Diagnosis and Therapy of Female Urinary Incontinence. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 015/091, January 2022): Part 2 with Recommendations on Interventional/Surgical Therapy of Overactive Bladder, Surgical Treatment of Stress Urinary Incontinence and Diagnosis and Therapy of Iatrogenic Urogenital Fistula.

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the surgical treatment of female patients with stress urinary incontinence and urge incontinence. Specific solutions for the diagnostic workup and treatment of uncomplicated and complicated urinary incontinence are discussed. The diagnostics and surgical treatment of iatrogenic urogenital fistula are presented.

Diagnosis and Therapy of Female Urinary Incontinence. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/091, January 2022): Part 1 with Recommendations on Diagnostics and Conservative and Medical Treatment.

Aim This completely revised interdisciplinary S2k-guideline on the diagnosis, therapy, and follow-up care of female patients with urinary incontinence (AWMF registry number: 015-091) was published in December 2021. This guideline combines and summarizes earlier guidelines such as "Female stress urinary incontinence," "Female urge incontinence" and "Use of Ultrasonography in Urogynecological Diagnostics" for the first time. The guideline was coordinated by the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group for Urogynecology and Plastic Pelvic Floor Reconstruction (Arbeitsgemeinschaft für Urogynäkologie und plastische Beckenbodenrekonstruktion e. V., AGUB). Methods This S2k-guideline was developed using a structured consensus process involving representative members from different medical specialties and was commissioned by the Guidelines Commission of the DGGG, OEGGG and SGGG. The guideline is based on the current version of the guideline "Urinary Incontinence in Adults" published by the European Association of Urology (EAU). Country-specific items associated with the respective healthcare systems in Germany, Austria and Switzerland were also incorporated. Recommendations The short version of this guideline consists of recommendations and statements on the epidemiology, etiology, classification, symptoms, diagnostics, and treatment of female patients with urinary incontinence. Specific solutions for the diagnostic workup and appropriate conservative and medical therapies for uncomplicated and complication urinary incontinence are discussed.

Effects of a one-week vacation with various activity programs on well-being, heart rate variability, and sleep quality in healthy vacationers-an open comparative study.

OBJECTIVES: This open comparative study aimed to analyze the effects of a one-week vacation with various activity programs on well-being, heart rate variability (HRV) and sleep quality in healthy vacationers. METHODS: Fifty-two healthy untrained vacationers spent a one-week vacation with regular exercise in East Tyrol. Exercise was performed on six of seven days. The study participants were divided into a) Group 1, playing golf (G), and b) Group 2 performing Nordic walking or e-biking (NW&EB). Well-being was measured with the WHO-5 well-being-index; stress and recovery status was obtained with the EBF-24-questionnaire (recovery-stress questionnaire). HRV parameters in the time and frequency domain (SDNN, pNN50, r-MSSD, log LF/HF and total power) were measured with a 24-h-ECG (electrocardiogram). Sleep quality was derived from the EBF-24 questionnaire and sleep architecture from HRV-analysis. Examinations were performed one day before and after the vacation. RESULTS: Well-being significantly improved in the G group (+ 40%, p < 0.001) and NW&EB group (+ 19%, p = 0.019). The stress and recovery profile also improved significantly in both groups (stress-decrease: -43.7% G group; -44.7% NW&EB group; recovery-increase: + 23.6% G group; + 21.5% NW&EB group). Except for the SDNN (standard deviation of the NN interval), no significant change was noted in HRV-parameters. SDNN improved significantly only in the NW&EB group (+ 9%, p < 0.05). Sleep quality (+ 21% G group, p = 0.029; + 19% NW&EB group, p = 0.007) and architecture (-10% G group, p = 0.034; -23% NW&EB group, p = 0.012) significantly improved in both groups. CONCLUSION: A short-term vacation with regular exercise was well tolerated by the study participants and improved well-being, sleep quality, HRV and autonomic regulation. TRIAL REGISTRATION: Registry and the registration no. of the study/trial: Approval was received from the ethics committee of the Leopold Franzens University of Innsbruck (AN2013-0059 332/4.8).

Aspects of Pelvic Floor Protection in Spontaneous Delivery - a Review.

The necessity of increasingly addressing aspects of pelvic floor protection, i.e., prevention of the most frequent female pelvic floor disorders, such as urinary incontinence, faecal incontinence and pelvic organ prolapse, is the result of the steadily improving understanding of the association of pregnancy and delivery with the prevalence of these disorders. About a quarter of all women experience one or more such symptoms during their life. Apart from age and weight, pregnancies and births play an important part. While initial discussion of pelvic floor protection often focused very rapidly on the mode of delivery and elective caesarean section as a possible protective intervention, it has become apparent in the last few decades how varied and wide-ranging the options are that can be used to protect against pelvic floor disorders. The mode of delivery as such is "only" one element among numerous other considerations and has diminished markedly in importance. Interprofessionality and interdisciplinarity undoubtedly represent an important development as resulting recommendations must always be incorporated in an overall context that considers mother and child at the same time. Considering the pelvic floor only certainly does not make sense. This review article will analyze in greater detail important pre-, intra- and postpartum aspects that in their entirety can provide insight into the various aspects of pelvic floor protection. The authors regard the following article as an additional basis for discussion on achieving a sustained reduction in the incidence and prevalence of female pelvic floor disorders.

Personal Preference of Mode of Delivery. What do Urogynaecologists choose? Preliminary Results of the DECISION Study.

INTRODUCTION: Currently, almost every third child in Germany is delivered by caesarean section. Apart from straightforward and clear indications for caesarean section which account for approx. 10%, the large proportion of relative indications in particular needs to be critically reviewed if the current C-section rate is to be effectively lowered. It is more than doubtful, however, whether this can be a realistic goal in Germany, especially in the context of international developments. All studies on this topic demonstrate that the personal attitude of the obstetric team has a considerable influence on the pregnant woman's personally preferred mode of delivery. Therefore, in the first part of the DECISION study, the personal preferences of urogynaecologists were evaluated regarding the best suitable mode of delivery. MATERIAL AND METHODS: All 432 delegates at the 9th German Urogynaecology Congress in Stuttgart in April 2017 were invited to participate in an online questionnaire study. The questionnaire was developed especially for this study. RESULTS: Of the 432 registered delegates, 189 (43.8%) participated in the survey. 84.7% (n = 160) of the study participants would prefer a vaginal delivery, in an otherwise uncomplicated pregnancy. Only 12.2% (n = 23) opted for an elective caesarean section. The main reasons stated for this decision were concerns about incontinence (87.5%) and pelvic floor trauma (79.2%). Amongst the study participants, 83.6% would like to be part of a risk stratification system presented in the questionnaire which, with the aid of specific parameters, is intended to allow early identification of a population with a high risk of developing pelvic floor disorders. There was also great interest in postpartum pelvic floor recovery (97.8%) and an associated optional pessary therapy (64.4%). The type of delivery already experienced (vaginal delivery vs. primary caesarean section) and parity also reveals to have a significant influence on the personal preferred mode of delivery as well. CONCLUSIONS: Urogynaecologists prefer vaginal delivery for themselves. There is a great interest to participate in a risk stratification process in order to approach childbirth in an individualized and risk-adapted manner.

The Diagnosis and Treatment of Ectopic Pregnancy.

BACKGROUND: Extrauterine pregnancy is a complication of the first trimester of pregnancy that arises in 1.3-2.4% of all pregnancies. METHODS: This review is based on articles and guidelines retrieved by a selective PubMed search. RESULTS: The presentation of extrauterine pregnancy is highly variable, ranging from an asymptomatic state, to pelvic pain that is worse on one side, to tubal rupture with hemorrhagic shock. 75% of tubal pre gnancies can be detected by transvaginal ultrasonography. In patients with a vital extrauterine pregnancy, the human chorionic gonadotropin concentration generally doubles within 48 hours. Laparoscopy is the gold standard of treatment. Two randomized, controlled trials comparing organ-preserving treatment with ablative surgery revealed no significant difference in pregnancy rates after the intervention, but precise details of the surgical procedures were not provided, and long-term fertility data are lacking. Metho - trexate therapy should be used only for strict indications. CONCLUSION: Further randomized, controlled trials with longer follow-up will be needed to answer currently open questions about the potential for individualized surgical treatment and the proper role of pharmacotherapy.

Competitive advantages of Caedibacter-infected Paramecia.

Intracellular bacteria of the genus Caedibacter limit the reproduction of their host, the freshwater ciliate Paramecium. Reproduction rates of infected strains of paramecia were significantly lower than those of genetically identical strains that had lost their parasites after treatment with an antibiotic. Interference competition occurs when infected paramecia release a toxic form of the parasitic bacterium that kills uninfected paramecia. In mixed cultures of infected and uninfected strains of either P tetraurelia or of P novaurelia, the infected strains outcompeted the uninfected strains. Infection of new host paramecia seems to be rare. Infection of new hosts was not observed in either mixtures of infected with uninfected strains, or after incubation of paramecia with isolated parasites. The competitive advantages of the host paramecia, in combination with their vegetative reproduction, makes infection of new hosts by the bacterial parasites unnecessary, and could be responsible for the continued existence of "killer paramecia" in nature. Caedibacter parasites are not a defensive adaptation. Feeding rates and reproduction of the predators Didinium nasutum (Ciliophora) and Amoeba proteus (Amoebozoa, Gymnamoebia) were not influenced by whether or not their paramecia prey were infected. Infection of the predators frequently occurred when they preyed on infected paramecia. Caedibacter-infected predators may influence competition between Paramecium strains by release of toxic parasites into the environment that are harmful to uninfected strains.