Postoperative prophylactic antibiotics for retropubic mid-urethral slings.

Objectives And Hypothesis: The primary objective is to measure the difference in urinary tract infection (UTI) rates within 6  weeks of placement of a retropubic mid-urethral sling (RMUS) in the setting of various postoperative prophylactic antibiotic regimens. UTI rates were measured by antibiotic prescriptions to treat UTI and/or culture. Secondary aims included determining risk factors for postoperative UTI.

Retropubic mid-urethral slings and de novo urinary urgency and frequency: The role of retropubic hematomas.

Aims: This is a prospective cohort study comparing de novo lower urinary tract symptoms (LUTS) in subjects undergoing a retropubic mid-urethral sling who either did or did not develop a postoperative retropubic hematoma within 6 weeks of surgery. The secondary objective was to measure the incidence and prevalence of retropubic hematomas, and subject characteristics associated with retropubic hematomas.

Methods: Eligible subjects were recruited before undergoing a retropubic mid-urethral sling with or without concurrent pelvic reconstructive surgery.

Pelvic floor changes in the first term pregnancy and postpartum period.

Objective: To follow a prospective cohort of women during their first term pregnancy to elucidate the nature and timing of changes to the pelvic floor during pregnancy and after vaginal delivery.

Methods: Enrolled subjects were evaluated at four time points with dynamic MRI, POP-Q examinations, and validated symptom questionnaires. The four assessments occurred during the first trimester (ePG), late third trimester (lPG), within a week after vaginal delivery (ePP), and three months postpartum (lPP).

Perineal body length and perineal lacerations during delivery in primigravid patients.

This study assessed the relation between perineal body length and the risk of perineal laceration extending into the anal sphincter during vaginal delivery in primigravid patients at an institution with a low utilization of episiotomy. This was a prospective study of primigravid patients in active labor. Primigravid women with singleton pregnancies who were in the first stage of labor at 37 weeks gestation or greater were recruited, and the admitting physician measured the length of the perineal body.

Incidence of Bladder Injury During Retropubic Midurethral Sling Placement After Prior Burch Colpopexy.

Objectives: To elucidate if prior Burch changes the risk of bladder injury or rates of voiding dysfunction and continence in the immediate postoperative period when undergoing retropubic midurethral sling (MUS) placement.

Methods: In this retrospective case control, charts were selected by Current Procedural Terminology codes for MUS placement. Women undergoing retropubic MUS placement with history of Burch urethropexy were considered.

Antibiotic prophylaxis for urinary tract infection after midurethral sling: a randomized controlled trial.

Objective: Because of the reported high percentage of bladder infections after placement of a midurethral sling (8.9%-34%), this study was undertaken to determine if a 3-day postoperative course of a urinary antibiotic would significantly lower the incidence of urinary tract infection (UTI) among treated women.

Methods: Women who were planning outpatient vaginal surgery for stress incontinence were enrolled, after informed consent, and randomized to receive placebo or nitrofurantoin (100 mg 2 times a day) for 3 days after surgery.

Lack of preoperative predictors of the immediate return of postoperative bladder emptying after uterosacral ligament suspension.

Objectives: To determine whether preoperative postvoid residual volume (PVR), pelvic organ prolapse quantification (POPQ) stage, patient characteristics, or concurrent operations are predictors of immediate postoperative bladder emptying after uterosacral ligament suspension (USLS).

Methods: A review of patients undergoing USLS in 2008 and 2009 was performed. The factors analyzed included patient age, body mass index, parity, preoperative PVR, POPQ stage, concurrent anterior repair, posterior repair, hysterectomy and/or sling procedures, and postoperative voiding trial status.

Indigo carmine extravasation to upper limb after pelvic reconstructive surgery.

Background: The use of dyes during cystoscopy to visualize the ureters adequately is prevalent in gynecologic surgery. Observing ureteral patency after procedures such as a hysterectomy or pelvic reconstruction is important for identifying injury to the upper urinary tract. Indigo carmine is commonly used.

Recognition and management of nerve entrapment pain after uterosacral ligament suspension.

Objective: To estimate the incidence, risk factors, and characteristics of neuropathic pain related to nerve entrapment after uterosacral ligament suspension.

Method: A review of patients who underwent uterosacral ligament suspension from January 2007 to August 2011 was performed. Patients with neuropathic pain attributable to nerve entrapment from uterosacral ligament suspensory suture placement were identified.

A novel transvaginal approach to correct recurrent apical prolapse after failed sacral colpopexy: case series.

Introduction And Hypothesis: The objective of the study was to describe the transvaginal approach utilizing the existing sacral colpopexy (SC) graft for recurrent apical prolapse following failed SC.

Methods: Twenty-two patients with recurrent vaginal vault prolapse following a prior SC were treated between January 2000 and December 2009. Twelve patients had a standard uterosacral ligament cuff suspension (USLS) performed.

Periurethral angioleiomyoma in a female patient.

A 51-year-old white woman, gravida 4, para 3-0-1-3 referred to our urogynecology clinic for evaluation of questionable symptomatic pelvic organ prolapse was found to have a periurethral mass with associated urinary urgency. She underwent transvaginal excision of this mass, and pathology revealed angioleiomyoma. Her urinary urgency has resolved after surgery.

A randomized comparison of bupivacaine versus saline during placement of tension-free vaginal tape.

Objectives: To compare postoperative urinary retention and pain control when bupivacaine versus saline for hydrodissection is used while placing tension-free vaginal tape midurethral slings.

Methods: A prospective, randomized, double-blind trial was performed after institutional review board approval. Sixty women were randomized to receive bupivacaine or saline for hydrodissection.

Incidence and risk factors of postoperative urinary tract infection after uterosacral ligament suspension.

Introduction And Hypothesis: We assessed the incidence of and risk factors for developing urinary tract infection (UTI) after uterosacral ligament suspension (USLS).

Methods: Retrospective analysis of patients undergoing USLS in 2008-2009 was performed. Postoperative UTI was defined as a positive urine culture within 1 month following surgery.

Permanent suture used in uterosacral ligament suspension offers better anatomical support than delayed absorbable suture.

Introduction And Hypothesis: The objective of this study was to compare the outcomes of uterosacral ligament suspension (USLS) procedures in relation to suture material used for apical suspension.

Methods: A retrospective chart review was performed for two senior surgeons who supervised and performed USLS with both suture types in 2008-2009. Permanent and delayed absorbable sutures were compared for failure of anatomical support.

Does body mass index impact passing voiding trial after midurethral sling procedures for stress urinary incontinence?

Objective: : To test the hypothesis that body mass index (BMI) is a factor associated with passing a voiding trial after midurethral sling procedures for stress urinary incontinence (SUI).

Study Design: : The medical records of 136 consecutive patients who underwent placement of either tension-free vaginal tape (TVT) or transobturator tape (TOT) for SUI during a 1-year period (September 1, 2007 to August 31, 2008) were retrospectively reviewed. Variables assessed were BMI, age, and passing or failing a postoperative urinary voiding trial.

Delayed presentation of complete ureteral obstruction deligated transvaginally.

Complete ureteral obstruction with delayed presentation is managed first by percutaneous nephrostomy and later with ureteral deligation, reimplantation, and stenting. Transvaginal deligation of complete obstruction after delayed presentation has not been described. We present two cases of ureteral ligation after pelvic reconstructive surgery.

Tension-free vaginal tape bowel perforation.

A 73-year-old para 3 white female with posthysterectomy pelvic organ prolapse and stress urinary incontinence underwent pelvic reconstructive surgery and placement of tension-free vaginal tape. On postoperative day 4, she underwent exploratory laparotomy for small bowel obstruction. She was found to have an injury to the small bowel secondary to a through-and-through perforation by tension-free vaginal tape.

Transverse cystocele repair with uterine preservation using native tissue.

The goals of this study were to describe the surgical procedure of the transverse cystocele repair with uterine preservation using native tissue and to examine the surgical complications and short-term anatomical outcomes of this operation. Patients who underwent transverse cystocele repair with uterine preservation at our institution were identified by retrospective chart review for the interval from January 2001 to September 2006. Sixty-nine patients were identified.

Evaluation of the aged female baboon as a model of pelvic organ prolapse and pelvic reconstructive surgery.

Objective: This study examines the baboon as an animal model of pelvic organ prolapse (POP) by describing the pelvic floor anatomy and adapting human clinical assessment tools.

Study Design: The pelvic anatomy of an adult female baboon was observed at necropsy, and comparisons were made to the human and squirrel monkey. The pelvic organ prolapse quantification (POP-Q) system was used to assess vaginal support in 12 living adult baboons, including 6 young, reproductive-age, nulligravid females (4.