Vaginal laxity syndrome (VLS) is a common pelvic floor disorder that compromises sexual function and quality of life. Although full-length vaginal tightening has been proposed as a more comprehensive approach than conventional non-full-length techniques, direct comparative evidence using multidimensional outcome measures remains scarce. This study aimed to compare the efficacy and safety of full-length versus non-full-length vaginal tightening procedures in patients with moderate-to-severe VLS. This retrospective cohort study included 100 patients with moderate-to-severe VLS who underwent surgery between January 2024 and May 2025 at Zhengzhou Central Hospital. Patients were divided into a control group (non-full-length vaginal tightening, n = 50) and an observation group (full-length vaginal tightening, n = 50). The primary outcomes included subjective sexual function assessments (vaginal laxity questionnaire [VLQ], sexual satisfaction questionnaire, female sexual function index, and female sexual distress scale-revised) and objective anatomical and physiological measures (vaginal capacity, levator hiatus area, genital hiatus, perineal body, and pelvic floor electromyography). Secondary outcomes included operative time, blood loss, hospital stay, and complications. Assessments were conducted preoperatively and at 3, 6, and 12 months postoperatively. The full-length group demonstrated significantly greater improvements in VLQ, sexual satisfaction questionnaire, female sexual function index total score, and female sexual distress scale-revised scores compared with the non-full-length group (all P for interaction <.05). Although both groups achieved a postoperative vaginal capacity of 2 fingerbreadths with no significant between-group difference (P = .595), the full-length group exhibited significantly higher VLQ scores (P = .008). The full-length group also showed significantly greater reductions in levator hiatus area and genital hiatus, and greater improvement in fast-twitch muscle contraction amplitude (all P for interaction <.05). No significant between-group difference was observed in perineal body improvement (P = .120). Operative time and blood loss were slightly higher in the full-length group (98.33 vs 92.73 minutes; 27.10 vs 23.88 mL, both P < .05), but these differences did not translate into increased complication rates or prolonged hospital stay. For patients with moderate-to-severe VLS, full-length vaginal tightening achieves more comprehensive anatomical reconstruction and functional restoration of pelvic floor support structures, significantly improves sexual function and quality of life, and does not incur additional surgical risks. Full-length vaginal tightening can be considered a preferred surgical option for moderate-to-severe VLS.

It is known that lipopolysaccharides (LPS) could lead to kidney injury and may play a role in intracavitary lithotripsy surgeries such as percutaneous nephrolithotomy (PCNL). Remote ischemic preconditioning (RIPC) has been demonstrated to have protective effects against kidney injury caused by various factors; however, its role in LPS-induced kidney injury remains unclear and its mechanisms require further exploration. Previous studies have shown that extracellular vesicles (EVs) induced by hypoxia mediated the renal protective effects of RIPC. In this study, we established a kidney injury model in rats by ligating the left ureter and injecting LPS into the renal pelvis, along with simultaneous removal of the right kidney (U-L model); EVs were isolated from the plasma of rats subjected to RIPC or sham treatment and administered to U-L model rats. Separately, EVs obtained from healthy human volunteers were applied to LPS-treated human renal tubular epithelial cells (HK-2). Results indicated that RIPC-EVs(R) reduced kidney injury caused by U-L by inhibiting apoptosis, inflammation, and oxidative stress. In vitro, RIPC-EVs(H) alleviate LPS-induced HK-2 cell injury by attenuating apoptosis and inflammation. Moreover, we identified 37 significantly upregulated differential proteins in the EVs sourced from human plasma after RIPC through 4D label-free proteomics, including Tenascin-C (TNC). Mechanistic studies revealed that RIPC-EVs(H) activated β-catenin, inhibited the p53 and NF-κB signaling pathways, and alleviated kidney injury. Clinical trial data showed that RIPC reduced the expression of kidney injury biomarkers in patients undergoing PCNL for kidney stones. Overall, the present study suggested that RIPC could mitigate kidney injury induced by LPS, possibly through the protective role of Tenascin-C carried by EVs.

Maternal expulsive force is a key determinant of fetal head descent during the active second stage of labour. Pushing is most effective when abdominal muscle contraction is synchronised with relaxation of the levator ani muscle, thereby widening the pelvic hiatus. Trans-perineal ultrasound studies show that 15-20% of nulliparous women paradoxically contract the levator ani (co-activation) during pushing, narrowing the hiatus and slowing head descent. Consequently, about 20% of primigravidas experience a prolonged second stage, with higher rates of operative birth and perineal trauma.

Robotic surgery depends on effective bedside assistance, yet staffing models vary between physician and non-physician assistants. We systematically reviewed comparative evidence evaluating these models in robotic abdominal and pelvic surgery. A PRISMA compliant systematic review was performed. PubMed, Embase, Ovid MEDLINE, Cochrane CENTRAL/CCTR and ClinicalTrials.gov were searched from inception to 12 April 2026. Comparative adult clinical studies were eligible if they directly compared physician bedside assistance with non-physician bedside assistance during robot-assisted abdominal or pelvic surgery. The primary outcome domain was operative efficiency. Training exposure and perioperative safety were secondary domains. Risk of bias was assessed using ROBINS-I. Meta-analysis was not performed because of clinical and outcome heterogeneity. The search identified 1587 records, with 4 additional records from other sources. After duplicate removal, 693 records were screened and 22 full texts assessed; 3 observational studies met inclusion criteria. These included colorectal, gynaecologic oncology, and transplant/hepatopancreatobiliary robotic settings. Across studies, non-physician or dedicated bedside assistance was associated with favourable time-based efficiency outcomes, including shorter operative or console time in selected procedures and improved operational metrics in a dedicated team model. Training exposure was inconsistently reported, although one programme-level study found increased fellow primary surgeon participation after implementation of a dedicated robotic team. Safety outcomes did not show an obvious harm signal, but reporting was heterogeneous and studies were subject to confounding. Direct comparative evidence evaluating physician versus non-physician bedside assistant models in robotic abdominal and pelvic surgery is limited. Available data suggest possible efficiency benefits without an evident safety penalty, but stronger prospective studies with standardised efficiency, training and safety outcomes are needed.

Pelvic fractures are critical injuries associated with high mortality rates, yet accurate diagnosis using conventional radiography remains challenging due to complex anatomical overlaps. This study evaluates the impact of segmentation-guided preprocessing on fracture detection from pelvic X-rays by introducing a Multi-Bone Segmentation Method. Unlike traditional approaches that restrict analysis to the pelvic ring or treat the pelvis as a single region, our framework utilizes a transformer-enhanced U-Net to distinctly isolate nine individual pelvic bones, creating an anatomically precise input for downstream classification. For segmentation, the model was trained on PXR150 and evaluated on both PXR150 and externally on AMERI PXR, while classification models were trained and evaluated separately for each dataset. We benchmarked this approach against three methods: a Conventional (raw X-ray input) baseline, a Conventional ROI-Guided Method (binary segmentation), and a Reference Segmentation (manual annotation) to establish a performance upper bound. Using the public PXR150 and private AMERI PXR datasets, we demonstrated that segmentation-guided analysis consistently enhances diagnostic precision. The Proposed Multi-Bone Method outperformed the Conventional ROI-Guided Method, achieving higher Accuracy (81.30%, 95% CI: 79.70-82.90 and 83.20%, 95% CI: 78.74-87.66) and AUROC (0.822, 95% CI: 0.794-0.851 and 0.838, 95% CI: 0.792-0.884) across both datasets. By effectively filtering non-anatomical artifacts, the multi-bone strategy achieved performance metrics close to the manually annotated reference standard. GradCAM visualizations further confirmed that multi-bone segmentation aligns model activation with clinically relevant fracture sites, enhancing interpretability. These findings underscore that anatomical completeness in segmentation is a decisive factor in improving the reliability and explainability of automated fracture detection systems.

The recent study by Basiouny et al. on transverse perineal support for obstructed defecation syndrome highlights the importance of objective assessment of pathological perineal descent. We wish to provide a historical and methodological clarification regarding the measurement device used in the study. The instrument illustrated as a "perineometer" may correspond to the previously described Perineocaliper[®], a device developed for the clinical measurement of perineal descent. Although objective measurement of perineal descent was first introduced by Henry and Parks using a different instrument, the Perineocaliper represents a distinct development. In addition, the term perineometer has traditionally been used in urogynecology for devices measuring pelvic floor muscle contraction strength. Accurate identification and terminology of measurement devices may improve methodological clarity and facilitate comparison between studies.

Adnexal lesions seen on US images are referred for MRI when there is a need for further characterization and more accurate cancer risk score assessment. MRI can help expedite referral to gynecologic oncologists when ovarian cancers are suspected and avoid unnecessary, overextensive surgery or unnecessary follow-up when benign lesions are identified. The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI was developed to provide standardized lexicon terminology and to allow predicting the risk of cancer when the appropriate MRI protocol is used. Only when the MRI protocol with the minimum technical requirements and dynamic contrast-enhanced imaging is used can the positive predictive values listed in the O-RADS MRI table be obtained. The O-RADS MRI recommended protocol includes multiplanar T2-weighted imaging, diffusion-weighted imaging, in- and opposed-phase imaging, and pre- and postcontrast imaging, including dynamic contrast-enhanced imaging. Optimizing each MRI sequence may be challenging but will lead to accurate risk stratification of adnexal lesions. It is also important to understand how each sequence is used to assess adnexal lesion characteristics for accurate risk scoring. This article reviews the necessary sequences in the recommended O-RADS MRI protocol and offers tips and tricks that can be used to optimize images, negate common artifacts, and avoid common errors in interpretation, including when the MRI examination is suboptimal. [©]RSNA, 2026 See the invited commentary by Lakhman and Rakow-Penner in this issue.

A 73-year-old female patient presented for an outpatient CT scan of the chest, abdomen, and pelvis with contrast medium injection, complaining of weight loss to rule out a space-occupying lesion. Computed tomography (CT) revealed an aortic dissection type Stanford A. The case demonstrates an incidental finding of a long-standing aortic dissection in an asymptomatic patient.

Endometriosis, affecting 10-15% of women of reproductive age, is more commonly found on the left side of the pelvis. This laterality phenomenon's etiology remains obscure. We reviewed the existing literature and proposed four different theories explaining the left laterality of endometriosis. The anatomical theory is based on the structural asymmetry of the pelvis. Organs surrounding the left adnexa serve as mechanical barriers and interfere with clearance of endometrial cells migrating to the pelvis, promoting in turn endometriotic implants. The physiological theory focuses on the role of the peritoneal fluid flow, shown to be slower and weaker on the left side, allowing more time for adherence of endometrial fragments or cells. The hormonal theory rests on the right ovulatory predominance that may impose progesterone richer milieu on the right hemipelvis which in turn inhibits endometriosis on that side. The vascular theory suggests that higher hydrostatic pressure in the left venous system, secondary to differences in anatomy, may favor local stasis and implantation of endometriosis. Although each theory can explain the phenomenon independently, they are likely to be interrelated. Whether the asymmetrical distribution of endometriosis is associated with asymmetric clinical manifestation is yet to be known. Further studies are required in order to elucidate our understanding of this common disease and its features. Understanding the lateral tendency of endometriotic lesions may improve diagnostic accuracy and assist surgical decision-making in operative planning.