Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications: A Systematic Review.

Objective: To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications.

Data Sources: PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022.

Pregnancy in Women With Prior Treatments for Pelvic Floor Disorders.

Although the peak incidence of surgery for pelvic floor disorders does not occur until after menopause, an increasing number of younger women are seeking treatment for these problems. Whereas most surgeons would recommend delaying surgery until the completion of childbearing, published cases and case series address outcomes after subsequent pregnancies in women who have been treated for urinary incontinence and pelvic organ prolapse. This document synthesizes the available evidence on the impact of pregnancy on women with prior treatment for pelvic floor disorders and on the impact of these prior treatments on subsequent pregnancy.

Surgical interventions for posterior compartment prolapse and obstructed defecation symptoms: a systematic review with clinical practice recommendations.

Introduction And Hypothesis: Several posterior compartment surgical approaches are used to address posterior vaginal wall prolapse and obstructed defecation. We aimed to compare outcomes for both conditions among different surgical approaches.

Methods: A systematic review was performed comparing the impact of surgical interventions in the posterior compartment on prolapse and defecatory symptoms.

All Levels of Providers Can Effectively and Efficiently Teach Pelvic Floor Strength Assessment at Time of Pelvic Examination.

Objective: In women who undergo provider-guided vaginal biofeedback of pelvic floor muscle strength, we sought to determine whether the level of the provider correlates with the patient's ability to achieve adequate pelvic floor muscle contractions (PFMCs).

Methods: From August 2017 to April 2018, patients from 2 urogynecology clinics were recruited to participate in an institutional review board-approved, prospective study examining PFMCs. Pelvic examination and teaching session were done by providers who had specific training on how to assess pelvic floor muscle strength using the validated, modified Oxford scale.

Now Anyone Can Kegel: One-Time Office Teaching of Pelvic Floor Muscle Exercises.

Objective: In women with pelvic floor disorders, we sought to determine time-to-teach (TTT) correct pelvic floor muscle (PFM) contraction, prevalence of inappropriate muscle contractions, and the association between TTT with PFM strength (PFMS).

Methods: From August 2017 to April 2018, patients from 2 pelvic floor disorder clinics participated in a prospective study examining PFMS. Assessment of PFMS was performed to obtain TTT, inappropriate accessory muscle, and Modified Oxford Grading Scale scores for pelvic floor muscle contractions 1 to pelvic floor muscle contractions 2.

Effectiveness of Assessing Ureteral Patency Using Preoperative Phenazopyridine.

Objectives: The aims of this study were to determine the efficacy of phenazopyridine when used intraoperatively to assess ureteral patency and to investigate factors that may influence its efficacy.

Methods: This is a retrospective chart review performed at the Olive View-UCLA Medical Center, a Los Angeles County teaching hospital, from January 2014 through July 2016. Patients undergoing cystoscopy at the time of gynecologic surgery were identified via department case logs.

The Relationship of Anterior Vaginal and Apical Position to Postvoid Residual Urine.

Objective: The aim of the study was to investigate the association between severity of anterior vaginal or apical prolapse and postvoid residual volume (PVR).

Methods: The charts of all women who presented to Urogynecology Clinic at Olive View-UCLA Medical Center for a 2-year period were reviewed. Demographic data, the degree of prolapse pelvic organ prolapse quantification points Aa, Ba, and C, and PVR were recorded.

Misconceptions and miscommunication among Spanish-speaking and English-speaking women with pelvic organ prolapse.

Introduction And Hypothesis: Limited data exist on women's experience with pelvic organ prolapse (POP) symptoms. We aimed to describe factors that prevent disease understanding among Spanish-speaking and English-speaking women.

Methods: Women with POP were recruited from female urology and urogynecology clinics in Los Angeles, California, and Albuquerque, New Mexico.

Communication barriers among Spanish-speaking women with pelvic floor disorders: lost in translation?

Objectives: The purpose of our study was to evaluate barriers in communication and disease understanding among office staff and interpreters when communicating with Spanish-speaking women with pelvic floor disorders.

Methods: We conducted a qualitative study to evaluate barriers to communication with Spanish-speaking women with pelvic floor disorders among office staff and interpreters. Sixteen office staff and interpreters were interviewed; interview questions focused on experiences with Spanish-speaking patients with pelvic floor disorders in the clinic setting.

Dysregulation of protease and protease inhibitors in a mouse model of human pelvic organ prolapse.

Mice deficient for the fibulin-5 gene (Fbln5(-/-)) develop pelvic organ prolapse (POP) due to compromised elastic fibers and upregulation of matrix metalloprotease (MMP)-9. Here, we used casein zymography, inhibitor profiling, affinity pull-down, and mass spectrometry to discover additional protease upregulated in the vaginal wall of Fbln5(-/-) mice, herein named V1 (25 kDa). V1 was a serine protease with trypsin-like activity similar to protease, serine (PRSS) 3, a major extrapancreatic trypsinogen, was optimum at pH 8.

The pessary process: Spanish-speaking Latinas' experience.

Introduction And Hypothesis: Little is known about women's experience with conservative management of pelvic organ prolapse. We sought to understand the experiences of Spanish-speaking women who choose a pessary.

Methods: Spanish-speaking women from a urogynecological pessary clinic were recruited for this study.

Clinical approach and office evaluation of the patient with pelvic floor dysfunction.

Pelvic floor disorders are common health issues for women and have a great impact on quality of life. These disorders can present with a wide spectrum of symptoms and anatomic defects. This article reviews the clinical approach and office evaluation of patients with pelvic floor disorders, including pelvic organ prolapse, urinary dysfunction, anal incontinence, sexual dysfunction, and pelvic pain.

Quantification of pelvic organ prolapse in mice: vaginal protease activity precedes increased MOPQ scores in fibulin 5 knockout mice.

Two mouse models of pelvic organ prolapse have been generated recently, both of which have null mutations in genes involved in elastic fiber synthesis and assembly (fibulin 5 and lysyl oxidase-like 1). Interestingly, although these mice exhibit elastinopathies early in life, pelvic organ prolapse does not develop until later in life. In this investigation we developed and validated a tool to quantify the severity of pelvic organ prolapse in mice, and we used this tool prospectively to study the role of fibulin 5, aging, and vaginal proteases in the development of pelvic organ prolapse.

Anatomic relationships of the distal third of the pelvic ureter, trigone, and urethra in unembalmed female cadavers.

Objective: The objective of the study was to examine the relationship of the ureter to paravaginal defect repair (PVDR) sutures and to evaluate the anatomy of distal ureter, trigone, and urethra relative to the anterior vaginal wall.

Study Design: Dissections of the retropubic space were performed in 24 unembalmed female cadavers following placement of PVDR sutures. Lengths of the vagina, urethra, and trigone were recorded.

Neurovascular anatomy of the sacrospinous ligament region in female cadavers: Implications in sacrospinous ligament fixation.

Objective: The objective of the study was to further characterize the anatomy of the coccygeus muscle-sacrospinous ligament (C-SSL) complex and to correlate the findings with sacrospinous ligament fixations (SSLF).

Study Design: Dissections were performed in 21 female cadavers.

Results: In all dissections, nerves originating from S3, S4, S5, or a combination passed over the anterior surface of the C-SSL at its midsegment, and either the pudendal or third sacral nerve coursed on the superior border of C-SSL at its midpoint.

Posterior division of the internal iliac artery: Anatomic variations and clinical applications.

Objective: The objective of the study was to characterize the anatomy of the internal iliac artery (IIA) and its posterior division branches and to correlate these findings to IIA ligation.

Study Design: Dissections were performed in 54 female cadavers.

Results: Average length of IIA was 27.

Regulation of elastolytic proteases in the mouse vagina during pregnancy, parturition, and puerperium.

Recent evidence indicates that failure of elastic fiber assembly and synthesis is involved in the pathophysiology of pelvic organ prolapse in mice. It has been long been hypothesized that parturition-induced activation of proteases in the vaginal wall and its supportive tissues may contribute to pelvic organ prolapse in women. In this investigation, we determined the expression of matrix metalloproteases with elastase activity (matrix metalloproteinase [MMP] 2, MMP9, and MMP12) and their inhibitors in the vaginal wall of nonpregnant, pregnant, and postpartum mice.

Vascular anatomy of the presacral space in unembalmed female cadavers.

Objective: The purpose of this study was to characterize the vascular anatomy of the female presacral space (PSS) and to correlate findings to the abdominal sacrocolpopexy.

Study Design: Detailed dissections of the PSS were performed in 52 unembalmed female cadavers.

Results: The closest cephalad vessel to the mid sacral promontory (MSP) was the left common iliac vein (LCIV), mean distance 27 mm (9-52 mm).

Endoscopic Surgery for Arterial Occlusive Disease.

Endoscopic surgery is not a recent development. In fact, the application of the Edison light bulb to the cystoscope in 1883 was followed by widespread use of endoscopy. In 1910, Jacobeaus proposed the diagnostic use of the cystoscope for investigation of serous cavities, and in 1922, he reported lysis of pleural adhesions to promote artificial pneumothorax in 40 patients with pulmonary tuberculosis.

Endovascular workforce for peripheral vascular disease: current and future needs.

Background: The current status and future needs of peripheral endovascular utilization and training have not been well defined. This topic is particularly relevant to the future of four specialties: interventional cardiology, cardiothoracic surgery, interventional radiology, and peripheral vascular surgery. We attempt to analyze the current numbers of cardiovascular patients and procedures and the numbers of treating physicians and surgeons to make predictions and recommendations for the future.