The Response of the Urinary Microbiome to Botox.

Introduction And Hypothesis: Our objective was to evaluate if botox alters the urinary microbiome of patients with overactive bladder and whether this alteration is predictive of treatment response.

Methods: This multicenter prospective cohort study included 18-89-year-old patients undergoing treatment for overactive bladder with 100 units of botox. Urine samples were collected by straight catheterization on the day of the procedure (S1) and again 4 weeks later (S2).

Use of a Digital Conversational Agent for the Management of Overactive Bladder.

Importance: Conservative therapy is effective for the treatment of overactive bladder (OAB) but may be limited by accessibility to care.

Objective: The objective of this study was to evaluate the efficacy of a digital conversational agent (CeCe) for the treatment of OAB.

Study Design: This was a prospective observational trial utilizing a digital conversational agent developed by Renalis University Hospitals (Cleveland, Ohio) for the treatment of OAB.

Opioid use following pelvic reconstructive surgery: a predictive calculator.

Introduction And Hypothesis: Our objective was to evaluate the amount of opioids used by patients undergoing surgery for pelvic floor disorders and identify risk factors for opioid consumption greater than the median.

Methods: This was a prospective cohort study of 18- to 89-year-old women undergoing major urogynecological surgery between 1 November2020 and 15 October 2021. Subjects completed one preoperative questionnaire ("questionnaire 1") that surveyed factors expected to influence postoperative pain and opioid use.

Management of Urgency and Mixed Urinary Incontinence.

Urinary incontinence (UI) is a prevalent disorder that significantly affects quality of life. This article reviews management of urgency and mixed UI by breaking the management algorithm down into observation, lifestyle and behavioral changes, pharmacologic therapy, and procedural management. Stress UI is best managed with mid-urethral slings and is covered in other chapters.

Tamsulosin vs placebo to prevent postoperative urinary retention following female pelvic reconstructive surgery: a multicenter randomized controlled trial.

Background: Postoperative urinary retention is common after female pelvic reconstructive surgery. Alpha receptor antagonists can improve dysfunctional voiding by relaxing the bladder outlet and may be effective in reducing the risk of postoperative urinary retention.

Objective: This study aimed to determine whether tamsulosin is effective in preventing postoperative urinary retention in women undergoing surgery for pelvic organ prolapse.

Complications following vaginal colpopexy for the repair of pelvic organ prolapse.

Introduction And Hypothesis: The primary aim of this study was to compare differences in complication rates across different types of vaginal colpopexy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

Methods: Patients who underwent intra- or extraperitoneal vaginal colpopexy with or without concurrent hysterectomy were identified in the 2014-2016 NSQIP database using Current Procedural Terminology codes. Patient demographics, preoperative comorbidities, American Society of Anesthesiologists (ASA) classification system scores, and total operating time were obtained.

Does Living With Human Immunodeficiency Virus Increase Pelvic Reconstructive Surgery Perioperative Complication Risk? A Multicenter Retrospective Cohort Study.

Objective: To determine if women with human immunodeficiency virus (HIV) undergoing pelvic reconstructive surgery (PRS) have an increased risk of perioperative and postoperative complications compared with HIV-negative controls.

Study Design: Multicenter, retrospective matched cohort study of patients with and without HIV infection who underwent PRS between 2006 and 2016. Cases were identified using International Classification of Disease, 9th edition Clinical Modification and 10th edition Clinical Modification and current procedural terminology (CPT) codes encompassing HIV diagnoses and pelvic reconstructive surgeries.

Evaluation of the ACS NSQIP surgical risk calculator in patients undergoing pelvic organ prolapse surgery.

Introduction And Hypothesis: The purpose of this study was to evaluate the accuracy of the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) surgical risk calculator in predicting postoperative complications in patients undergoing pelvic organ prolapse surgery.

Methods: We performed a retrospective review of 354 patients who underwent surgery for pelvic organ prolapse from 2013 to 2017 at a single academic institution. Patient medical information and surgical procedure were entered into the calculator to obtain predicted complication rates, which were compared with observed complications.

National Analysis of Perioperative Morbidity of Vaginal Versus Laparoscopic Hysterectomy at the Time of Uterosacral Ligament Suspension.

Study Objective: The objective of this study was to compare the morbidity of vaginal versus laparoscopic hysterectomy when performed with uterosacral ligament suspension.

Design: Retrospective propensity-score matched cohort study.

Setting: American College of Surgeons National Surgical Quality Improvement Program database.

Perioperative Safety of Surgery for Pelvic Organ Prolapse in Elderly and Frail Patients.

Objective: To evaluate the effects of old age and frailty on complication rates after surgery for pelvic organ prolapse.

Methods: The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify patients who underwent surgery for prolapse from 2010 to 2017. We compared our control group (45-64 years, index population) to those aged 65-79 years (elderly) and 80 years and older (very elderly).

Medical Malpractice Litigation in Non-Mesh-Related Pelvic Organ Prolapse Surgery: An Analysis of 91 Cases.

Introduction: Malpractice litigations have significant implications for patients and physicians. Studies have investigated mesh litigations in female pelvic reconstructive surgery, but none on nonmesh pelvic organ prolapse (POP) surgery. Our purpose is to determine the reasons for and outcomes of medical malpractice after nonmesh POP surgery.

Evaluation of Choline and Acetylcholine Levels in Responders and Nonresponders to Anticholinergic Therapy for Overactive Bladder Syndrome.

Objective: This study aimed to determine whether levels of choline (Ch) and acetylcholine (Ach) differ between responders and nonresponders to anticholinergic therapy.

Methods: Patients prescribed an anticholinergic were evaluated using the Overactive Bladder Symptom Score; Medical, Epidemiologic and Social Aspects of Aging and Incontinence Questionnaire; and Incontinence Impact Questionnaire-7. A 1-day voiding diary and a urine sample were collected.

Development and Validation of a Machine Learning Algorithm for Predicting Response to Anticholinergic Medications for Overactive Bladder Syndrome.

Objective: To develop and externally validate a prediction model for anticholinergic response in patients with overactive bladder (OAB).

Methods: A machine learning model to predict the likelihood of anticholinergic treatment failure was constructed using a retrospective data set (n=559) of female patients with OAB who were treated with anticholinergic medications between January 2010 and December 2017. Treatment failure was defined as less than 50% improvement in frequency, urgency, incontinence episodes, and nocturia, and the patient's subjective impression of symptomatic relief.

Multimodal opioid-sparing postoperative pain regimen compared with the standard postoperative pain regimen in vaginal pelvic reconstructive surgery: a multicenter randomized controlled trial.

Background: Postoperative pain control after urogynecological surgery has traditionally been opioid centered with frequent narcotic administration. Few studies have addressed optimal pain control strategies for vaginal pelvic reconstructive surgery that limit opioid use.

Objective: The objective of the study was to determine whether, ice packs, Tylenol, and Toradol, a novel opioid-sparing multimodal postoperative pain regimen has improved pain control compared with the standard postoperative pain regimen in patients undergoing inpatient vaginal pelvic reconstructive surgery.

Cerebral White Matter Disease and Response to Anti-Cholinergic Medication for Overactive Bladder in an Age-Matched Cohort.

Objective: To determine if the presence of cerebral white matter disease (WMD) affects the response to anti-cholinergic medications.

Materials And Methods: This was a retrospective cohort of age-matched patients treated for OAB with anti-cholinergic medications between January 2010 and December 2017. Inclusion criteria were a chief complaint of OAB, never evaluated by a urogynecologist for OAB, treated with a maximum dose for a minimum of 4 weeks, and underwent head computed tomography (CT) within 12 months of starting therapy.

Adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse.

Introduction And Hypothesis: Preoperative counseling about salpingectomy with pelvic surgery is recommended by the American College of Obstetrics and Gynecology for ovarian cancer risk reduction. Our objective was to determine recent practice patterns and patient factors associated with salpingectomy with vaginal hysterectomy (VH) for pelvic organ prolapse (POP) in the USA. We hypothesize that salpingectomy might have become more common in recent years.

Autonomic neurophysiologic implications of disorders comorbid with bladder pain syndrome vs myofascial pelvic pain.

Aims: The neuropathophysiology of a debilitating chronic urologic pain condition, bladder pain syndrome (BPS), remains unknown. Our recent data suggests withdrawal of cardiovagal modulation in subjects with BPS, in contrast to sympathetic nervous system dysfunction in another chronic pelvic pain syndrome, myofascial pelvic pain (MPP). We evaluated whether comorbid disorders differentially associated with BPS vs MPP shed additional light on these autonomic differences.

Apical Suspension Utilization at the Time of Vaginal Hysterectomy for Pelvic Organ Prolapse Varies With Surgeon Specialty.

Objective: To evaluate whether utilization of apical suspension procedures at the time of vaginal hysterectomy for pelvic organ prolapse varies with surgeon specialty.

Methods: This was a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2016. International Classification of Diseases, Ninth Revision, Clinical Modification with a diagnosis of pelvic organ prolapse who underwent vaginal hysterectomy with any combination of pelvic reconstructive procedures.

Predictors of goal achievement in patients undergoing hysterectomy.

Objective: The primary objective of our study was to identify predictors of goal achievement in patients undergoing simple hysterectomy for benign indications. We also sought to describe the goals of patients in this population.

Study Design: This was a prospective cohort study of patients undergoing hysterectomy for benign indications performed at a single academic institution.

Incidence and risk factors of early postoperative small bowel obstruction in patients undergoing hysterectomy for benign indications.

Background: Small bowel obstruction (SBO) is a major cause of postoperative mortality and morbidity following abdominal and pelvic surgery, with 225,000-345,000 annual admissions. SBO may be classified based on onset from day of surgery. Early SBO occurs within the first 30 days following surgery, whereas late SBO occurs after the initial 30-day postoperative window.