Female sexual function index for screening of female sexual dysfunction using DSM-5-TR criteria in Thai women: A prospective cross-sectional diagnostic study.

Thai Female Sexual Function Index discrimination using the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria has not been investigated. This study aimed to evaluate the Female Sexual Function Index as a tool for assessing sexual symptoms and to determine the prevalence of female sexual dysfunction in Thai women using the new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria. This prospective cross-sectional diagnostic study included sexually active women aged ≥18 years, interviewed from January to June 2023. The participants completed the Thai version of a comprehensive of the Female Sexual Function Index questionnaire encompassing general information and self-reported assessments of female sexual function, followed by a semi-structured interview of distress symptom severity. Female sexual function was determined by screening of the total Female Sexual Function Index score, whereas female sexual dysfunction was evaluated using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria. Using receiver operating characteristic curves, a clinical cutoff for the Female Sexual Function Index score of 23.1 was determined to identify female sexual dysfunction (area under the curve, 0.76; 95% confidence interval, 0.71-0.80; sensitivity, 75.6%; specificity, 67.7%; positive predictive value, 77.7%; negative predictive value, 65%). A prevalence of 40.2% for female sexual dysfunction was observed in the study population. The results of this study could be used as practical guidance for the screening of women affected by female sexual dysfunction in Thailand in the future.

Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women.

OBJECTIVE: The objective of this study was to estimate the association of vaginal sacrospinous ligament fixation with anterior-transobturator mesh repair surgery for advanced pelvic organ prolapse in patients of two different age groups. MATERIALS AND METHODS: Vaginal sacrospinous ligament fixation with anterior mesh repair as primary prolapse surgery was performed on 225 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was determined according to feedback of POPDI-6 (Questions 2 and 3). Patients provided responses to UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and postsurgery. Outcome measures were observed in cohorts of two age groups (<75 years and ≥75 years). RESULTS: Postoperative data of 217 patients were available. The cumulative objective cure rates were 93.0% and 92.5% for patients aged ≥75 years and <75 years, respectively, with mean follow-up of 33.93 ± 18.52 months and 36.44 ± 19.34 months respectively. The UDI-6, IIQ-7, POPDI-6, and PISQ-12 scores within each of the two age groups improved significantly after surgery. Comparatively, the POPDI-6 score was better whereas the PISQ-12 score was poorer among patients aged ≥75 years. Older women had significantly more preoperative comorbidities. The operative time, perioperative complications, and length of hospital stay showed no difference between the two groups. The intraoperative blood loss was significantly less in the older group and neither group had mortality. CONCLUSION: This study showed that adequately optimized older patients undergoing pelvic organ prolapse surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.

Low incidence of bacteriuria with outpatient flexible cystoscopy.

AIM: To evaluate the incidence of bacteriuria after outpatient diagnostic flexible cystoscopy utilising sterile catheter urine collection technique in women. MATERIALS AND METHODS: This is a prospective observational study on 78 women who had outpatient flexible cystoscopy for various indications between March and December 2011. Urine for culture was collected by transurethral catheterisation three to five days before cystoscopy, and a second urine sample was collected five to seven days after the procedure. Antibiotic prophylaxis was not administered. Significant bacteriuria was defined as 10(2)  cfu/mL or more of a single organism cultured. RESULTS: Five (6.4%) had significant bacteriuria and were asymptomatic. The most common organism cultured was Escherichia coli in 4 (80%) of the infected women. No other cystoscopic complication was observed. The mean age was 54.7 years (range 27-80), mean parity was 2.8 (range 0-7). In the study group, 54 (69.2%) women were postmenopausal, 9 (11.5%) had diabetes mellitus, 42 (53.8%) had pelvic organ prolapse and 22 (28.2%) had a prior hysterectomy. Most common indications for cystoscopy were hematuria and recurrent UTI, 48 (61.5%) and 22 (28.2%) women respectively. The cystoscopic findings were normal in 59 (75.6%) women. The procedure was completed within five minutes in all participants. CONCLUSION: The incidence of bacteriuria following outpatient flexible cystoscopy is low.

Delayed intravesical mesh erosion in a midurethral sling following further mesh-augmented pelvic prolapse surgery.

Intravesical mesh erosion and extrusion have been reported as devastating late complications of synthetic suburethral sling placement for the treatment of stress urinary incontinence. We report a case of a female patient with intravesical mesh erosion from a sling suspension that developed 4 years after primary prolapse surgery with mesh reinforcement. Intravesical mesh erosion was observed ultrasonographically and confirmed through cystoscopy. We excised the mesh via a vaginal approach and repaired both bladder mucosa and vaginal wall. As of this writing, the patient has been symptom-free for the past year post-surgery. Long-term follow-up is recommended in such cases. Anti-incontinence surgery followed by primary prolapse surgery could potentially jeopardize the former. Complications may arise several years later so long-term follow-up is essential. Ultrasonography is an effective tool in evaluating mesh morphology and detecting intravesical mesh erosion.

Assessment of collagen-coated anterior mesh through morphology and clinical outcomes in pelvic reconstructive surgery for pelvic organ prolapse.

STUDY OBJECTIVE: To assess the morphologic features of anterior armed transobturator collagen-coated polypropylene mesh and its clinical outcomes in pelvic reconstructive surgery to treat pelvic organ prolapse. DESIGN: Evidence obtained from several timed series with intervention (Canadian Task Force classification II-3). SETTING: Chang Gung Memorial Hospital, Taoyuan, Taiwan, China. PATIENTS: Between April 2010 and October 2012, 70 patients underwent surgery to treat symptomatic pelvic organ prolapse, stage III/IV according to the POP-Q (Pelvic Organ Quantification System). INTERVENTION: Anterior armed transobturator collagen-coated mesh. MEASUREMENT AND MAIN RESULTS: Morphologic findings and clinical outcome were measured. Morphologic features were assessed via 2-dimensional introital ultrasonography and Doppler studies. Clinical outcome was measured via subjective and objective outcome. Objective outcome was assessed via the 9-point site-specific staging method of the International Continence Society Pelvic Organ Prolapse Quantification before the operation and at 1-year postoperative follow-up. Subjective outcome was based on 4 validated questionnaires: the 6-item UDI-6 (Urogenital Distress Inventory), the 7-item IIQ-7 (Incontinence Impact Questionnaire), the 6-item POPDI-6 (Pelvic Organ Prolapse Distress Inventory 6), and the 12-item PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), at baseline and at 12 months after the operation. Data were obtained for 65 patients who underwent the combined surgery and were able to comply with follow-up for >1 year. Ultrasound studies reveal that mesh length tends to shorten and decrease in thickness over the 1-year follow-up. Vagina thickness also was reduced. Neovascularization through the mesh was observed in <8.5% of patients in the first month and at 1 year, and was evident in approximately 83%. The mesh exposure rate was 6.4%. The recorded objective cure was 90.8% (59 of 65 patients), and subjective cure was 89.2% (58 of 65 patients) at mean (SD) follow-up of 19.40 (10.98) months. At 2 years, UDI-6, IIQ-7, and POPDI-6 scores were all significantly decreased (p < .001), whereas the PISQ-12 score was significantly increased (p = .01). CONCLUSIONS: Ultrasound features suggest that the degeneration of collagen barrier may be longer than expected and that integration of collagen-coated mesh could occur up to 1 year. A substantially good clinical outcome was noted.

A delayed type of ureteric injury developed after transobturator mesh procedure for massive prolapse.

We report on a rare case of delayed presentation of ureteric injury with a transobturator mesh kit for anterior vaginal wall prolapse repair along with conventional vaginal pelvic reconstructive surgery: a case of a 56-year-old multiparous, postmenopausal woman with a body mass index of 22.1 kg/m, who had continuous leakage of urine per vagina 28 days after vaginal hysterectomy, mesh-augmented anterior repair with Avaulta Plus Anterior support system kit (CR Bard Inc, Covington, Ga), and sacrospinous ligament fixation for stage IV pelvic organ prolapse. Pelvic computed tomographic scan with contrast revealed an intact bladder, right hydroureteronephrosis, and right ureterovaginal fistula. Immediate laparotomy performed revealed that the right lower mesh arm was entangled with the distal end of the right ureter, 1.5 cm from the ureteric orifice. Category, time, site classification was 4CaT2S5. Right ureteric reimplantation was performed uneventfully. We herein emphasize that the development of a delayed type of ureteric injury is a possible associated complication of transobturator mesh surgery for the prolapse.

Bacteriuria and safety of female urodynamic studies.

INTRODUCTION AND HYPOTHESIS: Our aim was to study the incidence of bacteriuria after urodynamic studies (UDS) and prevalence of asymptomatic bacteriuria before UDS. METHODS: In this prospective study between March and September 2011, 140 women undergoing UDS were subjected to urine culture before the investigation. Urine was collected aseptically with a sterile catheter transurethrally. Multichannel UDS were performed 3-5 days after urine collection. Prophylactic antibiotics were not administered to these women. A second urine sample was collected within 5-7 days after UDS. Significant bacteriuria was defined as 10(2) colony-forming units (cfu)/ml or more of a single organism cultured. RESULTS: Thirty (21.4 %) women had asymptomatic bacteriuria before UDS and were excluded from the main study group. Among the 110 women in the study group, 4 (3.6 %) acquired infection after UDS. Three grew organisms found in the vagina (group B Streptococcus and yeast-like organism) and one grew Proteus mirabilis. Age 60 years and above is a significant risk factor. In contrast to the study group, among 30 women who had infection before UDS, Escherichia coli was the commonest pathogen in 19 (63.3 %) and 30 % had diabetes. Eleven (36.7 %) had persistent infection after UDS and the rest resolved spontaneously. In addition, no other related complication was observed on the UDS. CONCLUSIONS: This study shows that risk of post UDS bacteriuria is low in women and screening for vaginal infections may be necessary before UDS. Women over 60 years old are significantly at risk of infection. Bacteriuria is nevertheless mostly asymptomatic and transient in nature.

Delayed vaginal and urethral mesh exposure: 10 years after TVT surgery.

Delayed mesh exposure after tension-free vaginal tape (TVT) procedure is rare. We report a case of mesh exposure into the vagina and urethra that developed 10 years after TVT surgery. A 58-year-old postmenopausal woman presented with mixed urinary incontinence. She was investigated, and her stress urinary incontinence was cured with a TVT procedure 10 years ago. She was then scheduled follow-up annually. Two years postsurgery, a granulation tissue was observed and excised at the vaginal incision site. Vaginal examination 10 years postsurgery showed vaginal mesh erosion 0.5 cm from urethral meatus. Cystoscopy revealed concomitant urethral erosion at the posterior urethral wall. Mesh excision was performed, and urethra and vagina were repaired in layers. Postoperative recovery was uneventful. This finding shows that, although rare, complications can occur even after 10 years of TVT surgery.

Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women.

INTRODUCTION AND HYPOTHESIS: The aim of this study is to compare the outcomes of patients who underwent surgical repair of advanced pelvic organ prolapse amongst with normal-weight, overweight and obese Asian women. METHODS: Vaginal sacrospinous ligament fixation with anterior mesh repair as primary surgery was performed on 200 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was based on POPDI-6 (questions 2 and 3). Patients completed the UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and post-surgery. Outcome measures were observed in three categories of Asian BMI (normal weight 18.5 to 23.0 kg/m(2), overweight >23.0 to 27.5 kg/m(2), and obese ≥ 27.5 kg/m(2)). RESULTS: Postoperative data were available for 195 patients. Objective cure for the normal-weight, overweight, and obese were 93.0%, 92.5% and 90.6% respectively with an overall mean follow-up of 35.69 ± 18.97 months. The subjective cure was no different. All categories improved significantly with regard to anatomical outcome, UDI-6, IIQ-7, POPDI-6, PISQ-12 after primary surgery (p < 0.05) and none had recurrence requiring further surgery. However, obese patients have significantly less improvement in POPDI-6 (p <0.037) and PISQ-12 (p <0.005) compared with normal weight. There were no differences with regard to perioperative complications and the vaginal mesh exposure rate was 4.1%. CONCLUSIONS: There was no difference in the objective outcome of sacrospinous ligament fixation with anterior mesh repair surgery among the three Asian BMI categories; however, obese patients showed less improvement in POP symptoms and sexual function.

A comparative study of cost of care and duration of management for first-trimester abortion with manual vacuum aspiration (MVA) and sharp curettage.

OBJECTIVE: This study compared the hospital charges, duration of in-hospital procedures, clinical course and complications between manual vacuum aspiration (MVA) and sharp curettage. MATERIALS AND METHODS: A prospective observational study was conducted during the May 2007-April 2008 period in Songklanagarind Hospital, Thailand. Forty cases of pregnancy ≤9 weeks of gestation, with conditions of an incomplete abortion, a blighted ovum or missed abortion were treated with either MVA or sharp curettage. Both groups were compared in terms of demographic and obstetric data, hospitalization cost, clinical course and complications. RESULTS: The obstetric data of both groups showed that the median parity was two, with a median gestation age of 8 weeks. The median total hospital expenditure was 54.67 USD for patients using the MVA technique and 153.97 USD for the sharp curettage group (p < 0.01). The median duration of in-hospital care in the MVA group was significantly less than that of the sharp curettage group, 4 versus 20 h, respectively (p < 0.01). 90 % of patients in the MVA group had only one visit compared with 72.5 % in the sharp curettage group (p = 0.04). No complications needing further curettage or treatment in either group were noted. CONCLUSION: The use of MVA in the management of a first-trimester abortion is practical, safe, cheap and time-saving.