Israel Medical Association Journal

Genitourinary syndrome of menopause (GSM) has gained increasing attention in recent years, with growing literature on its pathophysiology, clinical presentation, and treatment options. A bibliometric analysis helps identify high-quality research based on citation rates and journal impact factors. In this review, our objective was to analyze the key themes and topics in GSM literature. We conducted a bibliometric analysis using the Thomson Reuters Web of Science database to identify the top 100 most-cited articles on GSM published over the past 50 years. Data were categorized into manuscript type, theme, author, country of origin, journal impact factor, and citation rate. The mean citation count per article was 67, ranging from 405 to 5. The most-cited paper, authored by the North American Menopause Society, had the highest citation rate of 45.0 citations per year. The majority of articles (n=65) were published between 2010 and 2019. Randomized controlled trials comprised the largest publication type (29%). Most articles (n=65) were published in Q1-ranked journals. Although GSM is a relatively recent concept, the most-cited articles from the past 50 years generally focus on its medical and surgical treatments, as well as its epidemiology. This bibliometric analysis is the first to evaluate the top 100 most influential publications on GSM.

Background: Cesarean section (CS) comprised almost one-third of all births. One of the complications after CS is intra-abdominal and pelvic adhesions formation.

Objectives: To investigate whether a previous CS poses an additional perioperative or postoperative risk for complications when performing a total laparoscopic hysterectomy (TLH).

Methods: We conducted a retrospective cohort study of women who had undergone a TLH between 2014 and 2020. Perioperative and postoperative complications were assessed according to the Clavien-Dindo classification system. Descriptive statistics were used to analyze the results.

Results: In total, 190 women underwent TLH during the study period, 50 (26.5%) had a previous CS (study group) and 140 (73.5%) had no history of CS. The complication rates using the Clavien-Dindo classification system were similar in both groups; however, the major complications rate was not significantly higher in the study group (CS 6% vs. no CS 1.4%, P = 0.08). Urethral injury was the most common major complication (2, 4% vs. 1, 0.7%). The duration of surgery (125 min vs. 112 min, P = 0.02), estimated blood loss (174 ml vs. 115 ml, P = 0.02), and additional postoperative endoscopic interventions (4% vs. 0%, P = 0.01) and were significantly greater in patients with a previous CS.

Conclusions: Although the need for postoperative endoscopic interventions, surgery duration, and estimated blood loss were significantly higher in patients with a previous CS, TLH remains a safe and recommended procedure for these patients. Major complications are rare and do not occur more frequently following a previous CS.

The prevalence of pelvic organ prolapse (POP) varies greatly and is reported to be between 3% and 50% differing greatly when based on POP symptoms or vaginal examination [1]. Age is a well-established risk factor in the reported prevalence of POP [2]. With advancing age, the prevalence escalates dramatically, from 6% at age of 30 years to over 50% at the age of 80 years [3]. The increase in life expectancy observed in recent years will most probably be accompanied by a respective increase in the absolute numbers of women presenting with POP [4]. POP is a major health burden and is expected to continue being so in the upcoming future; hence, the importance of a safe and efficient treatment.