Female Pelvic Medicine and Reconstructive Surgery最新文献

Objectives: d-Mannose is a promising nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI). Recurrent UTI is common in postmenopausal women and may be especially prevalent in those with cystitis cystica (CC) lesions found on cystoscopy. Our objectives were to determine whether CC lesions are associated with a higher UTI incidence rate and whether d-mannose reduces this rate in women with CC.

Methods: This is a retrospective cohort study of patients with rUTI who underwent cystoscopy at our institution (from which CC status was identified) and who were treated with d-mannose as a single agent for UTI prophylaxis. Participants were required to have at least 1 year of follow-up for UTIs both before and after d-mannose initiation to allow for a pre-post comparison.

Results: Twenty-seven patients were included in the analysis (13 with CC, 14 without CC). Most patients (88.9%) were postmenopausal. Patients with CC had a higher UTI incidence rate than patients without CC (4.69 vs 2.93 UTIs/year before starting d-mannose prophylaxis, P = 0.021). After initiating d-mannose prophylaxis, the UTI incidence rate decreased significantly in patients with CC (rate decrease = 2.23 UTIs/year, P = 0.0028). This decrease was similar in magnitude to that observed in patients without CC (rate decrease = 1.64 UTIs/year, P = 0.0007; P interaction = 0.58).

Conclusions: Patients with rUTI with CC had more frequent UTI episodes than patients without CC. Patients in both groups had fewer UTI episodes after beginning d-mannose prophylaxis. These findings add to the body of literature supporting d-mannose for the prevention of rUTI in women, including those with CC.

Importance: Understanding women's acceptance of telemedicine as a model of care for pelvic floor disorders (PFDs) allows for a more patient-centered approach to widespread implementation in female pelvic medicine and reconstructive surgery.

Objectives: The pandemic sparked rapid and widespread implementation of telemedicine. Our goal was to assess acceptance, satisfaction, and desire for future use of telemedicine among women seeking care for PFDs.

Study design: We performed a structured telephone survey of new patients who underwent video visits, and established patients who underwent video or telephone visits, when nonurgent, in-person visits were suspended. Our survey assessed the following domains: satisfaction, future use of telemedicine, level of comfort, perceived utility, and access and comfort with technology.

Results: Between April and July 2020, we conducted telemedicine visits with 221 patients, 131 (63% of eligible patients) of whom agreed to participate in our survey (63 (74%) telephone and 68 (56%) video, including 35 established and 33 new patients). Overall, most participants (96.3%) described being "very" or "somewhat satisfied" with telemedicine in addressing their needs and "comfortable" sharing personal information with providers in a telemedicine visit (94.7%). However, video participants (both new and established) were more likely to view telemedicine as valuable (P = 0.02) than telephone participants. Furthermore, established video participants perceived greater quality care of care (P = 0.01) than telephone participants.

Conclusions: Video telemedicine is a well-accepted adjunct model of care with the potential to expand the reach of quality subspecialty care of value to women with PFDs.

Importance: Symptoms of urinary frequency, urgency, and urinary leakage are characteristic of overactive bladder (OAB) syndrome. However, frequency and urgency symptoms are also present in most patients with interstitial cystitis/bladder pain syndrome (IC/BPS).

Objective: Our objective was to describe the urge incontinence among women with IC/BPS, which may indicate true overlap of OAB and IC/BPS.

Study design: This is a prospective study of women with IC/BPS diagnosed clinically in the Veterans Affairs Health Care system. Patients completed the OAB and Female Genitourinary Pain Index (F-GUPI) questionnaires. Questions from the OAB questionnaire were used to analyze symptoms of urinary urgency and urge incontinence. Pain symptoms, urinary symptoms, and impact on quality of life were assessed based on the F-GUPI. Patient demographics, comorbidities, and symptoms were reviewed.

Results: Within the cohort of 144 women with IC/BPS, 100 (69%) had urinary leakage associated with the strong desire to void and were more likely to have incontinence compared with healthy controls (P < 0.001). The IC/BPS group also had higher total and pain scores on the F-GUPI (P < 0.001), but pain scores were not affected by the presence of incontinence (P = 0.478).

Conclusions: The prevalence of OAB symptoms of urinary leakage is high among women with IC/BPS. This may explain the efficacy of OAB medication and third-line therapies in this population.

Objective: The objective was to determine whether a difference exists in short-term urinary retention after tension-free vaginal tape (TVT) midurethral sling placement when performed alone compared with when placed during a concomitant prolapse procedure.

Methods: We conducted a single-center retrospective cohort study that compared TVT procedures performed alone (group 1) to those with a concomitant prolapse procedure (group 2). The primary outcome was the proportion of patients discharged with an indwelling Foley catheter after failing postoperative voiding trial.

Results: There were 100 women in group 1 and 267 women in group 2. Concomitant prolapse procedures included vaginal approach (n = 47), robotic (n = 218), or both (n = 2). Forty-nine patients (13.4%) failed the initial voiding trial and 21 patients (5.7%) were discharged with an indwelling Foley catheter. The rate of short-term urinary retention requiring an indwelling catheter at discharge was not significantly different between group 1 and group 2 (9 [9.0%] vs 12 [4.5%], P = 0.1). The duration of catheterization after discharge was shorter in group 1 compared with group 2 (2.1 ± 1.1 vs 4.3 ± 2.0 days, P = 0.008). In multivariate analysis, patients discharged with a catheter were more likely to have diabetes with an odds ratio of 3.1 (95th confidence interval, 1.2-8.1).

Conclusions: The proportion of patients discharged with an indwelling catheter did not significantly differ if TVT was performed alone or at the time of a concomitant prolapse procedure (9.0% vs 4.5%, P = 0.1).