Are there age-related changes in the measurements of the urethral sphincter complex in nulliparous women? A three-dimensional ultrasound assessment.

Introduction And Hypothesis: The objective was to determine age-related changes in measurements of urethral sphincter complex components in asymptomatic nulliparous women.

Methods: Eighty nulliparous women ≥18 years underwent 3D ultrasound of the anterior pelvic compartment in a cross-sectional study. Measurements of the urethral sphincter components (smooth muscle sphincter [SMS] and striated urinary sphincter [SUS]) and urethra including area, length, width, and distance of the SUS and SMS from the urethrovesical junction were obtained.

Updates on the diagnostic tools for evaluation of pelvic floor disorders.

Purpose Of Review: Pelvic floor disorders are common and cause significant morbidity for women. Recent advances in the evaluation of women with pelvic floor dysfunction have improved diagnostic accuracy and, with the development and use of validated patient-reported outcomes, has improved measurement of outcomes important to patients. We describe recent advances in the evaluation and measurement of pelvic floor disorders (PFDs).

Dynamic assessment of sling function on transperineal ultrasound: does it correlate with outcomes 1 year following surgery?

Introduction And Hypothesis: To correlate dynamic assessment of sling function using 2D and 3D transperineal ultrasound with outcomes following transobturator sling surgery.

Methods: This is an unmatched case-control study of 100 patients who underwent transobturator sling surgery at our center between 2009 and 2012. Group A (n = 50) patients had successful outcomes and group B (n = 50) patients had suboptimal outcomes 1 year following surgery.

Transobturator versus single incision slings: 1-year results of a randomized controlled trial.

Introduction And Hypothesis: To compare 1-year surgical outcomes following transobturator (TO) sling placement and single incision (SI) sling placement for the treatment of stress urinary incontinence (SUI).

Methods: We performed a randomized trial at a single institution. Patients with urodynamically proven SUI were offered participation and randomized to placement of a TO sling (Monarc™) or a SI sling (MiniArc™) between 2008 and 2011.

De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence.

Introduction And Hypothesis: There is a paucity of data evaluating the risk of de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP) in women with no preoperative occult SUI. We hypothesized that apical suspension procedures would have higher rates of de novo SUI.

Methods: This was a retrospective database review of women who had surgery for POP from 2003 to 2013 and developed de novo SUI at ≥6 months postoperatively.

Levator ani defects in patients with stress urinary incontinence: three-dimensional endovaginal ultrasound assessment.

Introduction And Hypothesis: To determine the prevalence of levator ani (LA) muscle subdivision defects in patients with SUI using three-dimensional endovaginal ultrasound (3D EVUS).

Methods: This is a prospective cohort study of 100 patients with pure or predominant urodynamic SUI who underwent 3D EVUS. The 3D cubes obtained were analyzed and the LA muscle was divided into three subgroups: the puboperinealis/puboanalis, the puborectalis, and the iliococcygeus/pubococcygeus.

Endoscopic transurethral resection of urethral mesh erosion with the use of a pediatric nasal speculum.

Background: A rare but challenging complication of midurethral slings is erosion of mesh tape through the urethral wall.

Cases: In this report, we describe two cases in which a pediatric nasal speculum provided exposure for transurethral resection of eroded mesh. Exposure was sufficient for complete mesh resection endoscopically as well as with use of traditional surgical instruments.

Obliterative LeFort colpocleisis in a large group of elderly women.

Objective: To report on anatomical and functional outcomes, patient satisfaction, and associated morbidity and mortality in patients undergoing LeFort colpocleisis.

Methods: This was a retrospective case series of LeFort colpocleisis performed from January 2000 to October 2011. Data obtained from a urogynecologic database included demographics, comorbidities, medications, and urinary and bowel symptoms.

Three-dimensional endovaginal ultrasound examination following injection of Macroplastique for stress urinary incontinence: outcomes based on location and periurethral distribution of the bulking agent.

Introduction And Hypothesis: Our aim was to use three-dimensional enodovaginal ultrasound (3D EVUS) to identify sonographic parameters that are associated with successful outcomes following injection of Macroplastique.

Methods: Three hundred and sixty degree 3D EVUS was performed in 100 treatment-naïve patients following Macroplastique injection. The location, volumes, periurethral distribution, and distance of the hyperechoic densities from the urethrovesical junction were assessed.

Repeat versus primary slings in patients with intrinsic sphincter deficiency.

Introduction And Hypothesis: Our goal was to compare outcomes of repeat vs. primary synthetic slings in patients with stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD).

Materials And Methods: We reviewed patients who underwent a sling for SUI with ISD from 2003 to 2010.

Reattachment of the endopelvic fascia to the apex during anterior colporrhaphy: does the type of suture matter?

Introduction And Hypothesis: We aimed to determine if the use of permanent suture for the apical fixation during traditional anterior colporrhaphy results in improved outcomes compared to delayed absorbable suture.

Methods: A retrospective case-control study was performed in patients who underwent traditional non-grafted anterior colporrhaphy with reattachment of the anterior endopelvic fascia to the apex/cervix comparing permanent (group 1) or absorbable suture (group 2). Patients were matched based on age, body mass index, and presenting stage of prolapse.

A randomized clinical trial of the impact of local estrogen on postoperative tissue quality after vaginal reconstructive surgery.

Objective: To evaluate the use and effect of early administration of vaginal estrogen via a continuous low-dose estradiol vaginal ring placed immediately after pelvic reconstructive surgery.

Methods: This was a randomized controlled trial of 65 postmenopausal women undergoing vaginal reconstructive surgery. The subjects were randomly assigned to receive an estradiol-releasing vaginal ring, placebo vaginal ring, or control without vaginal ring for 12 weeks immediately after vaginal reconstructive surgery.

Predictors of successful salpingo-oophorectomy at the time of vaginal hysterectomy.

Study Objective: To determine prognostic factors related to successful salpingo-oophorectomy in menopausal women at the time of vaginal hysterectomy.

Design: Retrospective cohort study (Canadian Task Force Classification II-2).

Setting: Tertiary care center.

LeFort colpocleisis and stress incontinence: weighing the risk of voiding dysfunction with sling placement.

Introduction And Hypothesis: This study aims to evaluate clinical outcomes of concomitant suburethral sling with LeFort colpocleisis including its effect on postoperative voiding.

Methods: We performed a retrospective review of all LeFort colpocleisis procedures from our institution. We reviewed demographics, symptoms of stress urinary incontinence, incontinent events/day, pads usage/day, urodynamic parameters, and presence of voiding dysfunction.

Biologic grafts for cystocele repair: does concomitant midline fascial plication improve surgical outcomes?

Introduction And Hypothesis: This study aims to compare the efficacy of porcine graft-augmented anterior prolapse repair with and without underlying pubocervical fascia plication.

Methods: Women with symptomatic anterior prolapse who underwent transvaginal repair, using biologic graft via transobturator approach, were retrospectively studied. An initial cohort had the graft placed without fascial plication.

Validation of a global pelvic floor symptom bother questionnaire.

Introduction And Hypothesis: This study aimed to validate a symptom questionnaire to assess presence and patient bother as related to common pelvic floor disorders.

Methods: The validation of the Pelvic Floor Bother Questionnaire (PFBQ) included evaluation of internal reliability, test-retest reliability, and validity of the items.

Results: A total of 141 patients with mean age of 61.

"Eyeball" POP-Q examination: shortcut or valid assessment tool?

Introduction And Hypothesis: The objective of this study was to compare the results of the Pelvic Organ Prolapse Quantification (POP-Q) examination by visual estimation to measurement.

Methods: Women with pelvic organ prolapse underwent both "eyeball"/estimated and measured POP-Q examinations by two trained examiners in a randomized order. POP-Q points and stage were analyzed using the paired t test, chi-square, Pearson's correlation, and kappa statistics.

Primary versus recurrent prolapse surgery: differences in outcomes.

Introduction And Hypothesis: We set out to evaluate anatomical outcomes of recurrent vs. primary prolapse surgery, focusing on anterior colporrhaphy (AC).

Methods: A retrospective study was performed comparing patients who underwent AC for recurrent cystocele (group I) and a matched control group who underwent primary AC (group II).

Combined trans- and periurethral injections of bulking agents for the treatment of intrinsic sphincter deficiency.

The purpose of this study was to compare Contigen combined with Durasphere to Contigen injections alone for the treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). Subjective and objective incontinence outcomes were compared at 2 weeks and 6 months. We compared rates of urinary retention and future incontinence surgery between groups.

Pyometra necessitating hysterectomy after colpocleisis in an extremely elderly patient.

As the number of women more than the age 65 increases, so will the need for treatment of pelvic organ prolapse and the comorbidities that come with surgical treatment of an aging population gain significance. Colpocleisis is an option for women failing or refusing conservative prolapse management and not desiring sexual function. The advantages of colpocleisis are decreased operative time, low complication rate, and ability to use local or regional anesthesia.

Suburethral sling treatment of occult stress incontinence and intrinsic sphincter deficiency in women with severe vaginal prolapse of the anterior vs posterior/apical compartment.

Objective: The purpose of this study was to compare the efficacy of a Mersilene mesh suburethral sling for occult stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) in women with severe vaginal prolapse of the anterior compartment to the posterior/apical compartment.

Study Design: This was a retrospective study that compared women with stage or grade III/IV prolapse of the anterior compartment (group 1) with the posterior/apical compartment (group 2); both groups demonstrated occult SUI (leakage only with prolapse reduced) and ISD on urodynamics, and underwent concurrent pelvic reconstructive surgery. The sling was defined as efficacious if SUI was prevented in 85% of women and if obstructive symptoms (de novo or worsening urge incontinence, or urinary retention greater than 2 weeks) occurred in less than 10% of women.

Patient characteristics that are associated with continued pessary use versus surgery after 1 year.

Objective: The purpose of this study was to identify patient characteristics in women with symptomatic pelvic organ prolapse that is associated with continued pessary use versus surgery after 1 year.

Study Design: Fifty-nine women with symptomatic pelvic organ prolapse who were satisfied with their pessary at 2 months were evaluated prospectively at 1 year. Characteristics of women who continued to use a pessary were compared with women who underwent pelvic reconstructive surgery to identify predictors for continued pessary use versus surgery.

Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse.

Objective: Our purpose was to estimate, in women after 2 months of pessary use, patient satisfaction and the percentage of prolapse and urinary symptoms that improve or worsen.

Study Design: In a prospective study, 100 consecutive women with symptomatic pelvic organ prolapse were fitted with a pessary, and 73 women had a successful 2-week pessary fitting trial. Prolapse and urinary symptoms were assessed at baseline and at 2 months.

Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse.

Objective: Our purpose was to estimate the percentage of women with symptomatic pelvic organ prolapse who had a successful pessary fitting trial, to identify pelvic examination parameters that are associated with an unsuccessful pessary fitting trial, and to identify the most commonly used pessary for each stage of prolapse.

Study Design: In a prospective, observational study, 100 consecutive women with symptomatic pelvic organ prolapse were examined, staged, and fitted with either a ring or Gellhorn pessary. A successful pessary fitting trial occurred if a woman continued to use a pessary 1 week after being fitted.

Vaginal paravaginal repair with an AlloDerm graft.

Objective: This study was undertaken to describe outcomes of a technique of vaginal paravaginal repair that used AlloDerm graft (LifeCell, Branchburg, NJ) in women with recurrent stage II or with primary or recurrent stage III/IV anterior vaginal wall prolapse.

Study Design: This was an observational study. Thirty-three women underwent a vaginal paravaginal repair using AlloDerm graft.