Racial Differences in the Levator Ani Muscle and Levator Hiatus in Individuals of Reproductive Age.

Background: Most studies on pelvic floor muscle morphology (dimensions, shape) and its relationship with patient characteristic risk factors of pelvic floor dysfunction (demographics, medical history) have largely pertained to White individuals with vaginas. There is a need to establish normative data on pelvic floor muscle anatomy and identify morphological differences in racially diverse cohorts that may play a role in racial differences in the prevalence and pathophysiology of pelvic floor dysfunction.

Objective: (s): This study aimed to compare levator ani muscle thickness and levator hiatal morphology and their association with patient characteristics, between asymptomatic Black and White women-identifying individuals with a vagina of reproductive age.

Perioperative Opioid Use in Urogynecologic Mesh Removal.

Importance: Forty percent of patients with urogynecologic mesh pain complications are taking narcotics.

Objectives: We aimed to compare comorbidities and pain scores between patients with and without narcotic use and assess postoperative narcotic use rates.

Study Design: This was a secondary analysis of a prospective cohort study of patients undergoing urogynecologic mesh removal.

Green Cystoscopy: Does Minimizing the Use of Drapes Increase Infection Rates?

Importance: The U.S. health care system has an enormous carbon footprint made worse by the escalating use of single-use supplies.

Vaginal host response to polycarbonate urethane, an alternative material for the repair of pelvic organ prolapse.

Complications following surgical repair of pelvic organ prolapse (POP) with polypropylene mesh (PPM) are common. Recent data attributes complications, in part, to stiffness mismatches between the vagina and PPM. We developed a 3D printed elastomeric membrane (EM) from a softer polymer, polycarbonate urethane (PCU).

Apical Suspension Repair for Vaginal Vault Prolapse: A Randomized Clinical Trial.

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.

Patient perspectives in adverse event reporting after vaginal apical prolapse surgery.

Background: Many clinical trials use systematic methodology to monitor adverse events and determine grade (severity), expectedness, and relatedness to treatments as determined by clinicians. However, patient perspectives are often not included in this process.

Objective: This study aimed to compare clinician vs patient grading of adverse event severity in a urogynecologic surgical trial.

Regenerative Medicine in Gynecology.

The female reproductive tract undergoes dynamic changes across the life span. Congenital abnormalities, life events, and medical interventions can negatively affect the structure and function of reproductive tract organs, resulting in lifelong sequelae. The objective of regenerative gynecology is to discover and promote endogenous mechanisms by which a healthy tissue maintains overall tissue integrity after injury, after disease, or with age.

Dysregulated inflammatory response to urogynecologic meshes in women with diabetes and its implications.

Background: Diabetes is an independent risk factor for mesh complications in women undergoing mesh-augmented surgical repairs of stress urinary incontinence and/or pelvic organ prolapse. The underlying mechanism remains unclear.

Objective: This study aimed to define the diabetes-associated alterations in the host inflammatory response to mesh and correlate them with perioperative glucose management.

Management of mixed urinary incontinence: IUGA committee opinion.

Introduction And Hypothesis: Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI.

Dysregulated wound healing in the pathogenesis of urogynecologic mesh complications.

To test the hypothesis that dysregulated wound healing is associated with Urogynecologic mesh complications, we collected vaginal cell secretions using vaginal swabs after polypropylene mesh implantation in patients with (N = 39) and without (N = 40) complication. A customized multiplex immunoassay measured markers of inflammation (MCP-1, IGFBP-1, IL-2, IL-10, IL-17, PDGF-BB, bFGF, IL-1b, IL-6, IL-12p70, TNF-α), neuroinflammation (IL-1RA, TGF-β, IL-15, IL-18, IL-3, M-CSF), angiogenesis (VEGF), and matrix proteins (fibronectin, tenasin c, thrombospondin-2, lumican) between groups. Patients with complications were younger, heavier, implanted with mesh longer, and more likely to be ever smokers.

Sacrum and Coccyx Shape Changes During Pregnancy and After Delivery.

Remodeling of the sacrum and coccyx to accommodate pregnancy and delivery has been hypothesized but not directly quantified. This study aimed to quantify the remodeling of the sacrum and coccyx by comparing midsagittal lengths, angles, curvature, and shape between nulliparous, pregnant, and parous women using both 2 and 3 dimensional measures. Ninety pelvic magnetic resonance images of the pelvis were retrospectively collected and segmented.

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study.

Objective: To identify vaginal morphology and position factors associated with prolapse recurrence following vaginal surgery.

Design: Secondary analysis of magnetic resonance images (MRI) of the Defining Mechanisms of Anterior Vaginal Wall Descent cross-sectional study.

Setting: Eight clinical sites in the US Pelvic Floor Disorders Network.

The Use of Disposable Supplies: Measuring Suburethral Sling Surgical Waste by Cost and Weight.

Importance: The health care industry is a leading contributor to solid waste in the United States, and two thirds of a hospital's regulated medical waste is produced from surgery.

Objective: The primary objective was to assess the utilization of single-use disposable supplies during suburethral sling cases.

Study Design: We observed suburethral sling plus cystoscopy procedures at an academic medical center.

Deformation and Durability of Soft Three-Dimensional-Printed Polycarbonate Urethane Porous Membranes for Potential Use in Pelvic Organ Prolapse.

Pelvic organ prolapse (POP) is the herniation of the pelvic organs into the vaginal space, resulting in the feeling of a bulge and organ dysfunction. Treatment of POP often involves repositioning the organs using a polypropylene mesh, which has recently been found to have relatively high rates of complications. Complications have been shown to be related to stiffness mismatches between the vagina and polypropylene, and unstable knit patterns resulting in mesh deformations with mechanical loading.

Going green in gynecology: a call to action.

The climate change crisis poses a central threat to public health. The health outcomes of this crisis are well known, but lesser known to medical professionals is the role that healthcare delivery plays in worsening this crisis. The United States healthcare system is responsible for producing 10% of the total greenhouse gases.

Morphological Variation in the Pelvic Floor Muscle Complex of Nulliparous, Pregnant, and Parous Women.

Specific levator ani muscle imaging measures change with pregnancy and vaginal parity, though entire pelvic floor muscle complex (PFMC) shape variation related to pregnancy-induced and postpartum remodeling has never been quantified. We used statistical shape modeling to compute the 3D variation in PFMC morphology of reproductive-aged nulliparous, late pregnant, and parous women. Pelvic magnetic resonance images were collected retrospectively and PFMCs were segmented.

Reducing pelvic floor injury by induction of labor.

Introduction And Hypothesis: We hypothesized that elective induction of labor (eIOL) at 39 weeks is protective of levator ani muscle injury (LAMI) and is associated with decreased pelvic symptoms at 6 weeks postpartum compared to expectant management of labor.

Methods: Prospective cohort pilot study of uncomplicated, primiparous women with a singleton, vertex gestation enrolled immediately post-vaginal delivery (VD). Subjects were dichotomized into two groups based on labor management: eIOL without complication defined by the ARRIVE trial versus spontaneous VD between 39 weeks and 42 weeks or no indication for IOL prior to 40 weeks.

Mesh deformation: A mechanism underlying polypropylene prolapse mesh complications in vivo.

Polypropylene meshes used in pelvic organ prolapse (POP) repair are hampered by complications. Most POP meshes are highly unstable after tensioning ex vivo, as evidenced by marked deformations (pore collapse and wrinkling) that result in altered structural properties and material burden. By intentionally introducing collapsed pores and wrinkles into a mesh that normally has open pores and remains relatively flat after implantation, we reproduce mesh complications in vivo.