Who Places High Value on the Uterus? A Cross-sectional Survey Study Evaluating Predictors for Uterine Preservation.

Study Objective: To determine predictors for placing high value on the uterus in patients who no longer desire fertility. The secondary objective was to identify reasons for placing high value on the uterus.

Design: Cross-sectional survey study.

Development and validation of the Value of Uterus instrument and visual analog scale to measure patients' valuation of their uterus.

Background: Currently, there are no clear frameworks or tools to objectively or subjectively evaluate patient attitudes toward uterine preservation and how they influence the decision to proceed with hysterectomy vs uterine preservation when undergoing prolapse surgery.

Objective: This study aimed to develop a reliable and valid instrument to measure patients' valuation of their uterus.

Study Design: The Value of Uterus instrument was developed on the basis of existing literature and created with structured patient-reported outcome measurement development methodology.

Risk Factors for Bladder Perforation at the Time of Retropubic Midurethral Sling Placement.

Importance: There is conflicting evidence regarding predictive factors for bladder perforation during retropubic midurethral sling (R-MUS) placement and lack of evidence to support adoption of techniques to minimize such injury.

Objectives: The aims of the study were to describe the incidence of and factors associated with bladder perforation during R-MUS placement and to explore whether retropubic hydrodissection decreases the likelihood of perforation.

Study Design: This is a case-control study of women undergoing R-MUS placement from 2007 to 2017.

Intermediate term outcomes after transvaginal uterine-preserving surgery in women with uterovaginal prolapse.

Introduction And Hypothesis: There is growing interest in and performance of uterine-preserving prolapse repairs. We hypothesized that there would be no difference in pelvic organ prolapse (POP) recurrence 2 years following transvaginal uterosacral ligament hysteropexy (USLH) and sacrospinous ligament hysteropexy (SSLH).

Methods: This is a retrospective cohort study with a cross-sectional survey of women who underwent transvaginal uterine-preserving POP surgery from May 2016 to December 2017.

A randomized controlled noninferiority trial of reduced vs routine opioid prescription after prolapse repair.

Background: Given the accelerating opioid crisis in the United States and evidence that patients use fewer opioid tablets than prescribed, surgeons may choose to decrease prescribed quantities. The effect this may have on patient satisfaction with pain control after hospital discharge is unknown.

Objective: The primary objective of this study was to compare patient satisfaction with postoperative pain control between patients receiving a routine or reduced quantity opioid prescription after prolapse repair.

Pelvic organ prolapse recurrence in young women undergoing vaginal and abdominal colpopexy.

Introduction And Hypothesis: While pelvic organ prolapse (POP) recurrence is believed to increase over time, outcomes of young women who undergo POP surgery are unclear. We hypothesized POP recurrence incidence among women <49 years would be higher after vaginal versus abdominal colpopexy.

Methods: This is a retrospective cohort study with a cross-sectional survey of women 18-49 years who underwent primary POP surgery from January 2003 to September 2013.

The Effect of Commonly Performed Exercises on the Levator Hiatus Area and the Length and Strength of Pelvic Floor Muscles in Postpartum Women.

Objective: The aim oft his study was to compare the effects of 10 common exercises to traditional pelvic floor muscle (PFM) contractions (Kegel) on levator hiatus (LH) area and PFM length and strength.

Methods: This is a cross-sectional study of 15 healthy postpartum women. Ten exercises were studied.

A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy.

Background: The incidence of temporary gluteal pain after sacrospinous ligament colpopexy ranges from 6.1% to 15.3%.

Surgical Anatomy of the Uterosacral Ligament Colpopexy.

Objective: The aim of this study was to describe the relationship of the uterosacral ligament (USL) to the ureter and rectum along a surgeon's target location for suture placement under conditions simulating live surgery.

Methods: Dissections were performed in 11 unembalmed female cadavers. Steps were taken to identify the USL simulating USL colpopexy.

Increasing Utilization of Minimally Invasive Hysterectomy.

Once the decision to perform a hysterectomy has been made, the type and route of hysterectomy must be chosen, and efforts made to accomplish the surgery as safely as possible. Hysterectomy can be performed vaginally, abdominally with laparoscopic or robotic assistance, or open. The main goal of gynecologic surgeons should be to lower the rate of open abdominal hysterectomy and increase use of both vaginal and laparoscopic hysterectomy in their patients.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) in Gynecology.

Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging field in minimally invasive surgery. NOTES can be performed via a variety of approaches, including through the stomach, esophagus, bladder, and rectum, but the majority of cases have been performed transvaginally. Potential advantages of natural orifice surgery in gynecology include the lack of abdominal incisions, less operative pain, shorter hospital stay, improved visibility, and the possibility to circumvent extensive lysis of adhesion to reach the pelvic cavity.

Entry into the peritoneal cavity in posthysterectomy prolapse: an educational video.

Introduction And Hypothesis: Entry into the peritoneal cavity can be challenging in patients with posthysterectomy prolapse; however, it is important for vaginal surgeons to be able to enter the peritoneal cavity using various techniques to perform an intraperitoneal vaginal vault suspension.

Methods: We present surgical footage of various methods of accessing the peritoneal cavity in posthysterectomy prolapse using posterior, anterior and apical approaches.

Results: This video highlights surgical techniques that can be used to enter the peritoneal cavity in posthysterectomy prolapse in a safe and reliable manner.

Long-Term Effectiveness of Uterosacral Colpopexy and Minimally Invasive Sacral Colpopexy for Treatment of Pelvic Organ Prolapse.

Objectives: The objective of this study was to estimate rates of recurrent pelvic organ prolapse (POP) 6 years after patients underwent transvaginal uterosacral colpopexy, or laparoscopic or robotic sacral colpopexy at a large tertiary care center. We hypothesized that recurrence rates would be higher than those previously reported.

Methods: This is a retrospective study of women who underwent uterosacral colpopexy, laparoscopic, and robotic sacral colpopexy for treatment of POP between 2006 and 2012.

Laparoscopic Burch Colposuspension Using a 3-Trocar System: Tips and Tricks.

Study Objective: To describe a technique for performing laparoscopic Burch colposuspension using a 3-trocar system.

Design: This educational video provides step-by-step instructions for performing a laparoscopic Burch colposuspension. This study was exempt from institutional review board approval.

Vaginal hysterectomy, vaginal salpingoophorectomy and uterosacral ligament colpopexy: a view from above (in English and Spanish).

Aim Of The Video: The aim of this video is to make vaginal hysterectomy (TVH), vaginal salpingoophorectomy and uterosacral ligament (USL) colpopexy approachable by showing the key procedural steps from both the vaginal and abdominal perspectives.

Methods: This production shows TVH with salpingoophorectomy and USL colpopexy that was performed on a cadaver and filmed simultaneously from the vaginal and abdominal views. The video begins with an anatomy overview from the open abdomen and proceeds with the TVH.

Ultrasound Evaluation of the Urethra and Bladder Neck Before and After Transurethral Bulking.

Objectives: The aims of the study were to describe ultrasound findings in women with stress urinary incontinence (SUI) after transurethral injection of Coaptite, to describe symptoms 3 months after injection, and to determine whether there was an association between degree of improvement and sonographic findings.

Methods: This is a prospective cohort study of women with SUI undergoing transurethral Coaptite injection. Subjects completed the Urinary Distress Inventory and Incontinence Severity Index preinjection and 3 months postinjection.

Perioperative adverse events associated with colpocleisis for uterovaginal and posthysterectomy vaginal vault prolapse.

Background: Colpocleisis, a vaginal obliterative procedure, offers women with symptomatic pelvic organ prolapse an effective, durable anatomic repair and is associated with high patient satisfaction rates. Historically, colpocleisis was reserved for the medically frail or elderly with the goal of limiting anesthetic exposure, decreasing operative time, and minimizing adverse events. Several colpocleisis and colpectomy procedures exist and limited evaluation has been performed comparing these differences in regards to perioperative adverse events.

Vaginal Apical Pain After Sacrocolpopexy in Absence of Vaginal Mesh Erosion: A Case Series.

Introduction: Sacrocolpopexy is one of the most effective surgeries to correct pelvic organ prolapse. Previous studies have described complications, such as mesh erosion and dyspareunia. However, there are few studies on the development of pelvic pain in the absence of mesh erosion in patients who have undergone sacrocolpopexy.

Ultrasound Evaluation of Midurethral Sling Position and Correlation to Physical Examination and Patient Symptoms.

Objective: The primary objective was to evaluate the position and angle variation between 3 different midurethral slings (MUSs) using 3-dimensional ultrasound (US) technology. The secondary objective was to compare differences in findings on physical examination and symptoms of incontinence and sexual dysfunction between subjects.

Methods: This was a cross-sectional study of 61 subjects who had undergone MUS placement without concomitant anterior or apical compartment prolapse surgery (21 retropubic [RP], 19 out-to-in transobturator [TOT], 21 in-to-out transobturator [TVT-O]).

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse.

Objective: We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates.

Study Design: This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data.

Small bowel surgery for the gynecologist specializing in benign disease.

Introduction: Adhesions are fibrous bands of scar tissue that are often a result of surgery. Adhesions of the bowel are a common finding during gynecologic procedures, and their presence can lead to injury.

Method: This video article demonstrates enterolysis and small-bowel surgery in women undergoing surgery for a benign gynecologic condition and found to have severe adhesive disease.

Gluteal and posterior thigh pain in the postoperative period and the need for intervention after sacrospinous ligament colpopexy.

Introduction: Sacrospinous ligament (SSL) colpopexy is a transvaginal surgical option for the treatment of vaginal apex prolapse. The objective of this study was to determine the rate of gluteal and posterior thigh pain after SSL colpopexy using the Capio device in the immediate postoperative period, at the 6-week postoperative visit, and to determine the risk of needing intervention for this type of pain.

Methods: This was a retrospective cohort study of women who underwent SSL colpopexy with the Capio device for the treatment of vaginal apex prolapse between 2007 and 2012.

Assessing intraoperative judgment using script concordance testing through the gynecology continuum of practice.

Objective: To measure surgical judgment across the Obstetrics and Gynecology (OBGYN) continuum of practice and identify factors that correlate with improved surgical judgment.

Methods: A 45-item written examination was developed using script concordance theory, which compares an examinee's responses to a series of "ill-defined" surgical scenarios to a reference panel of experts. The examination was administered to OBGYN residents, Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows, practicing OBGYN physicians and FPMRS experts.