Testosterone dose-response relationships in hysterectomized women with or without oophorectomy: effects on sexual function, body composition, muscle performance and physical function in a randomized trial.

Objective: This study aims to determine the dose-dependent effects of testosterone on sexual function, body composition, muscle performance, and physical function in hysterectomized women with or without oophorectomy.

Methods: Seventy-one postmenopausal women who previously underwent hysterectomy with or without oophorectomy and had total testosterone levels less than 31 ng/dL or free testosterone levels less than 3.5 pg/mL received a standardized transdermal estradiol regimen during the 12-week run-in period and were randomized to receive weekly intramuscular injections of placebo or 3, 6.

Modified approach to vaginal hysterectomy without initial colpotomy.

Purpose Of Review: To evaluate the surgical technique and outcomes of women undergoing the modified approach to vaginal hysterectomy at Harbor-University of California, Los Angeles Medical Center from 2000 to 2011. A retrospective chart review was performed of all vaginal hysterectomy cases performed using the modified technique.

Recent Findings: There is much evidence in favor of the safety of vaginal hysterectomy over other modes of hysterectomy, such as the lower overall incidence of vaginal cuff dehiscence, shorter hospital stays and faster recovery from surgery.

Urinary retention and voiding dysfunction in women with uterine leiomyoma: a case series.

Objective: To examine urinary retention as an underreported complication of uterine leiomyoma. Reproductive-aged women with uterine leiomyoma often describe pelvic pressure and menorrhagia, however few complain of complete urinary retention.

Study Design: We dis-cuss the cases of 8 women who presented to our emergency room with acute urinary retention over a 4-year period.

Development of stem cell therapy for stress urinary incontinence.

Purpose Of Review: In recent years, stem cell therapy has been investigated as a promising approach for the treatment of stress urinary incontinence (SUI). This article reviews the biology of stem cells and their applications as a cell-based treatment for SUI. The current status and future direction of this forefront research in urinary incontinence are also examined.

Improving resident screening and workup of urinary incontinence in an OB/GYN residency program: a randomized controlled study.

Objectives: : With an aging US population, an increased prevalence of urinary incontinence, rising health care costs, and a disease that remains largely unidentified, there is an immediate need to train physicians to screen for and treat incontinence. We aim to evaluate resident physician screening of urinary incontinence with a chart-based review.

Methods: : This study entailed 2 parts: a retrospective chart review (part 1) and a prospective randomized trial (part 2).

Sacrospinous ligament fixation for pelvic organ prolapse in the era of vaginal mesh kits.

Purpose Of Review: To examine the sacrospinous ligament as a point of attachment for pelvic organ prolapse procedures, including vaginal mesh kits.

Recent Findings: Pelvic surgeons are increasingly employing the sacrospinous ligament as a point of attachment for biologic grafts and synthetic mesh kits during uterovaginal prolapse repairs. These techniques may have introduced a novel set of complications (mesh extrusion, erosion) in addition to those already known to occur in traditional sacrospinous ligament fixations.

Uterosacral ligament vaginal vault suspension using delayed absorbable monofilament suture.

Introduction And Hypothesis: We investigated the incidence of suture complications and recurrent prolapse following uterosacral ligament suspension (USLS) using delayed absorbable polyglyconate monofilament suture (Maxon).

Methods: We reviewed the medical records of subjects who underwent vaginal USLS using polyglyconate suture. Primary outcomes were suture complications and anatomic failures defined as recurrent apical prolapse stage 1 or greater.

Suture complications in a teaching institution among patients undergoing uterosacral ligament suspension with permanent braided suture.

Introduction And Hypothesis: Our study aimed to identify the rate of suture complications over a 5-year period using braided permanent suture for uterosacral ligament suspension (USLS) surgery.

Methods: We reviewed the medical records of patients who underwent vaginal uterosacral ligament suspensions using braided polyester suture. Outcome measures included rate and timing of suture complications, patient symptoms post-operatively, efficacy of treatment modalities and surgical success.

Stimulating vaginal repair in rats through skeletal muscle-derived stem cells seeded on small intestinal submucosal scaffolds.

Objectives: Grafts are used for vaginal repair after prolapse, but their use to carry stem cells to regenerate vaginal tissue has not been reported. In this study, we investigated whether 1) muscle-derived stem cells (MDSC) grown on small intestinal submucosa (SIS) generate smooth-muscle cells (SMC) in vitro and upon implantation in a rat model of vaginal defects; 2) express markers applicable to the in-vivo detection of vaginal endogenous stem cells; and 3) stimulate the repair of the vagina.

Methods: Mouse MDSC grown on monolayer, SIS, or polymeric mesh, were tested for cell differentiation by immunocytochemistry, Western blot and real-time polymerase chain reaction (PCR).

Impact of urodynamic based incontinence diagnosis on quality of life in women.

Aims: To characterize the effect of urodynamic diagnosis on degree of incontinence related bother and health related quality of life in a large, multi-ethnic population of women.

Methods: Effects of multichannel urodynamic diagnosis, urethral competency, and other patient characteristics on abbreviated Urogenital Distress Inventory (UDI6) and Incontinence Impact Questionnaire (IIQ7) composite scores were analyzed retrospectively.

Results: Six hundred eleven patients were included.

Update on the utilization of grafts in pelvic reconstruction surgeries.

Purpose Of Review: Implanted grafts are increasingly used by pelvic reconstructive surgeons and gynecologists. In addition, the marketing of a variety of grafts has been aggressively expanded without scientific evidence to support their use. This review aims to provide an update of the current status and role of grafts in reconstructive pelvic surgery and to review the current knowledge of the biology of currently marketed synthetic and biologic grafts.

Lower urinary tract dysfunctions in women with diabetes mellitus.

Purpose Of Review: This review discusses published data of the recent advances in understanding lower urinary tract dysfunctions in women with diabetes mellitus.

Recent Findings: Many studies have shown a relationship between diabetes mellitus and lower urinary tract dysfunctions. Although the pathophysiology of these disorders is multifactorial, microvascular damage and neuropathy causing dysfunctions of smooth muscle, urothelium, and neuronal components in the lower urinary tract are the most likely etiologies.

Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse.

Synthetic mesh augmentations for pelvic floor reconstructive surgeries are increasing in usage and popularity. Many studies are focusing on the anatomical success rates of transvaginal anterior compartment repairs with synthetic mesh, with minimal attention on its postoperative complications. We present a case report on a 59-year-old postmenopausal woman who underwent an anterior repair with 6x4-cm polypropylene mesh.

Tension-free transobturator tape procedure for stress urinary incontinence.

Purpose Of Review: Recent data on the tension-free transobturator tape procedure for the treatment of female stress urinary incontinence are reviewed.

Recent Findings: Although long-term data are not available, the effectiveness and safety of the tension-free transobturator tape procedure as reported during the past 5 years are very promising and this procedure is becoming a popular surgical treatment for female stress urinary incontinence. The continence rates obtained have been similar to those obtained using the retropubic tension-free vaginal tape on short-term follow-up.

A review of laparoscopic uterine suspension procedures for uterine preservation.

Purpose Of Review: The most appropriate surgical approach for uterine preservation still remains the subject of ongoing controversy. Uterine suspension procedures can be performed abdominally, vaginally, or laparoscopically. This article focuses on the three different laparoscopic approaches of uterine suspension for uterine preservation: suspension to the round ligaments; suspension to the uterosacral ligaments; and suspension to the anterior ligament of the sacral promontory.

Reevaluating occult incontinence.

Purpose Of Review: Occult incontinence is a controversial subject without significant exposure in the literature. Conventionally, it has been assumed to be a marker for increased risk of postoperative stress urinary incontinence (POSUI) after repair of pelvic organ prolapse. The controversy surrounds the performance of prophylactic incontinence procedures based on this assumption.

Intravesical injection of botulinum toxin for the treatment of overactive bladder.

Purpose Of Review: In recent years, botulinum toxin has been investigated for the treatment of various types of lower urinary tract dysfunctions. This review discusses recently published data related to the therapeutic applications of botulinum toxin in overactive bladder as well as the effects of repeated doses, cross-reactivity between different serotypes, and side effects of the toxin injection into the detrusor muscle.

Recent Findings: Botulinum toxin A has been employed initially in the treatment of neurogenic detrusor overactivity in spinal cord injured patients.

Newer pharmacologic options in management of overactive bladder syndrome.

Purpose Of Review: Urinary incontinence is an under-reported epidemic that currently affects an estimated 13 million people in the United States, of whom about 11 million are women, according to the National Institute of Diabetes and Digestive and Kidney Diseases (Publication No. 02-4132). Because many patients are unaware of curative options and perceive it to be an inevitable outcome of advancing age, they fail to report their symptoms and increase their risk of developing associated co-morbid disease.

Physiologic role of nitric oxide and nitric oxide synthase in female lower urinary tract.

Purpose Of Review: In recent years nitric oxide (NO) has gained increasing recognition as an important neurotransmitter and cell signaling molecule with a broad range of functions in the lower urinary tract. This review discusses recently published data related to the physiologic and pathophysiologic roles of NO and nitric oxide synthase (NOS) in the female lower urinary tract.

Recent Findings: Expression of three isoforms of NOS, namely endothelial NOS, neuronal NOS and inducible NOS, has been identified in various tissues of the lower urinary tract in animals and humans.

Anabolic effects of androgens on muscles of female pelvic floor and lower urinary tract.

Purpose Of Review: This review discusses recently published data concerning the anabolic effects of androgens on muscle and the mechanism by which testosterone regulates body composition with special emphasis on the anabolic effects of androgens on the muscles of the pelvic floor and lower urinary tract.

Recent Findings: Androgens have direct anabolic effects on skeletal muscle. Testosterone increases lean body mass and decreases fat mass in a dose- and concentration-dependent fashion.

Urinary incontinence: newer pharmacotherapeutic trends.

Purpose Of Review: Urinary incontinence is an under-reported epidemic with profound effects on quality of life. With recent pharmacologic advances, the belief that incontinence is an inevitable part of aging should be abandoned. Because many patients are unaware of curative options, they fail to report their symptoms and increase their risk of developing associated comorbid disease.