Does symptom severity predict response to low-dose onabotulinumtoxinA for the treatment of urgency urinary incontinence?

Objective: Intradetrusor onabotulinumtoxinA is a third-line treatment for urgency urinary incontinence (UUI) which is customarily reserved for severe disease. We sought to determine if symptom severity predicts the proportional response to onabotulinumtoxinA and whether low-dose injection may be an appropriate treatment for mild-moderate symptoms.

Study Design: This prospective cohort study compared patients with urgency urinary incontinence who were recruited from the Urogynecology Clinic with mild-moderate (2-9 episodes/3-day diary) and severe UUI (>9 episodes/3-day diary) symptoms.

Mild cough · wheezing · loud heart sounds · Dx?

A 25-year-old man, who was an active duty US Navy sailor, went to his ship's medical department complaining of a mild cough that he'd had for 2 days. He denied having any fevers, chills, night sweats, angina, or dyspnea. He said he hadn't experienced any exertional fatigue or difficulty completing the rigorous physical tasks of his occupation as an engineman on the ship.

Risk factors for mesh extrusion after prolapse surgery: a case-control study.

Objectives: To identify risk factors for mesh extrusion in women undergoing pelvic organ prolapse repair by abdominal sacral colpopexy (ASC) or vaginal mesh procedure (VMP).

Methods: A multicenter case-control study of patients who underwent ASC or VMP from 2006 to 2009 identified using diagnosis and procedure coding. Cases were defined as women who underwent eligible index procedure with synthetic mesh and had mesh visible through the vaginal epithelium at postoperative evaluation; controls were matched in an approximate 1:3 ratio by date and type of procedure.

Intraoperative and postoperative gastrointestinal complications associated with laparoscopic sacrocolpopexy.

Objective: This study aimed to quantify the risks of intraoperative and postoperative gastrointestinal (GI) complications associated with laparoscopic sacrocolpopexy and identify possible risk factors.

Methods: A total of 390 medical records were retrospectively reviewed for GI complications. Complications were classified as functional complications [ileus, small bowel obstruction (SBO), and prolonged nausea/emesis] or bowel injury.

Use of physical therapy to augment dilator treatment for vaginal agenesis.

Objective: : Dilator therapy has been used successfully for many years to treat vaginal agenesis. Our objective was to show how established physical therapy techniques can be used to augment dilator therapy.

Methods: : A 36-year-old woman desiring nonsurgical management of vaginal agenesis was instructed in the use of vaginal dilators by a pelvic-floor physical therapist.

Anatomical and histological examination of the porcine vagina and supportive structures: in search of an ideal model for pelvic floor disorder evaluation and management.

Objective: : The objective of the study was to examine the anatomy and histology of the swine vagina and adjacent supportive structures in comparison to human tissues to determine the potential utility of this model for pelvic floor disorder evaluation and management.

Methods: : This is a descriptive study of the gross anatomy and histology of the swine vagina, uterosacral ligament, cardinal ligament, and rectovaginal space. Tissue was collected from 6 different sites in each of the 6 animals, processed, and stained with hematoxylin-eosin, Masson trichrome, and van Gieson and evaluated by both gynecologic and veterinary pathologists.

Effect of operative technique on mesh exposure in laparoscopic sacrocolpopexy.

Objectives: To determine if opening the vaginal cuff during laparoscopic sacrocolpopexy influences the rate of mesh exposure.

Methods: A total of 390 medical records were retrospectively reviewed for demographic information, operative technique, and relevant outcomes.

Results: Eleven mesh exposures (2.

Laparoscopic hysterectomy using various energy sources in swine: a histopathologic assessment.

Objective: Analyze energy-induced damage to the swine vagina during laparoscopic hysterectomy.

Study Design: Laparoscopic colpotomy was performed in swine using ultrasonic, monopolar, and bipolar energy. Specimens (n = 22) from 13 swine were stained with hematoxylin and eosin and Masson's trichrome for energy-related damage.

Randomized clinical trial evaluating the frequency of membrane sweeping with an unfavorable cervix at 39 weeks.

Background: Despite the widely accepted use of membrane sweeping to prevent postmaturity pregnancies, the optimal frequency for this procedure has not been established.

Aim: To determine if the frequency of membrane sweeping in women with an unfavorable cervix at term results in fewer labor inductions.

Methods: This was a randomized trial of women with an unfavorable cervix (Bishop's score of ≤4) at 39 weeks randomized into three groups: control, once-weekly membrane sweeping, and twice-weekly membrane sweeping.