Background: The aim of this study was to assess the correlation between the overall rest–stress distance measured by transperineal ultrasound (TPUS) and Q-tip test angle in women with urodynamic stress incontinence (USI), and determine a cut-off value of rest–stress distance for predicting urethral hypermobility (UH). Methods: Women with USI scheduled for mid-urethral sling surgery were retrospectively recruited. UH was defined as a Q-tip angle more than or equal to 30 degrees. Ultrasonic measurement of the overall rest–stress distance was defined as the linear distance of bladder-neck position change from resting status to maximal strain. Results: Among the 132 enrolled women, the Pearson correlation coefficient between the overall rest–stress distance in TPUS and Q-tip test angle was 0.9104 (95% CI, 0.8758–0.9357, p < 0.001). In receiver-operating-characteristic-curve analysis, a rest–stress distance of more than 13.3 mm was an optimal cut-off value to predict UH (sensitivity = 76.47%, specificity = 93.3%; area = 0.937, 95% confidence interval: 0.881–0.972). Conclusions: The overall rest–stress distance in TPUS correlated well with the Q-tip test angle, indicating that it can be an alternative method for the assessment of USI. A rest–stress distance of more than 13.3 mm was an optimal cut-off value to predict UH in women with USI.

Background: Cervical elongation is commonly associated with pelvic organ prolapse (POP). It was an identified risk for recurrent prolapse after hysteropexy, requiring additional surgeries. The aim of the study is to investigate the risk factors for uterine cervical elongation among women with POP. Methods: In this single-center retrospective cohort study, women who underwent vaginal total hysterectomy for POP between 2014 and 2016 were collected. The cervical and total uterine lengths were measured by pathologists, while the ratio of cervical length to total uterine length were calculated. The cervical elongation is defined as corpus/cervix ratio ≤ 1.5. Results: A total of 133 patients were enrolled in this study. Among these patients, 43 women had cervical elongation and 90 women had normal length of uterine cervix. We found that age > 65 years old (67.4% vs. 42.2%, p = 0.007), total vaginal length ≥ 9.5 cm (65.1% vs. 45.6%, p = 0.035), uterine weight < 51 gm (72.1% vs. 52.2%, p = 0.03), and Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) ≥ 12 (30.2% vs. 14.4%, p = 0.032) were associated with the risk of cervical elongation. There were no significant differences on preoperative urodynamic parameters in the two groups. Conclusion: The patient age > 65 years old, the total vaginal length of POP-Q system ≥ 9.5 cm, uterine weight < 51 g, and POPDI-6 ≥ 12 are independent risk factors of cervical elongation in women with POP. For women scheduled for pelvic reconstructive hysteropexy, concomitant cervical amputation should be considered.

Background: The aim of the study was to assess the effect of high-intensity focused electromagnetic (HIFEM) technology in the treatment of female stress urinary incontinence (SUI). Materials and Methods: 20 women with SUI were delivered a treatment course with HIFEM technology. Patients attended 6 therapies scheduled twice a week. Validated questionnaires were assessed, including the overactive bladder symptoms score (OABSS), urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), international consultation on incontinence questionnaire (ICIQ), and valued living questionnaire (VLQ). Some urodynamic parameters, such as maximum flow rate (Qmax), residual urine (RU), and bladder volume at first sensation to void (Vfst). Bladder neck mobility in ultrasound topography was also collected pre- and post-treatment at 1- and 6-month follow-up visits. Results: HIFEM treatment significantly improved SUI symptoms on pad tests from 4.2 ± 5.5 to 0.6 ± 1.3 and patients’ self-assessment in the 6-month follow-up. Additionally, the data from urinary-related questionnaires, including OABSS (5.3 ± 3.9 to 3.9 ± 3.6), UDI-6 (35.7 ± 22.3 to 15.2 ± 10.6), IIQ-7 (33.1 ± 28.7 to 14.3 ± 17.2), and ICIQ (9.4 ± 5.0 to 5.4 ± 3.6), all showed a significant reduction. Then, the analysis of the urodynamic study revealed that only maximum urethral closure pressure (MUCP) (46.4 ± 25.2 to 58.1 ± 21.2) and urethral closure angle (UCA) (705.3 ± 302.3 to 990.0 ± 439.6) significantly increased after the six sessions of HIFEM treatment. The urethral and vaginal topography were performed and found that HIFEM mainly worked on pelvic floor muscles (PFM) and enhanced their function and integrity. Conclusions: The results suggest that HIFEM technology is an efficacious therapy for the treatment of SUI.

Objectives: Stress urinary incontinence (SUI) negatively affects the quality of life and sexual function in women. This study aimed to evaluate the efficacy of radiofrequency (RF) therapy in reducing SUI symptoms and its impact on sexual function. Methods: Thirty-four women with SUI were enrolled and underwent a single RF treatment session using the Viveve^® System (Viveve Medical Inc., USA) with parameters of 90 J/cm² and 220 pulses per hour. Assessments at baseline and 6 months post treatment included perineal ultrasound and personal interviews to evaluate lower urinary tract symptoms and sexual function. Urodynamic studies, voiding diaries, and questionnaires such as the Female Sexual Function Index (FSFI), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) measured outcomes. Results: RF therapy significantly improved sexual function, with higher FSFI scores in all domains except pain at 6 months. SUI symptoms were significantly reduced, as indicated by improved scores on OABSS, UDI-6, IIQ-7, and ICIQ-SF, alongside better voiding diary results. Anatomical changes included reduced bladder neck mobility, decreased vaginal width, and a reduced rotation angle of the proximal urethra. Conclusions: RF therapy is effective and safe for treating mild to moderate SUI and enhances sexual function, potentially due to changes in vaginal topography. These results suggest RF therapy as a viable non-surgical option for managing SUI and improving sexual health.

Background: To report our experiences of a tape-releasing suture with “long-loop” in women with iatrogenic urethral obstruction following the mid-urethral sling procedure. Methods: A total of 149 women underwent a tape-releasing suture with “Long Loop” during the operation. Post-void residual volume was evaluated after Foley removal. Lower urinary tract symptoms and urodynamic studies were assessed before and six months postoperatively. Results: Nine women out of 149 who underwent mid-urethral sling surgery were found to have iatrogenic urethral obstruction post-operatively based on their urinary symptoms and ultrasound findings. There was no apparent difference between tested groups in mid-urethral sling products and concomitant procedures. 77.8% had successful releases after the first Long-loop manipulation procedure, and 22.2% required two or more releases. However, the SUI cure rate is similar in groups receiving the Long-loop manipulation or not (88.9% and 87.1%, respectively). Conclusions: We are convinced of the practicability and efficacy of the tape-releasing suture “Long-loop.” We adopted subjective and objective means to evaluate both groups before and after a six-month follow-up. The Long-loop manipulation procedure can successfully resolve the iatrogenic urethral obstruction without compromising the effectiveness of mid-urethral sling for the treatment of SUI.

Background: The Minimally Invasive Prolapse System (MIPS) device, a novel single-incision transvaginal mesh, represents recent advancements in mesh technology, providing lightweight, biocompatible support for pelvic organ prolapse while reducing erosion, allowing for customization and improving surgical outcomes. This study aimed to identify factors associated with pelvic organ prolapse (POP) recurrence after transvaginal mesh (TVM) repair using the Minimally Invasive Prolapse System device. Methods: Two hundred and eighteen women with symptomatic stage II to IV POP underwent TVM. Preoperative and postoperative assessments included urinalyses and pelvic examinations using the POP quantification (POP-Q) staging system. Results: During a follow-up period of 12–46 months, 7 of 218 (3.2%) women experienced POP recurrence. Univariate analysis was conducted to identify predictors of surgical failure, revealing no significant differences in body mass index, POP stage, or preoperative urinary symptoms between the recurrence and success groups (p > 0.05). However, functional urethral length <20 mm based on urodynamics (p = 0.011), ICI-Q scores ≥7 (p = 0.012), and the first 60 surgical cases (p = 0.018) were significant predictors of surgical failure. Multivariate logistic regression confirmed these findings. Conclusions: Functional urethral length <20 mm, ICI-Q scores ≥7, and limited surgical experience were significant predictors of TVM failure using the Minimally Invasive Prolapse System kit. POP recurrence after mesh repair is less likely beyond the learning curve.