Shared decision-making in urology and female pelvic floor medicine and reconstructive surgery.

Shared decision-making (SDM) is a hallmark of patient-centred care that uses informed consent to help guide patients with making complex health-care decisions. In SDM, patients and providers work together to determine the best course of action based on both the current available evidence and the patient's values and preferences. SDM not only provides a framework for the legal and ethical obligations providers need to fulfil for informed consent, but also leads to improved knowledge of treatment options and satisfaction of decision-making for patients.

Obliterated Posterior Cul-de-sac Laparoscopic Surgical Simulation.

Background: Obliteration of the posterior cul-de-sac is a challenging, often unexpected surgical finding. Developing the dissection skills required to manage this finding during laparoscopy is essential for optimizing treatment of many pain disorders during hysterectomy or ovarian surgery; however, exposure of trainees to cul-de-sac dissection is variable. Currently, there are no widely available simulation models for teaching and practicing this technique.

Clinical profile of comorbid dysmenorrhea and bladder sensitivity: a cross-sectional analysis.

Background: Antecedents of chronic pelvic pain are not well characterized, but pelvic organ visceral sensitivity is a hallmark of these disorders. Recent studies have identified that some dysmenorrhea sufferers are much more likely to exhibit comorbid bladder hypersensitivity. Presumably, these otherwise healthy women may be at higher risk of developing full-blown chronic bladder pain later in life.

Cine MRI during spontaneous cramps in women with menstrual pain.

Background: The lack of noninvasive methods to study dysmenorrhea has resulted in poor understanding of the mechanisms underlying pain, insufficient diagnostic tests, and limited treatment options. To address this knowledge gap, we have developed a magnetic resonance imaging-based strategy for continuously monitoring the uterus in relationship to participants' spontaneous pain perception.

Objective: The study objective was to evaluate whether magnetic resonance imaging can detect real-time changes in myometrial activity during cramping episodes in women with dysmenorrhea, with a handheld squeeze bulb for pain reporting.

Surgical interventions for chronic pelvic pain.

Purpose Of Review: The objective of this study is to review an evidence-based approach to surgical treatment of key chronic pelvic pain (CPP) contributors emphasizing the importance of preoperative evaluation and counseling.

Recent Findings: CPP is a poorly understood but highly prevalent condition and there are limited, well constructed studies to guide effective, durable treatment. CPP arises from factors originating in multiple organ systems, including reproductive, urologic, gastrointestinal, and myofascial, all informing the central nervous system.

Power morcellators: a review of current practice and assessment of risk.

Power morcellation has come under scrutiny because of a highly publicized case of disseminated leiomyosarcoma following a laparoscopic hysterectomy. A recent Federal and Drug Administration safety communication discouraging use of power morcellators on presumed uterine leiomyoma further highlights the need for reexamination of uterine tissue extraction. This clinical opinion aims to summarize current approaches to uterine/fibroid tissue extraction including the associated immediate and long-term potential risks of open power morcellation.

Deliberate practice improves obstetrics and gynecology residents' hysteroscopy skills.

Introduction: Development of surgical skills is an integral component of residency education in obstetrics and gynecology.

Objective: We report data from a supervised, deliberate, dry lab practice in hysteroscopy for junior obstetrics-gynecology residents, undertaken to evaluate whether simulation training improved hysteroscopy performance to a skill level similar to that of senior residents.

Methods: A prospective, comparative, multicenter trial compared Objective Structured Assessment Of Technical Skills (OSATS) performance of 2 groups: 19 postgraduate year (PGY)-1 and PGY-2 and 18 PGY-3 and PGY-4 Ob-Gyn residents.

Route of hysterectomy influence and teaching hospital status.

Objective: The purpose of this study was to evaluate whether teaching hospitals are more likely to perform abdominal (laparotomy) compared with nonabdominal (vaginal, laparoscopic) hysterectomies for benign indications.

Methods: We conducted a retrospective, observational study comparing abdominal and nonabdominal inpatient hysterectomies performed in Illinois between 2000 and 2005 using the COMPdata database. Obvious cancer, prolapse, or indicated-abdominal surgeries (infection and pregnancy-related cases) were excluded.

Laparoscopic excision of endometriosis of the obturator nerve: a case report.

Endometriosis, a common cause of cyclic and chronic pelvic pain in women, can present with a multitude of symptoms. Numerous case reports exist describing the involvement of the sciatic nerve with endometriosis; however, there are few reported cases of infiltration of the other pelvic nerves such as the obturator nerve. To our knowledge, this is the first case of laparoscopic management of symptomatic endometriosis of the obturator nerve.

Surgical techniques: robot-assisted laparoscopic myomectomy with the da Vinci(®) surgical system.

Myomectomy remains the surgical option of choice for women with symptomatic leiomyomata who desire uterine conservation or in particular future fertility. The ability to enucleate leiomyomata and repair the uterus with a multilayer-sutured closure is both crucial and technically challenging. Advanced gynecologic pathology and the surgical limitations of conventional laparoscopy have often been cited as impediments to not only these critical steps but also to converting a myomectomy from a procedure predominantly performed by laparotomy to one accomplished by laparoscopy.

Medical students self-reported work hours: perception versus reality.

Objective: The objective of this study was to compare the students' actual work hours with their self-reported work hours during the obstetrics and gynecology clerkship, and to determine whether the number of hours worked correlate with the amount of "scut" reported or students' rating of the quality of the clerkship.

Study Design: Students self-reported work hours were compared against their actual scheduled hours over 2 different academic years. Pearson's correlation was performed to correlate the actual hours with the amount of reported "scut" work and the overall rating of the quality of the clerkship.

Interstitial pregnancy.

A 20-year-old woman with an interstitial pregnancy who underwent ultrasonographic and laparoscopic imaging before surgical management is described.

Victimization in patients with vulvar dysesthesia/vestibulodynia. Is there an increased prevalence?

Objective: To examine the prevalence of physical or sexual violence victimization among women referred to a specialty clinic for management of vulvar dysesthesia/vestibulodynia as compared to a healthy gynecology clinic population.

Study Design: The subjects in this case-control study were women who had completed routine questionnaires prior to presentation to the University of Michigan Center for Vulvar Diseases. Study subjects were all given a diagnosis of vulvar dysesthesia/vestibulodynia.