Női kismedencei funkciózavarok keresztmetszeti vizsgálata magyarországi populáción

Összefoglaló. Bevezetés és célkitűzés: A női kismedencei funkciózavarok változatos tünetekkel jelentkezhetnek, és jelentősen befolyásolják az érintettek életminőségét. Vizsgálatunk célja volt felmérni a medencefenék-diszfunkciós tüneteket és azok hatását az egyén életminőségére. Módszer: Vizsgálatunkba 203 nőt vontunk be. Az adatgyűjtést két kérdőív, egy általunk összeállított és az Australian Pelvic Floor Questionnaire segítségével végeztük. Az adatok statisztikai elemzéséhez SPSS 20.0 rendszert használtunk. Spearman-korrelációt, khi-négyzet-próbát, Mann–Whitney-féle U-tesztet, Kruskal–Wallis-próbát és többváltozós lineáris regressziót alkalmaztunk. A szignifikanciaszintet p≤0,05 határnál állapítottuk meg. Eredmények: A hólyagdiszfunkciók gyakorisága (56,2%) szignifikáns kapcsolatot mutatott az életkor növekedésével (p<0,001), az obesitassal (p<0,001), a szülésszámmal és -móddal (p<0,001; p<0,001), az episiotomiával (p<0,001) és a prolapsusműtétekkel (p = 0,010). A süllyedéses kismedencei kórképek gyakorisága (27,1%) szignifikáns kapcsolatot mutatott az életkor növekedésével (p = 0,002), a szülésszámmal és -móddal (p<0,001; p<0,001) és a korábbi episiotomiával (p<0,001). Az analis incontinentia gyakorisága (58,9%) a magasabb testtömegindexszel (p = 0,029) volt szignifikáns kapcsolatban. Szexuális diszfunkciót (53,2%) allergia és tüdőbetegségek (p = 0,048) jelenlétével kapcsolatban találtunk. A többes diszfunkció előfordulási gyakorisága az életkor növekedésével (p<0,001), az obesitassal (p = 0,043), a korábbi hysterectomiával (p = 0,046) és prolapsusműtétekkel (p<0,001) mutatott szignifikáns kapcsolatot. Minden diszfunkció esetén kimutatható volt az életminőség-romlás (hólyagfunkciók: p<0,001; bél- és székletürítési funkciók: p<0,001, hüvelyfali süllyedés: p<0,001, szexuális funkciók: p<0,001). Következtetés: Az általunk vizsgált női populációban nagy arányban találtunk kismedencei funkciózavarokat, melyek kedvezőtlen hatással voltak az érintettek életminőségére. Orv Hetil. 2021; 162(43): 1724–1731. Summary. Introduction and objective: Pelvic floor dysfunction (PFD) can cause several complaints in women and has an adverse effect on the quality of life (Qol). The aim of our study was to evaluate the prevalence of pelvic floor dysfunction and its effect on Qol. Method: 203 women were included. We used two questionnaires, a self-constructed and the Australian Pelvic Floor Questionnaire. Statistical analysis was performed by SPSS 20.0. Spearman’s correlation, chi-square, Mann–Whitney U, Kruskal–Wallis tests and multivariate linear regression were used. Statistical significance was set at p≤0.05. Results: There was a significant association between the prevalence of urinary incontinence (56.2%) and age (p<0.001), obesity (p<0.001), number and mode of deliveries (p<0.001; p<0.001), episiotomy (p<0.001) and pelvic organ prolapse (POP) surgery (p = 0.010); between the occurrence of POP (27.1%) and age (p = 0.002), the number and mode of deliveries (p<0.001; p<0.001) and episiotomy (p<0.001); between the prevalence of anal incontinence (58.9%) and obesity (p = 0.029); between sexual dysfunction (SD) (53.2%) and respiratory disease and allergy (p = 0.048). Multiple PFD was significantly associated with age (p<0.001), obesity (p = 0.043), hysterectomy (p = 0.046) and POP surgery (p = 0.010). There was a significant difference between women having more severe PFD than milder complaints regarding Qol (bladder p<0.001; bowel p<0.001; SD p<0.001 and POP p<0.001). Conclusion: Pelvic floor dysfunction was common in our study population and had a great adverse effect on Qol. Orv Hetil. 2021; 162(43): 1724–1731.

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Quo Vadis Urogynecology 2020 – Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1302-7803 ◽

2021 ◽

Vol 81 (02) ◽

pp. 183-190

Author(s):

Gert Naumann

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Professional Training ◽

Pelvic Floor Dysfunction ◽

Estrogen Therapy ◽

Pelvic Organ ◽

Alloplastic Materials ◽

Wide Range ◽

Quo Vadis

AbstractThe current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patientʼs state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.

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Arabic translation, cultural adaptation, and validation of Australian Pelvic Floor Questionnaire in a Saudi population

BMC Women s Health ◽

10.1186/s12905-020-01144-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Haifaa Malaekah ◽

Haifaa Saud Al Medbel ◽

Sameerah Al Mowallad ◽

Zahra Al Asiri ◽

Alhanouf Albadrani ◽

...

Keyword(s):

Pelvic Floor ◽

Cultural Adaptation ◽

Pelvic Floor Dysfunction ◽

Bowel Function ◽

Internal Consistency Reliability ◽

Bladder Function ◽

Arabic Version ◽

Saudi Population ◽

Prolapse Symptoms ◽

Pelvic Floor Questionnaire

Abstract Introduction and hypothesis The aims of the study were the translation, cultural adaptation, and validation of self-administered Australian Pelvic Floor Questionnaire (APFQ) on a Saudi population. Methods The translation and cultural adaptation was performed in 854 women over 18 and not pregnant who agreed to answer the Arabic version of the questionnaire. The content/face validity, internal consistency (reliability), and construct validity (factor analysis) were assessed. Statistical analysis was carried out using SPSS 24.0 statistical software. Results The Cronbach’s alpha results were above 0.8 for the questionnaire’s overall reliability (bladder function: 0.877, bowel function: 0.834, prolapse symptoms: 0.784, sexual function: 0.762) showing adequate internal consistency reliability and high statistical significance. A statistically significant correlation was observed among the 40 items of the questionnaire. The issue of multicollinearity was not found, and the determinant of the correlation matrix was 0.001. A value of > 0.5 was achieved when the Kaiser–Meyer–Olkin and Bartlett’s tests measured 0.806 and the Bartlett’s test of sphericity was statistically significant χ2 (780) = 4150.46 (p < 0.001). The values of loading indicate that all 4 factors (bladder function, bowel function, prolapse symptoms, sexual function) contributed to each of their items. Conclusions This study provides the Arabic version of the self-administered APFQ as a reliable and valid instrument for evaluating symptom severity and impact of pelvic floor dysfunction on the quality of life of Arabic women. It also will enable the researchers from Arab countries to use this instrument to assess pelvic floor dysfunction prevalence in their settings.

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Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods

Medicina ◽

10.3390/medicina57040387 ◽

2021 ◽

Vol 57 (4) ◽

pp. 387

Author(s):

Karolina Eva Romeikienė ◽

Daiva Bartkevičienė

Keyword(s):

Clinical Trials ◽

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Randomized Clinical Trials ◽

Pelvic Floor Muscle Training ◽

Pelvic Floor Muscle ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

Cochrane Library ◽

Muscle Training

Every woman needs to know about the importance of the function of pelvic-floor muscles and pelvic organ prolapse prevention, especially pregnant women because parity and labor are the factors which have the biggest influence on having pelvic organ prolapse in the future. In this article, we searched for methods of training and rehabilitation in prepartum and postpartum periods and their effectiveness. The search for publications in English was made in two databases during the period from August 2020 to October 2020 in Cochrane Library and PubMed. 77 articles were left in total after selection—9 systematic reviews and 68 clinical trials. Existing full-text papers were reviewed after this selection. Unfinished randomized clinical trials, those which were designed as strategies for national health systems, and those which were not pelvic-floor muscle-training-specified were excluded after this step. Most trials were high to moderate overall risk of bias. Many of reviews had low quality of evidence. Despite clinical heterogeneity among the clinical trials, pelvic-floor muscle training shows promising results. Most of the studies demonstrate the positive effect of pelvic-floor muscle training in prepartum and postpartum periods on pelvic-floor dysfunction prevention, in particular in urinary incontinence symptoms. However more high-quality, standardized, long-follow-up-period studies are needed.

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Sexual function in women with pelvic floor disorders

Canadian Urological Association Journal ◽

10.5489/cuaj.1625 ◽

2013 ◽

Vol 7 (9-10) ◽

pp. 199 ◽

Cited By ~ 11

Author(s):

Rebecca G. Rogers

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Sexual Function ◽

Pelvic Floor ◽

Pelvic Floor Disorders ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

The Impact

Pelvic floor disorders (PFDs) can impact sexual function. This summary provides an overview of the impact of stress urinary incontinence and pelvic organ prolapse and their treatments on sexual function. In general, interventions that successfully address PFDs will generally improve sexual function as well. However, there are patients whose sexual function will remain unchanged despite treatment, and a small but significant minority who will report worsened sexual function following treatment for their pelvic floor dysfunction.

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bFGF Activates Integrin β1 and Subsequently Upregulates Collagens via the p-MEK1/2/p-ERK1/2 Signaling Pathway in L929 Cells

10.21203/rs.3.rs-296400/v1 ◽

2021 ◽

Author(s):

Lian Yang ◽

Shasha Hong ◽

Yang Li ◽

Tingting Wang ◽

Li Hong

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Signaling Pathway ◽

Pelvic Floor Dysfunction ◽

Underlying Mechanism ◽

Pelvic Organ ◽

Integrin Β1 ◽

L929 Cells ◽

Signal Transduction Protein ◽

Special Project

Abstract The substantial loss of collagen in the supporting tissues of the pelvic floor is characteristic of pelvic organ prolapse (POP). A bFGF-induced collagen increase has been widely recognized by scholars, but the role of bFGF in pelvic floor dysfunction and the mechanism by which bFGF promotes collagen have not been reported. Here, we elucidated this mechanism. After bFGF stimulation, L929 cells showed significantly increased expression of collagen, integrin β1, and MEK1/2 signaling proteins. Our previous studies showed that integrin β1 plays an important role in electric stimulation-induced collagen expression, which suggests an underlying mechanism. By overexpressing and silencing integrin β1, we proved that integrin β1 is also an important signal transduction protein of bFGF that promotes collagen through the MEK1/2 pathway, which is a classic collagen-promoting pathway. In summary, these findings suggest that bFGF can stimulate the expression of collagen through the integrin β1/p-MEK1/2/p-ERK/1/2 signaling pathway in L929 cells. Keyword Pelvic organ prolapse; bFGF; integrinβ1; ERK1/2; Collagen Special project for Chinese women's pelvic floor dysfunction prevention and treatment (no. 201817092) and the Natural Science Foundation of Hubei Province（no.2019CFB149）.

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Role of Magnetic Resonance defecography in assessment of pelvic floor dysfunction

QJM ◽

10.1093/qjmed/hcaa068.015a ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M S Moussa ◽

Y I Abdelkhaleq ◽

S M Botros ◽

A A Montasser

Keyword(s):

Pelvic Organ Prolapse ◽

Physical Examination ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

Magnetic Resonance Defecography ◽

Facial Defect ◽

Floor Failure ◽

Muscle Tear

Abstract Purpose to assess the role of the role of MR defecography in assessment of pelvic floor failure . Methods and Material Thirty-six patients (twenty-seven female and nine male) with female and male patients, complaining of stress urinary incontinence, constipation, fecal incontinence or pelvic organ prolapse. Results MRI revealed 18 cystocele (50%), compared to physical examination 2 cases(5.6%),MRI revealed 28 rectocele ( 77.8%) compared to physical examination that showed 13 (36.1%) , MRI revealed 10 uterine descent (40.7%), compared to physical examination 6 (22.2%) I, MRI revealed 7 enterocele (19.4%) compared to physical examination that was negative. MRI revealed level I/II facial defect in and level III facial defect in, 19 cases of Intussusception (52.8%), urethral hypermobility in 14 (38.9%), sphincteric defect 7 (19.4%), levator angle weakness in 30 cases (83.3%), iliococcygeaus muscle tear in 5 cases (13.9%), puborectalis tear in 3 cases (8.3%),anorectal decent in 26 cases (72.2%), genital hiatus width in 23 (63.9%) Conclusion Dynamic MR imaging is a necessary tool in the diagnosis of multicompartment pelvic organ prolapse and it provides good concordance with clinical examination

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Pelvic Organ Prolapse and Pelvic Floor Dysfunction

General Gynecology ◽

10.1016/b978-032303247-6.10023-1 ◽

2007 ◽

pp. 543-581

Author(s):

Andrew I. Sokol ◽

Mark D. Walters

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ

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Correlation of Pelvic Organ Prolapse Quantification Technique with Pelvic Floor Dysfunction Symptoms

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i3.22169 ◽

2019 ◽

Vol 3 (3) ◽

pp. 528-531

Author(s):

Tarun Pradhan ◽

Pappu Rijal ◽

Baburam Dixit Thapa ◽

Rabindra Dev Bhatta ◽

Mohsina Hakkim ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Pelvic Floor Dysfunction ◽

Pelvic Organ ◽

Observer Variation ◽

Anatomical Site ◽

Significant Relation ◽

Site Specific ◽

Genital Hiatus ◽

A Prospective Study

Introduction: Assessment of POP by POP-Q gives anatomical site-specific measurement, which helps in surgery, follow-up and reduces inter-observer variation. The Pelvic Floor Distress Inventory (PFDI) is condition-specific health-related quality of life questionnaires for women with pelvic floor disorders. Objective: To assess pelvic organ prolapse by POP-Q technique and to correlate pelvic floor distress inventory questionnaire with POP-Q segments. Methodology A prospective study was done from March 2014 to February 2015 after ethical approval from IRC, B.P. Koirala Institute of Health Sciences. All patients with pelvic organ prolapse were included after informed verbal consent. The patients were then asked questions as in pelvic floor distress inventory questionnaire (PFDI) and noted in performa. The patients were then examined by POP-Q technique and noted. The informations were entered in the MS excel chart and statistical analysis done using SPSS 11.5. Results: There were 72 patients enrolled. The mean age of patients was 53.65 years. Majority of patients were found to have stage 4 prolapse (43.1%). POP-Q examination showed majority of patients had anterior and apical compartment defect. Correlation between POP-Q points and urinary symptoms showed significant relation with points in anterior compartment, genital hiatus and perineal bodies. Correlation with POP-Q points with colorectal symptoms showed involvement of genital hiatus significantly with strain stool and incomplete bowel movement. Correlation with pelvic distress symptoms with POP-Q sites showed significant relation with bulging, push up vagina for urination and defecation. Conclusion: POP-Q site specific points showed significant correlation with symptoms from Pelvic Floor Distress Inventry (PFDI) questionnaires.

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MRI comparative study of levator ani muscle changes in nulliparous and multiparous females

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0065-0 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Heba Azzam ◽

Manal Halim ◽

Hany El-Assaly ◽

Aya Heiba

Keyword(s):

Pelvic Floor ◽

Treatment Plan ◽

Pelvic Floor Dysfunction ◽

Levator Ani ◽

Control Group ◽

Puborectalis Muscle ◽

Levator Ani Muscle ◽

Vaginal Deliveries ◽

Significant Difference ◽

Muscle Changes

Abstract Background Pelvic floor dysfunction is known to be among the principal factors influencing public health, regarding frequency, cost and effect on women’s quality of life. Radiographic assessment of the pelvic floor function and anatomy plays a vital role in the recognition of pelvic floor defects. The aim of this study is to detect the postpartum-related levator ani muscle changes thus defining the relationship between the vaginal deliveries and the etiology of pelvic floor dysfunction in order to provide guidelines to decrease the incidence of pelvic floor injuries during parturition and guide the treatment plan. Results There was a significant difference in the puborectalis muscle thickness between the case and control groups in the right puborectalis (P value ≤ 0.001) and in the left puborectalis (P value (≤ 0.001) as well as significant midpoint thickness (P value = 0.03) with 46.2% puborectalis muscle injury in the case group compared with none in the control group. Conclusion Pelvic floor MRI is highly recommended as it is a contrast-free modality that allows for both anatomical and functional analysis. Its incorporation in the routine postpartum assessment will allow early detection of abnormalities even in asymptomatic cases thus ensuring proper management and preventing the development of pelvic floor dysfunction predisposed to by repeated vaginal deliveries.

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