Publications by authors named "Meriwether K"
Chronic pelvic pain (CPP) is a medically complex, multifaceted gynecological condition associated with psychological comorbidities and sexual trauma among women. Low rates of positive treatment outcomes underscore the need to better understand complex relationships between CPP, trauma exposure, and the psychosocial context of patients' lives. We conducted a secondary analysis of English and Spanish qualitative interviews with female-identity patients (N = 48) about CPP's impact on psychosocial well-being.
View Article and Find Full Text PDFObjective: To investigate whether yoga and meditation added to usual care improves treatment response in women with interstitial cystitis-bladder pain syndrome.
Methods: This randomized trial compared women with interstitial cystitis-bladder pain syndrome receiving standard care alone (control group) with those receiving standard care plus meditation and yoga (mind-body group). Standard care was defined as behavioral changes or medications recommended by the American Urological Association.
Article Synopsis
- Urinary incontinence can prevent women from being physically active, and midurethral sling (MUS) treatment has been shown to improve symptoms, possibly leading to increased activity levels.
- This study aimed to analyze changes in physical activity, measured through caloric expenditure, in women after receiving an MUS for stress urinary incontinence (SUI).
- Results showed a significant increase in mean caloric daily expenditure post-surgery, indicating that MUS treatment correlates with heightened physical activity.
Importance: The optimal surgical repair of vaginal vault prolapse after hysterectomy remains undetermined.
Objective: To compare the efficacy and safety of 3 surgical approaches for vaginal vault prolapse after hysterectomy.
Design, Setting, And Participants: This was a multisite, 3-arm, superiority and noninferiority randomized clinical trial.
We aimed to describe obstetrics and gynecology (OBGYN) trainees' anticipation of how the U.S. Supreme Court decision may affect their training.
View Article and Find Full Text PDFObjective: To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures.
Data Sources: We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022.
Objective: To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes.
Data Sources: PubMed and EMBASE were searched from inception through September 9, 2022.
Methods Of Study Selection: This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck-vaginal fistula).
Uterosacral ligament suspension for repair of prolapse has some challenges, such as visualization in the vagina, choice of suture, and avoidance of dangers such as ureteral kinking. This editorial offers some tips for performing a uterosacral suspension that are commonly discussed "at the scrub sink" before a case.
View Article and Find Full Text PDFObjective: To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications.
Data Sources: PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022.
Importance: Women with interstitial cystitis/bladder pain syndrome (ICBPS) face isolation and treatment challenges. Group medical visits using Centering models have successfully treated other conditions but have not been explored in ICBPS.
Objective: This study aimed to describe ICBPS pain and symptom control comparing standard treatment alone versus standard treatment augmented with Centering visits.
Postoperative Urinary Retention.
Urogynecology (Phila)
April 2023
Article Synopsis
- * A modified Delphi process was used to evaluate and reach consensus on 37 statements related to POUR, which were informed by a structured literature search.
- * Out of the original 37 statements, 34 achieved consensus across six categories including incidence, medications, and patient factors, while 3 statements were excluded.
Article Synopsis
- - Patients who undergo pelvic reconstructive surgery place significant importance on receiving guidance from surgeons about returning to sexual activity post-surgery.
- - A study analyzed counseling practices among surgeons and identified six major themes, including the safety of intercourse, specific suggestions for enhanced experiences, and potential surgical complications.
- - Overall, while surgeons typically reassure patients about safety, they tend to highlight that sexual experiences might be different or worse than before surgery, with less emphasis on potential improvements.
Article Synopsis
- Following standardized preoperative education and shared decision-making can improve postoperative narcotic practices for patients undergoing urogynecologic surgery.
- The study involved 174 women and compared two groups: one receiving standard preoperative education and another receiving patient-centered education, allowing them to choose their narcotic prescriptions.
- Results showed the patient-centered group had fewer narcotics prescribed and unused, but overall narcotic consumption and patient satisfaction levels were similar between both groups.
Objective: To conduct a systematic review to evaluate the effect of procedural interventions for leiomyomas on pelvic floor symptoms.
Data Sources: PubMed, EMBASE, and ClinicalTrials.gov were searched from inception to January 12, 2023, searching for leiomyoma procedures and pelvic floor disorders and symptoms, restricted to primary study designs in humans.
Background: Female sexual function has been shown to improve with overactive bladder (OAB) treatment.
Aim: The objective of this study was to evaluate the effects of anticholinergics (ACHs) or a beta-agonist (BAG) on female sexual function.
Methods: This was a prospective multicenter cohort study.
Article Synopsis
- The study aimed to evaluate how much opioid medication patients take and the frequency of ongoing opioid use after undergoing gynecologic surgery for non-cancerous reasons.
- Researchers analyzed data from 36 studies, finding that average opioid use after surgery varied significantly by the type of procedure, with higher consumption reported after abdominal hysterectomy.
- Persistent opioid use occurred in roughly 4.4% of patients, but results were inconsistent due to differences in study populations and how outcomes were defined.
Article Synopsis
- The study focused on understanding factors linked to increased estimated blood loss (EBL) and the need for transfusion during gynecologic surgeries at a tertiary medical center, specifically excluding malignancy and obstetrical cases.
- A total of 975 surgical procedures were analyzed, with findings showing that median EBL was low (50 mL), but increased surgical duration led to higher blood loss, particularly in open surgeries, which had a transfusion rate of 13% compared to other methods.
- Key risk factors for needing a transfusion included arterial line placement and additional IVs, while vaginal and urogynecologic surgeries were found to significantly lower the risk of requiring a transfusion.
Study Objective: Female patients with chronic pelvic pain (CPP) face complicated healthcare journeys, but narrative perspectives on CPP treatment are lacking.
Design: We collected data in English and Spanish from discussion groups and individual interviews with stakeholders around female CPP.
Setting: A tertiary care center for gynecologic care.
Importance: Women with interstitial cystitis/bladder pain syndrome (ICBPS) face challenging treatment and feelings of isolation. Centering models of group medical visits have been successful in other spheres but have not been explored in ICBPS therapy.
Objective: We sought to describe opinions of women with ICBPS regarding Centering visits, including advantages, experience, and barriers to participation and efficacy.
Objective: To evaluate the effect of simulation training vs traditional hands-on surgical instruction on learner operative skills and patient outcomes in gynecologic surgeries.
Data Sources: PubMed, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from inception to January 12, 2021.
Midurethral Sling Removal or Revision in Women with Chronic Pain.
Female Pelvic Med Reconstr Surg
May 2022
Objectives: The objectives of this study are (1) to estimate the incidence of midurethral sling revision/removal in women with preexisting pain diagnoses versus those without these diagnoses and (2) to describe associations between numbers and type of pain diagnoses with revision/removal.
Methods: Women who underwent midurethral sling surgery between 2009 through 2014 were identified in the MarketScan database and tracked and December 31, 2014. Patients with preoperative chronic pain diagnoses (fibromyalgia, endometriosis, irritable bowel, dyspareunia, low back pain, temporomandibular joint syndrome, interstitial cystitis, pelvic/perineal pain) were compared with controls (those without these diagnoses) regarding mesh sling revision/removal.
Article Synopsis
- The study aimed to determine whether midurethral sling mesh should be partially or totally removed in case of complications.
- A systematic review and meta-analysis of 45 studies found that partial mesh removal resulted in lower rates of postoperative stress urinary incontinence (SUI) compared to total removal.
- Both methods showed similar outcomes in terms of pain, bladder obstruction, and other symptoms, with infrequent adverse events reported.
Background: Although povidone-iodine (iodine) is the only Food and Drug Administration-approved vaginal antiseptic solution, there is a lack of comparative data evaluating alternatives. Chlorhexidine gluconate is readily accessible, recommended by multiple societies as an alternative for patients with iodine allergy, and preliminary data indicate that it may provide superior antisepsis.
Objective: This study aimed to compare the effectiveness of chlorhexidine and iodine as presurgical vaginal antiseptic solutions in preventing the most common surgery-associated infection after gynecologic surgery, urinary tract infections.
Preferences for Preoperative Education: A Qualitative Study of the Patient Perspective.
Female Pelvic Med Reconstr Surg
October 2021
Article Synopsis
- * Researchers conducted focus groups with English- and Spanish-speaking patients to gather their views on preoperative education and pain management, analyzing the discussions for common themes.
- * Five key themes emerged that patients wanted to know, including surgery preparation, pain control expectations, activity restrictions post-surgery, communication with the healthcare team, and overall care experiences.
Article Synopsis
- - The study examined how race and ethnicity reporting is handled in federally funded research related to pelvic floor disorders, focusing on work published by a specific health institute from 2003 to 2020.
- - Out of 111 relevant publications, 81% reported on race and 50% on ethnicity, with all primary trials addressing race and most also covering ethnicity.
- - A notable finding was that many publications limited their race categories to just "White," "Black," and "Other," indicating a lack of diverse racial representation in the data.