Single-Port Robotic Sacrocolpopexy: Description of an Advanced Minimally Invasive Approach and Review of the Relevant Literature.

Introduction And Hypothesis: Sacrocolpopexy is the gold standard for the surgical management of apical prolapse. Over the years, surgical advancements have transformed the procedure from a laparotomy with a hospital stay of several days to a minimally invasive approach with a much shorter hospital stay. One recent innovation has the potential to transform minimally invasive sacrocolpopexy.

Surgical Decision-Making: Who Should Be Offered Sacrocolpopexy?

Introduction And Hypothesis: Women undergoing surgery for apical pelvic organ prolapse have several medically sound options for specific surgical approaches.

Methods: We review the principles of shared decision-making as they pertain to surgery for prolapse. We review the literature supporting the superior sacrocolpopexy as a durable treatment for prolapse and the factors that may differentiate it from other repairs in risk and benefit.

Suture-Needle Management Device and Novel Port Configuration for Robotic Sacrocolpopexy.

Importance: Robot-assisted sacrocolpopexy (SCP) is a commonly performed procedure for the repair of apical pelvic organ prolapse; therefore, novel devices and techniques to improve safety and efficacy of this procedure should be explored.

Objective: The objective of this study was to assess safety and efficacy of 8-mm trocar site for use of a disposable suture/needle management device (StitchKit; Origami Surgical, Madison, NJ) for robot-assisted SCP with a 4-arm configuration and no assistant port.

Study Design: This is a retrospective case series of patients undergoing robot-assisted SCP at a tertiary center from 2018 to 2021.

Use of a Computerized Decisional Analysis Tool in Patients With Urgency Urinary Incontinence.

Importance: Decision analysis tools (DAT) are shared decision making instruments that include patient input on treatment goals and values that have been shown to decrease decisional regret in women's health care.

Objective: We describe a novel, computerized DAT for patients with urinary incontinence (UI), and our primary aim was to assess the concordance between treatment fit as determined by the DAT and treatment selected after physician counseling in patients with urgency urinary incontinence and urgency predominant mixed urinary incontinence.

Study Design: We partnered with a health care startup to develop a computerized DAT incorporating evidence about UI and patient input about treatment goals and personal values.

Patient Satisfaction With Telehealth Visits for New Patient Appointments for Pelvic Floor Disorders: A Randomized Trial of Telehealth Versus Standard In-Person Office Visits.

Importance: The acceptability and safety of telehealth have been reported in urogynecology for preoperative and postoperative care but not new patient consultation.

Objectives: This study aimed to determine if new patient telehealth encounters are noninferior to in-person encounters for women presenting to a urogynecology clinic using a satisfaction questionnaire. Secondary objectives were to describe patient experiences and follow-up.

Opportunities to Advance Postpartum Pelvic Floor Care With a Health Equity-based Conceptual Framework.

An essential part of postpartum care includes the evaluation and treatment of pelvic floor disorders (PFDs). Postpartum PFDs are common and occur in over 40% of postpartum women. Despite significant advancements in urogynecology to understand postpartum PFDs and their treatments, there has been a lack of attention to addressing equity in postpartum pelvic floor care.

Mesh complications after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy.

Introduction And Hypothesis: Our objective was to compare mesh exposure rates (4 months and 1 year) after total (TLH) vs supracervical (SLH) laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy (SCP). Secondary outcomes included 30-day complications and midurethral mesh exposure rates.

Methods: This a retrospective cohort study at a tertiary care referral center from 2011 to 2018.

Sex Differences in Commercial Patient Reviews of Women and Men Urogynecologic Surgeons.

Objective: The objective of our study was to describe differences in commercial patient reviews of women and men urogynecologic surgeons.

Materials And Methods: Reviews of surgeons on Healthgrades.com in 4 metropolitan areas were included.

Pelvic Organ Prolapse.

Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior and posterior vaginal walls, uterus (cervix), or apex of the vagina (vaginal vault or cuff scar after hysterectomy). Although POP can be asymptomatic, if the bulge extends beyond the opening of the vagina, it can have a significant impact on a woman's quality of life. Findings include vaginal bulging toward or through the vaginal introitus that the patient may feel, palpate, or see with a mirror.

Vaginal Electrical Stimulation for Postpartum Neuromuscular Recovery: A Randomized Clinical Trial.

Objective: The aim of this study was to compare 3-month postpartum anal incontinence symptoms in women who sustain obstetric anal sphincter injuries and begin immediate vaginal electrical stimulation versus sham therapy.

Methods: In this double-blind randomized controlled trial, women who sustained obstetric anal sphincter injuries were randomized to receive self-administered vaginal electrical stimulation using a commercial device or sham therapy with an identical device. Anal incontinence symptom severity was assessed at 1 week (baseline) and again at 13 weeks postpartum using the Fecal Incontinence Severity Index.

Molecular Effects of Topical Estrogen on Vaginal Granulation Tissue in Postpartum Women.

Objective: The aims of this study were to evaluate the biomolecular properties of vaginal and perineal granulation tissue in postpartum women and assess the potential impact of vaginal estrogen application.

Methods: We prospectively identified women referred to a subspecialty peripartum clinic between September 2016 and April 2018 who developed symptomatic perineal or vaginal granulation tissue. As part of routine clinical care, granulation tissue was excised from each participant by a urogynecologist and subjected to RNA extraction, real-time quantitative polymerase chain reaction, histologic evaluation, and immunohistochemistry.

Postpartum contraceptive uptake and fertility desires following obstetric anal sphincter injury.

Introduction And Hypothesis: Our primary objective was to compare rates of contraceptive use among postpartum heterosexual primiparous women with and without obstetric anal sphincter injury (OASIS). The secondary objective was to compare fertility desires among women with and without OASIS.

Methods: This was a planned secondary analysis of a prospective cohort study of postpartum sexual function among primiparous postpartum women.

The Influence of Patients' Goals on Surgical Satisfaction.

Objective: The objectives of this study were to describe patients' surgical goals and determine if goal attainment is associated with postoperative satisfaction and regret.

Methods: Women undergoing surgery for pelvic floor disorders between June and December 2019 were recruited. At their initial visit, patients listed up to 4 surgical goals.

Predicting obstetrical anal sphincter injuries in patients who undergo vaginal birth after cesarean delivery.

Background: Women with a history of previous cesarean delivery must weigh the numerous potential risks and benefits of elective repeat cesarean delivery or trial of labor after cesarean delivery. Notably, 1 important risk of vaginal delivery is obstetrical anal sphincter injuries. Furthermore, the rate of obstetrical anal sphincter injuries is high among women undergoing vaginal birth after cesarean delivery.

Prevalence of childhood trauma and its association with lower urinary tract symptoms in women and men in the LURN study.

Aims: To describe the association between childhood traumas (death of a family member, severe illness, sexual trauma, parental separation) reported by women and men and lower urinary tract symptoms (LUTS).

Methods: In this secondary analysis of the Lower Urinary Tract Research Network Observational Cohort Study, participants completed the LUTS tool, childhood trauma events scale (CTES), PROMIS depression and anxiety and perceived stress scale. LUTS tool responses were combined to quantify urinary urgency, frequency, incontinence, and overall LUTS severity.

Rates of Sling Procedures and Revisions-A National Surgical Quality Improvement Program Database Study.

Objective: The aim of this study was to describe trends in sling procedures and revisions, including fascial slings and midurethral slings (MUS) using a large, national database with respect to the 2011 U.S. Food and Drug Administration (FDA) mesh-related safety communication.

Concurrent Retropubic Midurethral Sling and OnabotulinumtoxinA for Mixed Urinary Incontinence: A Randomized Controlled Trial.

Objective: To evaluate whether retropubic midurethral sling combined with onabotulinumtoxinA is more effective than sling alone in improving mixed urinary incontinence symptoms.

Methods: We conducted a prospective, double-blind, randomized, controlled trial of women with mixed urinary incontinence, planning to undergo midurethral sling. Women were randomly assigned to receive 100 unites of intradetrusor onabotulinumtoxinA or placebo during surgery.

Adding Insult to Injury: Levator Ani Avulsion in Women With Obstetric Anal Sphincter Injuries.

Objective: In women with obstetric anal sphincter injuries, we compared the rate of major levator ani avulsion after forceps-assisted delivery versus spontaneous vaginal delivery.

Methods: Prospective cohort of primiparous women with obstetric anal sphincter injuries. The primary outcome was the rate of major levator ani avulsion as measured by 3-dimensional transvaginal ultrasonography performed between 1 and 2 weeks postpartum.

Bare Versus Hair: Do Pubic Hair Grooming Preferences Dictate the Urogenital Microbiome?

Objective: The aim of the study was to determine whether the genitourinary microbiome differs between and within women with and without pubic hair.

Methods: Premenopausal women who self-identified into 2 groups were recruited: in the "hair" group, women did not remove any pubic hair, and in the "bare" group, all pubic hair was removed routinely. Participants submitted a vaginal swab, a voided urine sample, and a catheterized urine sample, and then "crossed over.

Translation and validation of the Polish version of the Pelvic Floor Impact Questionnaire short form 7.

Introduction And Hypothesis: The aim of this study was to develop a Polish language version of the short form of the Pelvic Floor Impact Questionnaire 7 (PFIQ-7) and to validate it in a sample of Polish-speaking women with pelvic floor disorders (PFDs).

Methods: The PFIQ-7 was initially translated in a stepwise fashion as guided by the International Urogynecological Association (IUGA) Translation Protocol. First, two bilingual physicians in Poland and the USA performed a forward translation of the PFIQ-7.

Fibroids and Urinary Symptoms Study (FUSS).

Objective: The aims of the study were to characterize pelvic floor and urinary symptoms in women seeking treatment for uterine fibroids and to explore the association between uterine/fibroid size and pelvic floor symptoms.

Methods: Women seeking treatment for uterine fibroids at a single academic center were enrolled in this cross-sectional study. All participants underwent pelvic imaging and completed the Symptom Severity Subscale of the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (UFS-QOL) and the Pelvic Floor Distress Inventory (PFDI-20).

Impact of a Web-Based Decisional Aid on Satisfaction in Women Undergoing Prolapse Surgery.

Objectives: The objective of this study was to determine whether a computerized, condition-specific Decision Analysis Tool (DAT) for the surgical treatment of pelvic organ prolapse (POP) improves patient satisfaction and alters decision making.

Methods: Together with a health care startup company, we created a computerized DAT using the best evidence available on success rates and risks associated with sacrocolpopexy, native tissue apical suspension, and colpocleisis. Consecutively scheduled women before and after implementation of the DAT in an academic practice of 4 fellowship-trained, board-certified urogynecologists were included.