Extended Treatment-dose Antibiotic Therapy vs Low-dose Prophylaxis for the Management of Recurrent Uncomplicated Urinary Tract Infections in Peri- and Post-menopausal Women.

Objective: To assess treatment efficacy over 1year in women with recurrent urinary tract infection (UTI) receiving extended treatment-strength antibiotics compared to standard low-dose prophylactic antibiotic regimens.

Methods: A retrospective cohort study of adult women presenting with acute uncomplicated UTI between January 1, 2018 and October 1, 2020 meeting recurrent UTI criteria (≥2 in 6months or ≥3 in 1year). Women were offered either: (1) treatment-strength antibiotic therapy for 1month; or (2) up to 7days of treatment-strength antibiotics followed by ≥3-month of low-dose prophylactic antibiotics.

Correlation of Digital Rectal Examination and Anorectal Manometry with Patient-Reported Outcomes Among Women with Fecal Incontinence.

Introduction And Hypothesis: Standardized digital rectal examination (DRE) correlates with anorectal manometry (ARM) measures. However, less is known about the relationship between DRE/ARM measures and patient-reported outcomes (PROs), especially among women with fecal incontinence (FI). Our aims were to evaluate associations between DRE and ARM measures and compare PROs with diagnostic evaluation measures for women with FI.

Successful sacral neuromodulation treatment of refractory faecal incontinence in a patient with spina bifida and partial sacral agenesis.

A woman in her early 20s with a history of lumbosacral lipomyelomeningocele with associated partial sacral agenesis and tethered cord was referred for possible sacral neuromodulation treatment of her refractory faecal incontinence. Anorectal testing revealed a thinned and weakened anal sphincter complex with absent left-sided bulbocavernosus and anal wink reflexes.Through a two-stage approach, she underwent successful placement of a chronic tined quadripolar sacral nerve lead and implanted pulse generator.

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study.

Objective: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.

Design: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study.

Setting: Eight clinical sites in the US Pelvic Floor Disorders Network.

Inequities in Filled Overactive Bladder Medication Prescriptions in the US.

Importance: Anticholinergic medications to treat overactive bladder (OAB) have been associated with increased risk of cognitive decline, whereas β3-adrenoceptor agonists (hereafter, β3-agonists) have comparable efficacy and do not carry the same risk. Yet, anticholinergics remain the predominant OAB medication prescribed in the US.

Objective: To evaluate whether patient race, ethnicity, and sociodemographic characteristics are associated with receipt of anticholinergic vs β3-agonist OAB medications.

Characteristics associated with subjective and objective measures of treatment success in women undergoing percutaneous tibial nerve stimulation vs sham for accidental bowel leakage.

Introduction And Hypothesis: In randomized trials both percutaneous tibial nerve stimulation (PTNS) and sham result in clinically significant improvements in accidental bowel leakage (ABL). We aimed to identify subgroups who may preferentially benefit from PTNS in women enrolled in a multicenter randomized trial.

Methods: This planned secondary analysis explored factors associated with success for PTNS vs sham using various definitions: treatment responder using three cutoff points for St.

Strategies for Difficult Fluoroscopic Landmarking During Sacral Neuromodulation Lead Placement.

Objectives: Fluoroscopic guidance is a key tool used in combination with sensory and motor testing to ensure optimal sacral neuromodulation lead placement. The objectives of this video are to briefly review bony landmarks for fluoroscopic imaging and provide strategies to overcome common obstacles during fluoroscopic mapping for sacral neuromodulation lead placement.

Methods: Our video is divided into 2 parts.

Reoperation for prolapse recurrence after sacrospinous mesh hysteropexy: characteristics of women choosing retreatment.

Introduction And Hypothesis: Factors that contribute to reoperation and surgical approaches for the management of recurrent uterovaginal prolapse after vaginal mesh hysteropexy (mesh hysteropexy) are unknown. We aimed to describe surgical management of pelvic organ prolapse recurrence after vaginal mesh hysteropexy, and patient characteristics in those who chose reoperation.

Methods: This is a descriptive analysis of women who experienced treatment failure within 5 years of mesh hysteropexy in a multi-site randomized trial.

Is total laparoscopic hysterectomy with longer operative time associated with a decreased benefit compared with total abdominal hysterectomy?

Background: It is well known that, in general, total laparoscopic hysterectomy is associated with less perioperative morbidity compared with total abdominal hysterectomy. However, total laparoscopic hysterectomy is also associated with longer operating times, which itself is an independent predictor of morbidity. Currently, it is unknown whether there is an operative time threshold beyond which total laparoscopic hysterectomy provides a diminishing return and higher risk of morbidity than a shorter abdominal hysterectomy.

National Estimates of Labiaplasty Performance in the United States From 2016 to 2019.

The objective of this analysis was to provide national estimates of rates and patterns of labiaplasty performance among all payers in the ambulatory surgery setting. We used the Nationwide Ambulatory Surgery Sample database from 2016 to 2019 and estimated the annual rate of labiaplasty in the United States, along with the demographic characteristics of patients undergoing the procedure and characteristics of the facilities where the procedure was performed. The highest rate of cases was observed among adolescent and young women in the United States, with nearly 20% of all cases being performed in girls younger than age 18 years.

Risk of obstetric anal sphincter injuries at the time of admission for delivery: A clinical prediction model.

Objective: To develop and validate a model to predict obstetric anal sphincter injuries (OASIS) using only information available at the time of admission for labour.

Design: A clinical predictive model using a retrospective cohort.

Setting: A US health system containing one community and one tertiary hospital.

Quantifying the Added Value of 2 Common Frailty Measures for Predicting Adverse Outcomes After Elective Hysterectomy.

Importance: Although frailty is predictive of adverse outcomes in predominantly male general and orthopedic surgical populations, the utility of American College of Surgeons National Surgical Quality Improvement Program-based frailty measurement for hysterectomy is unclear.

Objectives: The objective of this study was to measure the added contribution of the modified frailty index (mFI) and Risk Analysis Index (RAI) for predicting adverse outcomes after hysterectomy.

Study Design: A secondary analysis of the 2011 to 2014 American College of Surgeons National Surgical Quality Improvement database was conducted.

Urinary basement membrane graft-augmented sacrospinous ligament suspension: a description of technique and short-term outcomes.

Introduction And Hypothesis: Since the discontinuation of manufacture and distribution of surgical mesh for transvaginal prolapse repair, the use of biologic grafts for transvaginal apical suspension has gained renewed attention. However, there is no FDA-approved device and minimal published data describing such an approach. The objective of this video is to describe a technique and to present limited short-term outcomes utilizing a porcine urinary basement membrane (UBM) graft to perform an augmented bilateral sacrospinous ligament suspension (SSLS).

Changes in Performance of Apical Suspension at the Time of Surgery for Prolapse: Assessment of the Influence of the American Urogynecologic Society and American College of Obstetricians and Gynecologists Practice Bulletin.

Objectives: To assess the association of publication of the American Urogynecologic Society (AUGS)/American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on pelvic organ prolapse and performance of an apical suspension at the time of surgery for pelvic organ prolapse.

Methods: Surgical procedures performed with a primary diagnosis of uterovaginal or female genital prolapse, cystocele, or enterocele were isolated from the 2011 to 2019 American College of Surgeons National Surgical Quality Improvement Program Database. An autoregressive interrupted time series regression estimated the overall temporal trend in performance of an apical suspension and assessed for a change in trend associated with publication of the AUGS/ACOG Practice Bulletin in April 2017.

Predictors of postoperative complications from stress urinary incontinence procedures: a NSQIP database study.

Introduction And Hypothesis: There are few studies examining patient risk factors for postoperative complications following midurethral sling (MUS) placement for stress urinary incontinence (SUI). The objective of this study was to describe 30-day postoperative complications after MUS using the National Surgical Quality Improvement Program database. Secondary objectives included rates of readmission and patient factors associated with postoperative complications and readmissions following MUS.

Outcomes of vaginal and laparoscopic hysterectomy with concomitant pelvic reconstructive surgery.

Introduction And Hypothesis: Although vaginal hysterectomy(VH) is traditionally considered the safest route of hysterectomy, newer data suggest that laparoscopic hysterectomy (LH) might have lower risks of perioperative complications in contemporary practice. Using a large surgical database, we aimed to assess the hypothesis that there are no significant differences in rates of major and minor complications between LH and VH when performed with pelvic reconstructive surgery, controlling for the number and type of pelvic reconstructive procedures.

Methods: A total of 27,941 eligible LH and VH from the 2010-2018 National Surgical Quality Improvement Program database were identified.

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.

Cost-effectiveness Analysis of Universal Cystoscopy at the Time of Benign Laparoscopic Hysterectomy.

Study Objective: To estimate the rate of lower urinary tract injury (LUTI) and percentage of LUTI needing to be recognized intraoperatively to make universal cystoscopy cost-effective and cost-saving during laparoscopic hysterectomy.

Design: A decision tree model was used to estimate the costs and quality-adjusted life years associated with delayed or intraoperative recognition of LUTI at the time of laparoscopic hysterectomy. Probabilities and utilities were estimated from published literature.

Timing of diagnosis of complex lower urinary tract injury in the 30-day postoperative period following benign hysterectomy.

Background: Complex lower urinary tract injury resulting from hysterectomy is a rare but highly morbid complication. Although intraoperative recognition reduces the risk of serious sequelae, observational studies have shown that most complex lower urinary tract injuries are recognized in the postoperative period. To date, limited research exists describing the timing of diagnosis of complex lower urinary tract injury or risk factors associated with complex lower urinary tract injury diagnosed in the postoperative period.

Is there an Association between Vaginal Birth after Cesarean Prediction and Obstetric Anal Sphincter Injury?

Objective: This study aimed to estimate whether there is an association between the predicted probability of vaginal birth after cesarean delivery (VBAC) and the occurrence of obstetric anal sphincter injuries (OASIS).

Study Design: This was a single-site retrospective cohort study of all women with a singleton vaginal birth after a previous cesarean section between January 2011 and December 2016. Women were divided into four ordinal groupings by the predicted probability of achieving vaginal birth after cesarean using the Maternal-Fetal Medicine Units Network VBAC calculator (less than 41%, 40.

Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018.

Background: There is a national shift toward laparoscopic hysterectomy as the predominant form of minimally invasive hysterectomy. Previous research suggests that vaginal hysterectomy is associated with lower operative time and improved outcomes; however, this has not been validated in a modern cohort of women.

Objective: This analysis aims to evaluate whether total vaginal hysterectomy remains associated with lower operative times and fewer postoperative complications than total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy, given recent shifts in clinical practice patterns and training experience.