Comparison of non-invasive magnetomyography to Brink score for assessment of pelvic floor muscle strength.

Levator ani muscles undergo significant stretching and micro-trauma at childbirth. The goal was to assess the neuromuscular integrity of this muscle group by means of magnetomyography (MMG) and correlate with Brink score-a commonly used digital assessment of pelvic floor muscle strength.Non-invasive MMG data was collected on 22 pregnant women during rest and voluntary contraction of the pelvic-floor muscles (Kegels).

Prevalence and Predictors of Urinary Incontinence at 1 Year Postpartum.

Objectives: Postpartum urinary incontinence estimates range from 13% to 47%. Clinical factors associated with incontinence 1 year after first delivery are varied. We assessed the prevalence of and factors associated with urinary incontinence in primiparous women at 12 months postpartum.

Magnetomyographic Recordings of Pelvic Floor Activity During Pregnancy and Postpartum: A Novel Non-invasive Approach.

The levator ani muscles (LAM) are integral to pelvic floor support and injury to this muscle complex has been associated with pelvic floor disorders, but our ability to evaluate their neuromuscular integrity is limited. During pregnancy, gravidas undergo systemic functional and anatomic modifications, including pelvic floor muscular adaptations. Magnetomyography (MMG) is a novel and non-invasive tool to passively measure the magnetic fields generated by depolarization activity of muscles and offers a unique method to evaluate the LAM.

Correlation of Electronic (Web-Based and Smartphone) Administration of Measures of Pelvic Floor Dysfunction: A Randomized Controlled Trial.

Objective: We hypothesized that instruments of pelvic floor dysfunction would yield similar responses on web-based and smartphone administration compared with paper.

Methods: Subjects presenting with pelvic floor disorders were prospectively enrolled at 5 sites and invited to complete 4 validated pelvic floor disorder questionnaires (Pelvic Floor Distress Inventory 20, Pelvic Floor Impact Questionnaire 7, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12, Bristol Stool Scale) on both paper and electronic formats, 2 weeks apart, with the order of administration being randomized. Participants completed the questionnaires electronically on the internet via REDCap or using the PelvicTrack App on a smartphone or tablet.

Considering Low Health Literacy: How Do the Pelvic Floor Distress Inventory-Short Form 20 and Pelvic Floor Impact Questionnaire-Short Form 7 Measure Up?

Objective: The objective of this study was to evaluate the readability and understandability of 2 commonly used pelvic floor disorder questionnaires, Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), in a low health literacy patient population.

Methods: Flesh-Kincaid, SMOG, Fry, and FORCAST readability assessment tools were used to assign US grade levels to each questionnaire (PFDI-20, PFIQ-7). Two health literacy experts used PEMAT and ELF-Q tools to determine understandability, organization, content, and quality of each form.

Assessing Readability: Are Urogynecologic Patient Education Materials at an Appropriate Reading Level?

Objective: The National Institutes of Health recommends readability of patient material not exceed sixth-grade level. Our aim was to determine readability of American Urogynecologic Society (AUGS) and International Urogynecological Association (IUGA) patient education documents.

Methods: Available English- and Spanish-language IUGA patient information leaflets and AUGS patient fact sheets were scored for grade reading level.

Characterizing pelvic floor muscles activities using magnetomyography.

Aims: To characterize levator ani muscle (LAM) activity in nulligravidas using magnetomyography (MMG) and define MMG characteristics associated with LAM activity with and without accessory muscle contributions.

Methods: MMG data were collected from eight nulligravidas during rest and voluntary LAM contractions (Kegels) of varying intensity. We utilized simultaneous vaginal manometry and surface electromyography (sEMG) to evaluate for accessory muscle recruitment.

Pregnancy and parturition negatively impact vaginal angle and alter expression of vaginal MMP-9.

Background: Parity is the greatest risk factor for the development of pelvic organ prolapse. The normally supported vagina is pulled up and back over the levator ani. Loss of vaginal angulation has been associated with prolapse and may represent injury to the vaginal supportive tissues.

Feasibility of prophylactic salpingectomy during vaginal hysterectomy.

Background: The American Congress of Obstetricians and Gynecologists recommends that "the surgeon and patient discuss the potential benefits of the removal of the fallopian tubes during a hysterectomy in women at population risk of ovarian cancer who are not having an oophorectomy," resulting in an increasing rate of salpingectomy at the time of hysterectomy. Rates of salpingectomy are highest for laparoscopic and lowest for vaginal hysterectomy.

Objective: The primary objective of this study was to determine the feasibility of bilateral salpingectomy at the time of vaginal hysterectomy.

Imaging of Pelvic Floor Reconstruction.

Stress urinary incontinence and pelvic organ prolapse are 2 common pelvic floor disorders that are important causes of pelvic pain and disability. Mesh and sling placement are some of the surgical treatment options available for treatment of these conditions. In addition to clinical assessment, imaging plays an important role in managing postoperative patients with complications such as recurrent organ prolapse and chronic pain.

Teaching the Retropubic Midurethral Sling Using a Novel Cadaver and Model-Based Approach.

Objective: To measure the impact of a model-based teaching program on resident comfort and skill with retropubic midurethral sling (MUS).

Study Design: Residents were assessed before and after a retropubic MUS teaching session, which included a brief lecture and three interactive teaching stations (cadaver pelvis, retropubic MUS pelvic model, cystoscopy model). Self-assessment measures included MUS-related visual analog scale (VAS), Likert, and open-ended questions.

Genital hiatus size is associated with and predictive of apical vaginal support loss.

Background: Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse. There are several reasons that this is likely: (1) Although the Pelvic Organ Prolapse-Quantification examination is the standard prolapse staging system used in the Female Pelvic Medicine and Reconstructive Surgery field for reporting outcomes, this assessment is not used commonly in clinical care outside the subspecialty; (2) no clinically useful and accepted definition of apical support loss exists, and (3) no consensus or guidelines address the degree of apical support loss at which an apical support procedure should be performed routinely.

Objective: The purpose of this study was to identify a simple screening measure for significant loss of apical vaginal support.

The Emotional Burden of Pelvic Organ Prolapse in Women Seeking Treatment: A Qualitative Study.

Objective: We aimed to qualitatively describe the emotional burden experienced by women seeking treatment for prolapse. We hypothesized that the condition of prolapse would have an impact on women's emotional well-being.

Methods: Women with stage II or greater symptomatic prolapse participated in focus groups or individual phone interviews.

Rectal perforation at the time of vaginal mesh placement and subsequent abdominal mesh removal.

Introduction: We present an uncommon complication of vaginally placed synthetic prolapse mesh and demonstrate repair of rectal mesh perforation.

Methods: A 41-year-old was referred with multiple complaints following rectocele repair using a posterior vaginal mesh kit 5 months earlier. In the immediate postoperative period, she experienced severe pain radiating down her right leg, pelvic pain, dyspareunia, dyschezia, diarrhea, and new onset fecal incontinence.

Management of recurrent stress urinary incontinence after burch and sling procedures.

Aims: To examine treatment options selected for recurrent stress urinary incontinence (rSUI) in follow-up after Burch, autologous fascial and synthetic midurethral sling (MUS) procedures.

Methods: We performed a secondary analysis of the SISTER and ToMUS trials of participants who underwent primary stress urinary incontinence (SUI) treatment (without prior SUI surgery or concomitant procedures). Using Kaplan-Meier analysis, retreatment-free survival rates by initial surgical procedure were compared.

Sleep quality in women seeking care for pelvic organ prolapse.

Objectives: To identify the prevalence of sleep disturbance in women seeking treatment for pelvic organ prolapse (POP) and identify correlates of poor sleep quality in this population by using a validated sleep scale.

Study Design: This is a cohort study of female patients with pelvic organ prolapse.

Main Outcome Measures: Pittsburgh Sleep Quality Index (PSQI), Pelvic Floor Disorders Inventory (PFDI), and Pelvic Floor Impact Questionnaire (PFIQ) measures were completed.

Maternal lower urinary tract injury at the time of Cesarean delivery.

Introduction And Hypothesis: To determine the incidence of lower urinary tract (LUT) injury at the time of Cesarean delivery (CD) and to identify factors associated with LUT injury.

Methods: Cases of LUT injury at delivery between 2001 and 2012, were identified by ICD-9 code. Chart review was utilized for verification and descriptive data collection.

Maternal adaptations in preparation for parturition predict uncomplicated spontaneous delivery outcome.

Objective: The objective of the study was to define maternal tissue adaptations in pregnancy associated with uncomplicated spontaneous vaginal delivery using anatomical and biological outcomes.

Study Design: Nulliparous gravidas were prospectively enrolled in the first trimester at 2 institutions. Demographic and delivery data were chart abstracted.

Most older women recover baseline functional status following pelvic organ prolapse surgery.

Introduction And Hypothesis: To evaluate postoperative functional status changes in older women undergoing pelvic organ prolapse (POP) surgery and determine predictors for nonrecovery of baseline status.

Methods: We enrolled women ≥ 65 years in whom POP surgery was planned and measured functional status using the Katz Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living (IADL) scales at baseline, 1 week, 2 weeks, and 3 months postoperatively. We used logistic regression modeling to identify predictors of postoperative nonrecovery of functional status (score < baseline) and calculated score change over time.

Body image in the Pelvic Organ Prolapse Questionnaire: development and validation.

Objective: The purpose of this study was to develop and validate a prolapse-specific body image questionnaire.

Study Design: Prolapse-specific body image themes that were identified in our previous work served as a framework for the development of a question pool. After review for face and content validity and reading level, the question pool was reduced to 21 items that represent predominant themes and that form the initial Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire.

Inpatient procedures in elderly women: an analysis over time.

Objectives: To describe inpatient surgical and diagnostic/therapeutic procedures in women ≥65 years old and assess procedure trends over time.

Study Design: Procedure data for all women ≥65 years was collected using the National Hospital Discharge Survey, a federal dataset drawn from a representative sampling of U.S.

Midurethral sling for treatment of occult stress urinary incontinence at the time of colpocleisis: a decision analysis.

Objective: The objective of this study was to estimate optimal timing for treatment of occult stress urinary incontinence in women undergoing colpocleisis using decision analysis methodology.

Methods: A decision tree was constructed comparing concomitant versus staged midurethral slings (MUSs). Simple roll-back methodology was used to determine average 1-year utilities of the compared approaches.

Effect of a preoperative self-catheterization video on anxiety: a randomized controlled trial.

Introduction And Hypothesis: The purpose of this study was to determine if a clean intermittent self-catheterization (CISC) instructional video could improve anxiety in women undergoing prolapse and/or incontinence surgery.

Methods: A total of 199 women were randomized to preoperative CISC video or routine counseling prior to prolapse/incontinence surgery. Patient anxiety, satisfaction, and concerns about CISC were evaluated using the State-Trait Anxiety Inventory-State (STAI-S) and study-specific visual analog scale (VAS) questions at four perioperative time points.