Publications by authors named "Matteo Frigerio"

86 Publications

Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review.

Medicina (Kaunas) 2022 Jul 23;58(8). Epub 2022 Jul 23.

Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80128 Naples, Italy.

Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women's quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.
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http://dx.doi.org/10.3390/medicina58080981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9331312PMC
July 2022

Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures.

Medicina (Kaunas) 2022 Jun 8;58(6). Epub 2022 Jun 8.

Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy.

To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs) have been adopted. The aim of this review is to narratively report the efficacy and safety of UBAs for SUI treatment. For this review, research from PubMed and EMBASE was performed to evaluate relevant studies that were undertaken from January 2012 to January 2022. Nineteen prospective studies were included. Several definitions of subjective and objective success were adopted. At a follow-up of <24 months, significant improvement was widely observed, even if with a heterogeneous rate of success between 32.7-90%, and a reinjection rate of 8.3-77.3%. Compared with other procedures, MUS resulted as significantly superior to UBAs but was balanced by a higher complication rate. Acute urinary retention, urinary tract infection and de novo urgency, and other complications, such as injection site rupture, urethral erosion and particle migration have been described after UBAs. SUI after UBAs treatment resulted in improvements in all studies and can be considered a safe and effective option to treat SUI. However, homogenous and longer-term data lack, limiting general recommendations. Thus, larger RCTs evaluating long-term effects are required.
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http://dx.doi.org/10.3390/medicina58060775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9227870PMC
June 2022

New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review.

Medicina (Kaunas) 2022 Jun 6;58(6). Epub 2022 Jun 6.

Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milan, Italy.

Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after adjuvant therapy for patients affected by breast cancer. Considering the high prevalence of VVA and the expected growth of this condition due to the increase in the average age of the female population, it is easy to understand its significant social impact. VVA causes uncomfortable disorders, such as vaginal dryness, itching, burning, and dyspareunia, and requires constant treatment, on cessation of which symptoms tend to reappear. The currently available therapies include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and Ospemifene. Considering, however, that such therapies have some problems that include contraindications, ineffectiveness, and low compliance, finding an innovative, effective, and safe treatment is crucial. The present data suggest great efficacy and safety of a vaginal laser in the treatment of genital symptoms and improvement in sexual function in patients affected by VVA. The beneficial effect tends to be sustained over the long-term, and no serious adverse events have been identified. The aim of this review is to report up-to-date efficacy and safety data of laser energy devices, in particular the microablative fractional carbon dioxide laser and the non-ablative photothermal Erbium-YAG laser.
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http://dx.doi.org/10.3390/medicina58060770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9230595PMC
June 2022

Hematocolpos due to imperforate hymen: a case report and literature systematic review.

Int Urogynecol J 2022 Jun 17. Epub 2022 Jun 17.

ASST Monza, San Gerardo University Hospital, via G.B. Pergolesi, 33, Monza, IT, Italy.

Introduction And Hypothesis: Hematocolpos is a rare condition, where menstrual blood fills the vagina, instead of being expelled, due to a series of uterovaginal pathologies, the most frequent of which is the imperforate hymen. To date, few cases of hematocolpos have been reported in the literature.

Methods: We report a case of hematometrocolpos due to imperforate hymen initially misdiagnosed as constipation and subsequently as ovarian mass; moreover, the present study undertakes a systematic review of studies on hematometrocolpos due to imperforate hymen to synthesize available knowledge on epidemiology, diagnosis, and management about this rare condition.

Results: A total of 35 studies, describing 61 patients, were identified. The presence of hematocolpos should be suspected in premenarchal patients complaining of low abdominal pain, abdominal swelling, and urinary retention. Genital examination disclosing a tender, pale hymen and ultrasound represent a useful tool for diagnosis. The goal of the management is to timely perform hymenotomy to drain the hematocolpos, followed by hymenectomy to prevent recurrence. Follow-up is needed to diagnose possible recurrences.

Conclusions: In the case of an adolescent girl complaining of genital pain associated with primary amenorrhea, hematocolpos due to imperforate hymen should be suspected.
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http://dx.doi.org/10.1007/s00192-022-05270-xDOI Listing
June 2022

Prevalence and severity of sexual disorders in the third trimester of pregnancy.

Minerva Obstet Gynecol 2022 Jun 8. Epub 2022 Jun 8.

Monza and Brianza Mother and Child Foundation, Obstetric Division, Monza, Italy.

Background: Female sexual function in pregnancy is an under-investigated topic by care providers. This study aimed to investigate the sexual function and the impact of traditional risk factors for pelvic floor disorders (PFDs) during the third trimester of pregnancy.

Methods: This is a secondary analysis of a multicentre cross-sectional study conducted in eight hospitals in Italy and Italian-speaking Switzerland. Women at the third trimester of pregnancy aged 18 years and over completed the Italian-PFQPP questionnaire anonymously.

Results: 927 patients in the third trimester of pregnancy answered the questionnaire. 29.5% of women reported reduced or absent sexual activity. The less reported symptom was coital incontinence (1.3%), while painful intercourses was the most frequent one (50.3%). Nicotine abuse was associated with traumatic sexual intercourses, impaired vaginal sensibility, and negative impact on sexual life and well-being. Familiarity for pelvic floor disorder resulted as a risk factor for coital incontinence (OR=3.61).

Conclusions: Sexual symptoms, with pain during intercourses being the most widely reported, are extremely common in the third trimester of pregnancy and can greatly affect quality of life. Familiarity for pelvic floor disorders and nicotine abuse resulted as significant risk factors for at least one sexual symptom.
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http://dx.doi.org/10.23736/S2724-606X.22.05118-1DOI Listing
June 2022

Italian validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

Int Urogynecol J 2022 Jun 1. Epub 2022 Jun 1.

ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy.

Introduction And Hypothesis: The aim of this study was to translate the English short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and evaluate its validity, internal consistency, and test-retest reliability.

Methods: The questionnaire was translated into Italian by standardized procedural steps, and the final version was submitted to women referred to urogynecological outpatient care for genital prolapse or urinary incontinence reporting sexual disorders (cases) or not (controls). For the test-retest evaluation, cases received the questionnaire 2 weeks later. The Wilcoxon test (non-parametric) was used to assess differences between cases and controls. Convergent validity was tested with the Italian version of the FSFI-19. The internal consistency was tested using Cronbach's alpha. The degree of concordance/agreement was measured with Cohen's kappa. The absolute agreement of test-retest results was tested with the intraclass correlation coefficient (ICC).

Results: Sixty women were recruited for the study and answered the questionnaire. The overall rate of missing items was 1.3%. Construct validity was demonstrated, as the questionnaire discriminated significantly between patients with and without symptoms. Convergent validity with FSFI-19 was tested, and a linear correlation between scores was demonstrated (F < 0.001). Internal consistency reliability evaluated with Cronbach's alpha was satisfactory (0.54-0.81). Cohen's kappa values as absolute agreement coefficients were between 0.59 and 0.80 (good agreement). Intraclass correlation coefficients ranged between 0.88 and 0.94 (very satisfactory agreement) for each functional domain.

Conclusions: The Italian version of the PISQ-12 is reliable, valid, and consistent.
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http://dx.doi.org/10.1007/s00192-022-05235-0DOI Listing
June 2022

Coexisting overactive-underactive bladder and detrusor overactivity-underactivity in pelvic organ prolapse.

Int J Gynaecol Obstet 2022 May 26. Epub 2022 May 26.

Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Ospedale San Paolo, Milan, Italy.

Objective: The coexisting overactive-underactive bladder (COUB) syndrome could be related to the increased urethral resistance caused by severe pelvic organ prolapse (POP). We aimed to evaluate the clinical and urodynamic findings of patients with COUB and/or detrusor overactivity-underactivity (DOU) in a cohort of patients scheduled for POP surgery and the possible risk factors of COUB after surgery.

Methods: This retrospective study analyzed all patients who underwent POP repair between 2008 and 2013, excluding women with a history of pelvic floor surgery. Patients were divided into COUB and non-COUB according to baseline symptoms and into DOU and non-DOU based on urodynamic findings. A multivariate model was performed to identify risk factors for COUB symptoms after surgery.

Results: A total of 533 women underwent POP surgery. Preoperatively, patients with COUB had more severe anterior compartment prolapse (Pelvic Organ Prolapse Quantification staging system Aa point, P = 0.008) and more frequently had overactive bladder compared with controls (P = 0.023). The rate of COUB decreased significantly after surgery. Preoperative opening detrusor pressure resulted as the only independent predictor of postoperative COUB symptoms (P = 0.034).

Conclusion: POP is a valid pathogenetic model for COUB development. POP repair induced a significant decrease in COUB symptoms with low opening detrusor pressure resulting as the only independent predictor of postoperative COUB.
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http://dx.doi.org/10.1002/ijgo.14288DOI Listing
May 2022

Quality of Life, Psychological Wellbeing, and Sexuality in Women with Urinary Incontinence-Where Are We Now: A Narrative Review.

Medicina (Kaunas) 2022 Apr 9;58(4). Epub 2022 Apr 9.

Gynecology Department, Campania Luigi Vanvitelli University, 81100 Naples, Italy.

Urinary incontinence (UI) is a very common condition, negatively affecting social, occupational, domestic, and psychophysical wellbeing. In particular, a peculiar and detrimental effect of UI has been described concerning sexual function. However, the impact of UI on quality of life is not fully understood yet, and further investigation into this issue is warranted. With this narrative review, we aimed to report the current evidence from recent literature regarding the quality of life and psychological wellbeing in patients with urinary incontinence, with a special focus on sexual function and its evolution after UI treatment. There is strong evidence that urinary incontinence-in its different forms, including stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, and coital urinary incontinence-negatively affects female sexual function. Treatments aimed to cure urinary incontinence-including pelvic floor muscles training, medications, and surgery-seem to improve quality of life by recovering, at least in part, sexual function. In conclusion, there is a substantial association between involuntary urinary loss and sex life quality. However, few studies are available and more evidence is needed before consistent conclusions can be made.
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http://dx.doi.org/10.3390/medicina58040525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9025831PMC
April 2022

Vaginal Laser Therapy for Female Stress Urinary Incontinence: New Solutions for a Well-Known Issue-A Concise Review.

Medicina (Kaunas) 2022 Apr 4;58(4). Epub 2022 Apr 4.

Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy.

: Insufficient connective urethra and bladder support related to childbirth and menopausal estrogen decrease leads to stress urinary incontinence (SUI). The aim of this review is to narratively report the efficacy and safety of new mini-invasive solutions for SUI treatment as laser energy devices, in particular, the microablative fractional carbon dioxide laser and the non-ablative Erbium-YAG laser. For this narrative review, a search of literature from PubMed and EMBASE was performed to evaluate the relevant studies and was limited to English language articles, published from January 2015 to February 2022. : A significant subjective improvement, assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF) was reported at the 6-month follow up, with a cure rate ranged from 21% to 38%. A reduction of effect was evidenced between 6 and 24-36 months. Additionally, the 1-h pad weight test evidence a significant objective improvement at the 2-6-month follow up. : SUI after vaginal laser therapy resulted statistically improved in almost all studies at short-term follow up, resulting a safe and feasible option in mild SUI. However, cure rates were low, longer-term data actually lacks and the high heterogeneity of methods limits the general recommendations. Larger RCTs evaluating long-term effects are required.
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http://dx.doi.org/10.3390/medicina58040512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9028572PMC
April 2022

The Learning Curve of Urodynamics for the Evaluation of Lower Urinary Tract Symptoms.

Medicina (Kaunas) 2022 Feb 23;58(3). Epub 2022 Feb 23.

Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland.

Urodynamics is considered the gold standard for lower urinary tract functional assessment. However, it requires very specific skills and training, which are currently difficult to master due to its reduced use. Moreover, no studies or data are available to define the workload and the learning curve of this diagnostic tool. As a consequence, we aimed to evaluate the learning curve of residents with no previous experience to correctly perform and interpret urodynamics, and properly address and manage patients with pelvic floor disorders based on urodynamics findings. This prospective study analyzed a series of proficiency parameters in residents performing urodynamics under consultant supervision, including the following: duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and therapeutic proposal. The number of procedures performed was then divided into groups of five to evaluate the progressive grade of autonomy (technical and full management autonomy) reached by each resident. In total, 69 patients underwent urodynamics performed by three residents, with every resident performing at least 20 exams. Duration of procedure, perceived difficulty, need for consultant intervention, accuracy of interpretation, and the appropriateness of the hypothetical proposal of management/treatment based on their interpretation of clinical data and urodynamic findings was shown to be directly related to the number of exams performed. Technical autonomy in the execution of uroflowmetry was reached in the group performing 6-10 procedures, while technical autonomy in the execution of cystomanometry with pressure/flow study was obtained in the group of 16-20 procedures. The latter corresponded also to the gain of full autonomy which also included an optimal therapeutic proposal. We found that there is a tangible learning curve for urodynamics in terms of several proficiency parameters. A workload of 5 uroflowmetries and 15 cystomanometries with pressure/flow studies may be adequate to complete the learning curve.
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http://dx.doi.org/10.3390/medicina58030341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8955767PMC
February 2022

Correlation between urinary symptoms and urodynamic findings: Is the bladder an unreliable witness?

Eur J Obstet Gynecol Reprod Biol 2022 May 14;272:130-133. Epub 2022 Mar 14.

ASST Monza, Ospedale San Gerardo, Monza, Italy.

Objective: The role of urodynamics as the gold standard to investigate bladder function has recently been questioned. We aimed to evaluate the agreement of lower urinary tract symptoms and urodynamic diagnosis and to build predictive models.

Study Design: Patients who underwent urodynamics for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Clinical evaluation investigated the presence of genital prolapse, stress urinary incontinence (SUI), overactive bladder (OAB), urge urinary incontinence (UUI), voiding symptoms (VS), and bulging symptoms. The degree of concordance/agreement between symptoms and corresponding urodynamic findings was measured. Multivariate models to predict specific urodynamic findings were built.

Results: 1972 women were analyzed. The best agreement was found for SUI and urodynamic SUI, with a proportion of agreement of 0.68 and a Cohen's Kappa of 0.37. Very poor agreement was found for OAB/UUI and detrusor overactivity, voiding dysfunction, and positive post-void residuals. Multivariate models resulted in poor accuracy for all urodynamic findings (AUC range 0.64-0.72).

Conclusion: Lower urinary tract symptoms and gynecological examination are poor predictors of urodynamic findings. This confirms the role of urodynamic assessment in defining bladder function and providing precious information to counsel patients and establishing optimal clinical guidance.
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http://dx.doi.org/10.1016/j.ejogrb.2022.03.023DOI Listing
May 2022

Pelvic organ prolapse and vaginal cancer: A systematic literature review.

Int J Gynaecol Obstet 2022 Feb 15. Epub 2022 Feb 15.

University of Milano-Bicocca, Monza, Italy.

Background: Primary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment.

Objectives: To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions.

Search Strategy: We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse", and "vaginal cancer", "vaginal carcinoma".

Selection Criteria: No article type restrictions were applied.

Data Collection And Analysis: Twenty-one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients.

Main Results: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed.

Conclusion: A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases.
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http://dx.doi.org/10.1002/ijgo.14137DOI Listing
February 2022

Selective suture removal for the management of buttock pain after uterosacral ligaments suspension.

Int Urogynecol J 2022 Jul 20;33(7):2057-2059. Epub 2022 Jan 20.

University of Milano-Bicocca, Monza, via G.B. Pergolesi, 33 20900, Monza, Italy.

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http://dx.doi.org/10.1007/s00192-021-05055-8DOI Listing
July 2022

Native-tissue prolapse repair: Efficacy and adverse effects of uterosacral ligaments suspension at 10-year follow up.

Int J Gynaecol Obstet 2022 Jan 19. Epub 2022 Jan 19.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Objective: To evaluate the 10-year outcomes of high uterosacral ligaments suspension as a primary repair for apical prolapse and to evaluate the long-term impact of prognostic factors.

Methods: A retrospective study analyzed 10-year follow up after repair of primary apical prolapse through high uterosacral ligament suspension. Bulging symptoms and postoperative prolapse stage II or above were considered subjective and objective recurrences, respectively. Patient Global Impression of Improvement score was used to evaluate subjective satisfaction after surgery.

Results: A total of 287 women were analyzed. Ten-year recurrence rates were 19.1% for objective recurrence and 6.3% for subjective recurrence; surgical retreatment rate was 2.1%. Premenopausal status was related to 15-fold increased risk of developing either objective or subjective recurrence. Conversely, anterior and posterior repair were protective factors against reoperation.

Conclusion: High uterosacral ligaments suspension is a safe and long-lasting effective procedure for the treatment of uterovaginal prolapse even 10 years after index surgery. Premenopausal status and lack of anterior and posterior repair represented long-term risk factors for surgical failure.
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http://dx.doi.org/10.1002/ijgo.14096DOI Listing
January 2022

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder.

Int J Womens Health 2022 4;14:1-7. Epub 2022 Jan 4.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Purpose: Intradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB.

Patients And Methods: This retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients' outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident.

Results: Twenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2-2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability.

Conclusion: Intradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.
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http://dx.doi.org/10.2147/IJWH.S345454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8742680PMC
January 2022

Prevalence and severity of pelvic floor disorders in pregnant and postpartum women.

Int J Gynaecol Obstet 2022 Aug 4;158(2):346-351. Epub 2021 Dec 4.

San Gerardo Hospital, Monza, Italy.

Objective: This multicenter study aimed to evaluate risk factors, prevalence and severity of pelvic floor disorders (PFDs) as well as their consequences on women's emotional well-being, using a questionnaire validated specifically for pregnancy and postpartum.

Methods: Prospective study conducted in eight teaching hospitals in Italy and Italian-speaking Switzerland. Pregnant and postpartum women completed the Italian Pelvic Floor Questionnaire for Pregnancy and Postpartum anonymously. Prevalence of, severity of, and risk factors for PFDs were evaluated for all the four domains considered: bladder, bowel, prolapse, and sexual function.

Results: A total of 2007 women were included: 983 of the patients were bothered by at least one kind of PFD: bladder, bowel, and sexual dysfunction were more frequently reported. There were no significant differences in PFD prevalence between pregnancy and postpartum, except for bladder disorders, which were more prevalent in pregnancy. Familiarity for PFDs, pelvic floor contraction inability, cigarette smoking, body mass index more than 25 (calculated as weight in kilograms divided by the square of height in meters), and age more than 35 years were confirmed risk factors for the development of PFDs during pregnancy and postpartum.

Conclusion: Almost half of the women included in the study suffered from PFD-related symptoms with important consequences on quality of life. Validated questionnaires are fundamental in early diagnosis and treatment of PFDs.
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http://dx.doi.org/10.1002/ijgo.14019DOI Listing
August 2022

Surgical management of vaginal cancer and concomitant complete uterovaginal prolapse.

Int Urogynecol J 2022 Feb 4;33(2):441-443. Epub 2021 Nov 4.

ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy.

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http://dx.doi.org/10.1007/s00192-021-05005-4DOI Listing
February 2022

Stem Cells in Clinical Trials for Pelvic Floor Disorders: a Systematic Literature Review.

Reprod Sci 2022 06 1;29(6):1710-1720. Epub 2021 Oct 1.

Division of Obstetrics and Gynecology, San Paolo Hospital Medical School, ASST Santi Paolo E Carlo, Via Antonio di Rudinì 8, 20142, Milan, Italy.

Pelvic floor disorders (PFDs) include a series of conditions that can be poorly tolerated, negatively affecting the quality of life. Current treatment options show unsatisfactory results and new ones are therefore needed. Stem cell (SC) therapy might be an alternative treatment strategy. This systematic review aims to define the state of art of SC therapy for PFDs in clinical trials, by systematically reviewing the available evidence. A systematic search strategy was conducted up to November 7, 2020, in PubMed, Scopus, Cochrane Library, and ISI Web of Science. Preclinical studies on animal models were not considered. Studies were included when the patients were affected by any PFDs and cells were isolated, cultured, and characterized as SC. The study protocol was registered in PROSPERO (CRD42020216551). A total of 11 prospective clinical studies were included in the final assessment, specifically 7 single-arm studies dealing with SC therapy for stress urinary incontinence and 4 with anal incontinence. Among the latter, there were two prospective, single-arm studies and two randomized controlled trials. No papers concerning the use of SC for prolapse repair were retrieved. Due to the great heterogeneity, data pooling was not possible. Stem cell injection resulted in a safe procedure, with few mild adverse side effects, mostly related to harvesting sites. However, a clear beneficial impact of SC treatment for the treatment of pelvic floor disorders could not be demonstrated. Further larger targeted studies with control arms are needed before any conclusions can be made.
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http://dx.doi.org/10.1007/s43032-021-00745-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110489PMC
June 2022

Risk factors for obstetric anal sphincter injury recurrence: A systematic review and meta-analysis.

Int J Gynaecol Obstet 2022 Jul 20;158(1):27-34. Epub 2021 Oct 20.

Department of Obstetrics and Gynecology, ASST Monza, San Gerardo Hospital, Monza, Italy.

Background: Women with previous obstetric anal sphincter injuries (OASIs) are at a higher risk of recurrence in the subsequent pregnancy, which may lead to the development or worsening of anal incontinence. Due to a lack of evidence, few recommendations can be made about the factors that may affect the risk of OASI recurrence.

Objective: We sought to conduct a systematic review and meta-analysis to investigate potential risk factors for recurrent OASIs.

Search Strategy: Studies up to May 2019 were identified from PubMed, Scopus, Cochrane Library, and ISI Web of Science.

Selection Criteria: Studies assessing the impact of risk factors on OASI recurrence in subsequent pregnancies were included. Reviews, letters to the editor, conference abstracts, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded.

Data Collection And Analysis: Data were extracted by two independent reviewers. Odds ratio and standardized mean difference were chosen as effect measures. Pooled estimates were calculated using the random-effects model.

Main Results: The meta-analysis showed that maternal age, gestational age, occiput posterior presentation, oxytocin augmentation, operative delivery, and shoulder dystocia were associated with the risk of recurrent OASIs in the subsequent delivery.

Conclusion: Prenatal and intrapartum risk factors are associated with recurrence of OASI. PROSPERO registration no. CRD42020178125.
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http://dx.doi.org/10.1002/ijgo.13950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9298380PMC
July 2022

Update on Italian-validated questionnaires for pelvic floor disorders.

Minerva Obstet Gynecol 2021 Jul 30. Epub 2021 Jul 30.

Department Obstetrics and Gynaecology EOC - Beata Vergine Hospital, Mendrisio, Switzerland.

Objectives: Pelvic floor disorders (PFDs), which include urinary incontinence, pelvic organ prolapse, sexual dysfunction and gastrointestinal disorders, affect over 20% of the adult population. Prevalence may also be underestimated, since a certain portion of patients may be reluctant to talk to physicians about PFDs due to embarassment. Consequently, there is a need for self-assessed diagnostic tools with the capability to screen population and collect clinical information. Symptom and quality of life (QoL) questionnaires - also identified as patient-reported outcomes (PROs) - have been developed with this purpose. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in the English language, few of them have been validated for the Italian language. The objective of this article is to update the list of Italian-validated PROs for PFDs along with practical information concerning literature references and suggestions on how to obtain every single questionnaire.

Methods: PubMed/MEDLINE databases and websites were used to update the list of available Italian-validated questionnaires about PFDs. Once identified, the possibility to get a copy of the questionnaire was verified and steps to obtain it are reported in the tables.

Results: eight additional questionnaires validated into the Italian language, for diagnosis and overall management of common urinary, vaginal, sexual and bowel conditions, were retrieved. The complete list of PFDs PROS is reported in a modular format for consultation.

Conclusions: This format is intended to serve as a tool to promote appropriateness in PROs adoption while investigating PFDs in Italian patients.
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http://dx.doi.org/10.23736/S2724-606X.21.04901-0DOI Listing
July 2021

Intraoperative ultrasound assessment of ureteral patency during pelvic surgery.

Int Urogynecol J 2021 Dec 25;32(12):3313-3315. Epub 2021 Jun 25.

San Gerardo Hospital, Monza, Italy.

Ureteral injuries probably represent the most feared complication of benign hysterectomies. Lack of proper intraoperative detection causes diagnostic delay, which results in additional hospitalization, prolonged catheterization, and multiple additional procedures. However, the policy of universal cystoscopy is still under debate, owing to costs, increased operative time, lack of proper training, and risk of trauma. Intraoperative ultrasound assessment can offer a valid alternative for evaluating ureteral patency. After intravenous administration of 300 ml of saline solution and 10 mg of furosemide, the bladder is filled with 300 ml of saline solution. Transabdominal ultrasound bladder scans are obtained with a convex 3.5-MHz probe in transverse planes. The power Doppler field size is set to include the entire posterior wall of the bladder, at the level of the ureterovesical junctions. Ureteral patency test is considered normal if jets are present on both sides. It is considered abnormal when either absent or comparatively diminished on one side. It is considered nondiagnostic when neither side is visualized. Cystoscopy should be performed in the case of abnormal or nondiagnostic sonographic findings. Intraoperative transabdominal power Doppler ultrasound represents a feasible, non-invasive, and inexpensive diagnostic tool for assessing ureteral patency during gynecological surgery.
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http://dx.doi.org/10.1007/s00192-021-04901-zDOI Listing
December 2021

Systematic review and meta-analysis on the impact of the levonorgestrel-releasing intrauterine system in reducing risk of ovarian cancer.

Int J Gynaecol Obstet 2022 Mar 8;156(3):418-424. Epub 2021 Jun 8.

Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.

Background: Ovarian carcinoma (OC) is one of the most widespread tumors in the world and is characterized by low survival rates.

Objective: To determine whether the levonorgestrel-releasing intrauterine system (LNG-IUS) can prevent OC.

Search Strategy: The literature until December 2020 were systematically reviewed according to the PRISMA Statement for Reporting Systematic Reviews (PROSPERO: CRD42019137957).

Selection Criteria: Studies assessing the impact of LNG-IUS on the risk of OC were included.

Data Collection And Analysis: Data were extracted independently by two authors to ensure accuracy and consistency.

Main Results: A total of 34 323 records were obtained, of which three satisfied the inclusion criteria. In total, 1687 events of OC in a population of 20 461 311 person-years were considered. Data pooling revealed that the use of LNG-IUS did not confer a lower risk of OC relative to the never-use of LNG-IUS, with an estimated odds ratio of 0.66 (95% confidence interval 0.41-1.08; I = 84%; P = 0.002).

Conclusion: The meta-analysis did not demonstrate a preventive role of LNG-IUS on OC. However, it was carried out on a few papers, and a definitive conclusion on the topic still cannot be drawn. Further studies are indicated in the future to define the impact of LNG-IUS on OC. The meta-analysis carried out on three papers did not demonstrate a preventive role of the levonorgestrel-releasing intrauterine device on ovarian cancer.
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http://dx.doi.org/10.1002/ijgo.13737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9290617PMC
March 2022

Transvaginal primary layered repair of postsurgical urethrovaginal fistula.

Int Urogynecol J 2021 07 5;32(7):1941-1943. Epub 2021 May 5.

ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy.

Introduction And Hypothesis: Urethrovaginal fistula (UVF) is a rare disorder, which implies the presence of an abnormal communication between the urethra and the vagina.

Methods: Surgical repair options include transurethral, transabdominal and transvaginal procedures, either with or without tissue interposition. The vaginal route is considered a safe and effective option to correct UVF. This video is aimed to present a case of direct transvaginal layered repair of urethrovaginal fistula, without the use of tissue interposition. The featured patient is a 66-year-old woman who developed a symptomatic UVF after a complicated laparoscopic hysterectomy for endometrial cancer 3 years before. Cystoscopy demonstrated the presence of a 7 mm urethral orifice a few millimeters caudal from the bladder neck. After proper informed consent, the patient was admitted to transvaginal primary layered repair, according to the technique demonstrated in the video. The featured procedure was completed in 60 min and blood loss was < 100 ml. No surgical complications were observed.

Results: The procedure was successful in restoring the anatomy and relieving the symptoms.

Conclusion: Transvaginal layered repair without tissue interposition represents a safe and effective procedure for the surgical management of postsurgical urethrovaginal fistula.
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http://dx.doi.org/10.1007/s00192-021-04819-6DOI Listing
July 2021

Detrusor underactivity prevalence and risk factors according to different definitions in women attending urogynecology clinic.

Int Urogynecol J 2022 04 30;33(4):835-840. Epub 2021 Apr 30.

ASST Monza, Ospedale San Gerardo, Monza, Italy.

Introduction And Hypothesis: There is still no consensus on definitions of detrusor underactivity; therefore, it is difficult to estimate the prevalence. The primary objective of the study was to evaluate the prevalence of detrusor underactivity in a cohort of patients with pelvic floor disorders according to different proposed urodynamics definitions. The secondary objectives were to estimate the association between detrusor underactivity and symptoms, anatomy and urodynamic findings and to build predictive models.

Methods: Patients who performed urodynamic evaluation for pelvic floor disorders between 2008 and 2016 were retrospectively analyzed. Detrusor underactivity was evaluated according to Schafer's detrusor factor, Abrams' bladder contractility index and Jeong cut-offs. The degree of concordance between each method was measured with Cohen's kappa, and differences were tested using Student's t test, Wilcoxon test and Pearson's chi-squared test.

Results: The prevalence of detrusor underactivity among a cohort of 2092 women, concerning the three urodynamic definitions, was 33.7%, 37.0% and 4.1%, respectively. Age, menopausal status, voiding/bulging symptoms, anterior and central prolapse, first desire to void and positive postvoid residual were directly related to detrusor underactivity. Conversely, stress urinary incontinence, detrusor pressures during voiding and maximum flow were inversely associated. Final models for detrusor underactivity resulted in poor accuracy for all considered definitions.

Conclusions: The prevalence of detrusor underactivity varies depending on the definition considered. Although several clinical variables resulted as independent predictors of detrusor underactivity, instrumental evaluation still plays a key role in the diagnosis.
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http://dx.doi.org/10.1007/s00192-021-04796-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9021137PMC
April 2022

Clinical and urodynamic predictors of Q-tip test urethral hypermobility.

Minerva Obstet Gynecol 2022 Apr 20;74(2):155-160. Epub 2021 Apr 20.

Department of Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.

Background: Urodynamics and Q-tip test represent diagnostic tools for the assessment of stress urinary incontinence. The aim of the present study was to investigate the possibility to predict the Q-tip test urethral hypermobility on the basis of clinical and urodynamic parameters.

Methods: We analyzed all women performed urodynamics between 2008 and 2016 presenting urodynamic stress urinary incontinence. Symptoms were collected by the Incontinence Questionnaire-Short Form Questionnaire.

Results: A total of 501 women presented urodynamic stress incontinence, of which 270 had urethral hypermobility, according to the Q-tip test. Patients with urethral hypermobility were younger (P<0.0001) and presented a more advanced anterior compartment descensus according to the POP-Q system (Aa point P=0.0155; Ba point P=0.0374), a higher detrusor pressure at maximum flow (P=0.0075) and maximum flow rate compared to controls.

Conclusions: Age, Aa POP-Q point and detrusor pressure at maximum flow were found to be independent predictors of Q-tip test urethral hypermobility. However, the final model cannot be used as an effective predictor of the Q-tip test result.
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http://dx.doi.org/10.23736/S2724-606X.21.04766-3DOI Listing
April 2022

Inability to walk and persistent thigh pain after transobturator tape procedure for stress urinary incontinence: surgical management.

Int Urogynecol J 2021 05 3;32(5):1317-1319. Epub 2021 Mar 3.

ASST Monza, Ospedale San Gerardo, via G.B. Pergolesi, 33 20900, Monza, Italy.

Introduction And Hypothesis: Groin pain after transobturator tape is often a self-limiting situation, but can occasionally persist and be associated with serious neurological sequelae. The video is aimed at presenting the surgical management of persistent groin pain and inability to walk after transobturator sling placement and subsequent partial removal.

Methods: The featured patient is a 31-year-old woman unable to walk after transobturator sling implantation 2 years before. She reported left thigh pain immediately after surgery that was not responsive to postoperative medication. Six months later, suburethral portion excision was performed but no pain relief was obtained. She was unable to walk, and needed a wheelchair. Electromyography showed axonal injury of the left obturator nerve. After providing proper informed consent, the patient was admitted for combined transvaginal and transcutaneous transobturator tape arm removal.

Results: The featured procedure was completed in 120 min and blood loss was <100 ml. No surgical complications were observed. The patient is currently doing left leg rehabilitation, has regained the ability to walk with the aid of a crutch, and the need for chronic pain control medication is greatly reduced.

Conclusion: This represents a valid surgical approach for the late management of this mesh-related complication.
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http://dx.doi.org/10.1007/s00192-020-04666-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927782PMC
May 2021

Telephone interview in urogynecology in the era of COVID-19 pandemic

J Turk Ger Gynecol Assoc 2021 02 28;22(1):8-11. Epub 2021 Jan 28.

Department of Gynecology, ASST Monza, San Gerardo Hospital, Monza, Italy

Objective: During the Coronavirus disease-2019 (COVID-19) pandemic deferable access, including non-urgent outpatient visits, have been suspended. In our practice non-urgent routine visits for pelvic floor symptom assessment were discontinued and rescheduled, and telephone interview was performed. The aim was to evaluate patients’ satisfaction for this alternative approach.

Material And Methods: Telephone interviews were conducted using a validated questionnaire to investigate pelvic floor symptoms. Patients were also asked if they had other symptoms or disorders, to identify patients who may need urgent hospital evaluation. At the end of the phone call, patients were asked to score their satisfaction with the telephone interview by grading their response to three questions from 0 (minimum) to 10 (maximum). The questions were: 1) “Was the telephone interview useful to check your state of health?”; 2) “Was the telephone interview an adequate healthcare tool in consideration of COVID-19 outbreak?”; 3) “Could the telephone interview replace the conventional visit?”.

Results: Fifty-three patients were evaluated. All patients showed great satisfaction with telephone interview (Q1 median: 10, IQ range: 10-10) and were similarly positive in response to the second question (Q2 median: 10, IQ range: 10-10). Although fewer patients felt that telephone interview could replace conventional clinic visits most remained positive (Q3 median: 7; IQ range: 6-8).

Conclusion: This simple experience showed that phone interviews with validated questionnaires are appreciated and effective to safely perform interview of selected urogynecologic patients.
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http://dx.doi.org/10.4274/jtgga.galenos.2020.2020.0131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7944235PMC
February 2021

Hydrouretonephrosis caused by uterine prolapse after gellhorn pessary displacement.

Eur J Obstet Gynecol Reprod Biol 2021 Feb 10;257:150-151. Epub 2020 Dec 10.

ASST Monza, San Gerardo University Hospital, Monza, Italy.

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http://dx.doi.org/10.1016/j.ejogrb.2020.12.008DOI Listing
February 2021

Obstetric outcomes after uterus-sparing surgery for uterine prolapse: A systematic review and meta-analysis.

Eur J Obstet Gynecol Reprod Biol 2021 Jan 20;256:333-338. Epub 2020 Nov 20.

ASST Monza, San Gerardo Hospital, Monza, Italy.

Up-to-date there are no guidelines about uterus-sparing prolapse repair procedures for women desiring childbearing. This systematic review and meta-analysis aims to evaluate obstetrical outcomes after uterus-sparing apical prolapse repair in terms of pregnancy rate, obstetrical adverse outcomes and delivery mode according to the type of procedure. To identify potentially eligible studies, we searched PubMed, Scopus, Cochrane Library and ISI Web of Science (up to April 15, 2020). Case reports, reviews, letters to Editor, book chapters, guidelines, Cochrane reviews, and expert opinions were excluded. Twenty-four studies met inclusion criteria and were incorporated into the final assessment, which included 1518 surgical procedures. In total 151 patients got pregnant after prolapse surgical repair, for a resulting pregnancy raw rate of 9.9 %. Overall, adverse obstetric outcomes resulted low, rating 4.6 %. Manchester procedure resulted associated with the highest risk of adverse obstetrical outcomes and preterm premature rupture of membranes (p < 0.0001). After exclusion of Manchester procedure, sacrohysteropexy was found to be associated with higher risk of obstetrical adverse outcomes compared to native-tissue procedures (p = 0.04). Native-tissue surgery might represent the most cautious option for women wishing for pregnancy.
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http://dx.doi.org/10.1016/j.ejogrb.2020.11.054DOI Listing
January 2021
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