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The aim of the study was to assess the effect of pelvic floor contraction on urethral mobility and the size of the urogenital hiatus, as well as to compare two ultrasonographic approaches for the assessment of urethral mobility: transperineal with a transabdominal probe and transvestibular with a transvaginal transducer.

Aim: The aim of the study was to assess the effect of pelvic floor contraction on urethral mobility and the size of the urogenital hiatus, as well as to compare two ultrasonographic approaches for the assessment of urethral mobility: transperineal with a transabdominal probe and transvestibular with a transvaginal transducer. Materials and methods: Modified Oxford Scale (MOS) was used for clinical evaluation of muscle contraction. The parameters obtained in both ultrasound approaches were assessed for all six Oxford grades. The values of ΔH, ΔD and vector, measured at rest and on pelvic floor muscle contraction, were used to evaluate urethral mobility parameters in both ultrasound methods. Patients with a history of urogynecological surgery, pelvic radiotherapy, significant pelvic prolapse (grade 2 or grater in at least one compartment), as well as those with unilateral or bilateral complete avulsion of the puborectalis muscle were excluded. Results: A total of 272 women were included in the analysis. A statistically significant correlation was found between the contraction force and urethral mobility parameters ΔH and vector-positive and ΔD-negative, obtained in both ultrasound approaches. However, no correlation was demonstrated between the contraction force and changes in the analyzed hiatal parameters. The Bland-Altman analysis showed a high agreement of both measurement methods. Conclusions: The force of pelvic floor muscle contraction, as measured with the Oxford Scale, correlated with urethral mobility in both ultrasound examinations. Assessment of urethral mobility using the three assessed parameters (ΔH, ΔD, vector) allows for the most comprehensive analysis. Only minor differences were found in the analyzed urethral mobility parameters between both ultrasonographic approaches. The impact of pelvic floor muscle contraction on the size of the urogenital hiatus was not confirmed.

Aim: This study aimed to examine the correlations between specific urethral function parameters observed in urodynamic testing and selected urethral characteristics evaluated by pelvic floor ultrasonography. Addition- ally, the presence of urethral funneling during straining was evaluated in female patients referred for surgical treatment of stress urinary incontinence. Material and methods: A retrospective study was conducted on 192 female patients referred for surgical treatment of stress urinary incontinence with the use of retropubic tension-free vaginal tape. Maximum urethral closure pressure and functional urethral length were evaluated urodynamically during resting profilometry. Ultrasound measurements, along with the assessment of funnel- ing, were performed as part of the pelvic floor examination, following the technique described by Kociszewski. Patients with clinically significant pelvic organ prolapse, a history of anterior compartment surgery, prior ra- diotherapy, or symptoms of overactive bladder were excluded from the analysis. Results: The values obtained from urodynamic and ultrasound examinations were evaluated statistically. No correlation was identified be- tween the analyzed urodynamic and ultrasound parameters. Long urethral funneling was confirmed in all patients with stress urinary incontinence assessed as eligible for the placement of tension-free vaginal tape. Conclusions: The results indicate that urodynamic and ultrasound examinations assess distinct aspects of ure- thral anatomy and function, and therefore their findings cannot be used interchangeably. Long urethral funnel- ing assessed during pelvic floor ultrasonography was noted in all patients with clinically and urodynamically confirmed stress urinary incontinence

Diagnosis and treatment of ectopic cesarean scar pregnancy has become a challenge for contemporary obstetrics. With an increase in the number of pregnancies concluded with a cesarean section and with the development of transvaginal ultrasonography, the frequency of cesarean scar pregnancy diagnoses has increased as well. The aim of the study is to evaluate various diagnostic methods (ultrasonography in particular) and analyze effective treatment methods for cesarean scar pregnancy. An ultrasound scan, Doppler examination and magnetic resonance imaging are all useful in early detection of asymptomatic cesarean scar pregnancy, thus enabling effective treatment and preservation of fertility. Dilatation and curettage is not recommended as it carries significant risk of bleeding and very high risk of hysterectomy and fertility loss. Systemic methotrexate treatment should not be applied on the routine basis due to its low efficacy, high risk of fertility loss and adverse effects. Local methotrexate therapy (under ultrasound or hysteroscopy guidance) should be considered a perfect management method as it offers fertility preservation in asymptomatic pregnant patients without concomitant hemodynamic disorders. Synchronous usage of several treatment methods is an effective way to manage cesarean scar pregnancy. The combination of local methotrexate with simultaneous aspiration of gestational tissues under ultrasound or hysteroscopy guidance seems optimal. Subsequently, the remaining gestational tissues can be removed hysteroscopically in combination with vascular coagulation at the implantation site. In more advanced cases, local methotrexate treatment should be considered followed by laparoscopic or laparotomic wedge resection with subsequent surgical correction of the cesarean section scar.

Aim: The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9–18 months postpartum. Materials and methods: The study included 100 women 9–18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4. Results: We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of p <0.002. Conclusions: Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one’s own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10–20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.

Hysterectomy is performed by various surgical methods: abdominal, vaginal, laparoscopic, or robotic, and with different extents: supracervical, total, or radical. Scientific reports indicate that hysterectomy is a risk factor for stress urinary incontinence (SUI). The aim of this paper is to review scientific studies on the effect of the type of hysterectomy on the incidence of SUI. Original open-access articles in English language available in the PubMed, Google Scholar, and ScienceDirect databases published in the period 2004-2024 were included. Studies suggest the following: vaginal hysterectomy is associated with a higher risk of SUI than abdominal hysterectomy; abdominal hysterectomy is associated with a higher risk of SUI than laparoscopic hysterectomy; and it is likely that supracervical hysterectomy is associated with a higher risk of SUI than total hysterectomy; however, some scientific reports do not show significant differences in SUI between the above types of hysterectomy, so the first 3 conclusions should be approached with caution; it is uncertain whether the removal of the adnexa during hysterectomy increases the risk of SUI; and there were no differences between traditional laparoscopic hysterectomy and robotic-assisted laparoscopic hysterectomy. More good-quality studies on the effect of the type of hysterectomy on the incidence of SUI are necessary.

The introduction of suburethral sling was a breakthrough in the treatment of stress urinary incontinence in women. The method is highly effective. However, the mechanism of action of a sling and the reasons for surgical failures are not fully understood. The aim of the study was to assess the impact of sling-pubic symphysis distance on eliminating the symptoms of stress urinary incontinence and urethral funneling. The analysis included 106 patients who reported 3 to 6 months after sling placement for a follow-up visit encompassing clinical examination and standard ultrasonography. We evaluated the position of sling in relation to the pubic symphysis, urethral length, as well as urethral funneling length and width. Cure criteria were met by 91 patients. Elimination of urethral funneling was achieved in 76.9% ( = 70) of cured patients. Urethral funneling was still present, yet shorter by a mean of 10.2 mm ( = 0.02) than before surgery in the remaining cured patients. There was a 32.5% reduction in the mean relative length of urethral funneling ( = 0.002). No significant differences were found in the pre- and postoperative funneling width. The tape-pubic symphysis distance was lower in cured women: 23.2 mm vs. 26.1 mm in failed women ( = 0.04). Similar observations were made for cured patients with persistent urethral funneling vs. failed patients (22.47 mm vs. 26.0 mm, = 0.027). There were no differences between cured patients without urethral funneling and cured patients with persistent postoperative funneling (23.5 mm; 22.5 mm; = 0.417). Tape position in relation to the pubic symphysis is important for the elimination of stress urinary incontinence. Sling location closer to the pubic symphysis reduces the length of urethral funneling, but has no effects on its width in cured patients with persistent postoperative funneling.

Results of short-term evaluation of multifilament microporous midurethral tape IVS differ a great deal. During the first year of implantation, erosions have been observed in 0%-26% of operated women. Long-term observations are rare. They suggest high risk of extrusion and infection even after years of implantation. The purpose of the study was to evaluate long-term risk of complications after IVS implantation. Between 2001-2005, 72 women were operated on with the use of IVS mid-urethral tape. Two women had vaginal erosions during the first 3 months after the operation. Twelve women had vaginal erosions, purulent vaginal discharge, with IVS tape sticking out of the abdominal wall or vagina, and abdominal abscess. These complications were diagnosed between 9 months and 6 years after IVS implantation. The patients were operated on vaginally and open abdominally, 1-5 times because of complications after IVS implantation. In the case of post-IVS complication, as much tape as possible should be excised. Long-term follow up on patients with IVS implantation should be recommended to the centres where IVS tape was used, even to patients after removal of the tape. Risk of erosion, extrusion and infection after midurethral multifilament microporous IVS tape implantation is too high - which is the reason it should no longer be used.

Anal sphincter injuries occurring during natural deliveries are often a reason for severe complications, including fecal incontinence. Currently, approximately 80% of these injuries remain unrecognized. Therefore, it is crucial to focus on finding a way to diagnose such injuries as early as possible to apply the tailored treatment. This study aimed to assess the accuracy of impedance spectroscopy in the diagnostics of obstetric anal sphincter injuries (OASIs) using a specially designed rectal probe called the ONIRY Probe. The protocol of the clinical trials is described at NCT03769792. Twenty women after natural delivery were enrolled in the study and divided into two groups referring to the stage of a perineal tear (Group A: 1- or 2-degrees, and Group B: 3- or 4-degrees of a perineal tear; without or with sphincter injury, respectively). The study design included three visits during which a number of diagnostic tests were performed, including impedance spectroscopy, and 3-dimensional endoanal ultrasound, anorectal manometry, and physical examination as a reference. Statistical analysis comprised raw data analysis, as well as post-processing with the Synthetic Minority Oversampling Technique (SMOTE) method, as the output reference grade was highly imbalanced. A variety of machine learning techniques were applied for the OASI classification (≤2 vs. >2), and Wexner scale (=0 vs. >0). The best efficacies were obtained using Random Forest and k-Nearest Neighbors methods. Best accuracies were 93.3% and 99.6%, for raw and re-analyzed data, respectively, for ultrasound assessed by the OASI classification; and 79.8% and 97.0%, respectively, for clinical evaluation using the Wexner scale. Impedance spectroscopy performed using the ONIRY Probe appears to be a promising diagnostic technique for anal sphincter injury detection but requires further investigation (the next phase of the pilot clinical trial is described at NCT04181840).

Analysis of feasibility, efficacy and short-term results after six-arm transvaginal mesh OPUR implantation in women with apical prolapse. The same surgeon operated all of 39 women using mesh OPUR. Preoperatively patients had a standardized interview and clinical examination. Intraoperative and postoperative complications were analyzed. Postoperative evaluation included standardized interview, clinical examination and standardized pelvic floor ultrasound performed with 2D transvaginal probe and 4D abdominal probe. There was no complication that needed operative intervention. Hematomas in 3 patients resolved spontaneously. Transient voiding difficulties which lasted less than 7 days were observed in 5 patients. No erosion was observed. Comparison of pre- and postoperative results in 34 women revealed that in all 3 compartments improvement in POP-Q scale was statistically significant (p < 0.0000). One patient with malposition and rolled up mesh needed re-operation. During PFS-TV in 94.1% of patients urethra was normobile or hypermobile. In all of the patients urethral end of the mesh was positioned far enough from the middle part of the urethra (ultrasound) to implant suburethral sling without risk of collision. Sexually active women did not inform of any important discomfort or pain during intercourse. It seems that six-arm OPUR mesh, if implanted under strict surgical rules, gives low risk of complications and high chance to successfully reduce POP symptoms in short term after the operation. It seems that OPUR mesh should not have negative influence on the results after anti-incontinence suburethral sling.