Self-assessment of nursing preparedness and knowledge in the care of patients with obstetric anal sphincter injuries and utilization of a computer-based learning module for continued nursing education in the United States.

Importance: Perineal injury is the most common complication of vaginal delivery, and labor and delivery (L&D) nurses are crucial in managing and educating women following perineal trauma.

Objective: The aims of this study were to assess L&D nurse experience, knowledge, and self-perception of preparedness in caring for women with obstetric anal sphincter injuries (OASIS) and to compare pre- and post-test scores using a computer-based learning module (CBL) for OASIS nurse education.

Study Design: All L&D nurses were invited to complete a voluntary, self-assessment questionnaire inquiring about prior experience, training, and education and current clinical practice in caring for patients with OASIS.

Pass or Fail? Postoperative Active Voiding Trials in an Enhanced Recovery Program.

Importance: Pelvic reconstructive surgery is often associated with transient postoperative voiding dysfunction.

Objective: This study aimed to compare postoperative active voiding trial (AVT) outcomes before and after implementation of an enhanced recovery program (ERP) for women undergoing pelvic reconstructive surgery. In addition, risk factors for postoperative urinary retention were identified.

Enhanced Recovery After Urogynecologic Surgery: A Survey of Patient Experience.

Objectives: The aim of this study was to identify which aspects/components of the enhanced recovery program (ERP) were associated with a positive patient surgical experience for patients undergoing urogynecologic surgery.

Methods: A total of 198 patients who underwent pelvic reconstructive surgery requiring hospital admission were invited to complete questionnaires modeled after the validated Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey patient experience survey. Patients were asked about 3 phases of ERP interventions: (1) before surgery (patient education, carbohydrate loading), (2) during the hospital stay (pain control, nausea, early ambulation), and (3) after discharge (return of bladder and bowel function).

The American Urogynecologic Society Action Plan on Diversity, Equity, and Inclusion: Developed by the Diversity, Equity, and Inclusion Task Force.

The American Urogynecologic Society (AUGS) identified diversity, equity, and inclusion as the cornerstone of excellence in governance and operations. Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs. In June 2020, the AUGS President, Dr Shawn Menefee, and Board of Directors called for a Presidential Task Force on Diversity, Equity, and Inclusion to study the current state of our society and make recommendations for future directions.

Evaluation and Treatment of Urinary Incontinence in Women.

This review focuses on the diagnosis, evaluation, and treatment of urinary incontinence (UI). UI is a common diagnosis that is encountered among women in their lifetime. Stress, urge (overactive bladder), and overflow are the most commonly encountered types of incontinence, but anatomic and neurologic causes are important to rule out.

Enhanced Recovery Program for Outpatient Female Pelvic Reconstructive Surgery.

Objectives: Enhanced recovery programs (ERPs) are evidence-based perioperative interventions designed to reduce narcotic use, decrease hospital length of stay, decrease medical costs, and improve patient satisfaction. Given the increase in outpatient procedures in female pelvic medicine and reconstructive surgery, we sought to compare patient outcomes before and after implementation of an ERP for women undergoing outpatient pelvic reconstructive surgery.

Methods: This was a prospective nonrandomized cohort quality improvement practice initiative.

Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery.

Introduction And Hypothesis: Enhanced recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients.

Methods: An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation.

Validation of the Simulated Vaginal Hysterectomy Trainer.

Study Objective: To establish construct validity of the simulated vaginal hysterectomy trainer (SimVaHT).

Design: A cross-sectional validation study (Canadian Task Force classification II-2).

Setting: A single academic medical center in the United States.

Use of Ketorolac After Outpatient Urogynecologic Surgery: A Randomized Control Trial.

Objective: Patient surveys highlight a prevalence of moderate to severe pain in the postanesthesia care unit. Multimodal analgesia has been promoted to improve this with fewer opioid-induced adverse effects. The aim of this study was to evaluate the opioid sparing and analgesic effect of postoperative intravenous (IV) ketorolac after outpatient transvaginal surgery.

Review of enhanced recovery programs in benign gynecologic surgery.

Introduction And Hypothesis: Enhanced recovery programs (ERPs) are evidence-based protocols designed to improve functional rehabilitation after surgery. ERPs have gained widespread acceptance in many surgical disciplines, and their use leads to significant improvements in patient outcomes while reducing hospital length of stay (LOS). There remains a paucity of data on the use of ERPs in benign gynecologic surgery.

Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough?

Introduction And Hypothesis: We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support.

Prevalence of positive screening test for cognitive impairment among elderly urogynecologic patients.

Background: Impaired cognition has been correlated with adverse postoperative outcomes, such as an increased incidence of delirium, a longer length of hospital stay, and higher 6 month mortality. The incidence of cognitive impairment in the elderly is high. Per the Centers for Disease Control and Prevention, 1 in 8 adults aged 60 years and older deal with memory loss and confusion, and less than 20% inform their health care providers.

Enhanced Recovery Implementation in Major Gynecologic Surgeries: Effect of Care Standardization.

Objective: To examine implementing an enhanced recovery after surgery (ERAS) protocol for women undergoing major gynecologic surgery at an academic institution and compare surgical outcomes before and after implementation.

Methods: Two ERAS protocols were developed: a full pathway using regional anesthesia for open procedures and a light pathway without regional anesthesia for vaginal and minimally invasive procedures. Enhanced recovery after surgery pathways included extensive preoperative counseling, carbohydrate loading and oral fluids before surgery, multimodal analgesia with avoidance of intravenous opioids, intraoperative goal-directed fluid resuscitation, and immediate postoperative feeding and ambulation.

Serous tubal intraepithelial carcinoma: an incidental finding at the time of prophylactic bilateral salpingo-oophorectomy.

Background. Serous tubal intraepithelial carcinoma (STIC) is a precursor lesion for high-grade pelvic serous carcinoma. The incidence of STIC is estimated to occur in 0.

Referral patterns for pelvic floor surgical prosthesis complications: from symptom onset and initial treatments to evaluation at a tertiary care center.

Unlabelled: Although complications of prosthesis products used for pelvic organ prolapse and stress urinary incontinence have been extensively characterized, little is known about their referral patterns and the time lapse from symptom onset to evaluation and treatment. The aim of our study was to retrospectively describe the patterns and timing of referral of prosthesis-related complications and initial prereferral treatments.

Methods: We retrospectively identified patients referred to the University of Virginia from January 2002 to October 2012 with prosthesis complications related to previously placed devices for pelvic floor disorders.

The multicenter urogynecology study on education: associations between educational outcomes and clerkship center characteristics.

Objective: : The objective of the study was to examine the effect of center characteristics on educational experiences and female pelvic medicine knowledge changes in third-year students at 6 medical schools.

Methods: : In this secondary analysis of data acquired during a prospective, multicenter study conducted from May 2008 through June 2009, preclerkship and postclerkship third-year medical students scored their knowledge of 12 female pelvic medicine topics and 4 office procedures (knowledge scores [KSs]). Postclerkship, students also reported the number and type of learning experiences they had encountered.

Multicenter Urogynecology Study on Education: Medical Student Educational Experiences and Knowledge Outcomes During the OBGYN Clerkship.

Objective: : The objective of this study was to describe self-assessed student knowledge of female pelvic medicine (FPM) during the OBGYN clerkship.

Methods: : Students at 6 sites scored their knowledge of 12 FPM topics and 4 procedures both before and after their clerkship. Analysis included Wilcoxon tests, Spearman correlation, and univariate and multivariate models.

Treatment strategies for pelvic organ prolapse: a cost-effectiveness analysis.

Introduction And Hypothesis: To compare the relative cost effectiveness of treatment decision alternatives for post-hysterectomy pelvic organ prolapse (POP).

Methods: A Markov decision analysis model was used to assess and compare the relative cost effectiveness of expectant management, use of a pessary, and surgery for obtaining months of quality-adjusted life over 1 year. Sensitivity analysis was conducted to determine whether the results depended on specific estimates of patient utilities for pessary use, probabilities for complications and other events, and estimated costs.

Racial differences in bother for women with urinary incontinence in the Establishing the Prevalence of Incontinence (EPI) study.

Objective: The purpose of this study was to compare differences in degree of bother in black and white women with urinary incontinence (UI).

Study Design: A population-based study was conducted in black and white women in Michigan. Participants completed an interview and the Incontinence Impact Questionnaire short form (IIQ-7).

Patient-centered treatment goals for pelvic floor disorders: association with quality-of-life and patient satisfaction.

Objective: We sought to determine the relationship of patient-centered goal achievement in pelvic floor disorder (PFD) treatment to PFD-specific quality-of-life (QOL), depression, health status, and patient satisfaction.

Study Design: Ninety women with PFD identified up to 5 goals for treatment and reported their level of goal attainment (-2 to +2) at 1.5, 3, 6, and 12 months; completed the Incontinence Impact Questionnaire, Urogenital Distress Inventory, Incontinence Quality-of-Life Scale, Patient Health Questionnaire, and Short Form-12 Health Survey; and indicated their satisfaction with treatment.

Distribution of pelvic organ support measures in a population-based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan.

Objective: The purpose of this study was to report the distribution of pelvic support among a population-based sample of middle-aged community-dwelling women, as defined by pelvic organ prolapse quantification (POP-Q) and study factors that might influence POP-Q measurements.

Study Design: We conducted a secondary analysis of a population-based study of community-dwelling, African American and white women aged 35-64 years from southeastern Michigan. Three hundred ninety-four women consented to physical examination using the POP-Q.

Stress urinary incontinence: relative importance of urethral support and urethral closure pressure.

Purpose: Treatment strategies for stress incontinence are based on the concept that urethral mobility is the predominant causal factor with sphincter function a secondary contributor. To our knowledge the relative importance of these 2 factors has not been assessed in properly controlled studies.

Materials And Methods: The Research on Stress Incontinence Etiology project is a case-control study that compared 103 women with stress incontinence and 108 asymptomatic controls in groups matched for age, race, parity and hysterectomy.

Establishing the prevalence of incontinence study: racial differences in women's patterns of urinary incontinence.

Purpose: We examine racial differences in urinary incontinence prevalence, frequency, quantity, type, and risk factors in a population based sample of community dwelling black and white women.

Materials And Methods: Women 35 to 64 years old were sampled from telephone records from 3 southeast Michigan counties. Women self-identifying as black or white race completed a telephone interview that assessed demographics, health history, lifestyle factors and urinary incontinence experience.

Practicalities and pitfalls of pessaries in older women.

Pelvic floor disorders are known to increase with age. With the number of elderly women more than doubling in the coming decades, gynecologists will need to be skilled in the assessment and treatment of these conditions. Conservative forms of therapy such as pessaries can often be successfully employed.