Abdominal and robotic sacrocolpopexy costs following implementation of enhanced recovery after surgery.

Objective: To compare perioperative costs and morbidity between open and robotic sacrocolpopexy after implementation of enhanced recovery after surgery (ERAS) pathway.

Methods: The present retrospective cohort study of patients undergoing open or robotic sacrocolpopexy (January 1, 2014, through November 30, 2017) used an ERAS protocol with liposomal bupivacaine infiltration of laparotomy incisions. Primary outcomes were costs associated with index surgery and hospitalization, determined with Medicare cost-to-charge ratios and reimbursement rates and adjusted for variables expected to impact costs.

Comparison of outcomes between pessary use and surgery for symptomatic pelvic organ prolapse: A prospective self-controlled study.

Purpose: We compared the degree of pelvic floor symptom improvement between pessary use and prolapse surgery.

Materials And Methods: Pessary-naïve women who elected prolapse surgery were enrolled and used a pessary preoperatively (for ≥7 days and ≤30 days). Pelvic floor symptoms were assessed at baseline, after pessary use, and at 3 months postoperatively.

Reoperation for Urinary Incontinence After Retropubic and Transobturator Sling Procedures.

Objective: To compare the reoperation rates for recurrent stress urinary incontinence (SUI) after retropubic and transobturator sling procedures.

Methods: We conducted a retrospective cohort study of all women who underwent midurethral sling procedures at a single institution for primary SUI between 2002 and 2012. To minimize bias, women in the two groups were matched on age, body mass index, isolated compared with combined procedure, and preoperative diagnosis.

Assessing the impact of procedure-specific opioid prescribing recommendations on opioid stewardship following pelvic organ prolapse surgery.

Background: Nationally, there is increasing concern regarding the volume of opioid medications prescribed postoperatively and the rate of prescription opioid-related adverse events. In evaluation of this, several reports have identified significant variability in postoperative opioid-prescribing patterns, including quantities exceeding patient's needs, especially after minor surgical procedures. However, data regarding patient's postoperative opioids needs following surgery for pelvic organ prolapse are sparse.

Randomized controlled trial of silver-alloy-impregnated suprapubic catheters versus standard suprapubic catheters in assessing urinary tract infection rates in urogynecology patients.

Introduction And Hypothesis: Catheter-associated urinary tract infections (UTI) are the most common health-care-related infections. We aimed to compare the UTI rate among women undergoing urogynecological procedures with a silver-alloy suprapubic catheter (SPC) and a standard SPC, and identify the risk factors predisposing patients to UTI.

Methods: Patients who were to undergo placement of an SPC as part of pelvic organ prolapse surgery were enrolled between 1 August 2011 and 30 August 2017, and randomized to either standard SPC or silver-alloy SPC.

Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial.

Objective: To evaluate 1- and 2-year urinary continence rates after Burch retropubic urethropexy compared with a retropubic midurethral sling for women with urinary incontinence undergoing sacrocolpopexy.

Methods: We conducted a planned secondary analysis of a multicenter, randomized, single-blind trial comparing Burch with a sling that enrolled participants from June 2009 to August 2013. Objective outcome measures of continence were assessed at 1- and 2-year follow-up through office visits and validated questionnaires.

Can Urodynamic Parameters Predict Sling Revision for Voiding Dysfunction in Women Undergoing Synthetic Midurethral Sling Placement?

Objective: The objective of the study was to evaluate the utility of urodynamic studies performed before primary midurethral sling placement for stress urinary incontinence in predicting the need for subsequent sling release for voiding dysfunction.

Methods: The health records of women managed with primary synthetic midurethral sling placement at Mayo Clinic (Rochester, MN) from January 1, 2002, to December 31, 2012, were reviewed. The primary outcome was surgical sling release for postoperative voiding dysfunction (ie, prolonged retention, elevated postvoid residual volumes with new voiding symptoms, or de novo onset or worsening of overactive bladder symptoms).

Long-term outcomes and predictors of failure after surgery for stage IV apical pelvic organ prolapse.

Introduction And Hypothesis: The aim of this study was to compare outcomes after uterosacral ligament suspension (USLS) or sacrocolpopexy for symptomatic stage IV apical pelvic organ prolapse (POP) and evaluate predictors of prolapse recurrence.

Methods: The medical records of patients managed surgically for stage IV apical POP from January 2002 to June 2012 were reviewed. A follow-up survey was sent to these patients.

Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery.

Introduction And Hypothesis: To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD).

Methods: Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded.

Perioperative Complications and Cost of Vaginal, Open Abdominal, and Robotic Surgery for Apical Vaginal Vault Prolapse.

Objectives: To determine the rate of perioperative complications and cost associated with Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), and robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse.

Methods: We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery (MMC, ASC, or RSC) between January 1, 2000, and June 30, 2012, at our institution. For all patients identified, perioperative complications, length of hospital stay, and inpatient costs to patients were abstracted from the medical records and compared by procedure.

Outcomes of Robotic Sacrocolpopexy Using Only Absorbable Suture for Mesh Fixation.

Objective: The optimal suture selection for mesh attachment during robotic sacrocolpopexy (RSC) is currently unknown. Here, we sought to evaluate the outcomes of RSC using absorbable sutures for vaginal and sacral mesh attachment.

Methods: We retrospectively reviewed 132 RSC surgeries that were performed for vaginal vault prolapse in the Division of Gynecologic Surgery at our institution from February 2007 to December 2013.

Burch Retropubic Urethropexy Compared With Midurethral Sling With Concurrent Sacrocolpopexy: A Randomized Controlled Trial.

Objective: To compare efficacy and safety of retropubic Burch urethropexy and a midurethral sling in women with stress urinary incontinence (SUI) undergoing concomitant pelvic floor repair with sacrocolpopexy.

Methods: Women were randomly assigned to Burch retropubic urethropexy (n=56) or retropubic midurethral sling (n=57) through dynamic allocation balancing age, body mass index, history of prior incontinence surgery, intrinsic sphincter deficiency, preoperative incontinence diagnosis, and prolapse stage. Overall and stress-specific continence primary outcomes were ascertained with validated questionnaires and a blinded cough stress test.

Evaluation of the local carcinogenic potential of mesh used in the treatment of female stress urinary incontinence.

Introduction And Hypothesis: To evaluate the carcinogenic potential of implanted synthetic mesh midurethral slings in the treatment of female stress urinary incontinence.

Methods: We identified female patients undergoing implantation of mesh materials for stress urinary incontinence at our institution from 1 January 2002 to 31 December 2012. This was accomplished by querying the medical records for CPT code 57288 ("sling operation for stress incontinence") and a subsequent chart review to identify patients who underwent synthetic mesh sling placement.

Patient Satisfaction After Sling Revision for Voiding Dysfunction After Sling Placement.

Objective: The aim of this study was to evaluate patient-reported outcomes after sling release for obstructive voiding after sling operation for female stress urinary incontinence.

Methods: All female patients who had sling release for obstructive voiding at Mayo Clinic in Rochester, Minnesota, from January 1, 2000, through October 31, 2008, were identified and mailed a survey including validated questions for voiding symptoms. A composite outcome for surgical success was chosen in which participants reported global improvement (at least "much better") and complete satisfaction on a 7-point Likert scale.

Comparison of Short Term Outcomes of Sacral Nerve Stimulation and Intradetrusor Injection of OnabotulinumtoxinA (Botox) in Women With Refractory Overactive Bladder.

Objectives: The aim of the study was to compare the short-term outcomes of sacral nerve stimulation (SNS) and intradetrusor injection of OnabotulinumtoxinA (Botox) for overactive bladder (OAB) symptoms refractory to behavioral modifications and pharmacologic therapy.

Methods: This is a retrospective cohort study evaluating the outcomes of SNS and Botox procedures that were performed for refractory OAB symptoms at a tertiary care referral center. The primary outcome was "failure" of treatment that was defined as less than 50% improvement from the baseline symptoms at 6 months.

Assessing the learning curve of robotic sacrocolpopexy.

Introduction And Hypothesis: The aim was to evaluate the learning curve of robotic sacrocolpopexy, adjusted for surgical risk.

Methods: The charts of 145 robotic sacrocolpopexies performed by urogynecologists at Mayo Clinic, Rochester, MN, USA, from 2007 to 2013, were reviewed. Outcomes of interest included operative time, intraoperative complications, and postoperative complications with a Clavien-Dindo grade 2 or higher.

Health-related quality of life and outcomes after surgical treatment of complications from vaginally placed mesh.

Introduction And Hypothesis: We aimed to report on health-related quality of life after surgical excision of vaginally placed mesh for treatment of pelvic organ prolapse and to identify predictors of successful surgical management.

Methods: We identified patients who underwent surgery for treatment of complications from vaginally placed mesh from January 1, 2003, through December 31, 2011, and conducted a follow-up survey. Logistic regression models were used to identify predictors of successful treatment.

Perioperative complications of robotic sacrocolpopexy for post-hysterectomy vaginal vault prolapse.

Introduction And Hypothesis: Open abdominal sacrocolpopexy has been the preferred treatment for post-hysterectomy vaginal vault prolapse. In light of the rise in popularity of less invasive robotic sacrocolpopexy, our objective was to compare perioperative complications of robotic vs open sacrocolpopexy.

Methods: This was a single-institution, retrospective cohort study of robotic and open sacrocolpopexies.

A cohort study comparing a single-incision sling with a retropubic midurethral sling.

Introduction And Hypothesis: Despite established comparable efficacy between retropubic midurethral (RMUS) and transobturator slings, there are conflicting data regarding single-incision mini-slings (SIMS). This study tests the null hypothesis that the MiniArc® Single-Incision Sling is equivalent to the ALIGN® Urethral Support System for treatment of stress urinary incontinence (SUI).

Methods: Women who underwent a sling for SUI from 1 January 2008 through 31 December 2009 were identified (N = 324).

Incidence of female urethral diverticulum: a population-based analysis and literature review.

Introduction And Hypothesis: Urethral diverticulum (UD) is a protrusion of the urethra through the periurethral fascia. We aimed to determine the population-based incidence of female UD.

Methods: Using the records-linkage system of the Rochester Epidemiology Project (REP), we identified women 18 years and older with a new diagnosis of UD in Olmsted County, Minnesota, USA, from 1 January 1980, through 31 December 2011.

Infection after urogynecologic surgery with the use of dexamethasone for nausea prophylaxis.

Study Objective: To determine if a single perioperative dose of dexamethasone increases the risk of infection after urogynecologic surgery.

Design: Retrospective chart review (2004 - 2006) of patient records from the preoperative period to follow-up of 6 weeks from procedure.

Setting: University-affiliated tertiary-care hospital.

Ureteral injury during vaginal mesh excision: role of prevention and treatment options.

Vaginal mesh kits are increasingly used in vaginal prolapse repair. Mesh erosion, infection, and pain may necessitate removal, which can lead to urinary tract injury. We describe 2 cases of ureteral injury at the time of mesh excision.

Plasma cell mucositis of the vagina: a case report.

Background: Plasma cell mucositis is a rare dermatologic condition known to affect the upper aerodigestive tract and external genitalia but has never yet been described to affect the vaginal epithelium.

Case: A 57-year-old woman presented to the urogynecology clinic with chief complaint of symptomatic pelvic organ prolapse and vaginal spotting. Examination of the pelvis revealed grade 2 pelvic organ prolapse and diffuse multifocal erythematous patches on the vaginal introitus, vagina, cervix, and periurethra.

Validation of a visual analog scale form of the pelvic organ prolapse/urinary incontinence sexual function questionnaire 12.

Objective: : This study aimed to validate a visual analog scale (VAS) form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12).

Methods: : This was a planned secondary analysis of a vaginal anatomy and sexual function study. All women undergoing vaginal reconstruction between October 2008 and December 2009 were asked to participate.

A three-incision approach to treat persistent vaginal exposure and sinus tract formation related to ObTape mesh insertion.

Mentor Corporation's ObTape has been associated with considerable morbidity. An unacceptably high exposure rate has been noted, and in some cases, multiple procedures may be necessary for complete mesh removal.We evaluated a patient who had prior ObTape placement complicated with persistent vaginal discharge and granulation tissue formation related to persistent mesh exposure (3Bc-T2-S2) followed by sinus tract formation (6Cd-T3-S3) according to the International Urogynecological Association Classification.