The Making of Confident Surgeons: Why and How?

Low self-confidence in surgical residents can be associated with poor self-efficacy and perceptions of sub-optimal preparedness for practice at graduation. The influence of social and biologic determinants of confidence deserves further study. Through a randomized controlled trial of procedure-specific didactic and low fidelity simulation training for vaginal surgery, we showed positive correlations between self-confidence and objective performance in the real operating room for three different surgical procedures and through validated scales.

COMET (Composite Outcomes of Mesh vs suture Techniques for prolapse repair)- Protocol for a single blind randomized controlled multicenter trial testing surgical innovation in female pelvic surgery.

Background: Pelvic organ prolapse (POP) increases in incidence and severity with aging. At least 1 in 4 women seek pelvic floor care and many more suffer with concurrent symptoms of bowel, bladder and sexual dysfunction, which can have a large impact on quality of life. It is estimated that 1 in 5 women will undergo surgery for POP.

Bilateral Sacrospinous Vaginal Vault Fixation With Synthetic Mesh Arms: A Novel Technique.

Sacrospinous ligament suspension is used for suspension of apical prolapse; however, it has a high rate of recurrence compared with sacrocolpopexy, and a high rate of pain compared with uterosacral suspension. We developed a novel surgical procedure of bilateral sacrospinous vaginal vault fixation with synthetic mesh arms. We previously demonstrated its safety, and in Supplementary video 1, we describe a step-by-step surgical approach that could be replicated.

Prediction of Postoperative Urinary Tract Infection Following Benign Gynecologic Surgery.

Introduction And Hypothesis: The objective was to develop a prediction model for urinary tract infection (UTI) after pelvic surgery.

Methods: We utilized data from three tertiary care centers of women undergoing pelvic surgery. The primary outcome was a UTI within 8 weeks of surgery.

Synthetic vs nonsynthetic slings for female stress and mixed urinary incontinence: a systematic review and meta-analysis.

Objective: This study aimed to systematically review objective and subjective success and surgical outcomes of suburethral sling surgery for female patients with stress or mixed urinary incontinence using synthetic vs nonsynthetic material with corresponding surgical approaches (retropubic or transobturator).

Data Sources: We systematically searched Medline, Embase, EBM Reviews, ClinicalTrials.gov, and Web of Science Core Collection using standardized Medical Subject Headings (MeSH) without date restrictions (PROSPERO-registered).

Procedure-specific simulation for vaginal surgery training: A randomized controlled trial.

Introduction: Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure-specific simulation skills, vs usual training, result in improved operative competence.

Asian-White disparities in obstetric anal sphincter injury: a systematic review and meta-analysis.

Objective: Obstetrical anal sphincter injury describes a severe injury to the perineum and perianal muscles after birth. Obstetrical anal sphincter injury occurs in approximately 4.4% of vaginal births in the United States; however, racial and ethnic inequities in the incidence of obstetrical anal sphincter injury have been shown in several high-income countries.

Summative Evaluation of Vaginal Surgery Skills: Setting A Pass-Fail Score.

Introduction And Hypothesis: We developed a summative assessment tool to evaluate competent performance on three procedure-specific low fidelity simulation models for vaginal surgery. Our purpose was to determine a pass-fail score for each model.

Methods: We enrolled participants (2011-2023, three Canadian academic centers) and grouped them according to operative competency in vaginal procedures.

Pelvic Floor Health Index: Initial validation of a practical postpartum tool for busy clinicians.

Objective: To design a primary care clinical tool (Pelvic Floor Health Index [PFHI]) to screen for postpartum pelvic floor disorders, as well as complete its psychometric validation.

Design: Prospective cohort study.

Setting: Two tertiary care obstetric centres in Vancouver, BC.

Asian-white disparities in obstetric anal sphincter injury: Protocol for a systematic review and meta-analysis.

Background: Obstetric anal sphincter injury (OASI) describes severe injury to the perineum and perineum and perianal muscles following birth and occurs in 4.4% to 6.0% of vaginal births in Canada.

Reducing urinary tract infection in female pelvic surgery: A retrospective cohort study.

Objective: To compare prebundle versus postbundle implementation urinary tract infection (UTI) rates among inpatients within 6 weeks of clean-contaminated pelvic reconstructive surgery.

Methods: The authors conducted a retrospective cohort study from September 2019 to December 2021 at a tertiary hospital. The bundle strategy included the following: universal preoperative UTI check with treatment if positive, replacing prolonged postoperative voiding trials on the ward with earlier discharge and indwelling catheter removal by a nurse continence advisor the next day, and daily cranberry extract for 6 weeks postoperatively.

Cannabis use preferences in women with myofascial pelvic pain: A cross-sectional study.

Objective: Myofascial tenderness is present in most chronic pelvic pain conditions and causes significant distress to patients. Treatment is challenging and often not curative. Cannabis is often used for self-management of chronic pelvic pain.

Abdominal sacrohysteropexy for large iatrogenic early postpartum vesicouterine fistula.

Sacrohysteropexy is a surgical technique employed for the surgical treatment of uterine prolapse when uterine preservation is desired. Vesicouterine fistulae are rare iatrogenic complications of difficult operative childbirth, typically via caesarean section. If further childbearing is planned, uterus-sparing fistula closure in layers, with interposition grafts, has been described.

Pelvic floor healing milestones after obstetric anal sphincter injury: a prospective case control feasibility study.

Introduction And Hypothesis: Severe perineal tears can predict bothersome pelvic floor disorders later in life. We have a poor understanding of pelvic floor changes during the third trimester and the first few postpartum months. We aimed to compare women with severe perineal trauma during childbirth with women who experienced minimal trauma, for condition-specific quality of life, sexual function, mental health and overall quality of life in the first 6 months postpartum.

International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain.

Introduction And Hypothesis: This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP.

Methods: An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP.

Surgical Management of Symptomatic Apical Pelvic Organ Prolapse: A Systematic Review and Meta-analysis.

Objective: To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP).

Data Sources: MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002-2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English.

Risk factors for urinary retention after urogynecologic surgery: A retrospective cohort study and prediction model.

Aims: Postoperative urinary retention (POUR) is a common complication of urogynecological surgery. Our study aimed to identify demographic and perioperative risk factors to construct a prediction model for POUR in urogynecology.

Methods: Our retrospective cohort study reviewed all patients undergoing pelvic reconstructive surgeries at our tertiary care center (Jan 1, 2013-May 1, 2019).

Preoperative Depression and Anxiety Impact on Inpatient Surgery Outcomes: A Prospective Cohort Study.

Objectives: To determine the association of preoperative mood symptoms and postoperative adverse outcomes; to explore sex-specific differences.

Background: Depression and anxiety can increase postoperative mortality. Psychological stress is associated with a chronic inflammatory response unfavorable to postsurgical healing.

Documenting Perineal and Obstetrical Anal Sphincter Injury Care at Childbirth: A Cross-Sectional Study.

Objective: This study evaluates whether maternity care providers document guideline-based recommendations for the prevention and care of obstetrical anal sphincter injuries (OASIS) for their labour and delivery patients.

Methods: We performed a cross-sectional study, aiming for a convenience sample of 60 primiparous women, over 19 years of age, equally representative of patients who experienced severe (third- and fourth-degree) and minimal (intact or first-degree) tears during vaginal birth. Information on patient demographics, delivery details, and guideline-endorsed preventative and management measures were collected.

Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women.

Objective: To compare success and complication rates of apical suspension procedures for the surgical management of symptomatic uterine or vaginal vault prolapse.

Target Population: Women with symptomatic uterine or vaginal vault prolapse seeking surgical correction.

Options: Interventions included abdominal apical reconstructive repairs (sacrocolpopexy, sacrohysteropexy, or uterosacral hysteropexy) via open, laparoscopic, or robotic approaches; vaginal apical reconstructive repairs (vault suspensions or hysteropexy, sacrospinous, uterosacral, iliococcygeus, McCall's, or Manchester types); and vaginal obliterative procedures (with or without uterus in situ).

Directive clinique n 413 : Traitement chirurgical du prolapsus génital apical chez les femmes.

Objectif: Comparer les taux de réussite et de complications des interventions de suspension apicale pour le traitement du prolapsus symptomatique de l'utérus ou du dôme vaginal.

Population Cible: Les femmes présentant un prolapsus symptomatique de l'utérus ou du dôme vaginal qui souhaitent obtenir un traitement chirurgical.

Options: Les interventions abordées sont les méthodes reconstructives apicales par voie abdominale (colposacropexie, hystérosacropexie ou hystéropexie avec suspension aux ligaments utéro-sacrés) par chirurgie ouverte, laparoscopique ou robotisée; les méthodes reconstructives apicales par voie vaginale (suspension du dôme vaginal ou hystéropexie, sacrospinofixation, suspension aux ligaments utéro-sacrés, suspension au muscle ilio-coccygien, culdoplastie de McCall ou amputation du col [technique de Manchester]); et les interventions vaginales oblitérantes (avec ou sans utérus in situ).

Recreational Cannabis Use Before and After Legalization in Women With Pelvic Pain.

Objective: To evaluate the prevalence and characteristics of recreational cannabis use in women with pelvic pain, and to examine the influence of cannabis legalization on these parameters.

Methods: We conducted a retrospective analysis of a prospective registry of women with self-reported moderate-to-severe pelvic pain referred to a tertiary care clinic in Vancouver, Canada, 2013-2019. We excluded patients aged 18 years or younger and those with unknown data on cannabis use.