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Objective To retrospectively investigate the efficacy of pelvic floor muscle training(PFMT)using APP-based home device in the real-world scenario.Methods A retrospective survey was conducted among 171 000 Chinese female users over 18 years old who freely registered APP and performed PFMT using a domestic manufactured home device from Oct 1,2019 to Mar 31,2021.The Patient Global Impression of Improvement(PGI-I)questionnaires concerning pelvic floor general condition,sexual satisfaction and other three major symptoms related to pelvic floor muscle laxity such as stress urinary incontinence(SUI),pelvic organ prolapse(POP),and vaginal laxity(VL)were broadcast public online for users to self-assess the improvement.The vaginal muscle strength values prior and post training recorded by APP were also reported.All data were collected anonymously for further stratified analysis.Results A total of 984 valid questionnaires were collected by systematic sampling.The PGI-I scores of pelvic floor general condition(P=0.000 1),sexual satisfaction(P=0.009),SUI(P=0.000 1),POP(P=0.044)and VL(P=0.034)were statistically significant in users who reported to use the device for 3 months or more compared with those less than 3 months.In addition,the increase of vaginal muscle strength was related to the improvement of PGI-I scores in SUI and POP with statistical significance.There were no significant difference in subgroups such as age,education,parity,and delivery mode.Conclusion The subjective benefit of pelvic floor function-related symptoms and the improvement of vaginal muscle strength could be observed after PFMT for three months or more using APP-based home device in Chinese women in the real-world scenario.

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Obesity is a growing condition within the society and more patients, who have underlying obesity, are presenting with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction (PFD). The effect of obesity on general health has been well documented, and its impact on the cardiovascular, endocrine, and musculoskeletal systems has been extensively studied. There is now a growing body of evidence on the effects of obesity on the female urogenital system. It seems to influence the prevalence, presentation, assessment, management, and outcome of various types of LUTS and PFD. A holistic approach is needed to assess and manage these patients. A clear understanding of the functions of the pelvic floor and the way it can be affected by obesity is essential in providing holistic care to this group. A frank discussion about patient weight is required in the clinics handling PFD. A multimodal approach to weight loss would help improve PFD symptoms and progression. Patients with obesity should still be offered standard treatment options for all PFDs and should not be forced to lose weight as a prerequisite before starting treatment. However, they should also be made aware of the impediments that being overweight adds to their care and their expectations should be managed accordingly.

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PURPOSE OF REVIEW: Female urogenital pain (FUGP) affects many women and is often a diagnosis of exclusion. The long path to a diagnosis and subsequent treatment frequently leads to suffering on the individual's behalf (Obstet. Gynecol. 121: 645-50, 2013). Additionally, this delay in diagnosis and thus treatment places stress on the US medical system (Obstet. Gynecol. 121: 645-50, 2013). There is a lack of knowledge regarding the scope of pelvic floor physical therapy (PFPT) across the medical community that may prevent physicians from referring patients (J Urol. 193:1545-53, 2015; Sex Med Rev., 2021). PFPT is a low-risk, potentially high-reward option that should be recognized as part of the multidisciplinary approach to managing FUGP. RECENT FINDINGS: Research databases (PubMed and Cochrane) were used to find articles on FUGP between 2005 and 2022. Systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohorts, and case-study analyses were included in reviewing the literature. The most recent studies in the last 2 years show the benefit of PFPT in certain FUGP diagnoses with improved pain scores and function when compared to no intervention or placebo treatment. The aim of this article is to elucidate the scope of PFPT in the treatment of FUGP with supporting research findings regarding efficacy. It is clear from the literature that PFPT should be recognized by referring physicians as part of a multidisciplinary approach to the treatment of FUGP.

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Objective: This study aims to investigate the feasibility and short-term efficacy of single-port laparoscopic-assisted transvaginal natural cavity endoscopic sacrospinous ligament suspensions (SvNOTES). Methods: A total of 30 patients diagnosed with anterior or/and middle pelvic organ prolapse Stages III and IV underwent natural vaginal cavity (SvNOTES), and 30 patients who underwent conventional sacrospinous ligament (SSLF) were used as a control group. The operation time, blood loss, postoperative POP-Q score, length of hospital stay, and complications were compared between the two groups. Results: The operation time for SvNOTE was (60 ± 13) min, which was longer than (30 ± 15) min for SSLF (P = 0.04). However, the bleeding amount in SvNOTE was 29.44 ± 2.56, significantly lower than that in the SSLF group (80 ± 10; P = 0.02), and the postoperative hospital stay in the SvNOTE group was (4 ± 2) days, longer than (3 ± 1) days in SSLF (P = 0.02). However, there were no intraoperative complications in the SvNOTE group, whereas one ureteral injury occurred in the SSLF group; in addition, the postoperative POP-Q score was significantly better in the SvNOTE group than that in the SSLF group with increasing time (P < 0.001). Conclusion: Compared with SSLF, single-port laparoscopic sacrospinous ligament suspension via the natural vaginal cavity is visualized, greatly improving the success rate of sacrospinous ligament fixation, with less blood loss and fewer complications, arguably a safer and minimally invasive surgical approach.

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BACKGROUND: In recent years, pelvic restoration surgery is widely used in the diagnosis and treatment of stress urinary incontinence (SUI) as people pay more attention to postpartum pelvic floor dysfunction (PFD). The therapeutic effect of pelvic restoration combined with anti-SUI surgery remains undetermined. The evaluation indicators of the therapeutic effects include the incidence of postoperative obstruction, the incidence of postoperative defecation difficulties, and the quality of life score. METHODS: PubMed, Cochrane Library, and EMBASE were searched from the establishment of the database to April 2021 for randomized control trials (RCTs) of pelvic restoration and anti-SUI surgery, and the RevMan5.3 software provided by the Cochrane Collaboration was used for meta-analysis. RESULTS: A total of 6 documents (a total of 1,944 patients) were included, including 1,021 patients in the experimental group and 923 patients in the control group. The incidence of obstruction after pelvic restoration combined with anti-SUI surgery was statistically significant (OR =1.35, 95% CI, 0.95-1.92, P=0.10); there was a statistically significant difference in the incidence of postoperative dyspareunia (OR =1.58, 95% CI, 0.91-2.74, P=0.10). DISCUSSION: A total of 8 documents included in this meta-analysis confirmed that pelvic restoration combined with anti-SUI surgery for PFD can improve the prognosis and quality of life of patients.

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BACKGROUND: Wearing high-heeled shoes is a common phenomenon among women. However, the association between wearing high heels and pelvic floor function is largely unknown. Our aim was to evaluate the effects of wearing different height shoes on pelvic floor function and to analyze the influencing factors. METHODS: This was a population-based, cross-sectional study performed in general hospitals with a pelvic floor subspecialty in some cities of China. All participants completed a Urogenital Distress Inventory (UDI-6) questionnaire that consisted of demographic data, information about wearing shoes, and information about pelvic floor function (UDI-6). One-way ANOVA was carried out to compare the differences among 4 groups according to the heel height (<3, 3-5, 5-7, and >7 cm groups). Multivariate logistic regression was performed to identify the factors influencing the effect of wearing 3-5 cm high-heeled shoes on pelvic floor function. RESULTS: In total, 1,263 participants finished the questionnaire and full data were collected. The 4 groups were comparable for clinical data, and participants who wore 3-5 cm high-heeled shoes had the lowest UDI-6 scores. Multivariate analysis revealed that the number of hours (≥8 h) wearing high heels per day and the thickness diameter (≥3 cm) of the heel were important factors affecting the protective effect of wearing 3-5 cm high-heeled shoes on pelvic floor function. CONCLUSIONS: Wearing heeled shoes with a 3-5 cm heel height and ≥3 cm thickness for a long period of time is good for the pelvic floor function of women.

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BACKGROUND: There has been a long-standing controversy about diastasis recti diagnostic criteria and its relation to pelvic floor dysfunction (PFD). This study aimed to establish ultrasound diagnostic criteria for diastasis recti and investigate the correlation between it and PFD in early postpartum females. METHODS: The inter-rectus distance (IRD) was measured at 3 locations in 116 healthy nulliparous females and 108 postpartum females. At the same time, they remained relaxed and then maintained a head-lift posture. The measurement for the 90th percentile was used to define the normal IRD in the nulliparous group. Afterward, the 108 postpartum females underwent an ultrasonographic examination of pelvic floor function. The correlations of these values with the IRD were then examined. RESULTS: We established the following ultrasonographic diagnostic criteria for diastasis recti: an IRD of >2 mm at 3 cm below the umbilicus, >20 mm at the umbilicus, and >14 mm at 3 cm above the umbilicus. The IRD was positively correlated with body mass index (BMI) in the nulliparous group (r=0.286, P<0.01) and with age in the postpartum group (r=0.230, P<0.05). The IRD was not relative to either the PFD ultrasound results or the clinical symptoms. CONCLUSIONS: We established a set of ultrasonographic diagnostic criteria for diastasis recti at 3 locations along the umbilicus. There is no clear correlation between diastasis recti and PFD in early postpartum females.

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BACKGROUND: Pregnancy and childbirth are the main causes of pelvic floor dysfunction (PFD). Although pelvic floor muscle tension is typically measured at 42 days postpartum to assess the severity of PFD and provide timely rehabilitation, it is still impossible to predict PFD and take targeted preventive measures in clinical practice. A PFD prediction model based on big data obtained in prenatal check-ups was established in this study to allow the formulation of personalized preventive strategies to reduce the incidence of PFD. METHODS: A total of 1,500 women who underwent regular prenatal checkups and examinations for PFD at 42 days postpartum at the Zhuji Maternal and Child Health Hospital between May 2015 and May 2020 were selected. The data from 1,000 of them were selected as the training cohort, and the data from 500 of them were used as the validation cohort. The women were divided into a PFD group and a non-PFD group according to whether PFD was diagnosed at 42 days postpartum. A nomogram prediction model was created using the influencing factors that lead to PFD, and the discrimination and calibration of the nomogram were evaluated through internal and external validation. RESULTS: A total of 389 cases (38.9%) of PFD were included in the training cohort. Multivariate analysis showed that age (odds ratio (OR) =1.896, P<0.001), history of childbirth (OR =4.531, P<0.001), history of constipation (OR =2.475, P<0.001), urinary incontinence during pregnancy (OR =4.416, P<0.001), and biparietal diameter at 32 weeks of gestation (OR =51.672, P=0.012) were independent influencing factors of PFD at 42 days postpartum. These factors were used to establish a nomogram prediction model. This prediction model maintained good discrimination between the training cohort and the external validation cohort (the area under the curve was 0.893 and 0.842 for the training and validation cohorts, respectively). CONCLUSIONS: The study validated that the nomogram prediction model based on the factors influencing PFD can be used to predict PFD at 32 weeks of gestation for timely intervention and prevention of PFD.

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INTRODUCTION AND HYPOTHESIS: Women seeking treatment for pelvic floor disorders (PFD) may have a high prevalence of frailty, which could potentially impact the risks of treatment. The present study was aimed to assess the prevalence of frailty in patients with PFD and additionally to compare post-treatment complications between frail and non-frail patients. METHODS: This is a prospective observational study conducted in a single secondary referral centre for PFD. Women with PFD and aged ≥ 65 years were eligible for inclusion. Frailty was classified using a validated screening tool, the Groningen Frailty Indicator (GFI). The primary outcome was to determine the prevalence of frailty in elderly women with symptoms of pelvic floor disorders. Secondary outcomes were clinical outcomes after treatment between frail and non-frail patients. RESULTS: A total of 263 women were included. The prevalence of frailty was 54.4% (143 women, 95% CI 48.1-60.5) in the studied group of patients. Frail patients had more comorbidities and used more medication compared to non-frail patients. Non-frail patients were more often surgically treated than frail patients. No differences were found in the incidence of postoperative complications. CONCLUSIONS: Our study shows a high prevalence of frailty in elderly women with symptoms of PFD. Further research is required to investigate whether these frail patients face an increased risk of complications and poor clinical outcomes after treatment for PFD.

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Pelvic floor dysfunction disease has a high incidence in women after pregnancy. During this special physiological period of women pregnancy, posture of woman pelvis will change, and the pelvic biomechanics will change as well. Such mechanical changes will bring corresponding diseases. The relationship between dynamic changes and occurrence of functional disorders were discussed, the influences of changes in abdominal pelvic mechanics on the pelvic floor after pregnancy were summarized, and the high risk factors of pelvic floor dysfunction （PFD） were investigated, so as to provide the optimal treatment plans and method for pelvic floor rehabilitation treatment.

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BACKGROUND: Female pelvic floor dysfunction (PFD), a common disease affecting women, has attracted a significant amount of attention in the field of obstetrics and gynecology in recent years. Pelvic floor disorders can induce urinary incontinence, vaginal prolapse and other dysfunction, which seriously affect the quality of life of patients. This study aimed to analyze the current status of PFD in urban women in Xi'an City. METHODS: A total of 1300 women in the urban area of Xi'an City were selected based on a multi-stage sampling method. A face-to-face questionnaire survey and gynecological examination were carried out, and the prevalence rates of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) and PFD were calculated, Multivariate logistic regression analysis was performed to analyze the risk factors of PFD in urban women in Xi'an City. RESULTS: The effective questionnaire recovery rate was 76.69% (997/1,300). The number of patients with SUI, POP, and SUI combined POP were 124 (55.11%), 64 (28.44%) and 37 (16.44%), respectively, and the prevalence of PFD was 22.57% (225/997). Multivariate logistic regression analysis showed that the risk of PFD in women with vaginal delivery, delivery times ≥2, menopause or prolonged labor was higher than that in women with cesarean section, delivery times of 1, no menopause, or no prolonged labor (P<0.05). CONCLUSIONS: The prevalence rate of PFD in urban women in Xi'an City cannot be ignored, especially women who have experienced vaginal delivery, delivered ≥2 children, menopause, or prolonged labor. It may be necessary to prioritize these women so as to actively prevent and control PFD.

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BACKGROUND: Pelvic floor dysfunction (PFD) is a condition affecting many women worldwide, with symptoms including stress urinary incontinence (SUI) and pelvic organ prolapse (POP). We have previously demonstrated stable elastin-expressing bone marrow-derived mesenchymal stem cells (BMSCs) attenuated PFD in rats, and aim to further study the effect of microRNA-29a-3p regulation on elastin expression and efficacy of BMSC transplantation therapy. METHODS: We inhibited endogenous microRNA-29a-3p in BMSCs and investigated its effect on elastin expression by RT-PCR and Western blot. MicroRNA-29-inhibited BMSCs were then transplanted into PFD rats, accompanied by sustained release of bFGF using formulated bFGF in poly (lactic-co-glycolic acid) (PLGA) nanoparticles (NP), followed by evaluation of urodynamic tests. RESULTS: MicroRNA-29a-3p inhibition resulted in upregulated expression and secretion of elastin in in vitro culture of BMSCs. After co-injection with PLGA-loaded bFGF NP into the PFD rats in vivo, microRNA-29a-3p-inhibited BMSCs significantly improved the urodynamic test results. CONCLUSIONS: Our multidisciplinary study, combining microRNA biology, genetically engineered BMSCs, and nanoparticle technology, provides an excellent stem cell-based therapy for repairing connective tissues and treating PFD.

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Objective To investigate the influences of different factors on postpartum pelvic floor muscle injury, and provide clinical evidence to the early prevention of pelvic floor dysfunction (PFD). Methods A total of 65 630 women, who participated the postpartum pelvic floor function screening in Tianjin, from December 2011 to December 2014 were selected in this study. The uniform detect methods was used in this study. The analysis based on the PFD was diagnosed by physi?cians of Women’s and Children’s Health Center in each district. The influences of different factors on postpartum pelvic floor muscle were analyzed. Results There were 19 452 (29.6%) women suffering from postpartum pelvic floor muscle inju?ry, with the abnormal rate 29.6%, which was higher in rural areas than that in urban areas (33.9%vs 27.8%). The abnormal rate was higher in women with junior middle education or below (34.1%) than that in women with senior middle or polytech?nic schooling (30.4%), and women with college or higher education (27.7%). There was a higher abnormal rate in women with vaginal surgery delivery (40.8%) than that in women with natural delivery (32.5%) and women with caesarean section (27.2%). The muscle abnormal rate was higher in women having given two or more than two times of deliveries (34.6% , 31.5%) than those having initial delivery (29.1%). Multiple factor analyses showed that city residency, higher education and less delivery times were protecting factors for postpartum pelvic floor muscle while vaginal surgery was a risk factor for post?partum pelvic floor muscle. Conclusion There is a high incidence of postpartum pelvic floor muscle injury in the region of Tianjin. Analyzing the risk factors and strengthening the management of pelvic floor muscle injury by early prevention or ear?ly treatment would help to reduce the incidence of PFD effectively during pre-pregnancy and perinatal periods.