Background: Hysteroscopy currently represents the gold standard for the diagnosis and treatment of intrauterine pathologies. Recent technological progress has enabled the integration of diagnostic and operative time, leading to the “see and treat” approach. Diode laser technology is emerging as one of the most innovative and intriguing techniques in this context. Methods: A comprehensive search of the literature was carried out on the main databases. Only original studies reporting the treatment of intrauterine pathologies using diode laser were deemed eligible for inclusion in this systematic review (PROSPERO ID: CRD42023485452). Results: Eight studies were included in the qualitative analysis for a total of 474 patients undergoing laser hysteroscopic surgery. Eighty-three patients had female genital tract abnormalities, 63 had submucosal leiomyomas, 327 had endometrial polyps, and one patient had a scar pregnancy. Except for leiomyomas, whose technique already included two surgical times at the beginning, only seven patients required a second surgical step. Cumulative rates of intraoperative and postoperative complications of 2.7% and 0.6%, respectively, were reported. Conclusions: Diode laser through “see and treat” hysteroscopy appears to be a safe and effective method. However, additional studies with larger sample sizes and improved designs are needed to consolidate the evidence currently available in the literature.

Use of Diode Laser in Hysteroscopy for the Management of Intrauterine Pathology: A Systematic Review

Lower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored. To assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline. Multicenter, prospective cohort study. Population-based. Participants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study. Data were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0–5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1–2), or frail (3–5). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0–35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI. Among 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during follow-up was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing nonlinearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria. Greater phenotypic frailty was associated with nonlinear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.

/pdf/longitudinal-associations-between-concurrent-changes-in-265mosls.pdf

Longitudinal Associations between Concurrent Changes in Phenotypic Frailty and Lower Urinary Tract Symptoms among Older Men

Background Erectile dysfunction (ED) is a multifactorial medical disorder often neglected in clinical practice between elderly men, defined as the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse and a common clinical entity among men and associated with impaired quality of life and cardiovascular diseases in elderly men. The aim of this study is to evaluate the association between ED and clinical, demographic and behavioral parameters in elderly men. Methods A total of 2436 males aged 60 years and over who participated in the health screening between January 2008 and December 2018 were included in this study. Laboratory exams, clinical and behavior profiles were analyzed. Logistic regression models were used. Results Men with ED were older (65.87±5.49 vs. 63.85±4.05 years old. p<0.001), higher prevalence of physical inactivity (23.8 vs. 19%, p = 0.039) and had a higher body mass index (BMI; 28.36±4.06 vs. 27.72±3.89 kg/m2. p<0.001) than men without ED. The multivariate model shown that hypertension (p = 0.001), diabetes mellitus (p<0.001), lower urinary tract symptoms (LUTS), depressive symptoms (p<0.001) and age (p<0.001), were strongly associated with ED. Conclusion The main risk factors associated with ED in elderly men were hypertension, diabetes mellitus, LUTS, depressive symptoms and age.

https://www.dovepress.com/getfile.php?fileID=91030

What are the Main Risk Factors Associated with Erectile Dysfunction in the Elderly? A Cross-Sectional Study of 2436 Brazilian Elderly Men

BACKGROUND
The effects of axial extension on pelvic floor displacement and abdominal muscle activity during pelvic floor muscle (PFM) exercises are not well known.


OBJECTIVE
To clarify the effect of sitting axial extension on pelvic floor displacement and abdominal muscle activity during a PFM task.


METHODS
Pelvic floor displacement, abdominal muscle activity, and subjective kinesthesia of the PFM were compared between the resting and axial-extended sitting positions during a pelvic floor task in 34 healthy young men.


RESULTS
No significant difference in pelvic floor displacement was observed between the resting and axial extension sitting position. Subjective kinesthesia was significantly easier to perform in axial extension than in resting sitting position during pelvic floor depression. Abdominal oblique muscle activity was higher in axial extension than in resting sitting position during pelvic floor depression. The changes in axial extension were significantly greater in the internal oblique muscles during elevation and in the internal and external oblique muscles during depression than in the lower rectus abdominis muscles.


CONCLUSION
Axial extension in the sitting position does not change pelvic floor displacement during the PFM task. However, axial extension may be effective in facilitating subjective kinesthesia of PFM and in increasing oblique abdominal muscle activity.

Effects of axial extension on pelvic floor displacement and abdominal muscle activity during a pelvic floor muscle task.

No incision required for long-lasting symptom relief in a selection of women suffering from uterine fibroids.

HYPOTHESIS/AIMS OF STUDY: Although male lower urinary tract symptoms (LUTS) have a multifactorial origin, the potential role of pelvic floor muscle (PFM) function has not been studied well in men. This may be due to difficulties in the assessment of PFM activity. These difficulties may be overcome using the Multiple Array Probe Leiden (MAPLe®), which is a probe with a matrix of 24 elec-trodes capable of anally registering EMG signals of individual pelvic muscles (1). To date, reported data in males incorporated healthy men only. We are unaware of any studies in male patients with LUTS. Therefore, the aim of the present study was to explore the association between PFM activity and symptom severity in men with LUTS. STUDY DESIGN, MATERIALS AND METHODS: We performed an observational study including adult men referred to a urology outpatient department for uncomplicated LUTS. As part of the standardized outpatient assessment, all men completed questionnaires (International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS)) before their first appointment. Patients (>18 years of age) with an IPSS score of 8 or higher were eligible for this study. Patients with insufficient knowledge of the Dutch language, a history of prostate cancer, bladder cancer, or prostate or bladder surgery were excluded. Men who were willing to participate provided written informed consent. Directly following the urologist appointment, additional assessment of the pelvic floor muscles was performed using MAPLe®, according to the manufacturers' protocol. This included the following tasks in supine position: 1-minute rest, five maximum voluntary contractions (MVC) held for 3 seconds and three maximal endurance contractions held for 15 seconds. We retrieved raw output data (for each electrode) through the MAPLe® manufacturer. These data were used to assess muscle activity, during each task, for the following PFM groups: puborectalis (PR), external anal sphincter (EAS), internal anal sphincter (IAS), pubo-and iliococcygeus (PIC) and urogenital diaphragm (UDF). So, for each PFM group three outcomes were calculated. To explore the possible association between PFM groups, we present the outcomes of the five muscle groups for the three tasks (rest activity, MCV and endurance). Friedman's test with a post hoc analysis Wilcoxon signed ranks test was used to assess the difference in uV between the different pelvic floor muscle groups, separately for the three tasks. To explore the possible association between PFM activity and symptom severity, we applied correlation coefficients between the outcomes of the PFM activity and the OABSS and IPSS scores. A Bonferroni correction for multiple testing was applied. A p-value of 0.005 or smaller was considered statistically significant. RESULTS: Data from 57 men (aged 67±10 years, mean IPSS score 19.2±6.2, mean OABSS score 6.1 ±3.2) showed that during the 1-minute rest task no significant differences were measured between the separate muscle groups (Figure 1 A). Therefore, in further analyses the five muscle groups were combined for the 1-minute rest task. During the MVC task the EAS showed signifcantly lower muscle activity (μV) than the IAS and PR (Figure 1B). During the endurance task, the EAS had a signifcantly lower muscle activity (μV) than the other four muscle groups (Figure 1C). There were no signifcant associations between PFM activity and symptoms measured with IPSS and OABSS (Table 1). The highest correlation coeficient was 0.21. None of the coef-cients was statistically signifcant (all p >0.005). INTERPRETATION OF RESULTS: PFM rest activity did not difer between the fve muscle groups. However, the EAS showed lower muscle activity than the other muscle groups during the MVC and endurance tasks. In general, muscle activity was lower for all muscle groups and all tasks when compared with the results from an earlier study in healthy subjects (1). In our study, the EAS showed the lowest muscle activity in all three tasks, while the EAS showed the highest activity in the study with healthy volunteers. We cannot explain these diferences, as one might expect higher PFM activity in men with LUTS. Measurements were performed using the same protocol in both studies. The absence of an association between PFM activity and LUTS symptom severity in our study needs further exploration. It is unclear if this is due to a true absence of such association, or due to the MAPLe® assessment, or testing situation (not during voiding). CONCLUDING MESSAGE: This is the frst study exploring PFM activity in a large group of men with LUTS. We found no association between PFM activity and LUTS severity as measured by OABSS and IPSS. Future studies should explore this in more detail, possibly looking for subgroups of patients with pelvic foor problems. Furthermore, larger studies in the general population are warranted to generate normal values of PFM activity. Of specifc interest would be to monitor PFM activity during voiding.

/pdf/exploring-pelvic-floor-muscle-activity-in-men-with-lower-4e5qn176hf.pdf

Exploring pelvic floor muscle activity in men with lower urinary tract symptoms.

Diffusion-weighted MRI with deep learning for visualizing treatment results of MR-guided HIFU ablation of uterine fibroids

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Exploring pelvic floor muscle activity in men with lower urinary tract symptoms.

Diffusion-weighted MRI with deep learning for visualizing treatment results of MR-guided HIFU ablation of uterine fibroids