Rujira Wattanayingcharoenchai

To characterize the urobiome and urine pH in women with and without overactive bladder (OAB) symptoms. We conducted a case-control study with 23 patients having OAB symptoms and 23 without OAB, based on overactive bladder symptom score questionnaires. Midstream urine samples were analyzed for pH and underwent 16S rDNA gene sequencing to identify the urobiome using diversity. Differential abundance analysis identified urobiome taxa associated with OAB symptoms. The mean age of patients with OAB and those without OAB was comparable (63.60 ± 9.27 vs 62.26 ± 9.14, p = 0.62). There were no statistically significant differences in body mass index, parity, and menopausal status. Mean urine pH was also comparable (6.23 ± 1.04 vs. 6.17 ± 0.95, p = 0.84), though a higher percentage of OAB patients had acidic urine (73.91% vs. 65.22%, p = 0.53). While the overall urobiome showed no significant differences between groups, Corynebacterium spp. and Rothia spp. were more abundant in OAB patients. Patients with overactive bladder had a higher abundance of certain urobiome bacteria but similar urine pH compared to those without symptoms.

Interpretation of urodynamic studies (UDS) is essential for the assessment of lower urinary tract dysfunction but remains resource-intensive and highly operator-dependent. Artificial intelligence (AI) has increasingly been applied to support urodynamic interpretation; however, the available evidence is heterogeneous and its clinical relevance remains uncertain. This systematic review aimed to synthesise current evidence on AI applications in urodynamic assessment and to summarise diagnostic performance and methodological quality. A systematic literature search of PubMed, Embase, Scopus, and IEEE Xplore was conducted in accordance with PRISMA 2020. Studies applying AI to uroflowmetry, cystometry, or pressure-flow studies in human participants were included. Eligible studies were categorised according to data representation as parameter-based, raw signal-based, or image-based models. Diagnostic performance was summarised narratively, and risk of bias was assessed using the QUADAS-AI framework. Eighteen studies met the inclusion criteria. Parameter-based models generally demonstrated modest to good diagnostic performance, particularly for binary classification tasks. Raw signal-based models more frequently reported high discriminative performance, with several studies achieving area under the receiver operating characteristic curve values above 0.85 and, in some cases, exceeding 0.90. Image-based models demonstrated feasibility for automated interpretation of urodynamic traces, although reported performance varied substantially. Most studies were retrospective and single-centre, relied on expert-defined reference standards, and lacked external validation, resulting in frequent high or unclear risk of bias. Artificial intelligence has been widely applied to urodynamic assessment and often demonstrates high diagnostic performance in research settings. However, substantial methodological limitations limit confidence in clinical generalisability. At present, AI-assisted urodynamic interpretation should be considered exploratory, and robust prospective studies with independent external validation are required before routine clinical implementation.

Pelvic organ prolapse (POP) is commonly associated with voiding dysfunction, often presumed to result from bladder outlet obstruction. However, neurologica

Background: Urinary incontinence (UI) is a prevalent condition among women, yet many do not seek care due to limited knowledge and stigma. Objective: To evaluate the effectiveness of a culturally tailored educational animation video in improving UI‐related knowledge, health‐seeking behavior, and quality of life. Methods: A randomized controlled trial was conducted among 354 community‐dwelling women with UI in Sing Buri, Thailand. Participants were randomized to receive a 4.5 min UI animation video or a control health education session. The primary outcome was UI knowledge proficiency (PIKQ‐UI), assessed immediately and at 2‐month follow‐up. Secondary outcomes included quality of life (IIQ‐7) and health‐seeking behavior. Results: The intervention group demonstrated significantly higher UI knowledge proficiency post‐intervention (89% vs. 13%, RR 6.67, p < 0.001) and at 2 months (42% vs. 13%, RR 3.18, p < 0.001). They also reported improved health‐seeking behavior (mean score 40.16 vs. 36.33, p < 0.001) and better quality of life (IIQ‐7 score 25.67 vs. 31.20, p = 0.002). Conclusion: A brief, culturally adapted animation video significantly improved UI knowledge and health‐seeking behavior, and was associated with better quality of life compared with controls, although no significant within‐group improvement was observed from baseline. This low‐cost, scalable intervention may be valuable in resource‐limited settings. Trial Registration: Thai Clinical Trials Registry TCTR20220601002 (retrospectively registered).

A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence.

Background: Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior compartment prolapse-related surgeries. As we know, postoperative urinary retention (POUR) is one of the most common complications following pelvic floor surgery. To prevent this complication, indwelling bladder catheterization is routinely applied. In contrast, to minimize risk of infection and the patient’s discomfort, the catheter should be removed as soon as possible. However, there is a lack of clarity regarding the optimal timing for catheter removal. Therefore, the aim of this trial is to compare the rate of POUR after anterior prolapse surgery between early transurethral catheter removal (24 h postoperatively) and our standard practice (on postoperative day 3). Methods: We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed, and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction. Analysis was performed according to the intention to treat principle. The calculated sample size was 68 patients (34 patients in each group) for a 95% confidence interval, 80% power, 5% probability of type I error, and 10% data loss. Discussion: This study demonstrated that early catheter removal was comparable in POUR rate to conventional treatment with shorter hospitalization among patients undergoing anterior compartment prolapse surgery. Additionally, we observed no re-hospitalization owing to POUR. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse-related surgery.

Non-invasive vaginal rejuvenation with radiofrequency (RF) and lasers devices have gained popularity, but well-designed studies confirming their effectiveness are lacking. The aim of this study was to compare the efficacy and safety of a multipolar RF and pulsed electromagnetic field-based device (PEMF) versus sham for vaginal laxity. Thirty-two premenopausal females with ≥ 1 vaginal delivery and self-reported vaginal laxity were randomized into 2 groups: active (RF + PEMF) and sham. Both groups received 3 vaginal treatments at 3-week interval. The Vaginal Laxity Questionnaire (VLQ), perineometer measurements, and Brink score were conducted at baseline, 4, and 12 weeks after treatments. Pre and post-treatment vaginal histology, Female Sexual Function Index (FSFI), subjects’ satisfaction, pain, and adverse events were assessed. The active group VLQ scores increased and were significantly better than the sham group (p < 0.001). At the final follow-up, 50% of the active group reported no vaginal laxity (VLQ > 4) versus 12% in the sham group (p = 0.054). In the active group, all domains of perineometer measurements and Brink scores (p < 0.001), FSFI scores (p < 0.05), and patients’ satisfaction (p < 0.001) were significantly increased and higher in the active group. Mild adverse effects including pain and burning sensation were not different between groups except for itch which was significantly higher in the sham arm (p = 0.014). Histology after RF + PEMF treatments demonstrated neocollagenesis, neoelastogenesis, and neoangiogenesis. In conclusion, combination RF + PEMF therapy was safe, improved vaginal laxity, strengthened pelvic floor muscles, and improved female sexual function for at least 12-week post-procedures with confirmed histological improvements. This study was registered on the Thai Clinical Trials Registry, TCTR20200803002 on 2020–07-30 “retrospectively registered.”

Background: The efficacy of hormonal regimens for the prevention of endometrioma recurrence in women who have undergone conservative surgery is still controversial.Objective: To compare the efficacy of different hormonal regimens in this context and to rank them.Search strategy: MEDLINE and Scopus databases were searched through January 2020.Selection criteria: Randomised controlled trials (RCTs) or cohorts, comparing the effect of any pair of interventions (i.e. cyclic oral contraceptives [OC], continuous OC, gonadotropin‐releasing hormone agonist [GnRHa], dienogest [DNG], levonorgestrel‐releasing intrauterine system [LNG‐IUS] and expectant management) on endometrioma recurrence were selected.Data collection and analysis: Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta‐analysis (NMA) and ranked in descending order.Main results: Six RCTs (675 patients) and 16 cohorts (3089 patients) were included. NMA of the RCTs involving expectant management, cyclic OC, continuous OC, GnRHa and GnRHa + LNG‐IUS, showed that all hormonal regimens had a nonsignificant lower risk of endometrioma recurrence compared with expectant management. NMA of the cohorts involving expectant, cyclic OC, continuous OC, GnRHa, DNG, LNG‐IUS, GnRHa + OC, and GnRHa + LNG‐IUS indicated that LNG‐IUS, DNG, continuous OC, GnRHa + OC and cyclic OC had a significantly lower risk of endometrioma recurrence than expectant management. LNG‐IUS was ranked highest, followed by DNG and GnRHa + LNG‐IUS. Long‐term use of hormonal treatment either OC or progestin had a significantly lower risk of endometrioma recurrence than expectant treatment.Conclusion: In the NMA of RCTs, there was no evidence supporting hormonal treatment for postoperative prevention of endometrioma recurrence. This was at odds with the cohort evidence, which found the protective effect of OC and progestin regimens, especially long‐term treatment. Large‐scale RCTs of these agents are still required.Tweetable Hormonal regimens given as long‐term treatment tend to reduce risk of endometrioma recurrence after conservative surgery.