Search Results (257)

Background: Endoscopic sacrocolpopexy (ESC) is a widely performed procedure for pelvic organ prolapse, with laparoscopic sacrocolpopexy (LSC) and robotic-assisted sacrocolpopexy (RSC) approaches. However, suturing to the anterior longitudinal ligament at the sacral promontory carries a risk of massive hemorrhage due to presacral vascular injury. This study aimed to determine the frequency of presacral venous variations considered clinically relevant during suturing at the promontory and to explore their association with perioperative outcomes using contrast-enhanced three-dimensional computed tomography (3D-CT). Methods: Among 319 consecutive ESC cases performed between 2014 and 2025, 265 patients who underwent preoperative contrast-enhanced CT were retrospectively analyzed in this single-center cohort study. Two vascular findings were defined as clinically significant: (1) anomalous drainage of the internal iliac vein into the contralateral common iliac vein and (2) a clearly visualized median sacral vein on 3D reconstruction. The clinical impact of vascular abnormalities was evaluated using surgical time, blood loss, and perioperative complication rates as indicators. Student’s t-test was used for comparing continuous variables, and the chi-squared test was used for comparing categorical variables. The data for this study were retrospectively collected from electronic medical records, anonymized, and then analyzed. Results: Anomalous internal iliac vein drainage was observed in 11.3% (30/265), and a visible median sacral vein was observed in 10.2% (27/265). Overall, 17.7% (47/265, CI: 13.2–22.2%) of patients had at least one clinically significant variation. There were no significant differences between the groups in terms of age, parity, BMI, operative time, blood loss, or perioperative complication rates. No cases required transfusion. Conclusions: Clinically significant presacral vein mutations were present in approximately 1 in 6 patients. The main findings of this study are that clinically significant presacral vascular mutations are relatively frequent (17.7%) in ESC and that there was no significant difference in perioperative outcomes between patients with and without vascular mutations. Clinically relevant presacral vascular variations are relatively common in ESC. Preoperative contrast-enhanced 3D-CT may support risk assessment and surgical planning. Full article

Pelvic organ prolapse (POP) is a common benign gynecological disorder that substantially affects quality of life, particularly in aging female populations. Current management strategies, including standardized vaginal pessaries and synthetic surgical meshes, are often limited by poor anatomical adaptability, mechanical mismatch with native pelvic tissues, and long-term safety concerns. These limitations have driven increasing interest in personalized and biomechanically compatible therapeutic solutions. Three-dimensional (3D) printing, also known as additive manufacturing, has emerged as a promising bioengineering technology to address these unmet clinical needs. By enabling layer-by-layer fabrication directly from digital models, 3D printing allows for precise control over device geometry, mechanical properties, and material composition, facilitating patient-specific design. This narrative review summarizes recent progress in 3D printing for POP management across three major application domains: (i) next-generation meshes based on biodegradable polymers, elastomeric materials, natural biomaterials, and hydrogel systems; (ii) customized vaginal pessaries tailored to individual pelvic anatomy using imaging-assisted workflows; and (iii) imaging-based pelvic models and prototype devices for surgical planning, education, and exploratory assessment. Overall, existing studies demonstrate that 3D printing enables improved biomechanical compatibility, enhanced tissue integration, and multifunctional device design, including drug delivery capability. Although current evidence is largely pre-clinical or based on pilot studies, additive manufacturing holds strong potential to advance POP management toward safer, personalized, and functionally optimized clinical solutions. Full article

Apical prolapse, a common form of Pelvic Organ Prolapse (POP), is often linked to weakened support structures such as the uterosacral (USL) and cardinal ligaments (CL), influenced by factors like vaginal childbirth, aging, and obesity. Although surgical mesh use is expected to increase, the Food and Drug Administration (FDA) banned polypropylene mesh for transvaginal anterior compartment prolapse in 2019 due to safety concerns, highlighting the need for alternatives such as biodegradable implants. This study developed four biodegradable mesh implants (square and sinusoidal geometries) mimicking the USL and CL. These were applied within a computational pelvic model to assess biomechanical behavior during the Valsalva maneuver and to explore different fixation methods (continuous, interrupted and simple stitch sutures). Baseline analysis of the healthy model established vaginal displacement under normal conditions. Without implant support, complete CL rupture increased displacement by 34%, and complete USL rupture raised displacement by 69%. Polycaprolactone implants consistently reduced anterior vaginal wall displacement in all impairment scenarios. Square implants mimicking the USL reduced displacement by up to 10% in cases of complete USL rupture with intact CL. Similarly, square implants mimicking the CL reduced displacement by up to 15% with complete CL rupture and healthy USL. Simulations with both ligaments impaired showed that USL contribute to support, while CL play a key role in stabilization. These findings demonstrate the potential of biodegradable implants to enhance POP repair. However, further studies are needed to evaluate long-term degradation and clinical applicability. Full article

Background/Objectives: Hernia and pelvic organ prolapse often involve defects necessitating reinforcement with synthetic materials. Polypropylene meshes of varying weights are commonly used in abdominal wall repair; however, their impact on tissue response, potentially linked to adverse events during wound healing, remains incompletely understood. This study aimed to evaluate and compare the tissue response to lightweight polypropylene (LWPP) and heavyweight polypropylene (HWPP) grafts used for abdominal wall defect closure in Wistar rats. Methods: Abdominal wall defects were surgically created in male Wistar rats and repaired using either LWPP (43 g/m²) or HWPP (76 g/m²) mesh. Three weeks post-implantation, tissue response and wound closure were evaluated across different phases by assessing expression of CD68, CD56, GATA-3, CD138, vimentin, α-smooth muscle actin, and collagen deposition. Results: HWPP promoted a more pronounced foreign body response, as evidenced by increased CD68, CD56, and CD138 expression, while LWPP improved tissue compliance, enhanced fibroblast migration, and increased vimentin-associated cellular activity. Conclusions: Three weeks post-implantation, HWPP was found to induce a stronger inflammatory response, whereas LWPP implantation was associated with increased vimentin expression, indicating differences in the balance between inflammation and extracellular matrix remodelling during early wound healing. Full article

Background/Objectives: Non-ablative vaginal Erbium-doped Yttrium Aluminium Garnet (Er:YAG) laser therapy has been proposed as a minimally invasive option for pelvic floor dysfunction (PFD), yet objective anatomical data using standardized measures remain limited. This study evaluated short-term anatomical and functional outcomes in a real-world care setting. Methods: This prospective single-arm interventional cohort study included women with PFD who underwent two sessions of non-ablative vaginal Er:YAG laser therapy. Outcomes were assessed at baseline, first follow-up (FU1), and second follow-up (FU2). Anatomical changes were measured using POP-Q parameters, including vaginal hiatus (Gh), total vaginal length (TVL), and compartmental staging. Sexual function was evaluated using the Female Sexual Function Index (FSFI). Pelvic floor muscle strength was assessed using the Oxford Scale. Non-parametric tests were used for repeated measures, and correlations between delivered laser energy and clinical outcomes were explored. Results: A total of 163 women were enrolled; 136 completed FU1 and 59 completed FU2. Median vaginal hiatus decreased significantly from baseline to FU1 and remained reduced at FU2 (p < 0.001). Improvements in anterior and posterior prolapse staging were observed, with a shift toward lower POP-Q stages at both follow-up visits. FSFI total scores did not change significantly across visits, although small changes were observed in specific domains, including a transient decrease in orgasms at FU1 (Δ = −0.2, p = 0.021) and a modest improvement in pain at FU2 (Δ = −0.4, p = 0.045). The magnitude of anatomical changes was modest, and their clinical relevance remains uncertain. Conclusions: Non-ablative vaginal Er:YAG laser therapy was associated with short-term improvements in vaginal hiatus and POP-Q prolapse staging in women with PFD, while sexual function remained stable. These findings provide objective anatomical data on early treatment effects in routine care, informing future evaluation of minimally invasive care models for pelvic floor dysfunction. Full article

Background and Objectives: The close anatomical relationship between pelvic support structures and the lower urinary tract contributes to high rates of urinary dysfunction among patients with pelvic organ prolapse (POP). POP reduction alone has been shown to alter urinary tract functioning. The aim of this study was to assess urinary functioning outcomes following a novel reconstructive surgical technique for POP. Materials and Methods: This randomized controlled trial was conducted between September 2024 and December 2025. The trial was registered in the German Clinical Trials Register (identifier: DRKS00038206), on 27 October 2025. Participants were randomly assigned to undergo either conventional laparoscopic sacrocervicopexy or the modified technique. Urinary outcomes were assessed using the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ-UI), the Urogenital Distress Inventory Short Form (UDI-6), the cough test, and urodynamic testing. Assessments were performed prior to surgery and at a 6-month follow-up. Results: Both the classical and modified techniques resulted in significant improvements in ICIQ-UI and UDI-6 scores. However, no statistically significant differences were observed between groups. De novo SUI occurred in 14.3% of patients in the classical technique group and in no patients in the modified technique group. Conclusions: Urinary symptoms improved in both groups, with no statistically significant between-group differences. De novo SUI occurred only in the classical technique group, but this finding should be interpreted cautiously given the limited sample size. These results are exploratory and hypothesis-generating, and larger studies with longer follow-up are needed to clarify whether true between-group differences in postoperative continence outcomes exist. Full article

Background/Objectives: This study investigates the predictive role of pre-operative sonographic assessment of ovarian mobility in determining intra-operative ovarian resectability among patients undergoing vaginal hysterectomy for pelvic organ prolapse. Methods: This prospective study was conducted in a tertiary academic urogynecology center. Women with pelvic organ prolapse scheduled for vaginal hysterectomy were consecutively recruited after providing informed consent. Pre-operatively, all patients had a detailed history, pelvic examination (POP-Q), and pelvic floor ultrasound (including assessment of the mobility of both ovaries and sonographic determination of ovarian descent in relation to the pelvic ischial spines). Patients were planned for vaginal hysterectomy, anterior and posterior colporrhaphy, McCall culdoplasty, and bilateral salpingo-oophorectomy (SO), where feasible. During surgery, the location and mobility of the ovaries, as well as the presence of peri-ovarian adhesions, were recorded. Pair-to-pair comparisons between sonographic and clinical findings were performed. Results: From February 2023 to January 2024, 50 Caucasian adult women underwent reconstructive vaginal surgery for prolapse. Thirty-five patients underwent concomitant bilateral SO via vaginal route, seven underwent unilateral SO, and three under went salpingectomy only. ROC analysis indicated that pre-operative ultrasound assessment of ovarian mobility predicts: (1) intra-operative ovarian mobility (sensitivity 95.6%, specificity 77.8%); (2) the presence of peri-ovarian adhesions (sensitivity 46.1%, specificity 94.2%); and (3) resectability, i.e., the ability to perform SO via the vaginal route (sensitivity 96.4%, specificity 50.0%). The absence of ovarian mobility was not associated with an increased risk of intra-operative and post-operative complications. Conclusions: Pre-operative sonographic assessment of ovarian location and mobility can predict ovarian location and resectability during vaginal surgery with high diagnostic accuracy. Full article

Background/Objectives: Pelvic floor disorders (PFDs), which include pelvic organ prolapse and urinary incontinence, are common conditions that often affect sexual health, but remain under-assessed within routine care. The following cases are presented to demonstrate the potential of a brief sexual health questionnaire in pelvic floor clinics and to explore how sexual function varies across common PFD phenotypes. Methods: A pilot case series was conducted with a group of five sexually active women diagnosed with PFDs at the Materno-Infantil University Hospital in Gran Canaria, Spain, between January and December 2025. Patients completed the Female Sexual Function Index (FSFI) at the index visit. Results: Mean age was 40.6 years (range 35–46), mean parity was 1.6 births and 60% were active smokers. Mean FSFI total score was 26.9 (range 21.4–32.2) and 60% scored below 26.55. Desire and arousal were relatively preserved (means 5.0 and 4.9), whereas lubrication (3.4) and satisfaction (3.9) showed greater variability. Pain scores were low overall (mean 5.2). Self-rated sexual satisfaction was low in 40%, moderate in 40% and high in 20%. Moderate-to-high anticipatory sexual anxiety was present in 80%. Conclusions: Integrating a concise questionnaire based on the FSFI into the pelvic floor consultation appears to be a reasonable approach, with the potential to address secondary sexual dysfunction in patients with PFD, thereby facilitating personalised counselling and treatment. Full article

Additive manufacturing (AM) offers new opportunities for biomedical device design; however, its translation to soft-tissue reinforcement remains challenging, particularly in pelvic organ prolapse (POP) applications requiring mechanical performance and tissue compatibility. In this study, a hybrid AM approach combining melt electrowriting (MEW) and controlled post-processing was developed to fabricate biodegradable poly(ε-caprolactone) (PCL) cog threads for minimally invasive pelvic reinforcement. This integrated fabrication workflow enables the precise deposition of microscale fibers via MEW followed by localized mechanical modification, offering a versatile platform for tailoring graft architecture and anchoring geometry. Smooth filaments were first produced via MEW and subsequently post-processed to introduce barbs for mechanical anchorage. The resulting structures were mechanically characterized through uniaxial tensile testing and evaluated as reinforcement elements in ex vivo sow vaginal tissue using ball burst testing. The MEW-fabricated cog threads increased the ultimate load of vaginal tissue from 83 ± 20 N (control) to 126 ± 15 N, corresponding to a 51.8% improvement (p = 0.0477). Compared with commercial PCL cog threads reported in the literature (177.0 ± 5.4 N), the reinforced specimens achieved approximately 71% of the benchmark load. Owing to their intermediate stiffness profile, the MEW-fabricated cog threads reduced mechanical mismatch with soft tissue compared to high-stiffness commercial alternatives. These findings demonstrate the feasibility of hybrid MEW-based additive manufacturing strategies for engineering mechanically compatible, application-driven soft-tissue reinforcement systems. Full article

Introduction: Pelvic floor disorders (PFDs) are a very widespread clinical phenomenon and are known to affect millions of women worldwide, significantly impairing their quality of life. New technologies and innovations such as electrotherapy and photobiostimulation are currently revolutionizing what concerns conservative treatment, allowing clinicians to tailor therapy to every woman. The aim of this study was to evaluate the feasibility of use of electrotherapy and photobiostimulation in PFD management and the initial results of treatment in clinical practice. Methods: This prospective study (IRB code: GSM-RF 2025) aimed to analyze the impact of the innovative DAFNE system to treat PFDs through electrotherapy and photobiostimulation. We enrolled patients with mild pelvic organ prolapse and stress urinary incontinence who desired a conservative treatment for their conditions. The following validated scales were used for assessing baseline quality of life before and after treatment: Urinary Distress Inventory-6 (UDI-6), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Female Sexual Function Index-6 (FSFI-6), 0–100 VAS Scale, and Vaginal Health Index. Electrotherapy was delivered through 4 gold rings, providing Functional Electrical Stimulation (FES), Transcutaneous Electrical Nerve Stimulation (TENS) and/or Microcurrent Electrical Neuromuscular Stimulation (MENS). The photobiostimulation system consisted of 24 LEDs per wavelength (420 nm UVA; 630 nm RED; 870 nm NIR/INFRARED) positioned at 360° along the entire length of the handpiece for antimicrobial purposes, microcirculation improvement, and anti-inflammatory action. The cycle of treatment consisted of 3–5 sessions, according to necessity. Overall improvement was measured through the Patient Global Impression of Improvement (PGI-I). Statistical analysis was performed using Student’s t-Test. A value of p < 0.05 was considered as significant. Results: In the period of interest, 32 women were treated with the DAFNE system. The mean age was 57.0 ± 16.6 years. Indications for treatment were stress urinary incontinence (16/32), mild pelvic organ prolapse (14/32), or both (2/32). The mean number of treatments per patient was 4. Quality of life improved as a consequence of the treatment according to the considered scales. Specifically, 87.5% of patients considered themselves improved. Conclusions: The DAFNE system has been successful in managing mild pelvic organ prolapse and stress urinary incontinence, improving quality of life scores. Embracing new technologies such as electrotherapy and photobiostimulation appears to be successful in conservatively managing a variety of PFDs. Full article

Background and Objectives: Obstetric anal sphincter injuries (OASISs) are severe complications of vaginal delivery that can result in long-term pelvic floor dysfunction and reduced quality of life. Global data indicate a rising incidence of OASISs, including in Lithuania. This study aimed to identify risk factors for OASISs and evaluate their impact on urinary (UI) and fecal incontinence (FI), pelvic organ prolapse (POP), and quality of life in affected women. Materials and Methods: A retrospective case–control study was conducted at the Lithuanian University of Health Sciences Hospital (LUHS) Kauno Klinikos in 2024. Women who gave birth between 2004 and 2023 and experienced OASIS (n = 90) were compared with women matched for birth history but without perineal tears (n = 90). Data were collected from medical records and electronic questionnaires, including the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF), Wexner score, Pelvic Organ Prolapse Symptom Score (POP-SS), and Pelvic Floor Impact Questionnaire (PFIQ-7). Participants were grouped by delivery year (2004–2013 or 2014–2023). Statistical analysis was performed using Mann–Whitney U, Chi-square, Fisher’s exact and Student’s t-tests, with p < 0.05 considered significant. Results: Newborn weight and vacuum-assisted delivery were significantly associated with OASIS (p < 0.05 and p = 0.029). In the 2014–2023 cohort, women with OASIS reported significantly higher rates and severity of UI, FI, and POP symptoms compared to controls. Quality of life scores related to UI and FI were significantly worse in the recent OASIS group, whereas no significant differences were observed in the 2004–2013 cohort. Conclusions: Between 2004 and 2023, 0.4% of women who gave birth at LUHS experienced third- or fourth-degree perineal tears, with newborn weight and vacuum extraction identified as risk factors. These women reported higher rates of UI and FI and POP, and those who delivered between 2014 and 2023 rated their related quality of life significantly worse than women without OASIS. Full article

Background: POP surgery improves anatomical support and quality of life, but urinary, bowel, sexual, and pain issues are common after surgery. The role of rehabilitation in addressing these problems is recognized, though not yet clearly defined. Objective: This scoping review aims to map the clinical evidence on conservative rehabilitation interventions for urinary, bowel, and sexual dysfunction, and pelvic pain after POP surgery. Methods: In accordance with PRISMA-ScR guidelines, we included randomized controlled trials, cohort studies, observational studies, and systematic reviews relevant to post-surgical rehabilitation options frequently encountered in clinical settings, including pelvic floor muscle training (PFMT), physiotherapy, and multimodal programs. Meta-analysis was not conducted due to clinical and methodological heterogeneity across the studies. Results: PFMT demonstrates beneficial effects on symptom severity and pelvic muscle function in women with POP. Postoperative rehabilitation may improve urinary continence, sexual function, and pelvic pain, although the strength of current evidence remains limited. Many studies prioritize surgical revision over conservative management, and the effectiveness of rehabilitation for persistent or de novo symptoms is not well established. Conclusions: Conservative rehabilitation, especially PFMT, may aid recovery and improve function after POP surgery. More research is needed to define the optimal protocols and to determine how to incorporate them into post-surgical care. Full article

Background/Objectives: The POP-Q system is conventionally used to evaluate pelvic organ prolapse (POP). Nevertheless, differences between clinical examination and intraoperative findings can hinder appropriate surgical planning. We aimed to assess the accuracy of a sequential protocol involving clinical POP-Q assessment and, in cases of uncertain diagnosis, transperineal ultrasound. Methods: We conducted a prospective observational study with 314 women scheduled for POP surgery from January 2021 to December 2024. A pelvic floor specialist assessed all patients using the POP-Q system. Transperineal ultrasound was carried out only when the clinical diagnosis remained uncertain. We compared the accuracy of this sequential approach (POP-Q ± ultrasound) versus POP-Q alone, using intraoperative findings as the gold standard. Sensitivity and specificity were determined for each type of prolapse. Results: Of the 314 patients, 181 (57.6%) had a definitive diagnosis with POP-Q alone, whereas 133 (42.4%) required additional ultrasound. In these uncertain cases, the addition of ultrasound significantly increased sensitivity for cystocele (by 0.5–11.3%), uterine prolapse (45.5–63.7%), cervical elongation (5.2–21.4%), rectocele (5.7–16.4%), and enterocele (58.7–74.7%) (all p < 0.05). Specificity also improved for uterine prolapse, cervical elongation, and rectocele. The sequential protocol’s performance in uncertain cases was comparable to clinical examination in straightforward cases. Conclusions: Applying a sequential protocol that adds transperineal ultrasound for unclear cases significantly increases diagnostic precision for surgical POP, potentially optimizing surgical planning. Full article

Background/Objectives: Perineoplasty can be performed as an adjunct to native tissue pelvic organ prolapse (POP) surgery; the optimal indication for perineoplasty is unknown due to limited evidence regarding its benefits and the absence of clear clinical guidelines. This study aims to describe patient-related factors associated with surgeons’ decisions to add perineoplasty to POP surgery and to quantify the frequency of intraoperative changes from preoperative surgical plans. Methods: In this multicenter observational cohort study, women ≥ 18 years scheduled for primary native tissue POP surgery between April 2023 and November 2024 were included. Baseline characteristics, pelvic floor anatomy (POP-Q), genital hiatus (GH), perineal body (PB) measurements, and surgeon-reported considerations regarding perineoplasty were collected. Surgical plans (“with”, “without”, or “undecided”) were documented and compared with the actual performed procedure. Logistic and linear regression analyses were used to identify factors associated with perineoplasty. Results: Among the 305 enrolled women, 285 underwent surgery, of whom 135 (47%) received perineoplasty. Patients who underwent perineoplasty had a larger GH size (5.2 cm) compared to patients without perineoplasty (4.5 cm). Obesity was associated with an increased rate of perineoplasty compared to normal weight (OR 2.3 95%CI 1.2–4.6). There was a strong exponential association between childbirth and perineoplasty, with a fivefold increase for two children (95%CI 1.3–17.1) and thirtyfold increase for four or more children (95%CI 6.3–142) compared to one child. Nearly all procedures (92%) followed the preoperative plan; surgeons were more likely to omit than add perineoplasty intraoperatively. Surgeons frequently reported GH/PB size and age as key considerations to perform perineoplasty and lack of evidence and fear of dyspareunia as reasons to not perform perineoplasty. Conclusions: Surgeons more often perform perineoplasty in patients with factors that have been associated with a higher risk of recurrent prolapse. Prospective comparative studies are required to determine whether perineoplasty reduces recurrent POP after primary surgical repair. Full article

Background/Objectives: The growing population of women aged ≥ 80 years poses a new challenge for urogynecology. Advanced age, comorbidities, and polypharmacy raise concerns regarding the safety of procedures in the management of pelvic floor disorders (PFDs) such as pelvic organ prolapse (POP), stress urinary incontinence (SUI), and overactive bladder (OAB). Individualized, frailty-based assessment is essential in this group. The aim of the study was to evaluate the safety profile of urogynecological surgical procedures among women aged ≥ 80 years at a single tertiary center. Methods: In a retrospective observational single-center study, we analyzed the medical documentation of 774 hospitalizations of women aged ≥ 80 years admitted between 2014 and 2023. The analysis included indications, comorbidities, treatment types, anesthesia, and complications. Comorbidity and surgical risk were evaluated using the Charlson Comorbidity Index (CCI) and Clavien–Dindo classification. Results: A total of 720 admissions with complete medical records were analyzed, of which 65% were for urogynecological conditions. In this group, the mean age was 83.0 years and mean BMI was 27.2 kg/m². Most patients (92.9%) had comorbidities, mainly hypertension (84.2%) and diabetes (21.1%). POP was the leading indication (52%), followed by SUI (35%) and OAB (27%). Surgical management was performed in 95% of POP cases, predominantly via vaginal native tissue repair (80%), especially LeFort colpocleisis (20%). The transobturator sling (TOT) was the most frequent SUI surgery. Intraoperative complications occurred in 1.5% of cases and postoperative ones were mainly minor (Clavien–Dindo I–II). No procedure-related deaths were recorded. Conclusions: In this cohort, surgical treatment of urogynecological problems in women ≥80 years was associated with a low rate of major complications, suggesting that it can be safely offered to elderly patients. Careful preoperative assessment based on frailty and comorbidity rather than chronological age remains essential. Full article