystitis Problem Index, and O'Leary-Sant Symptom scores demonstrated SMDs of -0.79, -0.84, and -1.18 respectively (all p < 0.0001). Functional bladder capacity (FBC) and uroflowmetry values improved, with FBC increasing from 267.6 ml to 322.0 ml and Qmax from 10.9 ml/s to 18.4 ml/s in some studies. Improvements were sustained up to 6 months. A low incidence of mild adverse events (dysuria, hematuria, UTIs) was reported. Symptom relief was consistent across short- and long-term follow-up groups, with no statistically significant differences between durations. Intravesical PRP significantly improves pain, urinary symptoms, and bladder function in patients with IC/BPS, while maintaining a low risk of adverse effects. However, larger, well-designed RCTs are needed to confirm long-term efficacy and optimize treatment protocols.
A subset of women with stress urinary incontinence (SUI) exhibit atypical features that may suggest hidden storage dysfunction or bladder overactivity. As urodynamic studies (UDS) are invasive and not always accessible, this study was aimed at examining whether a short solifenacin trial could improve symptoms and help treat women with SUI who present atypical leakage patterns. Fifty women (39-60 years old) suffering from clinically diagnosed SUI with atypical features were treated with solifenacin 5 mg daily over the course of 4 weeks. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) and the Overactive Bladder Symptom Score (OABSS) were used to measure changes in symptoms. The primary outcome measures were changes in total scores and achievement of clinically meaningful improvement (≥ 4-point reduction in ICIQ-UI-SF; ≥ 3-point reduction in OABSS). The mean age of the participants was 51.9 ± 4.9 years. Mean ICIQ-UI-SF scores decreased from 15.4 ± 2.7 to 6.7 ± 2.4 (p < 0.001; Cohen's d = 2.4), and OABSS scores from 5.4 ± 2.2 to 2.0 ± 1.3 (p < 0.001; Cohen's d = 1.8). Clinically significant improvement was observed in 92% (according to ICIQ-UI-SF) and 80% (according to OABSS) of patients (p < 0.001). Solifenacin therapy resulted in statistically and clinically significant improvement of UI and storage symptoms among women with SUI exhibiting atypical features and managed without baseline UDS. These results suggest that a pharmacological trial may be a practical, non-invasive first-line approach for this SUI phenotype, may be consistent with a cough-induced detrusor overactivity-like mechanism, but cannot confirm it in the absence of urodynamic study.
Urinary incontinence (UI) affects over half of adult women but is widely underdiagnosed and undertreated in primary care due to stigma, normalization, and limited routine screening. Identifying effective recruitment strategies is essential to improving UI care in these settings. We conducted semi-structured interviews and focus groups with grantee leaders and practice facilitators (n = 32), site visits and virtual interviews with providers and staff (n = 47) and collected quarterly quantitative recruitment and retention data from five grantees participating in a nationwide UI initiative. Qualitative data were analyzed thematically using the Consolidated Framework for Implementation Research. Quantitative data, including 1950 enrolled practices and 134,852 screened patients, were summarized with descriptive statistics. No single recruitment strategy was universally effective. All grantees utilized approaches such as leveraging professional relationships, engaging practice facilitators, and conducting in-person meetings, which were consistently linked to higher practice and provider recruitment. Leadership engagement facilitated recruitment success, while use of incentives and broad outreach alone were insufficient. Patient recruitment was most successful when UI screening was embedded in routine intake workflows. Across all grantees, 21% of screened patients tested positive for UI. Recruitment challenges included approval delays in large systems and increased workload related to integrating screening into routine care. Successful UI intervention recruitment in primary care requires combining leadership support, workflow integration, and tailored approaches. Limitations include reliance on aggregate data and absence of patient-reported perspectives or subgroup analyses. Future research should further investigate strategies to advance equitable UI care delivery.
Anticholinergics and β3 agonists are the mainstay of medical treatment for overactive bladder symptoms (OAB). Vaginal oestrogen has been shown to improve OAB symptoms. This review evaluated combination therapy (vaginal oestrogen + OAB medication) versus monotherapy. The project was registered with PROSPERO (CRD42023462373). A literature search of Embase, MEDLINE and CINAHL was conducted. Articles were screened independently by two reviewers according to PRISMA guidelines. Statistical analyses were performed using Review Manager (RevMan v5.4.1, Cochrane Collaboration). Study quality was assessed using the Newcastle-Ottawa scale. Initial search yielded 17 results. After screening, six articles were included in qualitative synthesis and four in quantitative synthesis. Five studies were randomised controlled trials, and one was non-randomised. All articles were of good quality (≥ 7 points Newcastle-Ottawa scale). Total number of participants was 544. Four studies reported that combination therapy is associated with significantly greater improvements in OAB symptoms, health-related quality of life (HRQL) and/or sexual function. Two studies reported no significant difference in OAB symptoms between monotherapy and combination therapy. Pooled analysis showed a significant reduction in urinary frequency with combination therapy compared with monotherapy (SMD -0.36 [-0.63, -0.08], p = 0.01, I2 = 0%). However, no significant difference was observed in OAB symptoms score (SMD -0.38 [-0.81, 0.05], p = 0.08, I2 = 60%) or health-related quality of life (SMD -0.15 [-0.41, 0.10], p = 0.24, I2 = 0%). Combination therapy may benefit urinary frequency but did not demonstrate significant improvement in overall OAB symptoms or HRQL. Further research is required to determine the benefit of vaginal oestrogen.
Satisfaction of surgical scars after robotic sacrocolpopexy have not yet been explored. To determine differences in patient perception of body image and cosmesis following single port (SP) versus traditional multiport (TMP) robotic sacrocolpopexy. We performed a prospective cohort study at a single tertiary care center of women undergoing robotic sacrocolpopexy between September 2023 and December 2024. Women undergoing SP or TMP robotic sacrocolpopexy for prolapse were included. At 3 months after surgery, participants completed the Body Image Questionnaire (BIQ). The BIQ is a 10-item survey which includes a body image, cosmetic, and self-confidence scale used to assess a patient's perception of body image and cosmesis after surgery. Low scores on the body image scale and high scores on the cosmetic indicated higher patient satisfaction. Changes in preoperative and postoperative self-confidence scores were calculated. A positive change in scores was associated with higher self-confidence after surgery. One hundred fourteen participants underwent robotic sacrocolpopexy: 63 (45%) SP and 77 (55%) TMP robot. Median (range) body image scale and cosmetic scale scores for the entire cohort were 5 (5-16) and 20 (5-24), respectively. Median preoperative and postoperative self-confidence scores were 8 (0-10) and 8 (2-10), respectively. There were no significant differences in total body image scale (p = 0.55) and cosmetic scale (p = 0.17) scores between groups. Change in self-confidence score after surgery was also similar (p = 0.14). Women were highly satisfied with their body image and cosmesis of surgical scars after robotic sacrocolpopexy without significant differences between SP and TMP approaches.
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Misconceptions about pelvic organ prolapse occur among Hispanic women. We develop and validate a novel scale measuring misconceptions about pelvic organ prolapse (POP) among Hispanic women. A cross-sectional survey of 406 Hispanic women was conducted. Participants completed 11 items about POP misconceptions, the Prolapse and Incontinence Knowledge Questionnaire (PIKQ-POP), and the Short Acculturation Scale for Hispanics (SASH). Principal component analysis was used. The Pelvic Organ Prolapse Misconceptions Scale (POPMS) had two subscales: personal habits and sequelae (PHS) and treatment approaches (TA), with high internal reliability (KR-20 = 0.90 and 0.81, respectively). The POPMS PHS and TA subscales were each positively correlated (both r = 0.25, p < 0.001) with general POP knowledge of the PIKQ-POP. College-educated women had higher mean scores on the PHS (p < 0.001) and TA (p = 0.01) than those not college educated. The correlations and mean scores indicate acceptable criterion validity. Misconceptions were common: 44% answered all PHS items incorrectly, and 56% answered all TA items incorrectly. The PIKQ-POP was positively associated with three SASH acculturation subscales (all p < 0.001). The POPMS was not associated with any of the three SASH acculturation subscales. In conclusion, the POPMS is a valid and reliable instrument to measure misconceptions about POP in Hispanic women. Importantly, while general POP knowledge correlates with acculturation, misconceptions do not. This shows that misinformation may persist even in more acculturated individuals. We recommend that clinicians consider administering the POPMS scale to their Hispanic patients. This will allow clinicians to better understand their patients' misconceptions about POP.
A distinction can be made between levator avulsions that preserve the appearance of a connection to the pelvic sidewall (type I), and those that do not (type II). We evaluated whether avulsion type affects hiatal area on straining. This retrospective observational study used archived patient data from a tertiary urogynaecological service between 2/2019 and 12/2020. All patients underwent a standardized interview, POP-Q examination, and 4D pelvic floor ultrasound. On analysing the archived volume data, the first author assessed hiatal area on maximum straining, the second author determined avulsion type, blinded to all other data. The primary outcome was hiatal area on straining, with avulsion type as the explanatory variable. Inter-rater reliability for hiatal area on straining showed an intraclass correlation coefficient (ICC) of 0.872. Five hundred and twenty-four archived volume data were available. Mean age was 58 years (range 20-95), mean body mass index (BMI) was 29.1 kg/m2 (range 16.9-56.8), and mean parity was 3 (range 0-8). Stress and urgency urinary incontinence were reported in 387 (73.9%) women, prolapse symptoms in 267 (51%). Mean POP-Q points were Ba = -1 cm (-3 to +5), C = -5 cm (-10 to +9), and Bp = -1 cm (-3 to +3). Mean hiatal area on straining was 26.9 cm2 (8.1-60 cm2). A full/complete avulsion defined as detachment of the pubococcygeous/puborectalis or 'pubovisceralis' muscle from its insertion on the inferior pubic ramus was diagnosed in 124 women (24%), with 43 (8%) bilateral. Avulsion type classification was impossible in 10 due to suboptimal image quality; in 80, we found a type I avulsion (15.3%), and in 34, a type II (6.5%). No significant difference was observed in hiatal area on straining between type I and type II avulsions (32.6 cm2 [SD 8.39] vs. 33.48 cm2 [SD 11.29]; P = 0.6). Levator avulsion type does not seem to significantly affect hiatal area.
Failure of the urogenital hiatus to remain closed in women is a major contributor to prolapse operation failure and development of prolapse after childbirth. This article presents a conceptual framework, the Urogenital Hiatus Closure System (UHCS), that explains how anatomic and neuromuscular elements interact to maintain, or fail to maintain, hiatal closure. Clinical observations demonstrate that no single structure reliably predicts hiatus size; instead, hiatal behavior results from the integrated functional components. The UHCS has three primary elements: the levator ani muscle, neuromotor control, and Level III connective tissues of the perineal complex-each of which can be injured, partially compensated, or overloaded. These structures form a neuromechanically integrated unit in which the medial levator ani, the perineal membrane and its central connection, and the afferent-efferent control loops work to provide resting tone, active contraction, resistance to dilation, and spatial alignment. A principle of the model is redundancy: failure in one component may not enlarge the hiatus, but combinations of failures exceed compensatory capacity and result in failure. It links Level III mechanics to Level I-II support by demonstrating how an open hiatus increases forces on apical and paravaginal tissues, driving a feed-forward cycle of prolapse dilation and muscle elongation. Conceptually, the UHCS is an interacting triad influenced by functional modifiers-loading conditions, prolapse effects, muscle length, motor activation, and connective-tissue properties-that determine hiatus size. This systems-based approach can guide classification of failure patterns to inform biomechanical, anatomical, and therapeutic research.