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BACKGROUND: The increased hypertonicity or activity of pelvic floor muscles can lead to chronic pelvic pain (CPP). It represents an aspecific and persistent pain with no apparent clinical reason, affecting an estimated 6% to 16% of women worldwide. This study aimed to evaluate with validated questionnaires the efficacy and the safeness of a new device that uses Top flat Magnetic Stimulation for the management of muscular hypertonia in women with CCP. METHODS: All patients underwent 8 treatments with a non-invasive electromagnetic therapeutic device. The device produces a TOP Flat Magnetic Stimulation with a uniform profile so, the muscle work aims to reduce pain while also inhibiting muscle activity. The PISQ-12 questionnaire was used for the evaluation of improvements. Side effects were monitored. RESULTS: The PISQ-12 total mean score decreases from 29,2 (±3.3) to 17 (±2). Regarding the behavioural-emotive items (1-4), a decrease from 12 (±2) to 7 (±0.9) was visible. Physical items (5-9) decrease from 10,6 (±1.8) to 6 (±1.4) and the Partner Related items (10-12) from 6,6 (±1.6) to 3,9 (±0.4).  Conclusions: The device we used in this research demonstrated to be a valid solution for the treatment of chronic pelvic pain in female patients.

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BACKGROUND: Pelvic organ prolapse (POP) is one of the most common pathologies of the pelvic floor, and it can be found among 40-60% of women who have given birth. Correction of the defect of the DeLancey level II without reconstruction of the apical defect is doomed to failure. Also, in the structure of pelvic floor defects, there is often an incompetency of the perineal body, as a consequence of traumatic delivery. Perineoplasty is considered to be the main method of correction for perineal body incompetency. However, it is worth mentioning that there are no randomized trials, which estimate the influence of simultaneous correction of the perineal body on the effectiveness of transvaginal apical fixation. METHODS: It is planned to include 310 patients in this trial. Patients who met the inclusion/exclusion criteria will be randomized into 2 groups: 1st group-patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy without perineoplasty, 2nd group-patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy and perineoplasty. Patients will be called to an appointment 6, 12, and 24 months after discharge. DISCUSSION: The aim of this trial is to evaluate the efficiency and safety of simultaneous perineoplasty on the clinical and anatomical efficacy of mesh-augmented sacrospinal fixation in advanced pelvic organ prolapse repair. Based on previous studies, it was difficult to estimate and comprehend whether colpoperinoplasty actually reduces the risk of prolapse recurrence. TRIAL REGISTRATION: NCT05422209. Registered on 18 May 2022.

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Background and Objectives: Urinary incontinence (UI) is the involuntary loss of urine caused by a weakness in the pelvic floor muscles (PFMs) that affects urethral closure. Myostatin, which prevents the growth of muscles, is a protein expressed by human skeletal muscle cells. Indeed, it has been observed that myostatin concentration rises during skeletal muscle inactivity and that suppressing serum myostatin promotes muscle growth and strength. Furthermore, therapeutic interventions that reduce myostatin signalling may lessen the effects of aging on skeletal muscle mass and function. For this reason, the aim of the study was to assess if flat magnetic stimulation technology affects serum myostatin levels, as myostatin can block cell proliferation at the urethral sphincter level. Materials and Methods: A total of 19 women, 75% presenting stress urinary incontinence (SUI) and 25% urgency urinary incontinence (UUI), were enrolled. A non-invasive electromagnetic therapeutic system designed for deep pelvic floor area stimulation was used for eight sessions. Results: The ELISA (enzyme linked immunosorbent assay) test indicated that the myostatin levels in blood sera had significantly decreased. Patients' ultrasound measurements showed a significant genital hiatus length reduction at rest and in a stress condition. The Pelvic Floor Bother Questionnaire consistently revealed a decrease in mean scores when comparing the pre- and post-treatment data. Conclusions: Effective flat magnetic stimulation reduces myostatin concentration and genital hiatus length, minimizing the severity of urinary incontinence. The results of the study show that without causing any discomfort or unfavourable side effects, the treatment plan significantly improved the PFM tone and strength in patients with UI.

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BACKGROUND: The potential benefit of exercise in alleviating symptoms of endometriosis is unclear. Still, exercise may be used to empower women and manage disease symptoms. The purpose of this study was to explore how regular supervised group- and individual exercise training, including pelvic floor muscle training (PFMT), is experienced among women with endometriosis after participating in a randomized controlled trial (RCT). METHODS: Among 41 women randomized to exercise training for four months, ten women were interviewed about their experiences with exercise training after participation in the trial. The weekly group training was led by women's health physiotherapists and included individualized and progressive muscular strength training of large muscle groups and the pelvic floor muscles, in addition to endurance-, flexibility, and relaxation training. An individual training program followed the same principles as the group training and was to be performed 3-5 times per week, depending on the level of intensity. PFMT was recommended daily. The women also received a group pain management course emphasizing exercise training as self-management. Using inductive reflexive thematic analysis, responses to the question "Did participation in the study change your view of exercise as part of the treatment for endometriosis?" were analyzed. RESULTS: The women brought forward the importance of knowledge about the benefits of exercise to make informed decisions in disease management. Further, the women described how exercise training was perceived as less frightening and manageable when exposed to various intensities, dosages, and types of exercises in a safe and supportive environment. PFMT was especially brought forward as something new and appreciated, and for some of the women, to be performed on days when their bodies could not handle the general exercise training. They also expressed that the supervised exercise brought an extra dimension of belonging through group participation. CONCLUSIONS: Individualization and regular supervision seem important to empower women with knowledge about exercise training as self-management and to experience exercise training as safe and non-threatening. Further, creating a sense of belonging through group training may improve social support and build active coping strategies that are essential for disease management of endometriosis. TRIAL REGISTRATION: NCT05091268 (registered 23.09.2021).

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INTRODUCTION: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain condition creating a wide range of urologic and pain symptoms. There is currently limited evidence to understand the mechanisms of IC/BPS. There have been recent studies suggesting that altered function in brain motor areas, particularly the supplementary motor cortex (SMA), relates to altered bladder sensorimotor control and may play an important role in IC/BPS. This study aims to provide evidence that non-invasive stimulation targeting the motor cortex may help reduce IC/BPS pain, as well as better understand the neural mechanism by which this stimulation targets neuromuscular dysfunction. This study is a two-group quadruple-blinded randomized controlled trial (RCT) of active vs. sham repetitive transmagnetic stimulation (rTMS). In addition, our study will also include functional magnetic resonance imaging (fMRI), pelvic floor electromyography (EMG), pelvic exam, and outcome measures and questionnaires to further study outcomes. ETHICS AND DISSEMINATION: All aspects of the study were approved by the Institutional Review Board of the University of Southern California (protocol HS-20-01021). All participants provided informed consent by the research coordinator/assistants. The results will be submitted for publication in peer-reviewed journals and disseminated at scientific conferences. TRIAL REGISTRATION: ClinicalTrials.gov NCT04734847. Registered on February 1, 2021.

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BACKGROUND: Urinary incontinence (UI) is the most prevalent pelvic floor disorder following treatment for gynaecological cancer with a distressing impact on quality-of-life in survivors. Physiotherapist-supervised pelvic floor muscle (PFM) training is recommended as the first-line intervention for UI in community-dwelling women. However, it is not known if this intervention is effective in women following treatment for gynaecological cancer, nor whether PFM training can be delivered entirely remotely. The primary aim of this study is to investigate if a telehealth-delivered PFM training program incorporating a novel biofeedback device reduces UI compared with usual care, following gynaecological cancer. METHODS: This is a pragmatic, two-arm parallel-group, stratified superiority randomised controlled trial recruiting 72 participants (ACTRN12622000580774). Recruitment sites include gynaecology-oncology outpatient clinics, supplemented by advertisements through community foundations/social media/care groups. Participants must have completed primary cancer treatment at least 6 months prior or adjuvant therapy at least 3 months prior, for Stage I, II or III uterine, cervical, fallopian tube, primary peritoneal or ovarian cancer or borderline ovarian tumour, and have UI occurring at least weekly. Participants randomised to the usual care group will receive bladder and bowel advice handouts and one audio telehealth physiotherapist consultation to answer any queries about the handouts. Participants randomised to the intervention group will receive the same handouts plus eight video telehealth physiotherapist consultations for PFM training with a biofeedback device (femfit®), alongside a home-based program over 16 weeks. The primary outcome measure is a patient-reported outcome of UI frequency, amount and interference with everyday life (measured using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form), immediately post-intervention compared with baseline. Secondary outcomes include quality-of-life measures, bother of pelvic floor symptoms, leakage episodes, use of continence pads and global impression of change. We will also investigate if the intervention improves intra-vaginal resting and squeeze pressure in women in the intervention arm, using data from the biofeedback device. DISCUSSION: If clinical effectiveness of telehealth-delivered physiotherapist-supervised PFM training, supplemented with home biofeedback is shown, this will allow this therapy to enter pathways of care, and provide an evidence-based option for treatment of post-cancer UI not currently available. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), ID 12622000580774. Registered 20 April 2022.

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Objective.Levator ani muscles undergo significant stretching and micro-trauma at childbirth. The goal was to assess the neuromuscular integrity of this muscle group by means of magnetomyography (MMG) and correlate with Brink score-a commonly used digital assessment of pelvic floor muscle strength.Approach.Non-invasive MMG data was collected on 22 pregnant women during rest and voluntary contraction of the pelvic-floor muscles (Kegels). The mean amplitude and power spectral density (PSD) of the Kegels were correlated to Brink pressure score.Main Results.The modified Brink pressure score demonstrated medium correlations (⩾0.3) with MMG amplitude and PSD with the average Kegel of medium intensity and rest. Data showed that the 'resting state' of the pelvic floor is, in actuality, quite dynamic and may have implications for pelvic floor disorder propensity postpartum.Significance.These results confirm the ability of non-invasive MMG to reliably capture pelvic floor contraction as these signals correlate with clinical measure.

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Vertical loading rate (VLR) and pelvic floor muscle activity (PFA) increase with running velocity, which may indicate a relationship between VLR and PFA. Foot strike pattern has been shown to influence VLR while running, but little is known about its influence on PFA. Twenty healthy women ran on a treadmill for 2 conditions: with a rearfoot strike and with a forefoot strike. PFA was measured with electromyography. Running kinematics associated with VLR were collected using inertial measurement units and tibial accelerometers. Change scores between conditions were calculated for average PFA and running kinematics: peak vertical tibial acceleration, vertical excursion of the center of mass (VO), and cadence. Paired t tests assessed differences between running conditions for all variables. Pearson correlations assessed the relationships between changes in PFA and running kinematics. PFA was significantly higher during the forefoot compared with the rearfoot strike condition. Change in vertical tibial acceleration was positively correlated with change in PFA during the right stance. Change in cadence was negatively correlated, and change in vertical excursion of the center of mass was positively correlated with change in PFA during left stance. The average PFA increased during the forefoot strike pattern condition. Changes in PFA were correlated with changes in running kinematics associated with VLR.

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Background: Stress urinary incontinence, fecal incontinence, and pelvic organ prolapse are common forms of pelvic floor dysfunction. Pelvic floor muscle training is used to improve pelvic floor function, through a program of exercises. We conducted a health technology assessment of pelvic floor muscle training for people with stress urinary incontinence, fecal incontinence, or pelvic organ prolapse, which included an evaluation of effectiveness, safety, and the budget impact of publicly funding pelvic floor muscle training, and patient preferences and values. Methods: We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of included studies using the ROBIS tool, for systematic reviews, and the Cochrane Risk of Bias tool, for randomized controlled trials, and we assessed the quality of the body of evidence according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search but did not conduct a primary economic evaluation. We also analyzed the budget impact of publicly funding pelvic floor muscle training in adults with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse in Ontario. To contextualize the potential value of pelvic floor muscle training as a treatment, we spoke with people with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse. Results: We included 6 studies (4 systematic reviews and 2 randomized controlled trials) in the clinical evidence review. In comparison with no treatment, pelvic floor muscle training significantly improved symptom severity and increased patient satisfaction in women with stress urinary incontinence or pelvic organ prolapse (GRADE: Moderate). For men with stress urinary incontinence after prostatectomy, pelvic floor muscle training yielded mixed results for symptom improvement (GRADE: Very low). For adults with fecal incontinence, pelvic floor muscle training did not improve symptoms in comparison with standard care (GRADE: Very low).In the economic literature review, we included 6 cost-utility analyses that had evaluated the cost-effectiveness of pelvic floor muscle training as a treatment for people with pelvic organ prolapse or urinary incontinence. We did not identify any economic studies on pelvic floor muscle training for women or men with fecal incontinence or men with pelvic organ prolapse. The analyses included in our review found that, for women with stress urinary incontinence, pelvic floor muscle training was likely cost-effective in comparison with other nonsurgical interventions. For men with urinary incontinence after prostate surgery, pelvic floor muscle training was likely not cost-effective in comparison with standard care. For women with pelvic organ prolapse, the cost-effectiveness of pelvic floor muscle training in comparison with no active treatment was uncertain.The average cost of pelvic floor muscle training was approximately $763 per patient. Publicly funding pelvic floor muscle training for women with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse would result in additional costs over 5 years of $185.3 million, $275.6 million, and $85.8 million, respectively. Publicly funding pelvic floor muscle training for men with stress urinary incontinence and fecal incontinence would result in additional costs over 5 years of $10.8 million and $131.1 million, respectively. The people we spoke with reported that stress urinary incontinence, fecal incontinence, and pelvic organ prolapse limited their social and physical activities, taking a huge emotional toll. Many were hesitant or even fearful of surgery, and most people with experience of pelvic floor muscle training reported that it relieved most or all of their symptoms and allowed them to return to normal daily activities. Conclusions: Pelvic floor muscle training is likely more effective (with respect to symptom improvement and patient satisfaction) than no treatment for women with stress urinary incontinence or pelvic organ prolapse. Pelvic floor muscle training may yield mixed results with respect to symptom improvement for men with stress urinary incontinence after prostatectomy and have little to no effect on symptom improvement for adults with fecal incontinence. We estimate that publicly funding pelvic floor muscle training for adults with pelvic floor dysfunction (stress urinary incontinence, fecal incontinence, and pelvic organ prolapse) in Ontario would result in a substantial budget increase over the next 5 years. People with stress urinary incontinence, fecal incontinence, and pelvic organ prolapse shared the negative impact these conditions have on their social and physical life and valued pelvic floor muscle training as a nonsurgical treatment option.

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BACKGROUND: Urinary incontinence (UI) is a highly prevalent condition in women with a profound influence on their well-being and quality of life. Pelvic floor muscle training (PFMT) is a widely accepted conservative management of incontinence. Adequate knowledge of PFMT can enhance the ability of individuals to perform them effectively unsupervised. OBJECTIVES: This study aimed to determine the prevalence of UI and knowledge of PFMT among older women in a selected suburban community in Nigeria. DESIGN: A cross-sectional design. METHODS: This study consecutively recruited 121 older women (65 years and above) with a mean age of 68.59 ± 4.94 years in Nnewi North LGA Anambra state, Nigeria. The International Consultation on Incontinence Questionnaire Short Form and an adopted pre-tested questionnaire were used to assess the prevalence of UI and knowledge of PFMT. Data was analyzed using Statistical Package of Social Sciences (SPSS) version 26 Descriptive statistics, and the chi-square test was utilized with significance determined at an alpha level of 0.05. RESULTS: The results revealed that 33.88% of the respondents experience UI, and 3.3% of them have heard about PFMT. There was significant association between prevalence of UI and number of pregnancies (χ2 = 11.16, p = 0.03) and children (χ2 = 9.77, p = 0.04). There was no significant association between the prevalence of UI and level of education (χ2 = 4.20, p = 0.12) and knowledge of PFMT (χ2 = 0.48, p = 0.42). There was no significant association between knowledge of PFMT and number of pregnancies (χ2 = 04.25, p = 0.37), and number of children (χ2 = 4.02, p = 0.40). There was a significant association between knowledge of PFMT and level of education among the participants (χ2 = 7.46, p = 0.02). CONCLUSION: The study showed a significant prevalence of UI and poor knowledge of PFMT in older women. Health professionals should sensitize older women in hospitals and care homes on the benefits of PFMT to improve their knowledge of PFMT.

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OBJECTIVE: To observe the efficacy of pelvic floor muscle training combined with electroacupuncture (EA) for bladder dysfunction after incomplete spinal cord injury (SCI). METHODS: Ninety patients with bladder dysfunction after incomplete SCI were randomly divided into an EA group (30 cases), a pelvic floor muscle training group (30 cases, 1 case dropped out), and a combined group (30 cases, 1 case dropped out). All groups received routine rehabilitation. The EA group received EA at Zhongji (CV 3), Guanyuan (CV 4), Mingmen (GV 4), Yaoyangguan (GV 3), bilateral Shenshu (BL 23), Ciliao (BL 32), and Pangguangshu (BL 28), with continuous waves at frequency of 100 Hz, and the needles were retained for 30 min, once daily, 6 times a week for 6 weeks. The pelvic floor muscle training group underwent pelvic floor muscle training two times a day, for 6 weeks. The combined group received both EA and pelvic floor muscle training. The daily average number of urinations, daily average number of urinary leakages, urodynamic indexes (residual urine volume, maximum bladder capacity, bladder compliance, and maximum urine flow rate), and generic quality of life inventory-74 (GQOLI-74) were compared before and after treatment in each group. RESULTS: Compared before treatment, the daily average number of urinations and urinary leakages were decreased (P<0.05), residual urine volume, maximum bladder capacity, and bladder compliance were reduced (P<0.05), and maximum urine flow rate and GQOLI-74 scores were increased (P<0.05) after treatment in all groups. After treatment, the combined group showed greater differences in the daily average number of urinations, daily average number of urinary leakages, residual urine volume, maximum bladder capacity, bladder compliance, maximum urine flow rate, and GQOLI-74 score compared to the EA group and the pelvic floor muscle training group (P<0.05). There was no statistically significant differences in the changes in these indexes between the EA group and the pelvic floor muscle training group (P>0.05). CONCLUSION: Pelvic floor muscle training combined with EA can effectively alleviate urination problems in patients with bladder dysfunction after incomplete SCI, improve bladder function, and enhance patients' quality of life.

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BACKGROUND: Recently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy. METHODS: We retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients' clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients' complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups. RESULTS: The two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p < 0.001) and significantly lower postoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p < 0.001). CONCLUSIONS: The rug-weaving plication technique may offer a viable alternative for cystocele repair without mesh, using natural tissue and potentially reducing mesh-related complications and recurrence rates. CLINICAL TRIAL NUMBER: NCT06410469 (03/05/2024).

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BACKGROUND: Urinary incontinence (UI) negatively affects the well-being of women globally. Pelvic Floor Muscle Training (PFMT) is a complex intervention that aims to decrease UI symptoms. Information about how the multiple complex components involved in PFMT achieve and maintain the desired effect are rarely studied as a whole. The evidence base lacks data about how women experience PFMT over time and in the longer-term. This study explored women's experiences of biofeedback-assisted PFMT and PFMT alone, to identify and understand what influenced self-reported adherence to PFMT, and UI outcomes over time. METHODS: This rigorous longitudinal qualitative case study, nested within a randomised controlled trial, recruited forty cases (women with stress or mixed UI; 20 in biofeedback-assisted and 20 in PFMT alone group). A case included up to four semi-structured interviews with each woman (prior to starting PFMT, end of treatment [6 months], 12 months, 24 months). Analysis followed case study analytic traditions, resulting in a Programme Theory about PFMT from the perspectives of women with UI. FINDINGS: The theory demonstrates factors that motivated women to seek UI treatment, and how these influenced long-term adherence. Therapists who delivered PFMT played a crucial role in supporting women to know how to undertake PFMT (to have capability). Some, but not all, women developed self-efficacy for PFMT. Where women did not have PFMT self-efficacy, adherence tended to be poor. When women had PFMT self-efficacy, the conditions to support adherence were present, but contextual factors could still intercede to inhibit adherence. The intercession of contextual factors was individual to a woman and her life, meaning any particular contextual factor had inconsistent influences on PFMT adherence over time for individual women and exerted varying influences across different women. CONCLUSION: Long term adherence to PFMT is a complex interaction between many different factors. Enquiring about an individual woman's motivation to seek treatment and understanding the contextual factors that affect an individual woman will enable a practitioner to support longer-term adherence.

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PURPOSE: To explore the effectiveness of sling surgery followed by pelvic floor muscle exercises (PFME) or PFME alone for moderate stress urinary incontinence (SUI) in women and its influencing factors. METHODS: This is a prospective observational cohort study investigating whether sling surgery or PFME is preferred for pre-menopause women with moderate uncomplicated SUI. Those who received PFME alone or sling surgery were divided to PT or TVT group, respectively. The primary outcome was objective cure at 12 months. The secondary outcomes included Incontinence Impact Questionnaire-Short Form (IIQ-7) scores and PFME adherence. RESULTS: The study sample comprised 130 and 74 patients in the PT and TVT groups, respectively. There was 38.2% of patients adhered to PFME twice weekly or more often, and the compliance varied by education level. At 12 months, the objective cure rate was significantly higher in the TVT versus PT group (75.7% vs 47.7%; adjusted OR = 4.27; 95% CI, 2.05-8.87; P < 0.001). In addition, the mean reduction in IIQ-7 scores was greater in the TVT group (16.2 vs 10.0; adjusted OR = 3.38; 95% CI, 1.93-4.82; P < 0.001). However, among patients with lower education or those without adherence to PFME at 12 months, the TVT was also favorized, and the discrepancy in cure rates was greater between the two groups. CONCLUSION: Sling procedures followed by PFME demonstrate greater efficacy versus physiotherapy alone for moderate female SUI management. Continued adherence to PFME was important, even for patients undergoing sling procedures. Educational factors influenced patient PFME adherence and the advantage conferred by sling procedures.

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OBJECTIVE: To evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP). METHODS: This study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of p<0.05 will be considered for all statistical tests. ETHICS AND DISSEMINATION: This study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery.

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OBJECTIVE: Despite high prevalence and burden of pelvic floor dysfunctions (PFD), there is a limited number of scales assessing knowledge of pelvic floor health (PFH), and no studies comparing their psychometric or feasibility properties. The study aimed both to investigate the psychometric properties and feasibility of Incontinence Quiz (IQ), Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and Pelvic Floor Health Knowledge Questionnaire (PFHKQ), and to compare level of PFH knowledge in women with and without PFD. STUDY DESIGN: In this prospective cross-sectional study, a total of 150 women were included. After recording physical-sociodemographic characteristics, obstetric histories and menstrual status, Pelvic Floor Distress Inventory-20 and Female Sexual Function Index were administered to classify them into study groups as women with and without PFD. Their PFH knowledge was assessed using IQ, PIKQ and PFHKQ, which were filled twice with one week interval for the test-retest purpose. The scores, reliability, validity, ceiling-floor effects and feasibility of the knowledge scales were compared with each other, and between the study groups. RESULTS: IQ, PIKQ, and PFHKQ scores of women with and without PFD were similar. Based on response patterns to items, PFHKQ had the highest internal consistency followed by PIKQ and IQ. The PIKQ was the most stable scale across the total sample and in the PFD group. The PFHKQ had the highest ICC value in women without PFD. There was a strong correlation between the total scores of knowledge scales in both groups. Scores of knowledge and symptom scales were not significantly correlated. IQ was completed in the shortest time, and was easier to complete than PFHKQ. Only the diagnosis/treatment subscale of PFHKQ had a ceiling effect. CONCLUSION: It was concluded that PFH knowledge of women with and without PFD were at a low-moderate level and similar to each other; IQ, PIKQ and PFHKQ were reliable, valid and feasible scales, which can be used in measuring knowledge level about PFH.

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OBJECTIVE: We hypothesized that combination therapy would provide a synergistic effect to improve treatment outcomes for overactive bladder (OAB), thus enhancing the motivation for continuous exercise, and that it would be associated with fewer adverse events than monotherapy. Therefore, we investigated whether biofeedback-assisted pelvic floor muscle training (PFMT), drug therapy, or a combination of both would be more effective in improving the symptoms of OAB. STUDY DESIGN: This randomized controlled trial included women diagnosed with OAB. Group 1 received biofeedback-assisted pelvic muscle floor training (PFMT) for 12 weeks; group 2 took 5 mg of solifenacin/day for 12 weeks; and group 3 received 5 mg of solifenacin/day in combination with biofeedback-assisted PFMT during the first 4 weeks and biofeedback-assisted PFMT for another 8 weeks. All participants had 5 follow-up visits. The primary outcomes were objective improvement of OAB symptoms and quality of life. The secondary outcomes were treatment-related adverse events, subjective improvement of OAB symptoms, and electromyographic activity of pelvic floor muscle (PFM) contraction. RESULTS: All participants reported significant improvement of OAB symptoms and quality of life. Participants in group 2 experienced more pronounced adverse events than those in group 3. Intervention duration was positively associated with subjective improvement in OAB symptoms in groups 2 and 3. Drug-related adverse events, including dry mouth, myalgia, and restlessness, had a negative impact on the subjective improvement of OAB symptoms in group 2. In group 1, exercise adherence was positively correlated with subjective improvement of OAB symptoms, whereas in group 3, PFM contraction and biofeedback effect were positively correlated with symptom improvement. CONCLUSION: Combination therapy is efficacious in treating women with OAB.

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OBJECTIVES: To determine whether diastasis of the rectus abdominis muscles was related to stress urinary incontinence, dysfunction of pelvic floor muscles, and of hiatal area size in postpartum women. STUDY DESIGN: This observational prospective study included 150 women from 6 weeks to 6 months postpartum, with a mean age of 33.1 years. Diastasis Recti Abdominis is a condition in which the abdominal muscles are separated by an increased inter-rectus distance due to widening of the linea alba, measured using 2D ultrasound. Pelvic floor muscle function was examined using manometry, and the size of the hiatal area was examined using 3D/4D ultrasonography. Stress urinary incontinence symptoms were assessed using the International Incontinence Consultation Questionnaire (ICIQ-UI SF). RESULTS: We identified a significant weak correlation between diastasis of the rectus abdominis and symptoms of stress urinary incontinence (r = 0.283). We also found weak significant correlations of diastasis of the rectus abdominis with the maximum voluntary contraction (r = -0.278) and with the duration voluntary contraction (r = -0.274). No correlation was found between diastasis of the rectus abdominis and size of the hiatal area. CONCLUSIONS: Diastasis of the rectus abdominis was weakly related to stress urinary incontinence and also to pelvic floor muscle dysfunction.

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INTRODUCTION: Pelvic organ prolapse is a common condition in middle-aged and older women. Laparoscopic pelvic floor surgery is frequently researched as a treatment for this issue. However, the effectiveness of this procedure has only been the subject of a few studies. METHODS: To quantitatively evaluate and display the relevant literature from the Web of Science database, we set the publication period of the literature from 1996 to 2022 and used VOSviewer and CiteSpace for visual analysis. RESULTS: Laparoscopic pelvic floor surgery research has increased year-on-year, with 1003 publications identified from 63 countries and published in 210 journals. In the global ranking of studies, the United States was the leader (n = 306; 30.5 %), with the most published authors being Campagna, Giuseppe (n = 17) and Scambia, Giovanni (n = 17). The International urogynecology journal included the most significant articles (n = 173; 17.2 %). Keyword analysis suggests that complications, rectal prolapse, native tissue repair, and warranty may have become hotspots in recent years. CONCLUSIONS: This bibliometric study shows that the depth and breadth of research on pelvic floor laparoscopic surgery have expanded rapidly over the last twenty-five years and that laparoscopic surgery has been recognized by different scholars or countries as an essential modality for the treatment of pelvic floor organ prolapse.

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