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).

International Urogynaecology Consultation chapter 1 committee 4: patients' perception of disease burden of pelvic organ prolapse.

Introduction And Hypothesis: This manuscript from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reports on the patients' perception of disease burden associated with pelvic organ prolapse.

Materials And Methods: An international group containing a team of eight urogynaecologists, a physiotherapist and a statistician performed a search of the literature using pre-specified search terms in PubMed and Embase (January 2000 to August 2020). The division of sections within this report includes: (1) perception of POP and the relationship with body image and poor health; (2) a vaginal bulge as it impacts health and wellbeing in women; (3) the impact of POP on sexual life; (4) body image and pelvic floor disorders; (5) POP and mood; (6) appropriate use of treatment goals to better meet patients' expected benefits; (7) using health-related quality of life questionnaires to quantify patients' perception of POP; (8) The financial burden of POP to patients and society.

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.

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.

A checklist for timeout on labor and delivery: a pilot study to improve communication and safety.

Objective: To assess the impact on staff communication of a standardized checklist for timeout for patients undergoing a trial of labor after cesarean section and/or elective induction at term.

Study Design: A comparison of presurvey and postsurvey questionnaire results for labor and delivery personnel assessing communication before and after checklist implementation.

Results: From October 2011 through March 2012, 52.

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.

Short-term surgical outcomes and characteristics of patients with mesh complications from pelvic organ prolapse and stress urinary incontinence surgery.

Introduction And Hypothesis: Surgical treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) can include the use of synthetic materials. Placement of synthetic materials into the vaginal wall, through either the vagina or the abdomen, includes the risk of complications such as vaginal wall extrusion or pain. There is little data regarding outcomes following treatment of mesh complications.

The effect of preoperative checklists on final histology and rates of hysterectomy for benign conditions.

Objectives: Our null hypothesis was that the introduction of preoperative hysterectomy checklists for fibroids, dysfunctional uterine bleeding (DUB), and chronic pelvic pain (CPP) would not affect the rate of hysterectomy or the proportion of cases with nonconfirmable final pathology.

Study Design: Using a prospective 6-month cohort, we compared the rate of hysterectomy (using ambulatory current procedural terminology codes for all eligible patients) and the preoperative diagnoses to final histologic diagnoses, to a baseline 6-month retrospective cohort. We also sought to determine the proportion of completed preoperative checklists among eligible cases.

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.

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.

Sexual functioning of Latino women seeking outpatient gynecologic care.

Introduction: A sample of Latino women from an ambulatory obstetrics and gynecology (Ob/Gyn) clinic were queried about their sexual functioning using the Changes in Sexual Functioning Questionnaire (CSFQ-14).

Aim: To assess the degree of self-reported sexual complaints in a sample of Latino women living in the United States; to assess if the prevalence of symptoms differs from one study of women living in Spain; and to determine if sexual complaints were associated with demographics, sexual/reproductive history, selected medications, or religious practices.

Main Outcome Measures: CSFQ-14 scores and demographic variables.

Surgical versus nonsurgical treatment of women with pelvic floor dysfunction: patient centered goals at 1 year.

Purpose: In women with pelvic floor dysfunction we assessed the degree to which treatment (surgical vs nonsurgical) was associated with achievement of patient centered goals, satisfaction with care and quality of life.

Materials And Methods: In this prospective cohort study between September 2003 and December 2004 we recruited women during their first referral visit for pelvic floor dysfunction treatment at our outpatient Urogynecology Clinic. At the first visit women enumerated up to 5 personal treatment goals, and anchored each goal by anticipating best and worst possible outcomes.

Vaginal symptoms and urinary incontinence in the elderly women.

Urogenital symptoms of vaginal dryness, urogenital irritation and itching, vaginal discharge, and urinary incontinence are common among postmenopausal women. Several studies have documented a lower rate of treatment-seeking behavior with increasing age in patients with urinary symptoms, and our clinical experience indicates a need for physician-initiated queries on vaginal/urinary symptoms. These urogenital conditions are amenable to treatment with pharmacotherapy and behavioral and/or surgical treatment.

Postpartum depression, urge urinary incontinence, and overactive bladder syndrome: is there an association?

The purpose of this prospective, cross-sectional study was to determine if there was an association between postpartum depression and symptoms of overactive bladder in postpartum women. At their 6 week postpartum visit, participants completed questionnaires regarding lifestyle, personal health, urinary incontinence, and depression symptoms, including the Urge-Urinary Distress Inventory (URGE-UDI), the Urge-Incontinence Impact Questionnaire (URGE-IIQ), and the Edinburgh Postnatal Depression Scale (EPDS). Past medical history, including obstetric variables, family history, and medications were extracted from the medical record.

Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up.

Objective: This study was undertaken to describe long-term postoperative perceived achievement of subjective preoperative goals for pelvic floor dysfunction (PFD) surgery.

Study Design: From March 2000 through December 2001, 123 PFD surgical patients completed a preoperative open-ended questionnaire on which they described up to 5 personal outcome goals for PFD surgery. Patients were asked to review their original goals list and assess the degree to which they had met their goals on a 5-point scale (-2=strongly disagree the goal had been met to +2=strongly agree that the goal had been met) 3 months after surgery and again between 1 and 3 years after surgery.

Patient-centered goals for pelvic floor dysfunction surgery: what is success, and is it achieved?

Objective: The purpose of this study was to describe patient-identified goals for pelvic floor dysfunction surgical procedures and patient-reported achievement of those goals.

Study Design: Thirty-three consecutive patients scheduled for pelvic floor dysfunction surgical procedures completed a preoperative questionnaire on which they listed up to 5 personal goals for surgical outcomes. At 6- and 12-week follow-up, patients reported the degree (rated 1-5) to which each goal had been met (1 = strongly disagree that the goal was met; 5 = strongly agree).