Reimagining general surgery resident selection: Collaborative innovation through design thinking.

Introduction: The process by which surgery residency programs select applicants is complex, opaque, and susceptible to bias. Despite attempts by program directors and educational researchers to address these issues, residents have limited ability to affect change within the process at present. Here, we present the results of a design thinking brainstorm to improve resident selection and propose this technique as a framework for surgical residents to creatively solve problems and generate actionable changes.

Cost Analysis of Bladder Catheterization After Pelvic Floor Surgery.

Importance: Approximately 15-45% of female patients develop transient postoperative urinary retention (POUR) following pelvic reconstructive surgery. Catheter options for bladder drainage include transurethral indwelling catheter (TIC), intermittent self-catheterization (ISC), and suprapubic tube (SPT). Each strategy has risks and benefits; none have been shown to be clinically superior, and to date, no comprehensive comparative economic analysis has been published.

Optimizing practices to prevent urinary tract infection after cystoscopy and urodynamics in women: A quality improvement study.

Objective: The objective of this study was to reduce the incidence of urinary tract infection (UTI) in women undergoing outpatient cystoscopy and/or urodynamic studies (UDS) at our centre by identifying and then altering modifiable risk factors through an analysis of incidence variability among physicians.

Methods: This was a quality improvement study involving adult women undergoing outpatient cystoscopy and/or UDS at an academic tertiary urogynecology practice. Prophylactic practices for cystoscopy/UDS were surveyed and division and physician-specific UTI rates following cystoscopy/UDS were established.

Stress, Allostatic Load, and Neuroinflammation: Implications for Racial and Socioeconomic Health Disparities in Glaucoma.

Glaucoma is the leading cause of irreversible blindness, and its pathophysiology includes neuroinflammatory changes. The present therapies for glaucoma target pressure-lowering mechanisms with limited success, making neuroinflammation a target for future interventions. This review summarizes the neuroinflammatory pathways seen in glaucoma and their interplay with stress.

A feasibility study of three-dimensional ultrasound imaging of the vagina under distension.

Background: The distension properties of the vagina are critical to its function including support of surrounding organs, childbirth, and intercourse. It could be altered by many pathophysiological processes like pregnancy, radiotherapy, and reconstruction surgery. However, there are no clinically available diagnostic tools capable of quantifying the distension properties of the vagina.

Surgical sexism in Canada: structural bias in reimbursement of surgical care for women.

Background: It is well established that female physicians in Canada are reimbursed at lower rates than their male counterparts. To explore if a similar discrepancy exists in reimbursement for care provided to female and male patients, we addressed this question: Do Canadian provincial health insurers reimburse physicians at lower rates for surgical care provided to female patients than for similar care provided to male patients?

Methods: Using a modified Delphi process, we generated a list of procedures performed on female patients, which we paired with equivalent procedures performed on male patients. We then collected data from provincial fee schedules for comparison.

Patient-Specific Pessaries for Pelvic Organ Prolapse Using Three-Dimensional Printing: A Pilot Study.

Importance: Vaginal pessaries are an effective nonsurgical treatment for pelvic organ prolapse (POP) when properly fitted. However, pessary fitting and use are often unsuccessful or imperfect.

Objective: The objective of this study was to assess the feasibility of using patient-specific pessaries fabricated from three-dimensional (3D)-printed molds to improve POP symptoms and increase overall satisfaction of pessary treatment in patients using standard vaginal pessaries.

Comparing vitamin B2 versus 5% dextrose in water for optimal ureteric jet visualisation at the time of pelvic reconstructive surgery: A randomised controlled trial.

Objective: To compare preoperative vitamin B2 versus intraoperative cystoscopy distension using 5% dextrose in water (D5W) for ureteric jet visualisation during pelvic reconstructive surgery.

Design: Double-blinded, randomised controlled trial.

Setting: Three tertiary hospitals in Toronto, Canada.

Pelvic floor symptoms in cisgender women with Ehlers-Danlos syndrome: an international survey study.

Introduction And Hypothesis: Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders associated with abnormal collagen, and is more prevalent in women than in men. The aim of this cross-sectional study was to characterize pelvic floor symptoms in cisgender women with EDS and to describe their impact on quality of life.

Methods: An online questionnaire on obstetric and gynecological experiences of cisgender women with EDS was disseminated through EDS patient societies and social media.

A risk calculator for postoperative urinary retention (POUR) following vaginal pelvic floor surgery: multivariable prediction modelling.

Objective: To determine the perioperative characteristics associated with an increased risk of postoperative urinary retention (POUR) following vaginal pelvic floor surgery.

Design: A retrospective cohort study using multivariable prediction modelling.

Setting: A tertiary referral urogynaecology unit.

Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection after Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study.

Objectives: The objective of the study was to determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women.

Design: A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS).

Methods: An online survey was used to assess prophylactic prescribing patterns of FPMRS that perform UDS and outpatient cystoscopy.

What Do Nurses Prefer? A Cross-sectional Study of Catheter Preference After Pelvic Organ Prolapse Surgery.

Purpose: The purpose of this study was to determine nursing preferences regarding catheter type (transurethral indwelling catheters vs intermittent catheterization vs suprapubic tube drainage) when caring for patients in hospital after pelvic organ prolapse surgery.

Design: Cross-sectional survey study.

Subjects And Setting: Registered nurses practicing in academic and community hospitals across North America (the United States and Canada).

Real-World Effectiveness of Pelvic Floor Muscle Training for Women With Urinary Tract Symptoms and/or Prolapse.

Objectives: To determine the real-world effectiveness of pelvic floor muscle therapy (PFMT) recommendations for patients.

Methods: We conducted a cross-sectional study of 70 women who were advised to undergo PFMT after their initial urogynaecology consultation for lower urinary tract symptoms and/or pelvic organ prolapse. About half (51%) of potential participants consented to answer our telephone survey.

Antibiotic prophylaxis for urodynamic testing in women: a systematic review.

Introduction And Hypothesis: Urinary tract infection is the most common complication after urodynamic studies (UDS). Practice guidelines recommend against antibiotic prophylaxis based on an outdated review of the literature, which advised on the premise of "a lack of good quality studies" and based on an assumed low incidence not consistently supported by the literature.

Objectives: This systematic review aims to update the assessment of the efficacy of antibiotic prophylaxis compared with placebo or no treatment for prevention of urinary tract infection in females over the age of 18 years undergoing UDS.

The extended pessary interval for care (EPIC) study: a failed randomized clinical trial.

Introduction And Hypothesis: To describe study design flaws and limited outcomes of a randomized trial that intended to compare satisfaction and complication rates between patients managing their pelvic organ prolapse with a pessary at different maintenance intervals.

Methods: A randomized clinical trial was conducted at two tertiary pessary clinics. After a successful fitting, patients were randomly allocated to follow-up at 3-month or 6-month intervals and followed for 12 months.

Comparing written and verbal delivery of a treatment regimen to women with overactive bladder: a randomized controlled trial.

Objective: Overactive bladder is a common condition among aging women requiring a multifaceted treatment approach, which is usually communicated by physician to the patient in the clinic setting. The objective of this two-center, randomized controlled trial was to determine if a transcribed list of six management strategies for overactive bladder improves immediate and delayed retention of these recommendations compared with a traditional verbal discussion.

Methods: Between March, 2015 and February, 2019, women newly diagnosed with overactive bladder were randomized to either the intervention group, where they received a transcribed list of six treatment recommendations, or to the control group, where the same six recommendations were communicated verbally by their physician.

Aftermath of a Midurethral Sling Placed in the First Trimester: A Case Report.

There are limited data on the management of pregnancy and delivery after midurethral sling (MUS) surgery for stress urinary incontinence (SUI). We report a case of a 39-year-old woman who underwent an MUS in July 2017. She reported a 10-year history of frequency, urgency with rare urge incontinence, nocturia, and occasional SUI when coughing or sneezing.

Is overactive bladder independently associated with anxiety?

Introduction And Hypothesis: Although some psychiatric anxiety questionnaires include overactive bladder (OAB) questions, there are few controlled data to confirm such an association. We tested the association between OAB and anxiety using a control group of women with non-OAB lower urinary tract symptoms (LUTS).

Methods: Patients referred to a urogynecology clinic for LUTS completed two questionnaires: the International Consultation on Incontinence Modular Questionnaire for Overactive Bladder (ICIQ-OAB), and the Generalized Anxiety Disorder 7-Item Scale (GAD-7).

The Preferred Catheter Type After Prolapse Surgery: A Survey Study of Surgeons.

Objective: The aim of this study was to determine surgeon preference for catheter type in the management of postoperative urinary retention after prolapse surgery, specifically comparing transurethral indwelling catheters (TIC), clean intermittent self-catheterization (CISC), and suprapubic tubes (SPT).

Methods: Electronic surveys were sent to 1182 urogynecologists and urologists through the American Urogynecologic Society and the Canadian Society of Pelvic Medicine.

Results: A total of 247 (21%) surveys were completed, where 53% of the respondents ranked TIC as the best catheter option, compared with 42% for CISC and 4% for SPT (P < 0.

Postrenal transplant infection: What is the effect of specific immunosuppressant agents?

Background: Immunosuppression is a known risk for post-transplant infections. Little data exist on the risk contributions of specific agents for various infections.

Methods: A triply robust propensity score-adjusted analysis was performed in a renal transplant cohort between February 2006 and January 2014.

Does low-dose gapapentin reduce opioid use postoperatively?: A randomized controlled trial in women undergoing reconstructive pelvic surgery.

Introduction And Hypothesis: Pre-emptive gabapentin has been shown to decrease postoperative pain in abdominal and vaginal hysterectomy. However, the effect of pre-emptive low-dose gabapentin has not been studied in vaginal hysterectomy combined with concomitant pelvic reconstruction.

Methods: A randomized double-blind placebo-controlled trial assessed all women seen for symptomatic prolapse requiring vaginal hysterectomy with concomitant pelvic reconstruction with or without midurethral sling.