Five-year evaluation of women with urinary incontinence and prolapse surgical operations in a university hospital: A retrospective study
Abstract
Aim: The aim of this study is to conduct a five-year retrospective evaluation of women who underwent urinary incontinence and prolapse surgery at a university hospital.
Material and Methods: Records of 137 patients who underwent urinary incontinence and prolapse surgery at a university hospital between 2017 and 2022 were retrospectively reviewed. Due to 17 repeated entries in the records, data from a total of 120 women were evaluated. Parameters such as age, obstetric and gynecological history, urogynecological complaints and duration, referring clinic, diagnoses, type of surgery performed, year of surgery, and length of hospital stay were analyzed.
Results: The mean age of the examined cases was 59.63±10.66 (min 34 - max 81), with 77.5% being in the postmenopausal period. The mean number of gravida and parity for women were 3.36±2.07 (min 0 - max 9) and 2.50±1.42 (min 0 - max 9), respectively. Of the women, 35% presented with urinary incontinence, 27.5% with pelvic organ prolapse, and 26.7% with both pelvic organ prolapse and urinary incontinence complaints. The average time to hospital admission was 4.03±5.52 (min 0 - max 25) years, with the most common diagnoses being urinary incontinence (28.3%) and cystocele (28.3%). The majority of cases underwent transobturator tape (TOT) (38.3%) and sacrocolpopexy (12.5%) surgeries. The average hospital stay due to surgery was 3.42±1.33 (min 1 - max 7) days. About 13.4% of women had a history of recurrent pelvic floor surgery and 5% reported dyspareunia in the postoperative period.
Conclusion: Women presented to the hospital with urogynecological symptoms approximately four years after their initial apply, with the majority being diagnosed with urinary incontinence and cystocele. TOT and sacrocolpopexy surgeries were predominantly performed. About one in ten women had a history of recurrent urogynecological surgery. Dyspareunia was reported at a low rate in the postoperative period. It is believed that maintaining more comprehensive and follow-up data records would guide healthcare professionals in their planning.
Keywords
pelvic floor surgery pelvic organ prolapse retrospective healthcare professionals urinary incontinence.
References
- Rubilotta E, Balzarro M, D’Amico A, et al. Pure stress urinary incontinence: analysis of prevalence, estimation of costs, and financial impact. BMC Urol. 2019;19(1):44. https://doi.org/10.1186/s12894-019- 0468-2 2
- Hakimi S, Aminian E, Mohammadi M, et al. Prevalence and Risk Factors of Urinary/Anal Incontinence and Pelvic Organ Prolapse in Healthy Middle-Aged Iranian Women. J Menopausal Med. 2020;26(1):24–8. https://doi.org/10.6118/jmm.19201
- Miller KL, Baraldi CA. Geriatric gynecology: Promoting health and avoiding harm. Am J Obstet Gynecol. 2012; 207(5): 355-67
- Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;30(4):CD004014. https://doi.org/10.1002/14651858.CD004014
- Seven M, Akyuz A, Acikel CH. Ürogenital Prolapsus Yaşam Kalitesi Ölçeğinin Geçerlik ve Güvenirlik Çalışması. TAF Prev Med Bull. 2008;7(4):317-22.
- Olsen A.L, Smith V.J, Bergstrom J.D, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.Obstet Gynecol,1997;89:501-06
- Çetinel B, Demirkesen O, Tarcan T, Yalcin O. et al. Hidden female urinary incontinentce in urology and obstetrics and gynecology outpatient clinics in Turkey: What are the determinants of bothersome urinary incontinence and help-seeking behavior? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(6):659-64.
- Rodríguez-Mias NL, Martinez-Franco EM, Aguado J, et al. Pelvic organ prolapse and stress urinary incontinence, do they share the same risk factors? Eur J Obstet Gynecol Reprod Biol. 2015;190:52–7. https://doi.org/10.1016/j.ejogrb.2015.04.015
- Vergeldt TFM, Weemhoff M, IntHout J, et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–1573. https://doi.org/10.1007/s00192-015-2695-8
- Dicpinigaitis PV. Prevalence of stress urinary incontinence in women presenting for evaluation of chronic cough. ERJ Open Res. 2021;7(1):00012–2021. https://openres.ersjournals.com/content/7/1/00012-2021
- Allen-Brady K, Cannon-Albright LA, Farnham JM, et al. Evidence for pelvic organ prolapse predisposition genes on chromosomes 10 and 17. Am J Obstet Gynecol. 2015;212(6):771.e1–7. https://doi.org/10.1016/j.ajog.2014.12.037
- Brown JS, Waetjen LE, Subak LL. et al. Procedures for pelvic organ prolapse in the United States. Am J Obstet Gynecol 2002; 186:712-716.
- Yalçın Ö. Pelvik Organ Prolapsusu. İn: Pelvik Taban Disfonksiyonu Tanı, Tedavi ve Bakımda Hemşirelere Yönelik Güncel Yaklaşımlar. Ed. Beji NK, Çayır G. İstanbul: Nobel Tıp Kitabevleri; 2020: 64-5.
- Walters MD, Paraiso MF. Anterior vaginal wall prolapse: Innovative surgical approaches. Review. Cleve Clin J Med. 2005;72(4):S20-7.
- Yıldız Ç, Akkar-Bozoklu Ö, Karakuş S, Korğalı E. Kadınlarda pelvik cerrahi sonrası cinsel yaşam. Androloji Bülteni, 2015;17(60), 56-9.
- Zhang Y, Song X, Mao M, Kang J, Ai F, Zhu L. Tension-free vaginal tape for the treatment of stress urinary incontinence: a 13-year prospective follow-up. Journal of Minimally Invasive Gynecology, 2019;26(4), 754-59.
- Banas J, Jankiewicz K, Rechberger T, Kołodyńska A, Bogusiewicz M. Outcome of transobturator sling for treatment of female stress urinary incontinence applied as a single procedure or concomitantly with pelvic organ prolapse surgery. Annals of Agricultural and Environmental Medicine 2023;30(1), 190-94.
- Dünya Sağlık Örgütü (DSÖ) ICD 10; 2016. Erişim tarihi: 28.06.2023. Erişim adresi: http://www.who.int/occupational_health/publications/en/oehicd10.pdf
- T.C Sosyal Güvenlik Kurumu (SGK) Sağlık Uygulama Tebliği (SUT), 2022. Erişim tarihi: 28.06.2023. Erişim adresi: https://www.sgk.gov.tr/Duyuru/Detay/27072022-SUT-Degisiklik-Tebligi-Islenmis-Guncel-2013-SUT-2022-07-27-05-04-57
- Mironska E, Chapple C, MacNeil S. Recent advances in pelvic floor repair. 2019; F1000Res, 8. https://doi.org/10.12688/f1000research.15046.1
- Hullfish KL, Bovbjerg VE, Steers WD. Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up. American journal of obstetrics and gynecology, 2004;191(1), 201-5.
- Srikrishna S, Robinson D, Cardozo L, Thiagamoorthy G. (2015). Patient and surgeon goal achievement 10 years following surgery for pelvic organ prolapse and urinary incontinence. International urogynecology journal. 2015;26, 1679-86.
- Mattsson NK, Karjalainen P, Tolppanen AM. Pelvic organ prolapse surgery and quality of life—a nationwide cohort study. Am J Obstet Gynecol. 2020;222:588.e1-10.
- Orhan A, Aslan K. Pelvik Organ Prolapsusunda Semptomlar ile Kliniğe Başvuru Süreleri Arasındaki İlişki. Osmangazi Tıp Dergisi. 2020;42(5), 532-540.
- Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11),1311–16. https://doi.org/10.1001/jama.300.11.1311
- Güvey H. Jinekoloji Polikliniğine Başvuran Geriatrik Hastalardaki Problemlerin Premenapozal Dönemdeki Hastalarla Kıyaslanması. Konuralp Medical Journal. 2020;12(1), 144-47.
- Bagbanci S, Dadalı M. Orta yoğunluklu bir üroloji kliniğinde ürojinekolojik cerrahi vakalarının etiyolojik dağılımı; Beş Yıllık Retrospektif Bir Analiz. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2017;50(2),62-7.
- Bilgiç D, Kizilkaya Beji N, Ozbas A, Çavdar İ, Aslan E, Yalcin O. Coping and help‐seeking behaviors for management of urinary incontinence. LUTS: Lower Urinary Tract Symptoms. 2017;9(3), 134-141.
- Adelowo AO, O‘Neal E, Hota LS. Underlying Factors Contributingto the Delay in Patients Seeking Care for Pelvic Floor Dysfunction. J Clin Trials. 2014;4:174.
- Cox A, Herschorn S, Lee L. Surgical management of female SUI: is there a gold standard?. Nature Reviews Urology, 2013;10(2),78-89.
- Pham T, Kenton K, Mueller E, et al. New pelvic symptoms are common after reconstructive pelvic surgery. Am J Obstet Gynecol. 2009;200:88.e1-88.e5.
- Alkış O, Zümrütbaş AE, Özlülerden Y, Aybek Z. Ayarlanabilir orta üretra askı ameliyatı sonrası cilt ve vajinal erozyon. Pam Tıp Derg 2014;7(3):230-33.
- Bandarian M, Ghanbari Z, Asgari A. Comparison of transobturator tape (TOT) vs Burch method in treatment of stress urinary incontinence, Journal of Obstetrics and Gynaecology, 2011;31:6, 518-20. DOI:10.3109/01443615.2011.578776
- Sharma JB, Thariani K, Kumari R, Kaur T, Uppal B, Pandey K, Dalal V. Short and long term follow up and efficacy of trans obturator tape for management of stress urinary incontinence. Journal of obstetrics and gynaecology of India. 2021;71(3),285–91. https://doi.org/10.1007/s13224-020-01398-2
- Shah AD, Kohli N, Raja, SS. et al. The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J. 2008;19,421–428. https://doi.org/10.1007/s00192-007-0457-y
- . Eryavuz AK, Özdemir M, Üçdoğruk Ş. Tükiye’de Hastanede Yatış Süresini Etkileyen Demografik Özelliklerin Sayma Verisi Modelleriyle İncelenmesi. Eurasian Econometrics Statistics & Emprical Economics Journal. 2022;17–29. https://doi.org/10.17740/eas.stat.2016‐V4‐02
- Karataş A, Duran B, Özlü T, Koç Ö, Dönmez ME, Güler A. Transobturator tape uygulanan olgularda tedavi başarısının değerlendirilmesi. Journal of Turkish Society of Obstetrics & Gynecology. 2014; 11(2): 115 – 18.
- Taner CE, Şenyuva İ, Camuzcuoğlu A, Karanfil C. Genital Prolapsuslarda Sakrokolpopeksi Sonuçları. Nobel Med. 2009; 5(1): 14-8.
- Medina CA, Costantini E, Petri E, Mourad S, Singla A, Rodríguez-Colorado, et al. Evaluation and surgery for stress urinary incontinence: A FIGO working group report. Neurourol Urodyn. 2017;36(2):518-28.
- Dökmeci F. Kadınlarda İzlenen Üriner İnkontinans: Uluslararası Kılavuzlar Ișığında Güncel Yönetim. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 2017; 70(3), 187-93.
Bir üniversite hastanesinde üriner inkontinans ve prolapsus cerrahisi geçiren kadınların beş yıllık değerlendirilmesi: Retrospektif bir çalışma
Abstract
Amaç: Bir üniversite hastanesinde üriner inkontinans ve prolapsus cerrahisi geçiren kadınların beş yıllık retrospektif olarak değerlendirilmesidir.
Gereç ve Yöntem: Bir üniversite hastanesinin 2017-2022 yılları arasında üriner inkontinans ve prolapsus cerrahisi geçiren 137 olgunun kayıtları retrospektif olarak incelenmiştir. Kayıtların 17’si tekrarlayan girişler olduğundan, toplamda 120 kadının verileri değerlendirilmiştir. Olguların yaş, obstetrik ve jinekolojik öyküsü, ürojinekolojik şikayetler ve süresi, başvuru yapılan klinik, tanıları, geçirilen operasyon tipi, yılı, yatış süresi gibi parametreleri analiz edilmiştir.
Bulgular: İncelenen olguların yaş ortalaması 59.63±10.66 (min 34- max 81) ve %77.5’i postmenopozal dönemdeydi. Kadınların ortalama gebelik ve doğum sayısı sırasıyla 3.36±2.07 (min 0-max 9) ve 2.50±1.42 (min 0-max 9) idi. Kadınların %35’si üriner inkontinans, %27.5’i perinede ele gelen kitle ve %26.7’si ise ele gelen kitle ile birlikte üriner inkontinans şikayetleri ile hastaneye başvurmuştu. Hastaneye başvuruların ortalama 4.03±5.52 (min 0- max 25) yıl sonra olduğu ve en sık üriner inkontinans (%28.3) ve sistosel (%28.3) tanılarıyla yatışlarının olduğu belirlenmişti. Olgular en fazla transobturator tape (TOT) (%38.3) ve sakrokolpopeksi (%12.5) operasyonu geçirmişti. Cerrahi nedeniyle hastanede yatış süresi ortalama 3.42±1.33 (min 1-max 7) gündü. Kadınların %13.4’ünün tekrarlayan pelvik taban cerrahisi mevcuttu ve %5’inin post-op dönemde disparoni bildirdiği saptandı.
Sonuç: Kadınlar ortalama dört yıl sonra ürojinekolojik semptomlarla hastaneye başvurmuşlar ve çoğunlukla üriner inkontinans ve sistosel tanısı almışlardır. Ağırlıklı olarak TOT ve sakrokolpopeksi cerrahisi uygulanmıştır. Yaklaşık her on kadından birinin tekrarlayan ürojinekolojik cerrahi öyküsü mevcuttur. Düşük oranda operasyon sonrası dönemde disparoni bildirilmiştir. Veri kayıtlarının daha kapsamlı tutulması ve takip edilmesinin sağlık çalışanlarının planlamalarına yol göstereceği düşünülmektedir.
Keywords
pelvik taban cerrahisi pelvik organ prolapsusu retrospektif sağlık profesyonelleri üriner inkontinans
References
- Rubilotta E, Balzarro M, D’Amico A, et al. Pure stress urinary incontinence: analysis of prevalence, estimation of costs, and financial impact. BMC Urol. 2019;19(1):44. https://doi.org/10.1186/s12894-019- 0468-2 2
- Hakimi S, Aminian E, Mohammadi M, et al. Prevalence and Risk Factors of Urinary/Anal Incontinence and Pelvic Organ Prolapse in Healthy Middle-Aged Iranian Women. J Menopausal Med. 2020;26(1):24–8. https://doi.org/10.6118/jmm.19201
- Miller KL, Baraldi CA. Geriatric gynecology: Promoting health and avoiding harm. Am J Obstet Gynecol. 2012; 207(5): 355-67
- Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;30(4):CD004014. https://doi.org/10.1002/14651858.CD004014
- Seven M, Akyuz A, Acikel CH. Ürogenital Prolapsus Yaşam Kalitesi Ölçeğinin Geçerlik ve Güvenirlik Çalışması. TAF Prev Med Bull. 2008;7(4):317-22.
- Olsen A.L, Smith V.J, Bergstrom J.D, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.Obstet Gynecol,1997;89:501-06
- Çetinel B, Demirkesen O, Tarcan T, Yalcin O. et al. Hidden female urinary incontinentce in urology and obstetrics and gynecology outpatient clinics in Turkey: What are the determinants of bothersome urinary incontinence and help-seeking behavior? Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(6):659-64.
- Rodríguez-Mias NL, Martinez-Franco EM, Aguado J, et al. Pelvic organ prolapse and stress urinary incontinence, do they share the same risk factors? Eur J Obstet Gynecol Reprod Biol. 2015;190:52–7. https://doi.org/10.1016/j.ejogrb.2015.04.015
- Vergeldt TFM, Weemhoff M, IntHout J, et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–1573. https://doi.org/10.1007/s00192-015-2695-8
- Dicpinigaitis PV. Prevalence of stress urinary incontinence in women presenting for evaluation of chronic cough. ERJ Open Res. 2021;7(1):00012–2021. https://openres.ersjournals.com/content/7/1/00012-2021
- Allen-Brady K, Cannon-Albright LA, Farnham JM, et al. Evidence for pelvic organ prolapse predisposition genes on chromosomes 10 and 17. Am J Obstet Gynecol. 2015;212(6):771.e1–7. https://doi.org/10.1016/j.ajog.2014.12.037
- Brown JS, Waetjen LE, Subak LL. et al. Procedures for pelvic organ prolapse in the United States. Am J Obstet Gynecol 2002; 186:712-716.
- Yalçın Ö. Pelvik Organ Prolapsusu. İn: Pelvik Taban Disfonksiyonu Tanı, Tedavi ve Bakımda Hemşirelere Yönelik Güncel Yaklaşımlar. Ed. Beji NK, Çayır G. İstanbul: Nobel Tıp Kitabevleri; 2020: 64-5.
- Walters MD, Paraiso MF. Anterior vaginal wall prolapse: Innovative surgical approaches. Review. Cleve Clin J Med. 2005;72(4):S20-7.
- Yıldız Ç, Akkar-Bozoklu Ö, Karakuş S, Korğalı E. Kadınlarda pelvik cerrahi sonrası cinsel yaşam. Androloji Bülteni, 2015;17(60), 56-9.
- Zhang Y, Song X, Mao M, Kang J, Ai F, Zhu L. Tension-free vaginal tape for the treatment of stress urinary incontinence: a 13-year prospective follow-up. Journal of Minimally Invasive Gynecology, 2019;26(4), 754-59.
- Banas J, Jankiewicz K, Rechberger T, Kołodyńska A, Bogusiewicz M. Outcome of transobturator sling for treatment of female stress urinary incontinence applied as a single procedure or concomitantly with pelvic organ prolapse surgery. Annals of Agricultural and Environmental Medicine 2023;30(1), 190-94.
- Dünya Sağlık Örgütü (DSÖ) ICD 10; 2016. Erişim tarihi: 28.06.2023. Erişim adresi: http://www.who.int/occupational_health/publications/en/oehicd10.pdf
- T.C Sosyal Güvenlik Kurumu (SGK) Sağlık Uygulama Tebliği (SUT), 2022. Erişim tarihi: 28.06.2023. Erişim adresi: https://www.sgk.gov.tr/Duyuru/Detay/27072022-SUT-Degisiklik-Tebligi-Islenmis-Guncel-2013-SUT-2022-07-27-05-04-57
- Mironska E, Chapple C, MacNeil S. Recent advances in pelvic floor repair. 2019; F1000Res, 8. https://doi.org/10.12688/f1000research.15046.1
- Hullfish KL, Bovbjerg VE, Steers WD. Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up. American journal of obstetrics and gynecology, 2004;191(1), 201-5.
- Srikrishna S, Robinson D, Cardozo L, Thiagamoorthy G. (2015). Patient and surgeon goal achievement 10 years following surgery for pelvic organ prolapse and urinary incontinence. International urogynecology journal. 2015;26, 1679-86.
- Mattsson NK, Karjalainen P, Tolppanen AM. Pelvic organ prolapse surgery and quality of life—a nationwide cohort study. Am J Obstet Gynecol. 2020;222:588.e1-10.
- Orhan A, Aslan K. Pelvik Organ Prolapsusunda Semptomlar ile Kliniğe Başvuru Süreleri Arasındaki İlişki. Osmangazi Tıp Dergisi. 2020;42(5), 532-540.
- Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, Spino C, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11),1311–16. https://doi.org/10.1001/jama.300.11.1311
- Güvey H. Jinekoloji Polikliniğine Başvuran Geriatrik Hastalardaki Problemlerin Premenapozal Dönemdeki Hastalarla Kıyaslanması. Konuralp Medical Journal. 2020;12(1), 144-47.
- Bagbanci S, Dadalı M. Orta yoğunluklu bir üroloji kliniğinde ürojinekolojik cerrahi vakalarının etiyolojik dağılımı; Beş Yıllık Retrospektif Bir Analiz. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. 2017;50(2),62-7.
- Bilgiç D, Kizilkaya Beji N, Ozbas A, Çavdar İ, Aslan E, Yalcin O. Coping and help‐seeking behaviors for management of urinary incontinence. LUTS: Lower Urinary Tract Symptoms. 2017;9(3), 134-141.
- Adelowo AO, O‘Neal E, Hota LS. Underlying Factors Contributingto the Delay in Patients Seeking Care for Pelvic Floor Dysfunction. J Clin Trials. 2014;4:174.
- Cox A, Herschorn S, Lee L. Surgical management of female SUI: is there a gold standard?. Nature Reviews Urology, 2013;10(2),78-89.
- Pham T, Kenton K, Mueller E, et al. New pelvic symptoms are common after reconstructive pelvic surgery. Am J Obstet Gynecol. 2009;200:88.e1-88.e5.
- Alkış O, Zümrütbaş AE, Özlülerden Y, Aybek Z. Ayarlanabilir orta üretra askı ameliyatı sonrası cilt ve vajinal erozyon. Pam Tıp Derg 2014;7(3):230-33.
- Bandarian M, Ghanbari Z, Asgari A. Comparison of transobturator tape (TOT) vs Burch method in treatment of stress urinary incontinence, Journal of Obstetrics and Gynaecology, 2011;31:6, 518-20. DOI:10.3109/01443615.2011.578776
- Sharma JB, Thariani K, Kumari R, Kaur T, Uppal B, Pandey K, Dalal V. Short and long term follow up and efficacy of trans obturator tape for management of stress urinary incontinence. Journal of obstetrics and gynaecology of India. 2021;71(3),285–91. https://doi.org/10.1007/s13224-020-01398-2
- Shah AD, Kohli N, Raja, SS. et al. The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J. 2008;19,421–428. https://doi.org/10.1007/s00192-007-0457-y
- . Eryavuz AK, Özdemir M, Üçdoğruk Ş. Tükiye’de Hastanede Yatış Süresini Etkileyen Demografik Özelliklerin Sayma Verisi Modelleriyle İncelenmesi. Eurasian Econometrics Statistics & Emprical Economics Journal. 2022;17–29. https://doi.org/10.17740/eas.stat.2016‐V4‐02
- Karataş A, Duran B, Özlü T, Koç Ö, Dönmez ME, Güler A. Transobturator tape uygulanan olgularda tedavi başarısının değerlendirilmesi. Journal of Turkish Society of Obstetrics & Gynecology. 2014; 11(2): 115 – 18.
- Taner CE, Şenyuva İ, Camuzcuoğlu A, Karanfil C. Genital Prolapsuslarda Sakrokolpopeksi Sonuçları. Nobel Med. 2009; 5(1): 14-8.
- Medina CA, Costantini E, Petri E, Mourad S, Singla A, Rodríguez-Colorado, et al. Evaluation and surgery for stress urinary incontinence: A FIGO working group report. Neurourol Urodyn. 2017;36(2):518-28.
- Dökmeci F. Kadınlarda İzlenen Üriner İnkontinans: Uluslararası Kılavuzlar Ișığında Güncel Yönetim. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 2017; 70(3), 187-93.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 18, 2023 |
| Submission Date | August 9, 2023 |
| Published in Issue | Year 2023 |