Defecatory Dysfunction.

Normal defecation is a complex and coordinated physiologic process that involves the rectum, anus, anal sphincter complex, and pelvic floor muscles. Any alteration of this process can be considered defecatory dysfunction, a term that covers a broad range of disorders, including slow-transit constipation, functional constipation, and functional or anatomic outlet obstruction. Evaluation should include history, physical, and consideration of additional testing such as colonoscopy, colonic transit studies, defecography, and/or anorectal manometry.

Cystoscopic findings: a video tutorial.

Introduction And Hypothesis: Cystoscopy is frequently performed by gynecologists to ensure ureteral patency and to prevent bladder injury when performing concomitant gynecological procedures. Generally, there are no additional findings on cystoscopy; however, when abnormalities arise, they may require either observation or intervention. Our aim was to create a visual library of benign, malignant, and foreign-body pathological conditions incidentally encountered on cystoscopy.

Symptom resolution after operative management of complications from transvaginal mesh.

Objective: Complications from transvaginal mesh placed for prolapse often require operative management. The aim of this study is to describe the outcomes of vaginal mesh removal.

Methods: A retrospective review of all patients having surgery by the urogynecology group in the department of obstetrics and gynecology at our institution for a complication of transvaginal mesh placed for prolapse was performed.

Apical descent in the office and the operating room: the effect of prolapse size.

Objectives: The support of the uterine cervix with Valsalva or cough assessed in the clinic and the support of the uterine cervix with traction in the operating room often differs. The objectives of this study were to test the null hypothesis that the difference between preoperative and intraoperative values of pelvic organ prolapse quantification (POP-Q) point C is not related to prolapse size and to determine if other factors exist that predict this difference.

Methods: This is a retrospective review of women who had a vaginal hysterectomy in the Female Pelvic Medicine and Reconstructive Surgery division between 2005 and 2011 and had preoperative and intraoperative POP-Q point C recorded.

Interdisciplinary simulation-based training to improve delivery room communication.

Introduction: Poor communication among obstetric and pediatric professionals is associated with adverse perinatal events leading to severe disability and neonatal mortality. This study evaluated the effectiveness of an interdisciplinary simulation-based training (SBT) program to improve delivery room communication between obstetric and pediatric teams.

Methods: Obstetric and pediatric teams participated in an SBT annually during 3 academic years, 2008-2011 (Y1-Y3), in a prospective, observational study.

Expectant management of cystotomy at the time of midurethral sling placement: a retrospective case series.

Introduction And Hypothesis: Cystotomy is one of the most common complications of retropubic midurethral sling placement. Some centers manage cystotomy with prolonged catheter drainage, and there are few published studies evaluating this practice. The purpose of this study is to review postoperative outcomes of patients who experienced cystotomy at the time of sling placement and did not undergo prolonged catheter drainage.

Vaginal approach to vesicovaginal fistula and vaginal vault prolapse preserving sexual function by Latzko repair and sacrospinous suspension.

The combination of vesicovaginal fistula and complete vaginal vault prolapse is rare. The only published treatment recommendations concern partial colpocleisis, an option that precludes intercourse. In this case report, we describe successful repair of this problem with a Latzko fistula repair and a concomitant Michigan 4-wall sacrospinous ligament suspension: instead of curing the fistula, correcting the prolapse, and preserving sexual function.