Effectiveness and safety of a novel, collapsible pessary for management of pelvic organ prolapse.

Background: Pessaries are an effective treatment for pelvic organ prolapse, yet currently available pessaries can cause discomfort during removal and insertion. An early feasibility trial of an investigational, collapsible pessary previously demonstrated mechanical feasibility during a brief 15-minute office trial. Longer-term, patient-centered safety and efficacy data are needed.

Utilization of Rectal Examinations Before Magnetic Resonance Defecography Studies.

Importance: More information is needed to guide referring subspecialists on the appropriate patient evaluation before magnetic resonance defecography (MRD).

Objectives: This study aimed to evaluate how often health care providers perform digital rectal examination (DRE) before ordering MRD to investigate causes of bowel and pelvic floor complaints.

Study Design: We conducted a retrospective cohort review, including MRD performed on female patients at an integrated health care system from 2016 through 2020.

Minimally Invasive Autologous Fascia Sling at the Midurethra: A Case Series.

Study Objective: The primary objective was to determine the improvement in stress urinary incontinence symptoms using autologous fascia lata sling placed at the midurethra. The secondary objective was to determine the presence of leg pain after harvest of fascia lata graft.

Design: Case series.

Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates.

Importance: Understanding differences in female pelvic medicine and reconstructive surgery (FPMRS) urology and gynecology-based fellowships is important because both are accredited by the American Board of Medical Subspecialties.

Objective: The aim of the study was to characterize urology-based and gynecology-based FPMRS fellowships.

Material And Methods: An institutional review board-approved 21-item survey was emailed to Accreditation Council for Graduate Medical Education-accredited FPMRS fellowship program directors from January 8 through March 9, 2021.

Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse.

Objective: To measure geographic variation in rates of apical support procedures for the treatment of pelvic organ prolapse (POP) among female Medicare beneficiaries.

Methods: We conducted a retrospective, cross-sectional study and used 100% Medicare fee-for-service claims to identify a cohort of women aged 65-99 years who had an apical support procedure, defined by Current Procedural Terminology codes, in 2016-2018. We included all vaginal and abdominal approaches (native tissue and mesh colpopexies) and obliterative procedures.

Cost-Effectiveness Analysis Between Sacral Neuromodulation and OnabotulinumtoxinA for the Treatment of Refractory Overactive Bladder in Women: A Systematic Review.

Objective: We summarized the evidence evaluating the cost-effectiveness of sacral neuromodulation (SNM) versus onabotulinumtoxinA (BONT/A) in the treatment of refractory overactive bladder (OAB) among women.

Methods: We searched PubMed Medline (1946-2019), EMBASE (1947-2019), Web of Science (1900-2019), Clinical Trials.gov, reviewed references of included studies, and Cochrane subsets of CDSR, DARE, CENTRAL, and NHSEED.

Autologous Fascia Lata for Combined Sacrocolpopexy and Rectopexy.

We present a case series and video of our technique using autologous fascia lata for combined sacrocolpopexy and rectopexy, with or without resection.

Information Priorities for Deciding on Treatment of Pelvic Organ Prolapse.

Objective: The objective of this study was to elicit information priorities from women considering treatment for pelvic organ prolapse (POP).

Study Design: This is a cross-sectional study of women before and after treatment of stage II or higher POP. Women were recruited either at the conclusion of their initial evaluation (before treatment) or at postoperative or pessary maintenance visits (after treatment).

Major postoperative complications following surgical procedures for pelvic organ prolapse: a secondary database analysis of the American College of Surgeons National Surgical Quality Improvement Program.

Background: Surgical approaches to the correction of pelvic organ prolapse include abdominal, vaginal, and obliterative approaches. These approaches require vastly different anatomical dissections, surgical techniques, and operative times and are often selected by the patient and surgeon to match preoperative multimorbidity and ability of the patient to tolerate the stress of surgery.

Objective: We sought to describe the occurrence of postoperative complications occurring after 3 different surgical approaches to treat pelvic organ prolapse: vaginal, abdominal, and obliterative.

Miniature atomic scalar magnetometer for space based on the rubidium isotope Rb.

A miniature atomic scalar magnetometer based on the rubidium isotope Rb was developed for operation in space. The instrument design implements both and mode operation and leverages a novel microelectromechanical system (MEMS) fabricated vapor cell and a custom silicon-on-sapphire (SOS) complementary metal-oxide-semiconductor (CMOS) integrated circuit. The vapor cell has a volume of only 1 mm so that it can be efficiently heated to its operating temperature by a specially designed, low-magnetic-field-generating resistive heater implemented in multiple metal layers of the transparent sapphire substrate of the SOS-CMOS chips.

Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction.

Introduction And Hypothesis: There is a growing body of evidence demonstrating frailty as an important predictor of surgical outcomes in older adults undergoing major surgeries. The age-related onset of many symptoms of female pelvic floor dysfunction (PFD) in women suggests that many women seeking treatment for PFD may also have a high prevalence of frailty, which could potentially impact the risks and benefits of surgical treatment options. Our primary objective was to determine the prevalence of frailty, cognitive impairment, and functional disability in older women seeking treatment for PFD.

Functional disability among older women with fecal incontinence.

Objective: The prevalence of functional disability for basic activities of daily living (ADLs) in older women with fecal incontinence (FI) is not well characterized. Our objective was to determine the prevalence of functional disability among community-dwelling older women with FI.

Study Design: We conducted a secondary database analysis of the 2005-2006 National Social Life, Health and Aging Project, a cross-sectional study of community-dwelling older adults that had been conducted by single in-home interviews.

Functional disability and compromised mobility among older women with urinary incontinence.

Objective: Our objective was to determine the prevalence of functional disability among older women with urinary incontinence (UI).

Methods: We conducted a secondary analysis of the 2005-2006 National Social Life, Health and Aging Project. Daily UI was defined as answering "daily" to the question, "How frequently… have you had difficulty controlling your bladder, including leaking small amounts of urine, leaking when you cough or sneeze, or not being able to make it to the bathroom on time?" We then explored functional status.

Anatomic and functional outcomes of sacrocolpopexy with or without posterior colporrhaphy.

Introduction And Hypothesis: The optimal surgery for combined apical and posterior vaginal prolapse is not well defined. Our objective was to examine the anatomic and functional outcomes following sacrocolpopexy (SCP) with or without posterior colporrhaphy (PC).

Methods: We retrospectively evaluated 258 women who underwent abdominal (n = 62) or laparoscopic (n = 196) SCP with or without PC.

Urodynamic leak point pressures weakly correlate with subjective urinary incontinence severity.

Objective: To evaluate preoperative abdominal leak point pressures (ALPP) with pre- and postoperative Incontinence Severity Index (ISI) scores.

Methods: A review of women who underwent a midurethral sling procedure between August 2004 and April 2006 was conducted. Eligible women completed preoperative urodynamic testing with ALPP determination and subjective incontinence severity assessment using the ISI before and 6 weeks after surgery.

Does pelvic organ prolapse reduction affect abdominal leak point pressures?

Objective: To determine if pelvic organ prolapse reduction decreases cystometric leak point pressure.

Study Design: A retrospective review was performed of women with pelvic organ prolapse points Aa, Ba or C > or = -1 cm that leaked with and without vaginal support (barrier testing) during multichannel urodynamic investigation (N=44). An analysis of the mean and difference between leak point pressure (LPP) (vesicle pressure) with and without prolapse reduction was used to determine significance.

Duloxetine compared with placebo for treating women with symptoms of overactive bladder.

Objective: To evaluate duloxetine (a serotonin-noradrenaline reuptake inhibitor) in women with symptoms of overactive bladder (OAB), as it has been shown to increase the bladder capacity in an animal model.

Patients And Methods: In all, 306 women (aged 21-84 years) were recruited and randomly assigned to placebo (153) or duloxetine (80-mg/day for 4 weeks increased to 120-mg/day for 8 weeks; 153). Symptoms of OAB were defined as bothersome urinary urgency and/or urge urinary incontinence (UI) for > or =3 months.

The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries.

Objective: The aim of this randomized crossover trial was to compare symptom relief and change in life impact for women using the ring with support and Gellhorn pessaries.

Study Design: Subjects were randomized to use each pessary for 3 months. Outcome data included a visual analog satisfaction score, and quality of life questionnaires.

Closure of the subcutaneous dead space and wound disruption after Cesarean delivery.

Objective: To determine whether suture closure of subcutaneous dead space decreases wound disruption after Cesarean delivery.

Methods: All patients undergoing Cesarean delivery at the New England Medical Center from September 1995 to June 1997 were eligible. One group (162 patients) was randomly assigned to have the subcutaneous fat layer closed with a running 3-0 plain suture.