Integrative medicine for pelvic floor disorders:A conceptual framework

1.Introduction Pelvic floor disorders encompass a wide range of dysfunctions,including issues of urination,defecation,pelvic organ prolapse,pain,and sexual health.These disorders are highly prevalent,with approximately one-quarter of adult women in the United States reporting the experience of at least one of these conditions.1 The co-occurring symptoms,arising from shared pathogenesis,have a significant impact on the patient's physical and emotional well-being,as well as impose economic burdens on both the individual and the healthcare system.Traditional single-specialty practices have proven insufficient to meet the diverse needs of patients.

Prevalence of pelvic floor disorders and the associated quality of life among institutionalized and noninstitutionalized elderly women:A cross-sectional study

Background:An increase in life expectancy has led to an increased elderly population.In turn,this aging population is more likely to develop health conditions,such as pelvic floor disorders(PFDs).This study aimed to assess the prevalence of these disorders and the associated quality of life in institutionalized and noninstitutionalized elderly women.Materials and methods:A cross-sectional study was conducted with 80 female participants older than 60 years,divided into 2 groups:institutionalized and noninstitutionalized participants.The Pelvic Floor Distress Inventory Short-Form and a sociodemographic questionnaire were used.A chi-squared test was used to assess the differences in prevalence between groups.Results:There was no statistically significant difference between the groups in the prevalence of PFDs or quality of life.In this study,the prevalence of PFDs was higher than that reported previously.In institutionalized women,a higher prevalence of PFDs and impaired quality of life were expected,although not observed.Conclusions:There was a higher prevalence of pelvic disorders and impaired quality of life due to these disorders in elderly women.

Mesh safety in pelvic surgery:Our experience and outcome of biological mesh used in laparoscopic ventral mesh rectopexy

BACKGROUND Laparoscopic ventral mesh rectopexy(LVMR)continues to be a popular treatment option for rectal prolapse,obstructive defecation/faecal incontinence and rectoceles.In recent years there have been concerns regarding the safety of mesh placements in the pelvis.AIM To assess the safety of the mesh and the outcome of the procedure.METHODS Eighty-six patients underwent LVMR with Permacol(Biological)mesh from 2012 to 2018 at University Hospital Wishaw.Forty were treated for obstructive defecation secondary to prolapse,rectocele or internal rectal intussusception,38 for mixed symptoms obstructive defecation and incontinence,5 for pain and bleeding secondary to full thickness prolapse and 3 with symptoms of incontinence.Questionnaires for the calculation of Wexner scores for constipation and incontinence were completed by the patients who were followed up in the clinic 12 wk after surgery and again in 6-12 mo.The average review of their notes was 18.3±4.2 mo.RESULTS The median Wexner scores for constipation pre-operatively and post-operatively were 14.5[Interquartile range(IQR):10.5-18.5]and 3(IQR:1-6),respectively,while the median Wexner score for faecal incontinence was 11(IQR:7-15)and 2(IQR:0-5),respectively(P<0.01).There were 4(4.6%)recurrences,2 cases that presented with erosion of a suture through the rectum and one with diskitis.No mesh complications or mortalities were recorded.CONCLUSION LVMR using a Permacol mesh is a safe and effective procedure for the treatment of obstructive defecation/faecal incontinence,rectal prolapse,rectoceles and internal rectal prolapse/intussusception.

Utility of magnetic resonance imaging in anorectal disease

Imaging of both benign and malignant anorectal diseases has traditionally posed a challenge to clinicians, and as a result history and physical exam have been relied on heavily. CT scanning and endorectal ultrasound have become popular in assessment of anatomy and staging of tumors, but have limitations. Magnetic resonance imaging (MRI) has the capability to fill in the gaps left open by more conventional imaging modalities and continues to be promising as the definitive imaging technique in the pelvis, especially with advancement of emerging technologies in this field. A comprehensive review of this topic has been undertaken. Anorectal disease is divided into three broad categories: cancer, fistula/abscess, and pelvic floor disorders. A review of the literature is performed to evaluate the use of MRI and other imaging modalities in these three areas. Preoperative imaging is useful in the evaluation of all three areas of anorectal disease. MRI is an effective tool in delineating anatomy and, when correlating with the specific clinical scenario, is an effective adjunct in clinical decision-making in order to optimize outcome. MRI continues to be a promising and novel approach to imaging various afflictions of the anorectum and the pelvic floor. Its role is more well-established in some areas than in others, and there are still signif icant limitations. As technology advances, MRI will shed more light on a complex anatomical area.

Single incision slings:Are they ready for real life?

AIM： To review of the efficacy and safety outcomes of different single incision slings （SIS） systems, also in comparison with traditional slings.METHODS： A literature search was conducted in PubMed/MEDLINE database. The research was re-stricted to randomized and/or prospective trials and retrospective studies, published after 2006, with at least 20 patients with non-neurogenic stress urinary incontinence （SUI）. The studies had to assess effcacy and/or safety of the SIS with a minimum follow-up of 12 mo. All the paper assessing the performance of tension free vaginal tape secur were excluded from this review. The fnal selection included 19 papers fulflling the aforementioned criteria. Two authors independently reviewed the selected papers.RESULTS： Four different SIS systems were analysed： Ajust , Ophira , Altis and MiniArc . The average objective cure rate was 88%. Overall no statistically significant differences were found between SIS and traditional mid-urethral slings （MUS） in terms of objective cure （all P 〉 0.005）. Only one paper showed a statistically lower success rate in MiniArc？ vs Advant-age？ slings （40% vs 90%） and higher rates of failure in the SIS group. Since there was a great variability in terms of tests performed, it was not possible to com-pare subjective cure between studies. The vast part of the studies showed no major complications after SIS surgery. We also observed very low reported pain rates in SIS patients. The RCTs on Ajust？ and MiniArc？, showed better outcomes in terms of post-operative pain compared to MUS. None of the patients reported long- term pain complains. CONCLUSION： SIS showed similar effcacy to that of traditional slings but lower short-term pain, complication and failure rates.