The Incidence of Pelvic and Low Back Pain in Patients with Pelvic Organ Prolapse.

Introduction And Hypothesis: To define the prevalence and incidence of pelvic/low back pain in patients with pelvic organ prolapse (POP).

Methods: Patients presenting for POP to three urogynecology centers in the US, UK, and Chile were enrolled in an IRB-approved cross-sectional study assessing pain, GU, GI and sexual function symptoms. For prevalence, symptoms were noted as present if the participant recorded the symptom and reported the degree of bother as "somewhat," "a moderate amount," or "a lot.

Impact of pre-pregnancy obesity on cesarean delivery rates in nulliparous pregnant people undergoing induction of labor.

Objective: To evaluate the impact of pre-pregnancy obesity on the cesarean delivery rate in nulliparous pregnant people undergoing induction of labor.

Study Design: This is a retrospective cohort study of nulliparous pregnant people with a normal weight and obesity who underwent induction of labor between 37 and 41 weeks gestation at a single institution from 2012 to 2018. Weight category was based on pre-pregnancy body mass index.

A Cost-Effectiveness Analysis of Post-Void Residual Bladder Scan Thresholds in the Postoperative Setting.

Introduction And Hypothesis: To identify the optimal cost-effectiveness threshold of post-void residual (PVR) by bladder scan in postoperative urogynecologic patients.

Methods: A cost-effectiveness analysis was performed as a secondary analysis of a previously published study of patients undergoing urogynecologic procedures with planned voiding trials, setting thresholds for postoperative PVR bladder scan volumes at 100 ml, 150 ml, and 200 ml. Patient-based scenarios were modeled for ambulatory office or emergency department (ED) resource utilization and to determine the cost-effectiveness of each threshold.

International Urogynecological Consultation: clinical definition of pelvic organ prolapse.

Introduction And Hypothesis: This segment of Chapter 1 of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) reviews the literature on the clinical definition of POP with the intent of creating standard terminology.

Methods: An international group containing nine urogynecologists and one university-based medical librarian performed a search of the literature using pre-specified search terms in PubMed, Embase, and Scopus. Publications were eliminated if not relevant to the clinical definition of POP, and those articles remaining were evaluated for quality using the Specialist Unit for Review Evidence (SURE).

Can We Trust the Math? Correlation of Objective Postvoid Residual With Calculated Subtraction Postvoid Residual.

Objective: The aim of the study was to determine the accuracy of postvoid residual (PVR) by subtraction as compared with objective measurement by bladder scan or catheterization.

Methods: This is a secondary analysis of postoperative patients who underwent avoiding trial by retrograde bladder instillation. Fill volume, spontaneous voided volume, and PVR were objectively measured; PVR was also calculated.

Treatment outcomes of overactive bladder with combined therapies of botulinum toxin injections and oral agents.

Objective: Treatment options for refractory overactive bladder (OAB) following behavioral modifications and oral OAB medications remain limited. Up to 33% of women fail botulinum toxin injections (Amundsen et al. Eur Urol.

The effect of preoperative phenazopyridine on short-term urinary retention following urogynecologic surgery.

Introduction And Hypothesis: Previous studies have found that administration of phenazopyridine decreased short-term urinary retention following surgery but other more recent trials have shown mixed results. This study sought to investigate the potential benefit of preoperative administration of oral phenazopyridine in relation to the prevention of short-term urinary retention following urogynecologic surgery.

Methods: This is a retrospective cohort study of a convenience sample of women undergoing urogynecologic surgery from June 2016 to March 2019.

Genital Hiatus Size as a Predictor of Progression of Pelvic Organ Prolapse.

Objective: This study aimed to determine if genital hiatus (GH) size is a predictor of worsening pelvic organ prolapse and a preference for a therapeutic intervention in women with pelvic organ prolapse who opt for expectant management over therapeutic intervention at their initial encounter.

Methods: This was a retrospective cohort study analyzing the GH size of women who opted for expectant management in the initial treatment of pelvic organ prolapse at one academic institution from 2002 to 2015. Participants were divided into 2 groups: (1) large GH was defined as ≥4 cm and (2) normal GH was defined as <4 cm.

Factors affecting patient choice for continued observation versus intervention for pelvic organ prolapse.

Introduction And Hypothesis: To analyze the reasons for eventual choice of a therapeutic intervention in subjects who initially chose observation for bothersome pelvic organ prolapse (POP) over therapeutic intervention at their first urogynecology clinic visit.

Methods: This is a retrospective cohort study of women with bothersome POP who initially chose observation over therapeutic intervention at one institution from 2002 to 2015. Subjects were followed over time with sequential pelvic organ prolapse quantification examinations (POP-Q) and assessments of symptoms and bother utilizing non-validated standard questions.

Subjective versus objective determination of bladder emptying following urogynecological surgery: "do you feel that you completely emptied your bladder?".

Introduction And Hypothesis: We tested the hypothesis that women can subjectively determine if they have emptied their bladder after a spontaneous voiding attempt following urogynecological surgery to rule out post-operative urinary retention as determined by a voiding trial.

Methods: This is a prospective observational study of women undergoing urogynecological surgery at two academic institutions from June 2016 to March 2019. Following surgery, subjects underwent a voiding trial followed by measurement of the PVR via ultrasound bladder scan or straight catheterization.

A narrative review of the epidemiology, diagnosis, and treatment of latent stress urinary incontinence.

Aims: To review the current literature on the development of latent stress urinary incontinence (SUI) or SUI that occurs following pelvic organ prolapse therapy in patients who were continent prior to therapy. To make recommendations on how to best evaluate and manage patients with pelvic organ prolapse who are continent.

Methods: This is a narrative review using Google scholar and cross referencing identified manuscripts.

Defining normal apical vaginal support: a relook at the POSST study.

Introduction And Hypothesis: The purpose of this study is to reanalyze data from the original 2005 Pelvic Organ Support Study (POSST) data set to define normal values for apical Pelvic Organ Prolapse Quantification (POP-Q) points C and D and total vaginal length (TVL) in an asymptomatic population of women.

Methods: In this retrospective observational data-set review, patient were >18 years presenting for annual gynecologic exams to six centers in the United States. Data included demographics, questions about prolapse symptoms, and POP-Q points.

Standing Vs Supine; Does it Matter in Cough Stress Testing?

Objectives: The aim of this study was to compare the sensitivity of cough stress test in the standing versus supine position in the evaluation of incontinent females.

Methods: We performed a prospective observational study of women with the chief complaint of urinary incontinence (UI) undergoing a provocative cough stress test (CST). Subjects underwent both a standing and a supine CST.

Construct and Predictive Validity of a Cystoscopic Checklist to Evaluate Surgical Competency in the Operating Room.

Purpose: The aim of this study was to demonstrate the construct and predictive validity of a task-specific checklist for cystoscopy in the operating room.

Methods: This study is a prospective observational study evaluating the validity of a task-specific checklist for cystoscopic proficiency on residents performing cystoscopy in the operating room over a 4-year period. Residents were scored on 2 task-specific checklists: (1) assembly and (2) performance of a diagnostic cystoscopy.

Polyethylene Glycol 3350 and Docusate Sodium Compared With Docusate Sodium Alone After Urogynecologic Surgery: A Randomized Controlled Trial.

Objective: To compare time to first bowel movement and additional gastrointestinal outcomes between women receiving polyethylene glycol 3350 (PEG3350) and docusate sodium and docusate sodium alone after urogynecologic surgery.

Methods: Participants received twice-daily 100 mg docusate sodium and were randomized to daily 1) PEG3350 or 2) inert placebo for 5 days after urogynecologic surgery. They completed bowel diaries, Bristol stool scale, validated Patient Assessment of Constipation Symptom Questionnaire, and Patient Assessment of Constipation Quality-of-Life Questionnaire preoperatively and 1 week after surgery.

Posterior tibial nerve stimulation for the treatment of fecal incontinence: a systematic evidence review.

Importance And Objectives: Posterior tibial nerve stimulation (PTNS) is a potential emerging therapy for fecal incontinence (FI). The aim of this study was to systematically review the literature regarding the efficacy of PTNS as a treatment of FI.

Evidence Acquisition: We searched MEDLINE/PubMed, EMBASE, and Cochrane databases from inception through November 2013.

Sexual activity and vaginal topography in women with symptomatic pelvic floor disorders.

Introduction: Pelvic floor disorders affect vaginal anatomy and may affect sexual function.

Aims: The aims of this study were to explore the relationship between vaginal anatomy and sexual activity in women with symptomatic pelvic floor disorders and to assess whether vaginal measurements (topography) correlate with sexual function.

Methods: This is a retrospective cohort study comparing sexually active and nonsexually active women planning urogynecologic surgery.

How does site of pelvic organ prolapse repair affect overactive bladder symptoms?

Objectives: To assess how site of pelvic organ prolapse repair affects overactive bladder (OAB) symptoms, we compared change in OAB symptoms in women undergoing isolated anterior/apical (AA) repair versus isolated posterior (P) repair.

Methods: This is a retrospective cohort study of women with bothersome OAB undergoing either AA or P prolapse repair. The subjects completed the Pelvic Floor Distress Inventory short form and the Overactive Bladder Questionnaire (OAB-q) validated questionnaires preoperatively and 6 weeks postoperatively.

Does concomitant anterior/apical repair during midurethral sling improve the overactive bladder component of mixed incontinence?

Introduction And Hypothesis: Midurethral sling (MUS) can improve overactive bladder (OAB) symptoms. It is unclear if anterior/apical prolapse (AA) repair provides additional benefit. We hypothesized that women with mixed urinary incontinence (MUI) experience greater improvement in the OAB component of their symptoms after concomitant MUS and AA repair compared with MUS alone.

Is postoperative bowel function related to posterior compartment prolapse repair?

Objectives: This study aimed to assess how posterior repair (PR) affects change in bowel function in women undergoing anterior/apical surgery for prolapse.

Methods: We performed a retrospective cohort study of women undergoing prolapse surgery. Our 2 cohorts were women who underwent anterior/apical prolapse surgery either with or without a PR.

Clinical challenges in the management of vaginal prolapse.

Pelvic organ prolapse is highly prevalent, and negatively affects a woman's quality of life. Women with bothersome prolapse may be offered pessary management or may choose to undergo corrective surgery. In choosing the most appropriate surgical procedure, there are many factors to consider.

Oral antibiotics to prevent postoperative urinary tract infection: a randomized controlled trial.

Objective: To evaluate whether nitrofurantoin prophylaxis prevents postoperative urinary tract infection (UTI) in patients receiving transurethral catheterization after pelvic reconstructive surgery.

Methods: In a randomized, double-blind, placebo-controlled trial, participants undergoing pelvic reconstructive surgery were randomized to 100 mg nitrofurantoin or placebo once daily during catheterization if they were: 1) discharged with a transurethral Foley or performing intermittent self-catheterization; or 2) hospitalized overnight with a transurethral Foley. Our primary outcome was treatment for clinically suspected or culture-proven UTI within 3 weeks of surgery.

Vaginal prolapse recurrence after uterosacral ligament suspension in normal-weight compared with overweight and obese women.

Objective: To compare recurrent prolapse after vaginal uterosacral ligament suspension in normal-weight compared with overweight or obese women.

Methods: We performed a retrospective cohort study of the risk of recurrent prolapse after uterosacral ligament suspension in normal-weight compared with overweight or obese women at our institution from December 1, 1996, through June 30, 2011. Women with fewer than 6 months of follow-up and those with a prior vault suspension were excluded.