Permanent Compared With Absorbable Suture for Vaginal Mesh Fixation During Total Hysterectomy and Sacrocolpopexy: A Randomized Controlled Trial.

Objective: To compare mesh and permanent suture exposure rates in the first year after minimally invasive total hysterectomy and sacrocolpopexy with a light-weight polypropylene mesh using permanent or delayed absorbable sutures.

Methods: Across five centers in the United States, women were randomized to permanent or delayed absorbable suture for vaginal attachment of a Y-mesh during hysterectomy and sacrocolpopexy for stage II prolapse and worse. The primary outcome was mesh or permanent suture exposure in the first year after surgery.

The effect of sacral neuromodulation on pudendal nerve function and female sexual function.

Aims: To quantify changes in pudendal nerve function with sacral neuromodulation (SNM). To understand the relationship of pudendal nerve function to SNM treatment response for overactive bladder. To assess the relationship between female sexual function and pudendal nerve function after SNM.

Robotic versus vaginal urogynecologic surgery: a retrospective cohort study of perioperative complications in elderly women.

Objectives: The primary objective was to compare perioperative complications after robotic surgery (RS) versus vaginal surgery (VS) for apical prolapse repair in elderly women. The secondary objectives were to (1) assess whether tools designed to predict surgical morbidity, the American Society of Anesthesiologists (ASA) class and the Charlson Comorbidity Index (CCI), are useful in the elderly urogynecologic population and (2) to classify complications during urogynecologic apical procedures using the Dindo classification system.

Methods: We reviewed medical records of women 65 years or older who underwent RS or VS between March 2006 and April 2011.

Relationship between race and abdominal anatomy: effect on robotic port placement.

Objectives: We sought to characterize differences between African American women and white women in abdominal wall dimensions that could affect robotic port placement. By better understanding these differences, surgeons could assess and adjust port placement to accommodate varying abdominal wall anatomy.

Methods: A radiologist blinded to race-reviewed abdominal/pelvic computed tomographic scans of women aged 30 to 70 prescreened for demographic inclusion criteria.

Obstetric sphincter injury interacts with diarrhea and urgency to increase the risk of fecal incontinence in women with irritable bowel syndrome.

Objectives: This study aimed to confirm that fecal urgency and diarrhea are independent risk factors for fecal incontinence (FI), to identify obstetrical risk factors associated with FI in women with irritable bowel syndrome, and to determine whether obstetric anal sphincter injuries interact with diarrhea or urgency to explain the occurrence of FI.

Methods: The study is a supplement to a diary study of bowel symptoms in 164 female patients with irritable bowel syndrome. Subjects completed daily bowel symptom diaries for 90 consecutive days and rated each bowel movement for stool consistency and presence of urgency, pain, and FI.

Effect of anticholinergic use for the treatment of overactive bladder on cognitive function in postmenopausal women.

Background: Overactive bladder (OAB) is a common condition affecting the elderly. The mainstay of treatment for OAB is medical therapy with anticholinergics. However, adverse events have been reported with this class of drugs, including cognitive changes.

Diagnostic accuracy of visual urethral mobility exam versus Q-Tip test: a randomized crossover trial.

Objective: The objective of the study was to compare the diagnostic accuracy of a visual urethral mobility examination (VUME) with a Q-Tip test in the assessment of urethral hypermobility.

Study Design: Subjects were randomized to a VUME or Q-Tip test first, followed by the alternate assessment. Outcomes included hypermobile, not hypermobile, or indeterminate.

Robotic vs abdominal sacrocolpopexy: 44-month pelvic floor outcomes.

Objective: To evaluate longer-term clinical outcomes after robotic vs abdominal sacrocolpopexy for the treatment of advanced pelvic organ prolapse (POP).

Material And Methods: This was a retrospective cohort assessment of women undergoing either robotic or abdominal sacrocolpopexy between March 2006 and October 2007. Pelvic floor support was measured using Pelvic Organ Prolapse Quantification (POP-Q) examination, and pelvic floor function was assessed via validated questionnaires, including the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).

Genitofemoral and perineal neuralgia after transobturator midurethral sling.

Background: Midurethral slings successfully treat stress urinary incontinence through a minimally invasive vaginal approach. Postoperative pain related to sling placement can occur and poses both diagnostic and treatment dilemmas.

Case: Four years after transobturator midurethral sling placement, the patient presented with complaints of left labial pain and dyspareunia since surgery.

Endometrial receptivity defects during IVF cycles with and without letrozole.

Background: Our aim was to study ways to improve IVF success rates in women with suspected endometrial receptivity defects.

Methods: We conducted a retrospective cohort study examining the effect of letrozole (aromatase inhibitor) on integrin expression as a marker of endometrial receptivity. We compared IVF outcomes in 97 infertile women who had undergone ανβ3 integrin assessment by immunohistochemistry in mid-luteal endometrial biopsies.

Diagnostic accuracy of retrograde and spontaneous voiding trials for postoperative voiding dysfunction: a randomized controlled trial.

Objective: To compare the diagnostic accuracy of two voiding trial methods to predict postoperative voiding dysfunction.

Methods: Women undergoing operations for urinary incontinence, prolapse, or both urinary incontinence and prolapse from November 2009 and March 2010 were randomized into one of two groups: retrograde or spontaneous. All patients underwent both techniques of voiding trials with randomization determining order.

Robot-assisted techniques and outcomes in the realm of pelvic reconstructive surgery.

Robotic-assisted surgery for the treatment of pelvic organ prolapse continues to grow in popularity as more surgeons adopt this technology. Encompassing all of the benefits of laparoscopic surgery, robotic-assisted techniques allow more surgeons the ability to perform complex tasks such as meticulous deep pelvic dissection and extensive suturing without having to resort to laparotomy. This chapter reviews the techniques involved in the robotic approach to pelvic reconstructive surgery and discusses the currently available information focusing on the outcomes of this procedure.

Overlapping anal sphincteroplasty: impact of suture selection on bowel symptoms.

Objective: To look at women who underwent overlapping anal sphincteroplasty (OAS) with the use of either permanent or absorbable sutures and to describe patient-reported fecal continence and quality of life.

Study Design: A case series of 40 women who underwent OAS completed the Modified Manchester Health Questionnaire a mean of 50 months after surgery. Descriptive statistics were used to describe those who had permanent sutures and those who had absorbable sutures.

Pelvic floor function before and after robotic sacrocolpopexy: one-year outcomes.

Study Objective: Estimate pelvic floor function and support 1 year after robotic sacrocolpopexy.

Design: Prospective cohort analysis of women undergoing robotic sacrocolpopexy for correction of advanced pelvic organ prolapse (Canadian Task Force Classification III). Primary outcome was pelvic floor function.

Bupivacaine injection during midurethral sling and postoperative pain: a randomized controlled trial.

Introduction And Hypothesis: The aim of this study was to investigate the impact of retropubic injection of 0.125% bupivacaine during midurethral sling placement on postoperative pain.

Methods: A randomized, double-blind trial of 42 women undergoing midurethral sling for stress incontinence was conducted.

Urethral condyloma accuminata causing bladder outlet obstruction in pregnancy: a case report.

Background: Condyloma accuminata represents the most common sexually transmitted disease in the United States. Pregnancy can lead to enlargement of existing lesions or development of new lesions.

Case: A 31-year-old woman presented at 28 weeks' gestation with a complaint of difficulty voiding due to an obstructing urethral mass.

Validation of web-based administration of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).

Introduction And Hypothesis: We studied a web-based version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12).

Methods: A randomized crossover study in which subjects completed both a web-based and paper-based version of the PISQ-12, with a 2-week separation between the completion of the two versions. Demographic data and questionnaire preferences were also assessed.

A novel approach to teaching the pelvic organ prolapse quantification (POP-Q) exam.

Introduction And Hypothesis: The purpose of this study is to develop an inexpensive, feasible, and useful 3-D model for teaching and performing the pelvic organ prolapse quantification (POP-Q) exam.

Methods: We constructed POP-Q models using socks and cardboard tubing. During lectures at two residency programs, residents completed a self-assessment before and after using the model.