We present a case of acute urinary retention (AUR) with hyper-angulation of the urinary bladder neck secondary to uterine leiomyoma. Our patient is a 45-year-old female who presented with AUR and suprapubic pain requiring catheterization. CT images highlight the level of obstruction secondary to suspension of the urinary bladder rather than direct urethral compression.
View Article and Find Full Text PDFObjective: This Clinical Practice Statement aims to provide clinicians with evidence-based guidance for the use of urethral bulking agents (UBAs) in the treatment of stress urinary incontinence (SUI).
Methods: We conducted a structured search of the English literature published from January 1960 to November 2022. Search terms identified studies of both current and historic UBAs.
Study Objective: To compare postoperative complications of laparoscopic myomectomy (LM) with total laparoscopic hysterectomy (TLH). A secondary outcome examined whether complications differ by age.
Design: A retrospective cohort study.
Objective: To determine whether elderly women (≥65 years) have an increased risk of complications and lower success when undergoing laparoscopic sacrocolpopexy (LSC) compared with younger women (<65 years).
Methods: This was a retrospective study of all LSC procedures performed from August 2014 to February 2021 by a single urogynecologic surgeon in an academic affiliated hospital system. Charts were identified through procedure codes.
Introduction And Hypothesis: Dexamethasone is a potent glucocorticoid that may improve quality of recovery (QoR). We hypothesized that standard administration of dexamethasone at induction may improve QoR compared to placebo in subjects undergoing ambulatory vaginal reconstructive surgeries.
Methods: This was a randomized prospective clinical trial on subjects scheduled for ambulatory vaginal reconstructive surgery for prolapse and/or urinary incontinence.
Int Urogynecol J
December 2022
Aim Of The Video/introduction: The aim was to demonstrate our minimally invasive technique for excision of eroded transvaginal cervical cerclage suture through the bladder mucosa using a suprapubic-assisted transurethral approach. Transvaginal cervical cerclage is a common treatment for cervical insufficiency in pregnancy. Complications such as erosion are rare, as the duration of treatment is typically several months, with cerclage placement in the second trimester and complete removal prior to the onset of labor.
View Article and Find Full Text PDFIntroduction And Hypothesis: Manufacturers of Macroplastique® for urethral bulking have not previously reported exposures as potential complications. This study was aimed at identifying presenting symptoms, management, and outcomes in patients experiencing urethral or bladder exposures.
Methods: A retrospective case series from 2010 to 2019 was performed in an academic affiliated hospital system.
Introduction And Hypothesis: Two cases are described and surgical techniques for recurrent pelvic organ prolapse after minimally invasive sacrocolpopexy are demonstrated at an academic affiliated hospital in patients with recurrent pelvic organ prolapse after minimally invasive sacrocolpopexy.
Methods: A laparoscopic approach was taken for surgical intervention, with excision of prior detached vaginal mesh and re-attachment of new sacrocolpopexy mesh.
Results: Two patients presented with recurrent pelvic organ prolapse after failed surgical treatment.
Female Pelvic Med Reconstr Surg
January 2021
Objective: The aim of the study was to compare which test is most sensitive in identifying stress urinary incontinence (SUI) in women with pelvic organ prolapse using urodynamics (UDS) as the criterion standard: cough stress test (CST) or pyridium pad test.
Methods: This was a prospective study of women with pelvic organ prolapse stage II or greater who desired surgical management for prolapse. Each patient underwent preoperative urinary testing: UDS, CST, and a 24-hour pyridium pad test.
Female Pelvic Med Reconstr Surg
April 2021
Historically, our health care system has been based on a fee-for-service model, which has resulted in high-cost and fragmented care. The Center for Medicare & Medicaid Services is moving toward a paradigm in which health care providers are incentivized to provide cost-effective, coordinated, value-based care in an effort to control costs and ensure high-quality care for all patients. In 2015, the Medicare Access and Children's Health Insurance Program Reauthorization Act repealed the Sustainable Growth Rate and the fee-for-service model, replacing them with a 2-track system: Merit-based Incentive Payment System and the advanced Alternative Payment Model (aAPM) system.
View Article and Find Full Text PDFBackground: Rates of postoperative incomplete bladder emptying vary significantly after pelvic reconstructive surgery. With enhanced recovery protocols the paradigm is shifting towards same-day discharge and the rates of incomplete bladder emptying are expected to increase. The optimal length of time for postoperative catheter drainage has not been clearly established.
View Article and Find Full Text PDFObjective: To treat mild-to-moderate apical compartment prolapse while preserving the uterus, our extraperitoneal uterosacral ligament hysteropexy repair technique was developed. Hysterectomy for prolapse accounted for 13% of all benign hysterectomies, which is the third most common reason. Although concomitant hysterectomy risks at time of prolapse surgery are not well defined, risks associated with hysterectomy have been well described in the literature.
View Article and Find Full Text PDFIntroduction And Hypothesis: Spinal anesthesia can be a potential risk factor for postoperative urinary retention (POUR). Our objective was to compare POUR rates for outpatient vaginal pelvic floor surgeries when using spinal versus general anesthesia. Our hypothesis was that spinal anesthesia would have higher POUR rates compared with general anesthesia.
View Article and Find Full Text PDFIntroduction And Hypothesis: Spinal anesthesia has been reported to be a risk factor for postoperative urinary retention (POUR) in various surgical specialties. We hypothesized that spinal anesthesia was a risk factor for POUR after outpatient vaginal surgery for pelvic organ prolapse (POP).
Methods: This was a retrospective review of an urogynecology database for all outpatient POP vaginal surgeries performed in 2014 to evaluate the risk of POUR after general versus spinal anesthesia.
Introduction And Hypothesis: Native tissue vaginal repairs are associated with relatively high levels of recurrence. Systematic reviews have noted that preoperative pelvic floor muscle strength was associated with increased risk of recurrence in the short term.
Methods: This is a retrospective review of patients who underwent a primary reconstructive surgery for anterior compartment vaginal prolapse between 2001 and 2015.
Introduction And Hypothesis: There is a paucity of data on the success of vaginal surgery for severe prolapse. The authors hypothesized that the success rates of total vaginal hysterectomy (TVH) with McCall culdoplasty in women with advanced pelvic organ prolapse (POP) and in women with less severe POP are similar.
Methods: This was a retrospective review of women undergoing TVH with McCall culdoplasty from 2005 to 2014.
Background: After the US Food and Drug Administration issued a safety warning concerning vaginal mesh implants in 2008, their use in correction of pelvic floor defects have decreased in the United States (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm479732.
View Article and Find Full Text PDFFemale Pelvic Med Reconstr Surg
December 2017
Background: Rectal prolapse is a disorder of the pelvic floor in which the layers of the rectal mucosa protrude outward through the anus. Surgical repair is the mainstay of treatment. Options include intra-abdominal procedures such as rectopexy and perineal procedures such as the Delorme and Altemeier perineal rectosigmoidectomy.
View Article and Find Full Text PDFObjective: To compare different modalities to aid in the evaluation of intraoperative ureteral patency on cystoscopy in the postindigo carmine era.
Methods: In a randomized controlled trial, participants undergoing pelvic surgery were randomized into one of four groups: saline distention (control), 10% dextrose distention, oral phenazopyridine, or intravenous sodium fluorescein. Our primary outcome was visibility of the ureteral jets.
Introduction And Hypothesis: This video demonstrates a transvaginal technique for vaginal vault suspension using an apical sling suspended from the sacrospinous ligaments.
Methods: This was a retrospective review of apical sling procedures performed from July 2013 to November 2014. The technique is started by marking the vaginal apex.
Female Pelvic Med Reconstr Surg
January 2013
Objectives: The purpose of this review was to identify common features of cerclage-related genitourinary fistulas.
Methods: A retrospective case series of cerclage-related fistulas was performed. The results were then pooled with available published case reports to identify common factors in these cases.
Female Pelvic Med Reconstr Surg
January 2013
Objective: This study aimed to quantify the risks of intraoperative and postoperative gastrointestinal (GI) complications associated with laparoscopic sacrocolpopexy and identify possible risk factors.
Methods: A total of 390 medical records were retrospectively reviewed for GI complications. Complications were classified as functional complications [ileus, small bowel obstruction (SBO), and prolonged nausea/emesis] or bowel injury.
Female Pelvic Med Reconstr Surg
May 2012
Objectives: To determine if opening the vaginal cuff during laparoscopic sacrocolpopexy influences the rate of mesh exposure.
Methods: A total of 390 medical records were retrospectively reviewed for demographic information, operative technique, and relevant outcomes.
Results: Eleven mesh exposures (2.
Objectives: Intraobserver reliability of post hoc urodynamic interpretation is greater than interobserver reliability, attributable to interpreter bias. If post hoc interpretation is qualitatively similar to interpretation at the time of study by a urodynamicist in attendance ("live" interpretation), a similar intraobserver bias should be observed. We therefore evaluated the intra- and interobserver reliability of post hoc versus "live" interpretation.
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