Atypical cases of recurrent postcoital cystitis in women: acquired urethral hypermobility

Introduction. Recurrent postcoital cystitis is considered as a disease that is a consequence of certain congenital prerequisites in the structure of the lower parts of the urogenital tract in women. Materials and methods. When writing the article, we used data on the surgical treatment of recurrent postcoital cystitis in women, posted in the PubMed databases (https://www.ncbi.nlm.nih.gov/pubmed/) and the Scientific Electronic Library Elibrary.ru (https://elibrary.ru/). When searching the databases, the following keywords were used: postcoital cystitis , honeymoon cystitis , acquired postcoital cystitis , hymenotomy , urethrogenital adhesions ( postcoital cystitis , honeymoon cystitis , acquired postcoital cystitis , transposition of the urethra , hymenotomy , urethro-hymenal fusion ). Results. Patients with recurrent postcoital cystitis represent a heterogeneous group from an etiological point of view. A detailed analysis of complaints and anamnesis of the disease, as well as the causes, conditions and time of recurrence of cystitis helps to clarify the pathogenesis of the disease in each case. The article presents clinical cases of acquired recurrent postcoital cystitis in women who have previously undergone surgery on the lower urinary tract. Conclusion. Recurrent postcoital cystitis can be the result of not only congenital anatomical prerequisites, but also acquired changes in the urogenital area due to surgery or injury.

Electromyostimulation in the treatment of early forms of postpartum pelvic floor dysfunction

Objective. To study the results of electromyostimulation using an electrical device Tonis in patients with minimal signs of postpartum pelvic floor trauma. Patients and methods. The study included 24 women aged 20–32 years (27.4 (24.4; 29.1)) who were observed 6–12 months after delivery of their first child through vaginal childbirth in a cephalic presentation and whose examination revealed minimal signs of pelvic floor trauma or dysfunction. The electromyostimulation trainer Tonis was used 20 minutes daily (postpartum rehabilitation program) for 3 months. Results. After 3 months of training, in all patients, previously minimal complaints ceased. The POP-Q measurements significantly improved almost in all patients: the uterus was in a higher position, the topography of both the anterior and posterior vaginal walls improved, and the genital hiatus narrowed. Conclusion. Transperineal ultrasound showed a statistically significant improvement in the height of the central tendon of the perineum and in the muscle mass, the number of patients with muscle diastasis decreased, urethral hypermobility also decreased. Key words: postpartum rehabilitation, POP-Q system, transperineal ultrasound, electromyostimulation

Present value of the Urethral mobility test as a tool to assess Stress urinary incontinence due to Intrinsic sphincteric deficiency

Q-tip test offers a simple approach for identifying urethral hypermobility. Considering surgical treatment, stress urinary incontinence (SUI) must be classified and the contribution of intrinsic sphincter deficiency (ISD) and/or urethral hypermobility must be determine. We believe there's a correlation between abdominal leak point pressure (ALPP) and urethral mobility degree, and the aim of this study is to explore it using Q-tip. We conducted a prospective study, between years 2014 and 2016. Females over 18 years presenting with signs and symptoms of SUI according to the 2002 ICS Standardization of Terminology were included. Assessment was made with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Q-tip test and invasive urodynamics. Urethral mobility (UM) and ALPP were analyzed. We built two composite variables based on reported risk factors for ISD, defined as composite variable A (equal to a Q-tip test < 30° AND ICIQ-SF ≥ 10 points) and composite variable B (equal to low urethral mobility AND/OR hypoestrogenism AND/OR history of radiotherapy AND/OR previous pelvic surgery). Correlation analyzes were made according to the type of variable. A total of 221 patients were included. Incontinence was rated as moderate and severe by 65.3% and 6.8%, respectively. The analysis showed a 61.75%, 51.61% and 70.6% agreement between ALPP and UM, ALPP and composite variable A and ALPP and composite variable B respectively. Correlation and concordances were low (r = 0.155, r_s = − 0.053 and r_s = − 0.008), (rho_c = 0.036, k = 0.116 and k = 0.016). Neither the degree of UM, nor the composite variables, correlate or agree with urethral function tests in UDS, suggesting that the ALPP cannot be predicted using the Q-tip test or the ICIQ-SF for classifying patients with SUI.

Behaviour of urinary incontinence in the face of sacrocolpopexy

The aim of this study was to determine whether an association exists between the performance of a sacrocolpopexy for genital prolapse and the bladder function. A case series study was performed that includes all patients who received sacrocolpopexy in a tertiary Spanish hospital. An analysis was performed to study the association of some variables and the occurrence or persistence of urinary incontinence after the surgery. Forty patients with indication of sacrocolpopexy were included. A year after sacrocolpopexy, the outcomes showed 97.3% of prolapse healing. 19.3% complained about de novo stress urinary incontinence, 33.3% recovered from it and another 66.7% remained the same. Only 10.8% asked for an anti-incontinence surgery after the sacrocolpopexy. The urethral hypermobility shows an increased risk of stress urinary incontinence after the sacrocolpopexy. Based on our results, we do not consider it necessary to perform a systematic antiincontinence procedure simultaneously with sacrocolpopexy unless a woman without urethral anti-incontinence surgical background shows a urethral hypermobility.

The Single-Incision Sling to Treat Female Stress Urinary Incontinence: A Dynamic Computational Study of Outcomes and Risk Factors

Dynamic behaviors of the single-incision sling (SIS) to correct urethral hypermobility are investigated via dynamic biomechanical analysis using a computational model of the female pelvis, developed from a female subject's high-resolution magnetic resonance (MR) images. The urethral hypermobility is simulated by weakening the levator ani muscle in the pelvic model. Four positions along the posterior urethra (proximal, midproximal, middle, and mid-distal) were considered for sling implantation. The α-angle, urethral excursion angle, and sling–urethra interaction force generated during Valsalva maneuver were quantitatively characterized to evaluate the effect of the sling implantation position on treatment outcomes and potential complications. Results show concern for overcorrection with a sling implanted at the bladder neck, based on a relatively larger sling–urethra interaction force of 1.77 N at the proximal implantation position (compared with 0.25 N at mid-distal implantation position). A sling implanted at the mid-distal urethral location provided sufficient correction (urethral excursion angle of 23.8 deg after mid-distal sling implantation versus 24.4 deg in the intact case) with minimal risk of overtightening and represents the optimal choice for sling surgery. This study represents the first effort utilizing a comprehensive pelvic model to investigate the performance of an implanted sling to correct urethral hypermobility. The computational modeling approach presented in the study can also be used to advance presurgery planning, sling product design, and to enhance our understanding of various surgical risk factors which are difficult to obtain in clinical practice.