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International Urogynecology Journal Oct 2016There is conflicting evidence on whether mediolateral episiotomy (MLE) reduces the risk of obstetric anal sphincter injuries (OASI) in spontaneous vaginal deliveries... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
There is conflicting evidence on whether mediolateral episiotomy (MLE) reduces the risk of obstetric anal sphincter injuries (OASI) in spontaneous vaginal deliveries (SVD).
OBJECTIVES
A systematic review was undertaken to compare rates of OASI amongst women who had undergone mediolateral episiotomy versus those who did not.
SEARCH STRATEGY
Electronic searches were performed in literature databases: CINAHL, Cochrane, EMBASE, Medline and MIDIRS from database inception to July 2015. Studies were eligible if MLE was compared to spontaneous tears and if OASI was the outcome of interest. Two reviewers independently selected and extracted data on study characteristics, quality and results. We computed events of OASI in those who did and did not have an episiotomy from individual studies and pooled these results in a meta-analysis where possible.
MAIN RESULTS
Of the 2090 citations, 16 were included in the review. All were non-randomised, population based or retrospective cohort studies. There was great variation in quality amongst these studies. Data from 7 studies was used for meta-analysis. On collating data from these studies where the majority of women (636755/651114) were nulliparous, MLE reduced the risk of OASI (RR 0.67 95 % CI 0.49-0.92) in vaginal delivery.
CONCLUSION
The pooled analysis of a large number of women undergoing vaginal birth, most of who were nulliparous, indicates that MLE has a beneficial effect in prevention of OASI. An accurately given MLE might have a role in reducing OASI and should not be withheld, especially in nulliparous women. Caution is advised as the data is from non-randomised studies.
Topics: Anal Canal; Case-Control Studies; Delivery, Obstetric; Episiotomy; Female; Humans; Perineum; Pregnancy; Retrospective Studies; Risk; Vagina
PubMed: 26894605
DOI: 10.1007/s00192-016-2956-1 -
International Urogynecology Journal Jan 2016Pelvic organ prolapse is showing an increasing prevalence (3 - 50%). The gold standard treatment of apical prolapse is sacrocolpopexy which can be performed via minimal... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
Pelvic organ prolapse is showing an increasing prevalence (3 - 50%). The gold standard treatment of apical prolapse is sacrocolpopexy which can be performed via minimal access (laparoscopy or robotics) or open approaches. The aim of this review was to appraise the effectiveness of minimal access surgery versus the open approach in the treatment of apical prolapse.
METHODS
Keywords were searched in: CINAHL, MEDLINE, CENTRAL, Cochrane MDSG Trials Register, Cochrane Library, Current Controlled Trials, ClinicalTrials.gov, WHO International Trials Registry Platform search portal, LILACS, and Google Scholar databases. Data up to 31 April 2014 were considered. Randomized and nonrandomized controlled trials evaluating all women who underwent minimally invasive sacropexy (MISC) and open sacropexy (OSC) were included. A data extraction tool was used for data collection. MISC was compared with OSC using narrative analysis and meta-analysis (RevMan) where appropriate.
RESULTS
MISC and OSC were compared in 12 studies involving 4,757 participants. MISC and OSC were equally effective in terms of point-C POP-Q measurements and recurrence rate. MISC was associated with a lower transfusion rate (odds ratio 0.41, 95% CI 0.20 - 0.83), shorter length of hospital stay (mean difference -1.57 days, 95% CI -1.91 - -1.23 days), and less blood loss (mean difference -113.27 mL, 95% CI -163.67 - -62.87 mL) but a longer operating time (mean difference 87.47, 95% CI 58.60 - 116.34, p < 0.0001).
CONCLUSIONS
MISC showed similar anatomic results to OSC with a lower transfusion rate, shorter length of hospital stay and less blood loss. The rate of other complications was similar between the approaches. Cautious interpretation of results is advised due to risk of bias caused by the inclusion of nonrandomized studies.
Topics: Controlled Clinical Trials as Topic; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Sacrum; Uterine Prolapse; Vagina
PubMed: 26249236
DOI: 10.1007/s00192-015-2765-y -
Surgical Technology International Mar 2014In this review we focus on the transvaginal meshes used for pelvic organ prolapse (POP) repair and possible changes in application after the first FDA warning in 2008. A... (Review)
Review
In this review we focus on the transvaginal meshes used for pelvic organ prolapse (POP) repair and possible changes in application after the first FDA warning in 2008. A systematic review of the literature was performed. The data was reviewed for reoperation rates and complications following the Clavien-Dindo classification. A total of 11 randomized controlled and 9 prospective studies with 2,289 patients (most POP-Q ≥ II, median follow-up 12 mos) were included. The results showed a mean total complication rate of 27% in anterior, 20% in posterior, and 40% in combined mesh repair group (ns). Grade ≥ III complications occurred in 8% anterior, 3.5% posterior, and 13% combined (p < 0.05) mesh repairs. No differences were found for reoperation rates for POP (2% to 3%). The following risk factors for complications were identified: operative technique, surgeon experience, previous prolapse repair, concomitant hysterectomy, total mesh repair, mesh properties (light weight, collagen coating were positive factors), young age, sexual activity, and smoking. Due to high complication rates (especially mesh erosion, voiding dysfunction, and dyspareunia) a careful individualized selection of patients and materials, education of patients, and elimination of identified risk factors are urgent prior to implantation of vaginal meshes.
Topics: Female; Humans; Pelvic Organ Prolapse; Postoperative Complications; Reoperation; Surgical Mesh; Vagina
PubMed: 24700225
DOI: No ID Found -
Cancers Apr 2023Medical use of (non-)thermal plasmas is an emerging field in gynaecology. However, data on plasma energy dispersion remain limited. This systematic review presents an... (Review)
Review
Medical use of (non-)thermal plasmas is an emerging field in gynaecology. However, data on plasma energy dispersion remain limited. This systematic review presents an overview of plasma devices, fields of effective application, and impact of use factors and device settings on tissues in the female pelvis, including the uterus, ovaries, cervix, vagina, vulva, colon, omentum, mesenterium, and peritoneum. A search of the literature was performed on 4 January 2023 in the Medline Ovid, Embase, Cochrane, Web of Science, and Google Scholar databases. Devices were classified as plasma-assisted electrosurgery (ES) using electrothermal energy, neutral argon plasma (NAP) using kinetic particle energy, or cold atmospheric plasma (CAP) using non-thermal biochemical reactions. In total, 8958 articles were identified, of which 310 were scanned, and 14 were included due to containing quantitative data on depths or volumes of tissues reached. Plasma-assisted ES devices produce a thermal effects depth of <2.4 mm. In turn, NAP effects remained superficial, <1.0 mm. So far, the depth and uniformity of CAP effects are insufficiently understood. These data are crucial to achieve complete treatment, reduce recurrence, and limit damage to healthy tissues (e.g., prevent perforations or preserve parenchyma). Upcoming and potentially high-gain applications are discussed, and deficits in current evidence are identified.
PubMed: 37190314
DOI: 10.3390/cancers15082386 -
International Urogynecology Journal May 2022The objective was to systemically review the current literature on the association of gut, vaginal, and urinary dysbiosis in female patients with overactive bladder...
INTRODUCTION AND HYPOTHESIS
The objective was to systemically review the current literature on the association of gut, vaginal, and urinary dysbiosis in female patients with overactive bladder (OAB).
METHODS
We performed a comprehensive literature search following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols for systematic reviews. In the EMBASE, CINAHL, and Medline databases, a search was conducted using key words such as "microbiome," "microbiota," "microflora," "overactive bladder," "urge," "gut," "vaginal." Articles were screened using the online tool www.covidence.org . Two independent reviewers screened studies at each stage and resolved conflicts together. We excluded papers that discussed pediatric patients and animal studies. In total, 13 articles met this criterion, which included 6 abstracts.
RESULTS
After identifying 817 unique references, 13 articles met the criteria for data extraction. Articles were published from 2017 to 2021. No study reported the same microbiota abundance, even in healthy individuals. Overall, there was a loss of bacterial diversity in OAB patients compared with controls. Additionally, the bacterial composition of the controls and OAB patients was not significantly different, especially if the urine was collected midstream. Overall, the composition of the microbiome is dependent on the specimen collection methodology, and the metagenomic sequencing technique utilized. OAB urine microbiome is more predisposed to alteration from the gut or vaginal influences than in controls.
CONCLUSIONS
Current evidence suggested a potential relationship among gut, vaginal, and urinary microbiome in OAB patients, but there are very limited studies.
Topics: Bacteria; Child; Female; Humans; Microbiota; Urinary Bladder, Overactive; Urinary Tract; Vagina
PubMed: 35237854
DOI: 10.1007/s00192-022-05127-3 -
Frontiers in Microbiology 2022Genital mycoplasmas (GM), such as , and are commonly associated with spontaneous preterm labor (SPTL), spontaneous preterm birth (PTB), and preterm prelabor rupture of... (Review)
Review
Genital Mycoplasmas and Biomarkers of Inflammation and Their Association With Spontaneous Preterm Birth and Preterm Prelabor Rupture of Membranes: A Systematic Review and Meta-Analysis.
Genital mycoplasmas (GM), such as , and are commonly associated with spontaneous preterm labor (SPTL), spontaneous preterm birth (PTB), and preterm prelabor rupture of membranes (PPROM). This study determined the association between GM and such adverse pregnancy outcomes. We searched for studies published 1980-2019 in MEDLINE, EMBASE, and Web of Science. Studies were eligible when GM was detected during pregnancy. We included 93 and 51 studies in determining the prevalence and the inflammatory biomarkers associated with GM, respectively, using the "metafor" package within R. The protocol was registered with PROSPERO (registration no. CRD42016047297). Women with the studied adverse pregnancy outcomes had significantly higher odds of presence with GM compared to women who delivered at term. For PTB, the odds ratios were: (OR: 2.25; CI: 1.35-3.75; : 44%), (OR: 2.04; CIL 1.18-3.53; : 20%), (OR: 1.75; CI: 1.47-2.07; : 0%), (OR: 1.50; CI: 1.08-2.07; : 58%). SPTL had significantly higher odds with (OR: 1.96; CI: 1.19-3.23; : 1%) or (OR: 2.37; CI: 1.20-4.70; : 76%) compared to women without SPTL. Women with PPROM had significantly higher odds with (OR: 2.09; CI: 1.42-3.08; : 0%) than women without PPROM. However, our subgroup analysis based on the diagnostic test and the sample used for detecting GM showed a higher prevalence of GM in maternal samples than in fetal samples. GM presence of the cervix and vagina was associated with lower odds of PTB and preterm labor (PTL). In contrast, GM presence in the AF, fetal membrane, and placenta was associated with increased odds of PTB and PTL. However, genital mycoplasmas may not elicit the massive inflammation required to trigger PTB. In conclusion, GM presence in the fetal tissues was associated with significantly increased odds of PTB and PTL.
PubMed: 35432251
DOI: 10.3389/fmicb.2022.859732 -
BMJ Clinical Evidence Mar 2012Prolapse of the uterus or vagina is usually the result of loss of pelvic support, and causes mainly non-specific symptoms. It may affect over half of women aged 50 to 59... (Review)
Review
INTRODUCTION
Prolapse of the uterus or vagina is usually the result of loss of pelvic support, and causes mainly non-specific symptoms. It may affect over half of women aged 50 to 59 years, but spontaneous regression may occur. Risks of genital prolapse increase with advancing parity and age, increasing weight of the largest baby delivered, and hysterectomy.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments in women with genital prolapse? What are the effects of surgical treatments in women with anterior vaginal wall prolapse? What are the effects of surgical treatments in women with posterior vaginal wall prolapse? What are the effects of surgical treatments in women with upper vaginal wall prolapse? What are the effects of using different surgical materials in women with genital prolapse? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: abdominal Burch colposuspension; abdominal sacral colpopexy; abdominal sacrohysteropexy; anterior colporrhaphy with mesh reinforcement; laparoscopic surgery; mesh or synthetic grafts; native (autologous) tissue; open abdominal surgery; pelvic floor muscle exercises; posterior colporrhaphy (with or without mesh reinforcement); posterior intravaginal slingplasty (infracoccygeal sacropexy); sacrospinous colpopexy (vaginal sacral colpopexy); sutures; traditional anterior colporrhaphy; transanal repair; ultralateral anterior colporrhaphy alone or with cadaveric fascia patch; vaginal hysterectomy; vaginal oestrogen; vaginal pessaries; and vaginal sacrospinous colpopexy.
Topics: Female; Gynecologic Surgical Procedures; Humans; Hysterectomy, Vaginal; Incidence; Pelvic Floor; Prolapse; Surgical Mesh; Uterine Prolapse; Vagina
PubMed: 22414610
DOI: No ID Found -
International Braz J Urol : Official... 2015This study aimed to compare the effectiveness and complications between the retropubic and transobturator approaches for the treatment of female stress urinary... (Comparative Study)
Comparative Study Meta-Analysis Review
Comparison between the retropubic and transobturator approaches in the treatment of female stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications.
OBJECTIVE
This study aimed to compare the effectiveness and complications between the retropubic and transobturator approaches for the treatment of female stress urinary incontinence (SUI) by conducting a systematic review.
MATERIALS AND METHODS
We selected all randomized controlled trials (RCTs) that compared retropubic and transobturator sling placements for treatment of SUI. We estimated pooled odds ratios and 95% confidence intervals for intraoperative and postoperative outcomes and complications.
RESULTS
Six hundred twelve studies that compared retropubic and transobturator approaches to midurethral sling placement were identified, of which 16 were included in our research. Our study was based on results from 2646 women. We performed a subgroup analysis to compare outcomes and complications between the two approaches. The evidence to support the superior approach that leads to better objective/subjective cure rate was insufficient. The transobturator approach was associated with lower risks of bladder perforation (odds ratio (OR) 0.17, 95% confidence interval (CI) 0.09-0.32), retropubic/vaginal hematoma (OR 0.32, 95% CI 0.16-0.63), and long-term voiding dysfunction (OR 0.32, 95% CI 0.17-0.61). However, the risk of thigh/groin pain seemed higher in the transobturator group (OR 2.53, 95% CI 1.72-3.72). We found no statistically significant differences in the risks of other complications between the two approaches.
CONCLUSIONS
This meta-analysis shows analogical objective and subjective cure rates between the retropubic and transobturator approaches to midurethral sling placement. The transobturator approach was associated with lower risks of several complications. However, good-quality studies with long-term follow-ups are warranted for further research.
Topics: Female; Humans; Intraoperative Complications; Postoperative Complications; Prosthesis Implantation; Randomized Controlled Trials as Topic; Risk Assessment; Suburethral Slings; Treatment Outcome; Urinary Incontinence, Stress; Urologic Surgical Procedures; Vagina
PubMed: 26005962
DOI: 10.1590/S1677-5538.IBJU.2015.02.06 -
International Urogynecology Journal Dec 2023The aim of this review is to synthesize existing evidence on the combined effects of the vaginal microenvironment on pelvic dysfunctional diseases. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this review is to synthesize existing evidence on the combined effects of the vaginal microenvironment on pelvic dysfunctional diseases.
METHODS
This systematic review was conducted in accordance with the PRISMA guidelines. The PubMed, Embase, Cochrane Library, Web of Science, Wanfang, and China Knowledge Network (CNKI) databases were systematically searched up to January 2023 using the following MeSH terms: "pelvic organ prolapse", "stress urinary incontinence" and "vaginal microenvironment", "microenvironment", "vaginal cleanliness", "vaginitis", "lactobacillus" and other related keywords. Study methods were limited to case-control studies or cross-sectional studies. Quality assessment was performed using the Newcastle-Ottawa scale, and meta-analysis of the included literature was performed using Review Manager 5.3.
RESULTS
A total of eight articles were included in this systematic review (SR) and meta-analysis (MA), which involved a total of 7298 study participants. The pooled results of this meta-analysis showed that the vaginal microenvironment (number of vaginal lactobacilli, leukorrhea cleanliness, and presence of vaginitis) were all statistically significantly associated with pelvic dysfunctional diseases in Chinese women.
CONCLUSION
This review indicates that the vaginal microenvironment has an impact on the development of PFD in Chinese women.
TRIAL REGISTRATION
The protocol of this systematic review (SR) and meta-analysis (MA) has been registered in PROSPERO databases with the Registration number of CRD42023407251.
Topics: Female; Humans; Cross-Sectional Studies; Pelvic Organ Prolapse; Vagina; Urinary Incontinence, Stress; Pelvis
PubMed: 37650904
DOI: 10.1007/s00192-023-05635-w -
International Journal of Gynecological... Sep 2014Quality of life (QoL) and sexual health have become increasingly important in cervical cancer survivors (CCSs). The aims of this review were to summarize research... (Review)
Review
OBJECTIVES
Quality of life (QoL) and sexual health have become increasingly important in cervical cancer survivors (CCSs). The aims of this review were to summarize research findings of QoL and sexual function in CCSs after treatment on the basis of self-reported questionnaires and to update the current knowledge of overall QoL and sexual function in CCSs.
METHODS
Studies from electronic database between May 1966 and May 2013 were rated on their internal validity as methodological assessment. Thirty-two studies were included, wherein 15 studies had a relatively good methodology.
RESULTS
Anorectal function, urinary symptoms, and lymphedema were commonly reported as physical symptoms. As to psychosocial domains, the studies illustrated that anxiety decreased with age, whereas depression generally increased with age. Sexual function was involved in most of the studies. Vaginal dryness, dyspareunia, short vagina, and sexual dissatisfaction were prominent issues of sexual dysfunction and vaginal changes in CCSs. In terms of treatment modality, radiotherapy was thought to be associated with worse QoL and sexual function in CCSs.
CONCLUSIONS
The studies showed that QoL and sexual function in CCSs were compromised compared with the general population to different extents. Quality of life and sexual function should be paid with more attention in patients with cervical cancer after treatment.
Topics: Anxiety Disorders; Depressive Disorder; Female; Humans; Quality of Life; Sexual Dysfunction, Physiological; Sexuality; Surveys and Questionnaires; Survivors; Uterine Cervical Neoplasms
PubMed: 25033255
DOI: 10.1097/IGC.0000000000000207