Consideration of pelvic floor myofascial release for overactive bladder.

Introduction: Physical therapy has been shown to be effective for women with overactive bladder (OAB). We report on our experience with pelvic floor physical therapy (PFPT) with or without myofascial release as treatment for women with symptoms of urinary urgency or urge incontinence.

Methods: We performed a retrospective chart review, of patients who presented to our tertiary care Urogynecology practice.

It Takes a Village: The First 100 Patients Seen in a Multidisciplinary Pelvic Floor Clinic.

Objective: This study aimed to assess the characteristics of patients assessed and treated at a multidisciplinary pelvic floor program that includes representatives from multiple specialties. Our goal is to describe the process from triaging patients to the actual collaborative delivery of care. This study examines the factors contributing to the success of our multidisciplinary clinic as evidenced by its ongoing viability.

Screening for Microscopic Hematuria in a Urogynecologic Population.

Objectives: The objectives of this were to determine the correlation of greater than or equal to 3 red blood cells per high-power field (RBCs/HPF) with a positive urine dipstick for blood and to identify clinically relevant factors than can influence this relationship.

Methods: The charts of women with positive blood urine dipsticks were reviewed from August 2012 to August 2013. The cohort of women was divided into 2 groups; those with urine with greater than or equal to 3 RBCs/HPF on microscopy and those without.

Increasing Age Predicts Increasing Residual Urine Volume.

Objectives: To determine reference values for postvoid residual (PVR) volume for patients referred to a tertiary urogynecology center.

Methods: After Institutional Review Board approval, we performed a retrospective chart review of all new patients presenting to our referral center. We assessed associations between PVR and patient demographics, pelvic floor symptoms, and physical examination by Wilcoxon rank sum or Kruskal-Wallis tests as appropriate.

Pelvic floor myofascial pain in patients with symptoms of urinary tract infection.

Objective: To correlate lower urinary tract symptoms typically associated with a urinary tract infection (UTI) with physical examination findings of pelvic floor myofascial pain (PFMP).

Methods: This retrospective review included all new patients presenting to a urogynecology clinic between August 2 and December 19, 2016. Patients completed validated questionnaires, had a catheterized urine specimen, and underwent pelvic examination.

IL22 regulates human urothelial cell sensory and innate functions through modulation of the acetylcholine response, immunoregulatory cytokines and antimicrobial peptides: assessment of an in vitro model.

Human urinary disorders are generally studied in rodent models due to limitations of functional in vitro culture models of primary human urothelial cells (HUCs). Current HUC culture models are often derived from immortalized cancer cell lines, which likely have functional characteristics differ from healthy human urothelium. Here, we described a simple explant culture technique to generate HUCs and assessed their in vitro functions.

Vaginal cancer in a patient with complicated prolapse history: a case report.

Background: In the setting of multiple pelvic floor procedures, vaginal abnormalities are not unusual.

Case: We present the case of a 59-year-old woman with voiding dysfunction and inability to have intercourse after multiple pelvic floor procedures who presented with a vaginal mass on bimanual examination, thought to be related to prior procedures with permanent sutures. Imaging was obtained, and the lesions were thought to be suture granuloma.

Snoring during pregnancy and delivery outcomes: a cohort study.

Study Objective: This cohort study examined the impact of maternal snoring on key delivery outcomes such as mode of delivery, infant birth centile, and small-for-gestational age.

Design: Cohort study.

Setting: A large tertiary medical center.

Skill acquisition, credentialing, and maintenance of skills in surgical treatment of pelvic organ prolapse and urinary incontinence.

Female pelvic medicine and reconstructive surgery, or urogynecology, has undergone a unique evolution with recent recognition as a subspecialty of Obstetrics and Gynecology and Urology. It has never suffered from a shortage of innovation nor of innovators, and thus new treatments and therapeutic options are regularly being introduced. Who is best to perform or prescribe new, therapeutic options and their implementation in a responsible manner is controversial.

Vulvar ulcer causing osteomyelitis of the pubic bone.

Background: Osteomyelitis of the pubic bone is a rare entity. Risk factors for infection of the symphysis pubis and osteomyelitis of the pubic bone include direct trauma, previous urogynecologic procedures, extreme physical exercise, and immunocompromised state. The treatment modalities range from conservative antibiotic treatment to extensive surgery.

Pregnancy-onset habitual snoring, gestational hypertension, and preeclampsia: prospective cohort study.

Objective: This study aimed to prospectively examine the impact of chronic vs pregnancy-onset habitual snoring on gestational hypertension, preeclampsia, and gestational diabetes.

Study Design: Third-trimester pregnant women were recruited from a large, tertiary medical center from March 2007 through December 2010 and screened for the presence and duration of habitual snoring, as a known marker for sleep-disordered breathing. Clinical diagnoses of gestational hypertension, preeclampsia, and gestational diabetes were obtained.

Urethral closure pressures among primiparous women with and without levator ani muscle defects.

Introduction And Hypothesis: Vaginal birth is an established risk factor for levator ani (LA) defects and incontinence. We hypothesized an association between urethral pressure profiles and LA defects.

Methods: One hundred sixty primiparous women, 9-12 months postpartum, were assessed with MRI for LA defects, urodynamic testing, and instrumented speculum for vaginal closure force.

Levator defects affect perineal position independently of prolapse status.

Objective: The purpose of this study was to determine the effect of levator defects on perineal position and movement irrespective of prolapse status.

Study Design: Forty women from an ongoing study were divided into 2 groups of 20 women with and without severe levator defects. Prolapse status was matched between groups, with 50% of the women having stage III or greater anterior wall prolapse.

Management of vulvovaginal strictures/shortened vagina.

Vaginal strictures are generally difficult to manage and tend to reccur despite appropriate initial therapy. Vaginal dilation with or without surgery is the main stay of treatment. Causes, diagnosis and management of the vulvovaginal strictures are presented.

Anterior vaginal wall prolapse: assessment and treatment.

Assessment and management of anterior vaginal wall defects presents a unique surgical challenge. It is often the most common site of initial prolapse in women and the most common site of recurrence. This chapter discusses the anatomy, evaluation, and surgical approach to the treatment of anterior vaginal wall defects.