The Impact of Preoperative Pain on Outcomes After Vaginal Reconstructive Surgery and Perioperative Pelvic Floor Muscle Training.

Importance: The impact of preoperative pain on outcomes can guide counseling.

Objective: The objective of this study was to compare outcomes after vaginal reconstructive surgery and pelvic muscle training between women with and without preoperative pain.

Study Design: This is a secondary analysis of the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, which randomized patients to a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (pelvic floor muscle training vs usual care).

Host inflammatory response in women with vaginal epithelial abnormalities after pessary use.

Background: Vaginal epithelial abnormalities (VEA) are a common complication associated with pessary use. The objective of this study was to determine if there is a host pro-inflammatory response associated with pessary use and VEA.

Methods: Patients wearing pessaries for at least two weeks for the management of pelvic organ prolapse and/or urinary incontinence were screened for eligibility.

The impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery.

Background: Pelvic pain is a debilitating condition that is common among women with pelvic floor disorders. Limited information is known about the impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery.

Objective: This study aimed to compare the outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain.

Relationship Between Maternal Age at First Delivery and Subsequent Pelvic Organ Prolapse.

Objective: To determine the relationship between age at first delivery and subsequent risk of pelvic organ prolapse.

Study Design: We performed a retrospective cross-sectional study using the National Health and Nutrition Examination Survey data from 2005 to 2012. Our primary outcome was self-reported prolapse.

Predictors of delayed postoperative urinary retention after female pelvic reconstructive surgery.

Introduction And Hypothesis: Risk factors can be used to determine what patients will develop delayed postoperative urinary retention after female pelvic reconstructive surgery.

Methods: A case-control study was performed including all female pelvic reconstructive surgeries necessitating a voiding trial. All patients passed their previous voiding trial.

Perioperative Adverse Events for Stress Urinary Incontinence Surgery: A National Analysis.

Objective: The aim of the study was to compare perioperative morbidity of stress urinary incontinence surgery using data from a nationwide cohort.

Methods: This is a retrospective cohort study of the American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2016. Stress urinary incontinence surgery was defined using current procedural terminology (CPT) for abdominal retropubic colposuspension (CPT 51840, 51841), laparoscopic retropubic colposuspension (CPT 51990, 51992), and suburethral sling (CPT 57288).

Timing of Office-Based Pessary Care: A Randomized Controlled Trial.

Objective: To evaluate the influence of pessary visit intervals on development of vaginal epithelial abnormalities.

Methods: We conducted a randomized, noninferiority trial of office-based pessary care. Eligible participants were adult women wearing a ring, Gellhorn, or incontinence dish pessary to treat pelvic organ prolapse or incontinence or both.

Suburethral sling procedures in the United States: complications, readmission, and reoperation.

Introduction And Hypothesis: Hospital readmission is increasingly used as a measure of quality care. Our objective was to evaluate the rate of readmission and associated factors in women undergoing suburethral sling placement in the USA.

Methods: This is a cohort study of suburethral sling procedures performed in the USA from 2012 to 2014 using the American College of Surgeons' National Surgical Quality Improvement Program database.

Transdermal Scopolamine and Acute Postoperative Urinary Retention in Pelvic Reconstructive Surgery.

Objective: To evaluate the relationship between perioperative use of transdermal scopolamine and the rate of urinary retention after stress urinary incontinence and pelvic organ prolapse procedures in women.

Methods: This is a retrospective, cohort study; the primary outcome is the rate of acute postoperative urinary retention. Study candidates were adult female patients who underwent pelvic reconstructive surgery at a tertiary care center.

Advanced pelvic organ prolapse and routine health screening.

Objective: To evaluate whether patients with advanced pelvic-organ prolapse (POP) were less likely than controls to obtain screening Papanicolaou (Pap) test, mammography, and colonoscopy.

Study Design: Records were reviewed from 7/2/2010 through 4/22/2011. We identified patients with advanced POP, defined as prolapse > or = 4 cm beyond the hymenal ring, and made age- and parity-matched controls from patients whose prolapse was <4 cm.

A comparison of shoulder pressure among different patient stabilization techniques.

Objective: The purpose of this study was to evaluate the pressure placed on the shoulders as a function of varying degrees of head-down tilt (the Trendelenburg position) and to compare these pressures among 3 different patient-positioning systems.

Study Design: Participants were placed in the dorsal-lithotomy position with arms tucked and tilted at 5, 10, 15, 20, 25, and 30 degrees of head-down tilt. Using a manometer, we measured the pressure (centimeters of water) on the shoulders at each angle for 3 support devices: the Skytron shoulder support (Skytron, Grand Rapids, MI), the Allen shoulder support (Allen Medical Systems, Acton, MA), and the Allen Hug-u-Vac.

Socioeconomic status and race as predictors of treatment-seeking behavior for pelvic organ prolapse.

Objective: We sought to evaluate the prevalence of pelvic organ prolapse (POP) among a diverse group of women and to determine if race/ethnicity and/or socioeconomic status (SES) are factors in treatment-seeking behavior.

Study Design: All data were collected from the National Institutes of Health-supported Boston Area Community Health Survey. SES was calculated by a 2-factor index that combined household income with years of education.

Surgeon activity in robotic versus abdominal gynecologic surgery.

One proposed advantage of robotic surgery is improved ergonomics and decreased surgeon fatigue. The objective of this study is to quantify and compare the physical activity of surgeons during robotic and abdominal surgery using accelerometers. Eight gynecologic surgeons who perform both abdominal and robotic surgery were the subjects of this study.

Abdominal extraperitoneal excision of a foreign body in the pararectal space.

Permanent suture material and synthetic grafts can be used as part of pelvic organ prolapse surgery. These materials are often attached to the sacrospinous ligament or passed in retroperitoneal spaces. There is a risk for erosion and granulation tissue formation with any of these materials.

Effect of surgical approach on physical activity and pain control after sacral colpopexy.

Objective: We sought to compare recovery of activity and pain control after robotic (ROB) vs abdominal (ABD) sacral colpopexy.

Study Design: Women undergoing ROB and ABD sacral colpopexy wore accelerometers for 7 days preoperatively and the first 10 days postoperatively. They completed postoperative pain diaries and Short Form-36 questionnaires before and after surgery.

Complex sacral abscess 8 years after abdominal sacral colpopexy.

Background: Sacral colpopexy is an effective, durable repair for women with apical vaginal or uterovaginal prolapse. There are few reports of serious complications diagnosed in the remote postoperative period.

Case: A 74-year-old woman presented 8 years after undergoing posthysterectomy abdominal sacral colpopexy using polypropylene mesh.

Characteristics of nulliparous women who would consider cesarean delivery on maternal request.

Introduction/hypothesis: To identify factors that influence nulliparous women to choose cesarean delivery on maternal request (CDMR).

Methods: Nulliparous women at > or = 34 weeks completed a 76-item survey about concerns during labor, delivery and postpartum.

Results: Mean age of the 294 respondents was 28.

Is Burch or mid-urethral sling better with abdominal sacral colpopexy?

Introduction And Hypothesis: This study aims to compare the post-operative rates of stress urinary incontinence (SUI) after abdominal sacral colpopexy (ASC) with either Burch or mid-urethral sling, tension-free vaginal tape (TVT), or no anti-incontinence procedure. The null hypothesis was there would be no difference in SUI among groups.

Methods: A cohort of women who had undergone ASC (n = 150) either alone or with an anti-continence procedure were analyzed to determine the rates of post-operative SUI.

Difference in quality of life in women with urge urinary incontinence compared to women with stress urinary incontinence.

Introduction: We evaluated whether women with urge urinary incontinence (UUI) have lower quality of life (QOL) than women with other forms of urinary incontinence.

Methods: Patients completed three validated questionnaires when presenting for evaluation at a urogynecology practice and were divided into four groups based on their responses: those with symptoms of stress urinary incontinence (SUI), UUI, both SUI and UUI (mixed UI), and neither SUI nor UUI (controls).

Results: A total of 465 women were included: 53 women with UUI (11.

A comparison of costs for abdominal, laparoscopic, and robot-assisted sacral colpopexy.

The aim of this study was to compare the short-term estimated hospital costs and charges for open, laparoscopic, and robot-assisted sacral colpopexy. The null hypothesis was that there would be no difference in costs and charges. Fifteen comparable cases were reviewed for demographics, surgical information, and estimated hospital charges and costs and then compared with analysis of variance.

Is there a relationship between glomerular filtration rate and detrusor overactivity in women?

Aims: The relationship of detrusor overactivity (DO) to neuromuscular causes is well established, but a connection to kidney function has not yet been studied. We sought to evaluate whether patients with DO have differences in estimated glomerular filtration rate (eGFR).

Methods: After Institutional Review Board approval, we collected data from all patients who underwent urodynamic testing in our office from September 1, 2006 to February 28, 2007 and calculated eGFR using the equation derived from the Modification of Diet in Renal Disease (MDRD) study.

Patterns of telephone calls triaged by registered nurses in a urogynecology practice.

The volume and time required to manage a nurse telephone triage line in an urogynecology practice can be a concern for staffing, time management, and office patient flow. Therefore, telephone triage logs were retrospectively reviewed for a 12-month period to investigate whether call volume differed on days of the five-day office work week. Results showed Monday to be the busiest telephone triage day, with an average of 32.

Vesicovaginal fistula repair without intentional cystotomy using the laparoscopic robotic approach: a case report.

Background And Objectives: Fistulas inaccessible from the vagina may require abdominal repair; we sought to evaluate the robotic-assisted laparoscopic approach for this procedure.

Methods: A 41-year-old nulliparous woman presented with urinary incontinence following an abdominal hysterectomy, and office evaluation identified a vesicovaginal fistula. After discussion with the patient regarding the surgical options, the robotic approach was chosen to facilitate precise dissection, fine visualization, and suturing.

Can community-dwelling women reliably identify infected urine?

The purpose of this study was to evaluate whether community-dwelling women can reliably identify infected urine samples. A convenience sample of 25 women judged six urine samples. Of these, two were normal, two contained culture-proven infections, and two were intentionally abnormal because of ingestion of asparagus or vitamins.

Anterior vaginal wall prolapse and voiding dysfunction in urogynecology patients.

We investigated whether women with and without anterior vaginal wall prolapse have voiding differences. Women (n=109) who presented to a urogynecology practice were categorized into two groups based on anterior vaginal wall prolapse: stages 0 and 1 and stages 2, 3, and 4. Women with prolapse were older than the women without prolapse but the groups were otherwise similar demographically.