Overactive bladder phenotypes: development and preliminary data.

Introduction: The purpose of this study is to develop overactive bladder (OAB) phenotypes that can be used to develop diagnostic and treatment pathways and offer clues to the underlying etiologies of patients with OAB.

Materials And Methods: This is a retrospective, multicenter study of patients with lower urinary tract symptoms (LUTS). Evaluation included a 24-hour bladder diary (24HBD), the lower urinary tract symptoms score (LUTSS) questionnaire, uroflowmetry (Q), and post-void residual urine (PVR) measurement.

Urinary symptoms after bladder flap at the time of primary cesarean delivery: a randomized controlled trial (RTC).

Introduction And Hypothesis: The aim of this study was to evaluate urinary symptoms in the postpartum period after omission of the bladder flap at the time of primary cesarean delivery.

Methods: This was a single-blind parallel-group randomized comparison (bladder flap, no bladder flap) in women scheduled for a primary cesarean delivery at 37 weeks gestation or later. The primary outcome was urinary symptom scores at 6-8 weeks postpartum.

Anatomic relation between single-incision slings and the obturator vessels.

The risk of arterial vascular injury within the retropubic space is a potentially life-threatening complication associated with mid-urethral sling placement for the treatment of female stress urinary incontinence. To determine the relationship between the major blood vessels and a single incision sling, these slings were placed in 12 fresh female cadavers. Following the insertion of each sling, the retropubic space was dissected and sling placement was observed relative to the obturator neurovascular bundle bilaterally.

Prevalence and Predictors of Intimate Partner Violence in a Military Urogynecology Clinic.

Background: Intimate partner violence (IPV) is common, with prevalence in women of 15 to 71% over the lifespan, 4 to 54% currently. Violence is associated with poor health, and may be more common in military populations. A history of abuse is also common in patients with pain, urinary/bowel symptoms, and dyspareunia.

Minimally invasive management of retropubic bleeding and hematoma evacuation after a TVT Secur or mini-sling procedure.

Background: Retropubic hematomas may complicate up to 4.1% of tension-free vaginal tape (TVT) procedures in the surgical treatment of stress urinary incontinence. Symptomatic or expanding hematomas often require intervention, usually accomplished through an abdominal incision.

The impact of pregnancy on the individual and military organization: a postpartum active duty survey.

Using a postpartum survey, comparing singles to married, we sought to expand existing information on pregnancy occurring among active duty service women. The study instrument was a 59-question survey distributed in the initial 24 hours postpartum and collected prior to discharge. The majority affirmed that pregnancy had not changed career plans.

Factors affecting caesarean operative time and the effect of operative time on pregnancy outcomes.

Aim: To determine the factors that influence caesarean operative time and operative time effects on pregnancy outcomes.

Methods: Prospective observational study of women undergoing a caesarean delivery (CD). Multiple antepartum, intrapartum and neonatal outcomes were assessed for their influence on the time of the CD and the time effect of CD on pregnancy outcomes.

Anorectal symptoms in pregnancy and the postpartum period.

Objective: To determine the frequency of anorectal complaints in nulliparous, pregnant women before and after delivery.

Study Design: This was a prospective, observational study. Nulliparous, pregnant women attending an active-duty prenatal clinic completed a 6-item anorectal symptom questionnaire that assessed anal continence and defecatory symptoms.

Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study.

The aim of this study was to determine if certain occupations or socioeconomic levels are associated with pelvic organ prolapse. Investigators at six American sites performed pelvic organ prolapse quantification examinations on women presenting for routine gynecologic care. Between September 1999 and March 2002, 1,004 patients were examined.

Decreased anal sphincter lacerations associated with restrictive episiotomy use.

Objective: To determine whether restrictive episiotomy use was associated with decreases in anal sphincter lacerations and the risk of anal sphincter laceration attributable to episiotomy.

Study Design: This was a retrospective database study. Rates of episiotomy, anal sphincter laceration (third- or fourth-degree tear), and other confounding variables were compared among vaginal deliveries before (1999) and after (2002) restrictive episiotomy use was implemented at our institution.

Pelvic Organ Support Study (POSST) and bowel symptoms: straining at stool is associated with perineal and anterior vaginal descent in a general gynecologic population.

Objective: The purpose of this study was to evaluate the association of constipation symptoms and anal incontinence with vaginal wall and pelvic organ descent in a general gynecologic population.

Study Design: In this multicenter, cross-sectional study, 1004 women attending routine gynecologic healthcare underwent pelvic organ prolapse quantification (POPQ) measurements, and were surveyed regarding anal incontinence, digitation, < 2 bowel movements (BMs)/week, and > 25% frequency of: straining, hard/lumpy stools, and incomplete emptying. Constipation scores reflected the sum of positive responses.

Pelvic organ support in pregnancy and postpartum.

The purpose of this study was to evaluate pelvic organ support during pregnancy and following delivery. This was a prospective observational study. Pelvic organ prolapse quantification (POPQ) examinations were performed during each trimester of pregnancy and in the postpartum.

An active duty woman with anal incontinence after vaginal delivery: an elusive diagnosis.

Anal sphincter injury as a result of birth trauma is the leading cause of fecal incontinence in women presenting to surgical clinics. A 36-year-old active duty woman was referred to the Urogynecology Clinic at Madigan Army Medical Center for evaluation of a deficient perineal body. She reluctantly reported a 12-year history of anal incontinence since the birth of her first child, predating her entry into the naval service.

Informed consent and birth: protecting the pelvic floor and ourselves.

The controversy over elective cesarean versus vaginal birth with regard to pelvic floor trauma has left many caregivers and patients confused. With the growing evidence to support the development of fecal incontinence as a result of childbirth, we believe that it is imperative to reevaluate modern obstetric practices both for the patient's benefit and for our medical-legal protection. Our attention and energy need to be focused on good informed consent regarding these risks along with improved postpartum surveillance for injury.

Pelvic organ support in nulliparous pregnant and nonpregnant women: a case control study.

Objective: Our purpose was to compare pelvic organ support in nulliparous pregnant and nonpregnant women at a single institution.

Study Design: This was a case-control study. Pregnant patients and nonpregnant control subjects were matched according to age and race.