Publications by authors named "Lee A Richter"
Article Synopsis
- - This systematic review and meta-analysis aimed to find the best prophylactic antibiotic regimen to reduce urinary tract infections (UTIs) in patients receiving botulinum toxin (BTX) injections for overactive bladder (OAB), as there are currently no evidence-based guidelines on the topic.
- - The researchers reviewed 27 studies involving 2,100 patients, primarily focusing on idiopathic OAB, and found that while no studies made direct comparisons of different antibiotic regimens, there was a general preference for using antibiotics for 2-3 days post-injection.
- - The analysis revealed a 10% UTI rate at 4 weeks and 15% at 12 weeks after the injection, indicating that more research is necessary to
Article Synopsis
- The study aimed to investigate why patients discontinue onabotulinumtoxinA treatments for overactive bladder (OAB) and how previous treatments like sacroneuromodulation affect discontinuation rates.
- A retrospective analysis of 214 women treated for OAB from January 2014 to July 2019 was conducted, comparing those who continued with the treatment versus those who stopped.
- The results indicated that 40.2% of participants discontinued treatment, with higher rates seen in those who had previous pelvic surgeries, painful bladder syndrome, or recurrent urinary tract infections after treatment.
Article Synopsis
- The study investigates pelvic floor disorders in breast cancer survivors, focusing on their prevalence, the impact of endocrine therapy, and surgery rates compared to women without cancer.
- Data was collected from medical records of 19,483 breast cancer survivors and 19,483 matched controls, revealing that survivors had a lower prevalence of pelvic floor disorders (8.8% vs. 22.6%).
- Despite the lower prevalence, breast cancer survivors had similar or even higher rates of pelvic floor surgery for certain conditions, indicating a need for routine screening in survivorship care.
Article Synopsis
- This study aimed to assess the incidence of vaginal complications following cystectomy in women aged 65 and older, focusing on issues like vaginal prolapse and fistulas.
- Out of 481 women analyzed, 21.2% experienced vaginal complications within the study period, with vaginal cuff dehiscence being the most common issue.
- The findings highlight a higher-than-expected rate of complications in this population, stressing the need for awareness and potential interventions among healthcare providers.
Article Synopsis
- The text aims to review existing research on vaginal complications like pelvic organ prolapse, vaginal fistula, and dyspareunia following radical cystectomy for bladder cancer, along with treatment methods for these issues.
- A systematic search of published literature from January 2001 to January 2021 identified 229 articles, ultimately narrowing down to 28 for detailed analysis.
- Key findings show that vaginal fistulas occur in 3-6% of patients, sexual function is influenced by maintaining certain anatomical structures, and more standardized research is needed to accurately assess and address these complications and their effects on quality of life.
Article Synopsis
- The study aimed to evaluate how the preoperative D-point relates to apical outcomes in women who underwent uterine surgery over 24 months, using data from the OPTIMAL trial.
- It involved secondary analysis of a multi-centered clinical trial comparing two surgical methods for pelvic support, focusing on anatomical outcomes and defining a D-point cut-off for predicting success.
- Results showed that a higher preoperative D-point was linked to better anatomical results post-surgery, with a specific cut-off of -4.25 cm identified as a predictor of success, while the D-point did not strongly predict subjective outcomes.
Article Synopsis
- Cystourethroscopy is a procedure that obstetrician-gynecologists can use for both diagnosing and sometimes treating conditions related to the urinary tract, focusing on urethra, bladder, and ureters.* -
- The monograph details the necessary instruments and techniques for performing cystourethroscopy specifically in women who have normal anatomical structures.* -
- It also illustrates various benign and malignant conditions of the urethra and bladder, highlights intraoperative complications, and provides clinical scenarios to help with identifying and managing common findings during the procedure.*
Article Synopsis
- The study aimed to evaluate the characteristics of women with genitourinary (GU) fistula in Kigali, Rwanda, over five years, focusing on the impact of increased cesarean section rates.
- Out of 2,091 women evaluated, 630 (30%) were diagnosed with GU fistula, with the majority being vesicovaginal, and a growing percentage involving the ureter, uterus, or cervix over the study period.
- The findings indicate a significant rise in certain types of fistula, particularly after cesarean deliveries, suggesting a need for further investigation into the effects of increasing surgical interventions on women's health outcomes.
Article Synopsis
- This article reviews the use of MRI as a dynamic imaging tool for assessing female pelvic floor disorders, including conditions like pelvic organ prolapse, rectal prolapse, and issues with defecation.
- New guidelines have emerged that emphasize the importance of MRI in evaluating these disorders, despite its high costs, as it aids in making informed surgical decisions to prevent treatment failures.
- Recent advancements, such as standardized measurements and radiographic guidelines, aim to improve the consistency of MRI techniques and enhance research collaboration, making pelvic floor assessments more accessible for patients.
Objective: The aim of the study was to evaluate knowledge, attitudes, and practice patterns of physicians prescribing topical estrogen for women with urogenital atrophy and a history of breast cancer.
Methods: A cross-sectional survey of breast surgeons, urogynecologists, and gynecologists was distributed via their professional societies: the American Society of Breast Surgeons (ASBrS), the American Urogynecologic Society (AUGS), and the Society of Gynecologic Surgeons (SGS). Providers reported level of comfort prescribing vaginal estrogen for urogenital symptoms for women with different categories of breast cancer and current treatment: estrogen receptor (ER) negative, ER positive no longer on endocrine therapy, and ER positive currently on adjuvant endocrine therapy.
Article Synopsis
- - The study aimed to assess how often women with a history of breast cancer on hormone therapy (HT) filled prescriptions for topical estrogens, analyzing variations by HT type and over time.
- - Researchers reviewed data from 2010-2015, focusing on women under 65 who were using tamoxifen, aromatase inhibitors, or other HTs; they found that only 3% filled any topical estrogen prescriptions within a year.
- - Results showed that women on aromatase inhibitors filled prescriptions more frequently (3.3%) compared to those on tamoxifen (2.4%), and there was a slight upward trend in fill rates over the study period.
A Cost Analysis of Icon Reusable Underwear Versus Disposable Pads for Mild to Moderate Urinary Incontinence.
Female Pelvic Med Reconstr Surg
September 2020
Objective: The objective of this study was to perform a cost analysis assessing the economic feasibility of reusable underwear as alternative for disposable pads for women with mild to moderate urinary incontinence.
Methods: A consumer-perspective cost analysis was performed with the following assumptions: (1) consumers have mild to moderate urinary incontinence and use 2 pads per day (PPD); (2) consumers have a 2-week supply of underwear; (3) there is no difference in laundering cost between 2 incontinence options; (4) there is no difference in use of labor/other accessories of care; (5) there is no difference in skin complaints/associated cost; (6) cost of products are nonfluctuant with time; and (7) all incontinence products were purchased online. Sensitivity analyses were performed varying the longevity of underwear, price of regular underwear, price of pads, pads used per day, and shipping and handling.
Article Synopsis
- Female pelvic medicine and reconstructive surgery has become a certified subspecialty for urologists and gynecologists, requiring a fellowship for those graduating after 2010.
- From 2010 to 2016, data shows a consistent increase in applicants for fellowship positions, particularly in obstetrics and gynecology, which outpaces the availability of roles in urology.
- The disparity in residency graduates leads to a much higher number of obstetrics/gynecology graduates competing for fellowship spots, emphasizing the need to encourage urologists to enter this field.
Article Synopsis
- - Women in the USA have a 12.6% lifetime risk of needing surgery for pelvic organ prolapse, with techniques evolving towards uterine conservation options like hysteropexy, instead of the more traditional hysterectomy.
- - Recent studies indicate that sacrospinous hysteropexy has similar success rates to vaginal hysterectomy while offering benefits like shorter hospital stays and quicker recovery times.
- - There is currently a lack of comprehensive randomized controlled trials comparing different hysteropexy methods, highlighting the need for more research into long-term outcomes, patient selection, and the effectiveness of various surgical approaches.
Article Synopsis
- The study aimed to compare the effectiveness of Icon™ reusable underwear and disposable pads for managing urinary incontinence, focusing on quality of life and product performance metrics.
- It involved a randomized trial with women experiencing mild to moderate urinary incontinence, assessing their experiences with both products over a week.
- Results showed no significant difference in quality of life scores between the two, but Icon™ underwear was rated better on various performance aspects, including comfort and fit.*
Objectives: Classically, radical cystectomy (RC) involves hysterectomy and bilateral salpingo-oophorectomy (BSO). Current understanding of ovarian cancer pathogenesis and effect of premature oophorectomy has lead to a shift within gynecology toward risk-reducing salpingectomy without oophorectomy in the absence of gynecologic malignancy. The purpose of this study was to assess knowledge base and practice patterns of urologic oncologists with regard to management of the gynecological organs at the time of RC.
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- - The study evaluates the effectiveness of the AdVance sling for men experiencing incontinence after prostate surgery, focusing on how adjuvant radiation therapy affects outcomes and patient satisfaction over time.
- - A total of 52 men underwent the procedure, with 18 having received radiation; significant improvements in incontinence scores and pad use were noted, with radiation-free men showing better outcomes.
- - While most patients reported satisfaction with the treatment at short and long-term follow-ups, those who had radiation therapy experienced lower satisfaction and less efficacy, particularly over extended follow-up periods.
Article Synopsis
- The study aimed to identify risk factors associated with microscopic hematuria (MH) in women, analyzing cases from 2010 to 2014 across multiple centers.
- Researchers reviewed 10 specific risk factors and compared 493 cases of women with MH to 501 control subjects.
- Significant risk factors for MH included current smoking, a history of pelvic radiation, and nephrolithiasis, while factors like vaginal atrophy and menopausal status were not linked to MH.
Utilizing Technology in Assessment of Lower Urinary Tract Symptoms: A Randomized Trial of Electronic Versus Paper Voiding Diaries.
Female Pelvic Med Reconstr Surg
November 2017
Article Synopsis
- The study compared a Web app called "BladderTrakHer" with a traditional paper voiding diary (PVD) to evaluate reliability and user satisfaction among women with lower urinary tract symptoms.
- Results showed good reliability for both methods, but patients recorded more entries in the PVD than in the electronic version.
- Interestingly, over half of the participants preferred the electronic version, while many practitioners found the PVD easier to interpret, yet favored the potential of an organized electronic format.
Article Synopsis
- This study aimed to assess the frequency of ureteral kinking during uterosacral ligament suspension (USLS) procedures and how it relates to the surgeon's training level.
- Out of 161 USLS procedures analyzed, 6.2% resulted in ureteral kinking, predominantly occurring with less experienced surgeons.
- Management of ureteral kinking increased surgery time by an average of 86 minutes, highlighting the need for improved training methods to mitigate this complication.
Pelvic Organ Prolapse---Vaginal and Laparoscopic Mesh: The Evidence.
Obstet Gynecol Clin North Am
March 2016
Article Synopsis
- The report reviews existing literature on the use of abdominal, laparoscopic, and transvaginal mesh for treating pelvic organ prolapse.
- It discusses both objective and subjective cure rates, as well as potential complications related to synthetic mesh use.
- The article emphasizes recent findings that help determine the most suitable situations for using synthetic mesh, but does not cover its use in repairing urinary incontinence.
Does Pelvic Organ Prolapse Quantification Examination D Point Predict Uterosacral Ligament Suspension Outcomes?
Female Pelvic Med Reconstr Surg
November 2017
Article Synopsis
- * It analyzed data from 125 women treated between 2008 and 2013, finding that 96% achieved apical success post-surgery, and that lower preoperative D point measurements were linked to better postoperative support.
- * A critical threshold for the D point was identified at -4.25, suggesting that this measurement can help predict who will achieve successful outcomes after the surgical procedure.
Article Synopsis
- The study examines young adults' knowledge about pelvic floor disorders (PFD) in women and erectile dysfunction (ED) in men, focusing on definitions, prevalence, causes, and treatments.
- The survey results showed that participants underestimated the prevalence of PFD compared to ED, with a notable lack of knowledge regarding pelvic organ prolapse (POP).
- Overall, men had better knowledge of ED than women, while education level and age positively correlated with familiarity about these conditions, highlighting a gap in awareness particularly for women regarding POP.
Uretero-Uterine Fistula: Delayed Presentation After Ureteral Reimplantation for Vesicoureteral Reflux.
Female Pelvic Med Reconstr Surg
April 2016
Article Synopsis
- - Primary cyclic hematuria at menstruation can indicate a fistula (abnormal connection) between reproductive structures and the urinary tract, often caused by congenital issues.
- - A case is discussed where a patient with a bicornuate uterus experienced cyclic hematuria starting at 14, linked to a fistula with the ureteral stump from childhood surgery.
- - Successful surgical repair of the fistula eliminated the hematuria, and the article also reviews relevant embroyology regarding this rare occurrence.
Article Synopsis
- This report reviews current literature on transvaginal mesh (TVM) used for treating pelvic organ prolapse, focusing on when it's used and how to handle complications.
- It highlights that most complications related to vaginal mesh are treated surgically and that many patients report pain relief after these interventions.
- Although the use of TVM has stabilized, there is a significant increase in the removal of synthetic mesh, with many patients needing multiple surgeries for relief.