Trends of Overactive Bladder and Pharmacologic Treatment Among U.S. Women.

Importance: To evaluate and consider how prescribing practices have changed in relation to high-risk overactive bladder (OAB) medications.

Objective: The objective of this study was to evaluate trends in the prevalence of OAB and pharmacologic treatment over time in the United States.

Study Design: Data from the National Health and Nutrition Examination Survey (NHANES, 2001-2018, n = 30,478) and the National Ambulatory Medical Care Survey (NAMCS, 2003-2019, n = 251,330) were used to identify women with symptomatic incontinence and overactive bladder (OAB) (NHANES) as well as determine the frequency of prescription use for OAB medications (NHANES and NAMCS) using sampling-based weights.

Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence.

Introduction And Hypothesis: Limited data exist comparing different surgical approaches in women with advanced vaginal prolapse. This study compared 2-year surgical outcomes of uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) in women with advanced prolapse (stage III-IV) and stress urinary incontinence.

Methods: This was a secondary analysis of a multicenter 2 × 2 factorial randomized trial comparing (1) ULS versus SSLF and (2) behavioral therapy with pelvic floor muscle training versus usual care.

Vaginal Hysterectomy Suturing Skills Training Model and Curriculum.

Background: Declining vaginal hysterectomy numbers in obstetrics and gynecology training programs highlights the need for innovative methods to teach vaginal surgical skills. We describe our experience with a vaginal hysterectomy skills simulation curriculum.

Instrument: A low-fidelity bench model was constructed to simulate four vaginal hysterectomy suturing tasks.

Pain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence.

Background: Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse.

Objective: The objectives of the study were to describe postoperative pain and functional activity after transvaginal native tissue reconstructive surgery with apical suspension and retropubic synthetic midurethral sling and to compare these outcomes between patients receiving 2 common transvaginal prolapse repairs, uterosacral ligament, and sacrospinous ligament vaginal vault suspension.

Study Design: This planned secondary analysis of a 2 × 2 factorial randomized trial included 374 women randomized to receive uterosacral (n = 188) or sacrospinous (n = 186) vaginal vault suspension to treat both stages 2-4 apical vaginal prolapse and stress urinary incontinence between 2008 and 2013 at 9 medical centers.

Comparisons of Functional Apical Support After Sacral Hysteropexy Versus Sacral Colpopexy: A Cadaveric Study.

Objectives: Prolapse procedures with uterine preservation offer an alternative to colpopexy with hysterectomy. Few studies have examined the differences in anatomic or subjective outcomes following sacral hysteropexy versus sacral colpopexy with hysterectomy. This study sought to compare the ability of sacral hysteropexy and sacral colpopexy with hysterectomy to resist downward traction as an estimate of apical support in human cadavers.

Concomitant Anterior Repair, Preoperative Prolapse Severity, and Anatomic Prolapse Outcomes After Vaginal Apical Procedures.

Objective: The aim of the study was to compare anterior and overall prolapse prevalence at 1 year in surgical participants with or without concomitant anterior repair (AR) at the time of sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (ULS).

Methods: This is a secondary analysis of two surgical trials; concomitant AR was performed at surgeon's discretion. Anterior anatomic success was defined as pelvic organ prolapse quantification of prolapse point Ba ≤0 and overall success was defined as pelvic organ prolapse quantification points Ba, Bp, and C ≤0 at 12 months.

Sacrocolpopexy With Concomitant Total vs Supracervical Hysterectomy: Functional Support Comparisons in Cadavers.

Objective: This study aimed to compare the ability of abdominal sacrocolpopexy (ASC) with concomitant total vs supracervical hysterectomy to resist downward traction as a measure of functional anatomic support in human cadavers.

Methods: Supracervical hysterectomy was performed on unembalmed cadaver specimens, followed by ASC attaching polypropylene mesh to the posterior cervix/vagina only and then the anterior and posterior cervix/vagina. Using a metal bolt placed through the cervix tied to a filament passing through a fixed pulley system, successive weights of 0.

Effect of mesh width on apical support after sacrocolpopexy.

Introduction And Hypothesis: We evaluated the effect of polypropylene mesh width on vaginal apical support, mesh elongation, and mesh tensile strength for abdominal sacrocolpopexy.

Methods: Abdominal sacrocolpopexy was performed on ten cadavers using pieces of polypropylene mesh of width 1, 2, and 3 cm. Weights of 1, 2, 3, and 4 kg were sequentially applied to the vagina.

Proximity of uterosacral ligament suspension sutures and S3 sacral nerve to pelvic landmarks.

Introduction And Hypothesis: To describe the relationships between pelvic bony landmarks to points along the third sacral nerve and to uterosacral ligament suspension sutures.

Methods: Three transvaginal uterosacral ligament suspension sutures were placed bilaterally in unembalmed female human cadavers. The third sacral nerve was marked at the foramen (S3a) and at two additional points at 1-cm intervals along its course caudally (S3b, S3c).

Pelvic Organ Prolapse: New Concepts in Pelvic Floor Anatomy.

As the field of reconstructive pelvic surgery continues to evolve, with descriptions of new procedures to repair pelvic organ prolapse, it remains imperative to maintain a functional understanding of pelvic floor anatomy and support. The goal of this review was to provide a focused, conceptual approach to differentiating anatomic defects contributing to prolapse in the various compartments of the vagina. Rather than provide exhaustive descriptions of pelvic floor anatomy, basic pelvic floor anatomy is reviewed, new and historical concepts of pelvic floor support are discussed, and relevance to the surgical management of specific anatomic defects is addressed.

Change in Overactive Bladder Symptoms After Surgery for Stress Urinary Incontinence in Women.

Objective: To assess change in overactive bladder (OAB) symptoms up to 5 years after surgery and to identify associated predictors of change from baseline.

Methods: This is a secondary analysis of data from three multicenter urinary incontinence (UI) surgical trials of women with stress-predominant mixed UI assigned to Burch colposuspension, autologous fascial sling, or retropubic or transobturator midurethral slings. The primary outcome was improvement of 70% or greater from baseline in symptoms measured by the Urinary Distress Inventory-Irritative subscale.

Unruptured second-trimester ovarian pregnancy.

Ovarian ectopic pregnancies are rare, with the majority diagnosed in the first trimester and often treated due to symptoms related to ovarian rupture. We report our experience with the diagnosis, management, and histologic evaluation of an unruptured second-trimester ovarian ectopic pregnancy. A 37-year-old woman presented with vague abdominal discomfort and irregular menses.

Myogenic stem cell-laden hydrogel scaffold in wound healing of the disrupted external anal sphincter.

Objective: To evaluate the effect of myogenic stem cell-laden hydrogel scaffold on contractile function and histomorphology of the external anal sphincter (EAS) after transection without repair.

Methods: Eighty female rats underwent anal sphincter transection without repair. After 2 weeks, animals were injected at the transection site with: nothing (non-repaired control, NRC group); a polyethylene glycol-based hydrogel matrix scaffold combined with phosphate-buffered saline (PBS/hydrogel group); a hydrogel matrix scaffold combined with myogenic stem cells (stem cell/hydrogel group): or type I collagen (collagen) group.

Obturator neuropathy after retropubic tension-free vaginal tape placement.

Background: We report a case of obturator neuropathy associated with retropubic midurethral sling.

Case: After retropubic tension-free vaginal tape (TVT) placement, a 36-year-old woman reported right inguinal region and thigh pain, both exacerbated with internal rotation and adduction. Neurologic examination was remarkable for two-fifths strength with right thigh adduction and an involuntary lateral drift of her right thigh with straight leg raise.

Effect of myogenic stem cells on the integrity and histomorphology of repaired transected external anal sphincter.

Introduction And Hypothesis: The objective was to evaluate the effect of myogenic stem cells on histological properties and the volume of striated muscle of the external anal sphincter after transection and repair.

Methods: Histological analysis was performed on the external anal sphincters of 40 young female rats euthanized at 7 or 90 days after transection and repair and randomization to injection of either phosphate buffered solution (PBS) or myogenic stem cells (SC) at the transection site. Sphincter complexes, previously evaluated for neurophysiological function, were processed for histology and analyzed for possible disruption, amount of inflammation, and volume of striated muscle.

Patient satisfaction following midurethral sling surgeries.

Purpose Of Review: Patient-reported outcomes and satisfaction are recognized as being equally important as traditional objective measures of success following midurethral sling (MUS) procedures. The objective of this article is to review the success after MUSs in the context of patient satisfaction.

Recent Findings: Patient satisfaction for both transobturator and retropubic MUSs at 2 years is high with rates up to 88%.

Effectiveness of blinding: sham suprapubic incisions in a randomized trial of retropubic midurethral sling in women undergoing vaginal prolapse surgery.

Objective: This planned secondary analysis of the Outcomes Following Vaginal Prolapse Repairs and Midurethral Sling trial assessed whether treatment knowledge differed between randomized groups at 12 months and whether treatment success was affected by treatment perception.

Study Design: Sham suprapubic tension-free vaginal tape (TVT) incisions were made in the Outcomes Following Vaginal Prolapse Repairs and Midurethral Sling trial participants randomized to no-TVT. Primary surgical outcomes and maintenance of blinding was assessed at 12 months.

Cystolith formation complicating single-incision sling.

Single-incision slings are the newest midurethral slings developed for the surgical treatment of stress urinary incontinence. We report the case of a patient who underwent single-incision sling placement who presented with recurrent stress incontinence 3 years after the procedure. She was found to have a 1.

Estrogen alters remodeling of the vaginal wall after surgical injury in guinea pigs.

Loss of pelvic organ support (i.e., pelvic organ prolapse) is common in menopausal women.

Functional and anatomic comparison of 2 versus 3 suture placement for uterosacral ligament suspension: a cadaver study.

Objective: The objective of the study was to compare the vaginal apex pullout distance using 2 vs 3 suspension sutures during transvaginal uterosacral ligament suspension (USLS) and to describe relationships to ipsilateral ureter and nerve structures.

Study Design: Eight fresh-frozen female cadavers were studied. After hysterectomy, a transvaginal USLS was performed with placement of 3 suspension sutures per side.

Patient satisfaction after midurethral sling surgery for stress urinary incontinence.

Objective: To identify factors that may contribute to patient satisfaction with outcome in women who received retropubic and transobturator midurethral slings.

Methods: Satisfaction was assessed 12 months postsurgery as a planned analysis in 597 participants from a multicenter randomized trial comparing retropubic with transobturator midurethral slings using the Incontinence Surgery Satisfaction Questionnaire. Significantly related variables associated with satisfaction in univariable analyses were entered into multivariable logistic regression models to test their independent association with satisfaction.

Mechanical performance of surgical knots in a vaginal surgery model.

Objective: To evaluate the integrity of 3 different types of sliding knots in a vaginal surgery model.

Study Design: Nonidentical sliding (NS), loop-to-strand sliding (LTS), and parallel sliding (PS) knots with 4 throws each were tied on a vaginal surgery model with 0 polyglactin-910 and tested until failure. The main outcomes studied were the maximum load reached at failure and the proportion of each type of sliding knot that either unraveled or broke during standardized laboratory testing.

Surgical knot integrity: effect of suture type and caliber, and level of residency training.

Objective: To evaluate if suture type and caliber or level of residency training affects strength and mode of failure of surgical knots.

Design: All residents in an obstetrics and gynecology training program were invited to tie knots on a bench model using 2 calibers (0 and 3-0) of 2 types of surgical suture (polyglactin 910 and polydioxanone). The failure load, mode of failure, and loop lengths of the knots were determined.

Effect of repeat acute injury on contractile function of the external anal sphincter in an animal model.

Introduction And Hypothesis: Our aim was to estimate the physiologic effects of early repeat transection and repair on the contractile properties of the external anal sphincter (EAS) in a rat model.

Methods: Eighty young female rats underwent anal sphincter transection and repair. After 7 days, they were randomized to repeat sphincter transection (injury-injury, n = 40) or sham operation (injury-sham, n = 40).

Utility of clinical parameters, cystourethroscopy, and magnetic resonance imaging in the preoperative diagnosis of urethral diverticula.

Introduction And Hypothesis: Our purpose was to assess the accuracy of history and physical, cystourethroscopy, and magnetic resonance imaging (MRI) in preoperative diagnosis of urethral diverticula.

Methods: This was a retrospective review of all patients who underwent surgical excision of periurethral masses between 1998 and 2009. Presenting symptoms and examination and cystourethroscopic findings were noted.