Pub Date : 2022-03-01DOI: 10.1097/SPV.0000000000001134
C. McKenzie, Christopher L. Crafton, A. Plair, C. Matthews
Objective The aim of the study was to compare rates of persistent gluteal and posterior thigh pain, procedural efficacy, and postoperative complications at 1 year after sacrospinous ligament fixation using either an anchor-based or suture-capturing device. Methods This prospective cohort study evaluated outcomes 1 year after operation in patients previously enrolled in a randomized controlled trial comparing an anchor-based versus suture-capturing device for sacrospinous fixation. Symptom scores were evaluated via Pelvic Floor Distress Inventory 20 and Pelvic Floor Impact Questionnaire 7. Pain was evaluated using the Numerical Rating Scale. Composite surgical failure was defined as prolapse beyond the hymen or C-point greater than one half down the vagina, vaginal bulge symptoms, or a need for prolapse retreatment via surgery or pessary management. Descriptive and bivariate statistics were performed. Results Forty three (21 anchors, 22 sutures) of the original 47 patients (91%) returned for follow-up. The mean follow-up time was 15.4 months, age was 69 years old, body mass index was 30, and preoperative Pelvic Organ Prolapse Quantification stage was 2.7. No patients reported significant increase in pain at sacrospinous fixation site above baseline, and there was no significant difference in posterior thigh or gluteal pain on the side of fixation compared with baseline in the anchor-based or suture-capture groups (−0.2 ± 0.9 and −0.5 ± 1.6, respectively, P = 0.719). Two patients demonstrated surgical failure (anchor group) due to bulge symptoms (P = 0.233). The devices similarly improved Pelvic Floor Distress Inventory 20 (−71.0 ± 45.5 vs −66.3 ± 64.4, P = 0.652) and Pelvic Floor Impact Questionnaire 7 (−40.6 ± 62.4 vs −26.4 ± 65.7, P = 0.768) scores. Conclusions Persistent gluteal or posterior thigh pain and surgical failure is uncommon 12 months after sacrospinous fixation and was not associated with the type of fixation device.
{"title":"Sacrospinous Ligament Fixation Using an Anchor Versus Suture-Capturing Device: A Prospective Cohort Study","authors":"C. McKenzie, Christopher L. Crafton, A. Plair, C. Matthews","doi":"10.1097/SPV.0000000000001134","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001134","url":null,"abstract":"Objective The aim of the study was to compare rates of persistent gluteal and posterior thigh pain, procedural efficacy, and postoperative complications at 1 year after sacrospinous ligament fixation using either an anchor-based or suture-capturing device. Methods This prospective cohort study evaluated outcomes 1 year after operation in patients previously enrolled in a randomized controlled trial comparing an anchor-based versus suture-capturing device for sacrospinous fixation. Symptom scores were evaluated via Pelvic Floor Distress Inventory 20 and Pelvic Floor Impact Questionnaire 7. Pain was evaluated using the Numerical Rating Scale. Composite surgical failure was defined as prolapse beyond the hymen or C-point greater than one half down the vagina, vaginal bulge symptoms, or a need for prolapse retreatment via surgery or pessary management. Descriptive and bivariate statistics were performed. Results Forty three (21 anchors, 22 sutures) of the original 47 patients (91%) returned for follow-up. The mean follow-up time was 15.4 months, age was 69 years old, body mass index was 30, and preoperative Pelvic Organ Prolapse Quantification stage was 2.7. No patients reported significant increase in pain at sacrospinous fixation site above baseline, and there was no significant difference in posterior thigh or gluteal pain on the side of fixation compared with baseline in the anchor-based or suture-capture groups (−0.2 ± 0.9 and −0.5 ± 1.6, respectively, P = 0.719). Two patients demonstrated surgical failure (anchor group) due to bulge symptoms (P = 0.233). The devices similarly improved Pelvic Floor Distress Inventory 20 (−71.0 ± 45.5 vs −66.3 ± 64.4, P = 0.652) and Pelvic Floor Impact Questionnaire 7 (−40.6 ± 62.4 vs −26.4 ± 65.7, P = 0.768) scores. Conclusions Persistent gluteal or posterior thigh pain and surgical failure is uncommon 12 months after sacrospinous fixation and was not associated with the type of fixation device.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"131 - 135"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48292400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.1097/SPV.0000000000001156
E. Morocco, K. Latack, K. Ciesielski, Brian T. Nguyen, C. Dancz
Importance Antimuscarinic medications are often discontinued, and there is a paucity of data regarding patient experience of medications within this class. Objective The objective of this study is to qualitatively explore patient experience of antimuscarinic medications used for overactive bladder using reviews on Drugs.com. Study Design We examined reviews prior to February 2, 2020 (available since 2008) for oral antimuscarinic medications. User content was reviewed qualitatively via inductive content analysis. Investigators coded third-party impressions, categorizing each review as positive, mostly positive, mostly negative, or negative. The prevalence of side effects, themes, and impressions are described, with comparisons by drug using χ2, Mann–Whitney U, and Kruskal-Wallis tests, as appropriate. Correlation between ordinal and categorical variables was performed using Tau and Spearman correlation coefficients, respectively. Results We analyzed 469 user reviews. 68.2% reported symptom improvement. The most common side effects were dry mouth (29%) and fatigue (10.7%). Fewer neurologic side effects were reported in the solifenacin (13.9%) and trospium (none) groups (P = 0.009). Tolterodine and trospium immediate release had lower rates of ears, nose, and throat side effects (22.5% and 26.2%, respectively, P = 0.001.) Analysis of themes suggested 2 domains driving overall satisfaction: improvement and side effects. Improvement was associated with a positive satisfaction score (ρ = 0.64, P < 0.001) and gestalt impression (ρ = 0.74, P < 0.001). The factors that most negatively affected these measures were persistent symptoms followed by gastrointestinal side effects (P < 0.001). Conclusions Our data suggest important differences within this class of medication both in terms of side effects and patient satisfaction. Furthermore, symptom improvement is the leading factor for patient satisfaction, whereas gastrointestinal side effects are associated with dissatisfaction.
{"title":"Patient Experience of Antimuscarinic Treatment for Overactive Bladder: A Qualitative Exploration of Online Forum Content","authors":"E. Morocco, K. Latack, K. Ciesielski, Brian T. Nguyen, C. Dancz","doi":"10.1097/SPV.0000000000001156","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001156","url":null,"abstract":"Importance Antimuscarinic medications are often discontinued, and there is a paucity of data regarding patient experience of medications within this class. Objective The objective of this study is to qualitatively explore patient experience of antimuscarinic medications used for overactive bladder using reviews on Drugs.com. Study Design We examined reviews prior to February 2, 2020 (available since 2008) for oral antimuscarinic medications. User content was reviewed qualitatively via inductive content analysis. Investigators coded third-party impressions, categorizing each review as positive, mostly positive, mostly negative, or negative. The prevalence of side effects, themes, and impressions are described, with comparisons by drug using χ2, Mann–Whitney U, and Kruskal-Wallis tests, as appropriate. Correlation between ordinal and categorical variables was performed using Tau and Spearman correlation coefficients, respectively. Results We analyzed 469 user reviews. 68.2% reported symptom improvement. The most common side effects were dry mouth (29%) and fatigue (10.7%). Fewer neurologic side effects were reported in the solifenacin (13.9%) and trospium (none) groups (P = 0.009). Tolterodine and trospium immediate release had lower rates of ears, nose, and throat side effects (22.5% and 26.2%, respectively, P = 0.001.) Analysis of themes suggested 2 domains driving overall satisfaction: improvement and side effects. Improvement was associated with a positive satisfaction score (ρ = 0.64, P < 0.001) and gestalt impression (ρ = 0.74, P < 0.001). The factors that most negatively affected these measures were persistent symptoms followed by gastrointestinal side effects (P < 0.001). Conclusions Our data suggest important differences within this class of medication both in terms of side effects and patient satisfaction. Furthermore, symptom improvement is the leading factor for patient satisfaction, whereas gastrointestinal side effects are associated with dissatisfaction.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e49 - e54"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49405525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.1097/SPV.0000000000001169
G. Northington, Marian G Acevedo-Alvarez, M. Willis-Gray, A. Hardart, C. Carter-Brooks, K. Hung, O. Brown, E. Trowbridge
ABSTRACT The American Urogynecologic Society (AUGS) identified diversity, equity, and inclusion as the cornerstone of excellence in governance and operations. Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs. In June 2020, the AUGS President, Dr Shawn Menefee, and Board of Directors called for a Presidential Task Force on Diversity, Equity, and Inclusion to study the current state of our society and make recommendations for future directions. The charge was intentionally broad. In review of the literature, there was little to inform the best means to proceed aside from administering climate surveys to gauge the current culture of inclusion and bias. The task force believed that the challenge was not only to describe the problem but also to articulate solutions. We ultimately moved to rewrite the Diversity and Inclusion and Code of Conduct Statements and develop an Action Plan that would accelerate the efforts of AUGS to foster inclusion and improve equity through the existing governance structure. In this document, we describe how the task force was organized and conducted the work to develop strategies that were aligned with the AUGS mission: "As the leader in female pelvic medicine and reconstructive surgery, AUGS drives excellence in care for women through education, research, advocacy, and interdisciplinary collaboration."
{"title":"The American Urogynecologic Society Action Plan on Diversity, Equity, and Inclusion: Developed by the Diversity, Equity, and Inclusion Task Force.","authors":"G. Northington, Marian G Acevedo-Alvarez, M. Willis-Gray, A. Hardart, C. Carter-Brooks, K. Hung, O. Brown, E. Trowbridge","doi":"10.1097/SPV.0000000000001169","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001169","url":null,"abstract":"ABSTRACT\u0000The American Urogynecologic Society (AUGS) identified diversity, equity, and inclusion as the cornerstone of excellence in governance and operations. Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs. In June 2020, the AUGS President, Dr Shawn Menefee, and Board of Directors called for a Presidential Task Force on Diversity, Equity, and Inclusion to study the current state of our society and make recommendations for future directions. The charge was intentionally broad. In review of the literature, there was little to inform the best means to proceed aside from administering climate surveys to gauge the current culture of inclusion and bias. The task force believed that the challenge was not only to describe the problem but also to articulate solutions. We ultimately moved to rewrite the Diversity and Inclusion and Code of Conduct Statements and develop an Action Plan that would accelerate the efforts of AUGS to foster inclusion and improve equity through the existing governance structure. In this document, we describe how the task force was organized and conducted the work to develop strategies that were aligned with the AUGS mission: \"As the leader in female pelvic medicine and reconstructive surgery, AUGS drives excellence in care for women through education, research, advocacy, and interdisciplinary collaboration.\"","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 3 1","pages":"127-130"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42471690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.1097/SPV.0000000000001145
Hannah Millimet, Kerac N. Falk, J. Harroche, Annalise R. Littman, N. Metcalfe, G. Northington
Objectives Anticholinergic medications are a core treatment strategy for overactive bladder (OAB). There is evidence that exposure to anticholinergic medications is associated with an increased risk of developing dementia. We launched an initiative to inform our patients of this risk and give them an opportunity to engage in shared decision-making about their treatment. This quality improvement initiative encompassed 3 aims: (1) to evaluate the feasibility of 2 different routes to deliver the written outreach; (2) to evaluate if and how patients changed their OAB treatment; and (3) to assess satisfaction with the outreach initiative. Methods A query was performed via the electronic medical record for all patients who had been prescribed an anticholinergic for treatment of OAB. We sent either electronic messages or traditional mail to patients. We contacted patients by telephone to assess if they received the message, were satisfied with their respective method of communication, and decided for ongoing treatment. Health care provider satisfaction was also measured. Results Of the 231 patients sent the outreach, 32 were still taking the anticholinergic at the time they received the communication. The majority of patients, 84.38%, were satisfied with the initiative and elected to change therapy after learning about the increased risk of dementia. The physicians also uniformly reported satisfaction with the initiative. Conclusions Overall, this outreach initiative resulted in an increase in patient counseling that led to a change in treatment for most patients. This initiative was received favorably by patients and health care providers.
{"title":"A Physician-Led Communication Initiative to Inform OAB Patients of Dementia Risk Associated With Anticholinergic Medications","authors":"Hannah Millimet, Kerac N. Falk, J. Harroche, Annalise R. Littman, N. Metcalfe, G. Northington","doi":"10.1097/SPV.0000000000001145","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001145","url":null,"abstract":"Objectives Anticholinergic medications are a core treatment strategy for overactive bladder (OAB). There is evidence that exposure to anticholinergic medications is associated with an increased risk of developing dementia. We launched an initiative to inform our patients of this risk and give them an opportunity to engage in shared decision-making about their treatment. This quality improvement initiative encompassed 3 aims: (1) to evaluate the feasibility of 2 different routes to deliver the written outreach; (2) to evaluate if and how patients changed their OAB treatment; and (3) to assess satisfaction with the outreach initiative. Methods A query was performed via the electronic medical record for all patients who had been prescribed an anticholinergic for treatment of OAB. We sent either electronic messages or traditional mail to patients. We contacted patients by telephone to assess if they received the message, were satisfied with their respective method of communication, and decided for ongoing treatment. Health care provider satisfaction was also measured. Results Of the 231 patients sent the outreach, 32 were still taking the anticholinergic at the time they received the communication. The majority of patients, 84.38%, were satisfied with the initiative and elected to change therapy after learning about the increased risk of dementia. The physicians also uniformly reported satisfaction with the initiative. Conclusions Overall, this outreach initiative resulted in an increase in patient counseling that led to a change in treatment for most patients. This initiative was received favorably by patients and health care providers.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e16 - e21"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41740329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.1097/SPV.0000000000001142
A. Wyman, J. Salemi, S. Lai-Yuen, K. Greene, R. Bassaly, R. Kedar, L. Hoyte
Objective The aim of the study was to investigate the clinical utility of estimated levator ani subtended volume (eLASV) as a prospective preoperative biomarker for prediction of surgical outcomes. Study Design This is a prospective case-control pilot study. Patients were recruited and gave consent between January 2018 and December 2020. Surgical failure was defined by composite score. The eLASV was calculated for each patient based on a previously published algorithm. Descriptive statistics, Fisher exact test, log-binomial regression, area under a receiver operating characteristics, Bland-Altman plot, Lin coefficient, and κ coefficient were all performed for analysis. Results Fifty-one patients gave consent, 31 completed preoperative magnetic resonance imaging, 27 underwent surgery (uterosacral ligament suspension), and 19 followed up for 1-year examination. Five patients (26.3%) were defined as surgical failure with median eLASV volume of 57.0 (interquartile range, 50.1–66.2). Fourteen patients (73.7%) were defined as surgical success with median eLASV of 28.2 (interquartile range, 17.2–24.3). Eighty percent of the surgical failure group (4/5) had elevated volume of eLASV, where only 14.3% of the success group (2/14) had an elevated volume (P = 0.0173). No confounders were found and unadjusted log-binomial regression suggested that patients with a high eLASV were 8.7 (95% confidence interval, 1.2–61.9) times more likely to experience surgical failure compared with those with low eLASV. The c-statistic (area under a receiver operating characteristics) was high at 0.829 along with Lin concordance coefficient of 0.949 (95% confidence interval, 0.891–0.977) for continuous data between the 2 interrater observer teams. Conclusions In this small prospective pilot study, patients with elevated eLASV on a preoperative pelvic magnetic resonance imaging were associated with an increased risk for surgical failure at 1 year regardless of age, body mass index, stage, or parity. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT03534830
{"title":"Estimated Levator Ani Subtended Volume: A Predictive Biomarker for Surgical Outcomes Following Native Tissue Apical Repair","authors":"A. Wyman, J. Salemi, S. Lai-Yuen, K. Greene, R. Bassaly, R. Kedar, L. Hoyte","doi":"10.1097/SPV.0000000000001142","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001142","url":null,"abstract":"Objective The aim of the study was to investigate the clinical utility of estimated levator ani subtended volume (eLASV) as a prospective preoperative biomarker for prediction of surgical outcomes. Study Design This is a prospective case-control pilot study. Patients were recruited and gave consent between January 2018 and December 2020. Surgical failure was defined by composite score. The eLASV was calculated for each patient based on a previously published algorithm. Descriptive statistics, Fisher exact test, log-binomial regression, area under a receiver operating characteristics, Bland-Altman plot, Lin coefficient, and κ coefficient were all performed for analysis. Results Fifty-one patients gave consent, 31 completed preoperative magnetic resonance imaging, 27 underwent surgery (uterosacral ligament suspension), and 19 followed up for 1-year examination. Five patients (26.3%) were defined as surgical failure with median eLASV volume of 57.0 (interquartile range, 50.1–66.2). Fourteen patients (73.7%) were defined as surgical success with median eLASV of 28.2 (interquartile range, 17.2–24.3). Eighty percent of the surgical failure group (4/5) had elevated volume of eLASV, where only 14.3% of the success group (2/14) had an elevated volume (P = 0.0173). No confounders were found and unadjusted log-binomial regression suggested that patients with a high eLASV were 8.7 (95% confidence interval, 1.2–61.9) times more likely to experience surgical failure compared with those with low eLASV. The c-statistic (area under a receiver operating characteristics) was high at 0.829 along with Lin concordance coefficient of 0.949 (95% confidence interval, 0.891–0.977) for continuous data between the 2 interrater observer teams. Conclusions In this small prospective pilot study, patients with elevated eLASV on a preoperative pelvic magnetic resonance imaging were associated with an increased risk for surgical failure at 1 year regardless of age, body mass index, stage, or parity. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT03534830","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"385 - 390"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46158042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.1097/SPV.0000000000001164
L. Tholemeier, Colby P. Souders, C. Bresee, F. Nik-Ahd, A. Caron, K. Eilber, J. Anger
Importance A better understanding of the effect of elective cesarean delivery (CD) on the development of pelvic floor disorders can help obstetricians counsel pregnant women. Objective This study aimed to perform a systematic review and meta-analysis evaluating whether primary elective CD is protective against pelvic floor disorders. Study Design Using the MOOSE criteria, electronic databases were searched for studies that compared the prevalence of pelvic floor disorders among primiparous women. Outcomes of interest were urinary incontinence (UI), fecal incontinence (FI), anal incontinence (AI), and pelvic organ prolapse (POP). Comparisons were made between CD before the onset of labor (“Elective CD”), CD after trial of labor (“Labor CD”), and vaginal delivery (VD). Risk ratios (RRs) were computed using STATA. Between-study heterogeneity was assessed via Cochrane’s homogeneity test and review of the I2 statistic. Results Nineteen studies were included. The overall prevalence of UI for Elective CD was estimated at 7% (95% confidence interval [CI], 3%–13%), Labor CD at 14% (95% CI, 8%–21%), and VD at 26% (95% CI, 20%–32%). Meta-analysis demonstrated a decreased risk of UI after Elective CD compared with Labor CD (RR, 0.75; P = 0.011) or VD (RR, 0.43; P < 0.001). There was a decreased risk of FI or AI after Elective CD compared with VD, but not when compared with Labor CD. Only 2 studies examined POP, precluding meta-analysis. Conclusions Among primiparous women, Elective CD may be protective against UI when compared with Labor CD. There was not a protective effect of Elective CD against FI and AI when compared with Labor CD. More data on the effect of elective CD on POP are needed.
{"title":"Seeking the Truth About Primary Elective Cesarean Delivery and Pelvic Floor Disorders: A Systematic Review and Meta-Analysis","authors":"L. Tholemeier, Colby P. Souders, C. Bresee, F. Nik-Ahd, A. Caron, K. Eilber, J. Anger","doi":"10.1097/SPV.0000000000001164","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001164","url":null,"abstract":"Importance A better understanding of the effect of elective cesarean delivery (CD) on the development of pelvic floor disorders can help obstetricians counsel pregnant women. Objective This study aimed to perform a systematic review and meta-analysis evaluating whether primary elective CD is protective against pelvic floor disorders. Study Design Using the MOOSE criteria, electronic databases were searched for studies that compared the prevalence of pelvic floor disorders among primiparous women. Outcomes of interest were urinary incontinence (UI), fecal incontinence (FI), anal incontinence (AI), and pelvic organ prolapse (POP). Comparisons were made between CD before the onset of labor (“Elective CD”), CD after trial of labor (“Labor CD”), and vaginal delivery (VD). Risk ratios (RRs) were computed using STATA. Between-study heterogeneity was assessed via Cochrane’s homogeneity test and review of the I2 statistic. Results Nineteen studies were included. The overall prevalence of UI for Elective CD was estimated at 7% (95% confidence interval [CI], 3%–13%), Labor CD at 14% (95% CI, 8%–21%), and VD at 26% (95% CI, 20%–32%). Meta-analysis demonstrated a decreased risk of UI after Elective CD compared with Labor CD (RR, 0.75; P = 0.011) or VD (RR, 0.43; P < 0.001). There was a decreased risk of FI or AI after Elective CD compared with VD, but not when compared with Labor CD. Only 2 studies examined POP, precluding meta-analysis. Conclusions Among primiparous women, Elective CD may be protective against UI when compared with Labor CD. There was not a protective effect of Elective CD against FI and AI when compared with Labor CD. More data on the effect of elective CD on POP are needed.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e108 - e114"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45431583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.1097/SPV.0000000000001151
A. Jackson, Cori Ackerman, N. Alesna, Kimiah Hicks, J. Tanner, E. Chang, A. Wyman, R. Bassaly, R. Hidalgo, K. Greene
Objective The objective of this study is to identify the incidence of and risk factors for urinary tract infection (UTI) after office cystoscopy and urodynamic studies (UDS) in a female population. Methods This was a retrospective cohort study investigating incidence of and risk factors for UTI after office testing. Inclusion criteria included women presenting for either cystoscopy or UDS from September 2019 to February 2020. Modified Poisson regression with robust error variance was used to identify risk factors for UTI after cystoscopy and UDS in a female population. Results A total of 274 patients met inclusion criteria. One hundred eighty-five patients underwent office cystoscopy. Nine (4.8%) had a postcystoscopy UTI. Significant risk factors for postcystoscopy UTI included recurrent UTI (relative risk, 7.51; 95% confidence interval, 1.66–34.05) and a history of interstitial cystitis (relative risk, 4.56; 95% confidence interval, 1.52–13.73). Of those with recurrent UTI, 13.7% had a postcystoscopy UTI. Among patients with interstitial cystitis, 25% had a postcystoscopy UTI. One hundred ninety-two patients underwent UDS. Ten (5.2%) developed a post-UDS UTI. No risk factors were identified. Conclusions Patients with recurrent UTI were 7.51 times more likely to develop a UTI after cystoscopy, whereas those with interstitial cystitis were 4.56 times more likely to develop a UTI after cystoscopy. The incidence of UTI after UDS was low overall. Understanding who is at higher risk of postprocedural UTIs may help identify subpopulations that may benefit from prophylactic strategies.
{"title":"A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures","authors":"A. Jackson, Cori Ackerman, N. Alesna, Kimiah Hicks, J. Tanner, E. Chang, A. Wyman, R. Bassaly, R. Hidalgo, K. Greene","doi":"10.1097/SPV.0000000000001151","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001151","url":null,"abstract":"Objective The objective of this study is to identify the incidence of and risk factors for urinary tract infection (UTI) after office cystoscopy and urodynamic studies (UDS) in a female population. Methods This was a retrospective cohort study investigating incidence of and risk factors for UTI after office testing. Inclusion criteria included women presenting for either cystoscopy or UDS from September 2019 to February 2020. Modified Poisson regression with robust error variance was used to identify risk factors for UTI after cystoscopy and UDS in a female population. Results A total of 274 patients met inclusion criteria. One hundred eighty-five patients underwent office cystoscopy. Nine (4.8%) had a postcystoscopy UTI. Significant risk factors for postcystoscopy UTI included recurrent UTI (relative risk, 7.51; 95% confidence interval, 1.66–34.05) and a history of interstitial cystitis (relative risk, 4.56; 95% confidence interval, 1.52–13.73). Of those with recurrent UTI, 13.7% had a postcystoscopy UTI. Among patients with interstitial cystitis, 25% had a postcystoscopy UTI. One hundred ninety-two patients underwent UDS. Ten (5.2%) developed a post-UDS UTI. No risk factors were identified. Conclusions Patients with recurrent UTI were 7.51 times more likely to develop a UTI after cystoscopy, whereas those with interstitial cystitis were 4.56 times more likely to develop a UTI after cystoscopy. The incidence of UTI after UDS was low overall. Understanding who is at higher risk of postprocedural UTIs may help identify subpopulations that may benefit from prophylactic strategies.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"165 - 172"},"PeriodicalIF":1.6,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48274400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-23DOI: 10.1097/SPV.0000000000001162
E. Lai, C. Grimes, M. Kasoff, Yaniv Brailovschi, Tudi-Max Brown-Thomas, H. Winkler, D. Pape, Soo-Hyeon Kwon
Objective This study aimed to assess and trend fears surrounding elective surgery and office procedures in benign gynecologic and urogynecologic patients during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a multicenter, prospective, observational study. Recruitment occurred from June 23, 2020, to March 23, 2021. Females 18 years or older presenting for elective benign gynecologic or urogynecologic surgery or office procedures were eligible. Patients were excluded if non-English speaking or undergoing an emergent procedure or surgery. Fear was assessed by the Surgical Fear Questionnaire (SFQ), which was also modified to include 2–4 additional questions pertaining to COVID-19 (modified version of the Surgical Fear Questionnaire [mSFQ]). Total SFQ scores and short- and long-term fear scores were compared between procedures and surgery and to historic data. Results A total of 209 patients undergoing 107 procedures or 102 surgical procedures completed the questionnaire. Participants were separated into subgroups determined by the timing of questionnaire completion related to phases of the pandemic. The most common procedure was urodynamics (n = 59 [55%]). The most common elective surgical procedure was hysterectomy (n = 59 [57.8%]). Furthermore, 72.5% of surgical procedures were for urogynecologic indications. Fear levels were low and not different in patients undergoing procedures versus surgery (12.38 ± 12.44 vs 12.03 ± 16.01, P = 0.958). There was no difference between procedures versus surgery for short- (6.21 ± 8.38 vs 6.81 ± 8.44, P = 0.726) or long-term fear (6.18 ± 8.89 vs 5.22 ± 8.20, P = 0.683). Compared with historic data, our hysterectomy patients had less surgical fear. The mSFQ demonstrated higher fear scores for both procedures and surgery (mSFQ, 20.57 ± 20.55 for procedures; 28.78 ± 28.51 for surgery). There were no significant fluctuations in SFQ score in relation to critical COVID-19 events. Conclusions Fear of surgery and office procedures was low and consistent throughout the COVID-19 pandemic and lower than historic data.
目的本研究旨在评估2019冠状病毒病（新冠肺炎）大流行期间良性妇科和泌尿生殖系统患者对择期手术和办公程序的恐惧，并对其进行趋势分析。方法这是一项多中心、前瞻性、观察性研究。招聘时间为2020年6月23日至2021年3月23日。18岁或18岁以上的女性接受选择性妇科或泌尿生殖系统良性手术或办公室手术是合格的。如果患者不会说英语或正在接受紧急手术或手术，则将其排除在外。恐惧通过手术恐惧问卷（SFQ）进行评估，该问卷也进行了修改，包括2-4个与新冠肺炎有关的额外问题（手术恐惧问卷的修改版本[mSFQ]）。将手术和手术之间的SFQ总分、短期和长期恐惧评分与历史数据进行比较。结果共有209例患者接受了107种手术或102种外科手术，完成了问卷调查。参与者被分为亚组，亚组由与疫情阶段相关的问卷完成时间决定。最常见的手术是尿动力学（n=59[55%]）。最常见的选择性手术是子宫切除术（n=59[57.8%]）。此外，72.5%的手术是针对泌尿生殖系统适应症。手术患者的恐惧水平较低，与手术患者没有差异（12.38±12.44 vs 12.03±16.01，P=0.958）。手术与手术患者的短期恐惧（6.21±8.38 vs 6.81±8.44，P=0.726）或长期恐惧（6.18±8.89 vs 5.22±8.20，P=0.683）没有差异。与历史数据相比，我们的子宫切除术患者的手术恐惧较少。mSFQ在手术和手术中都表现出更高的恐惧评分（mSFQ，手术为20.57±20.55；手术为28.78±28.51）。与新冠肺炎重大事件相关的SFQ评分没有显著波动。结论在整个新冠肺炎大流行期间，对手术和办公室程序的恐惧程度较低且一致，低于历史数据。
{"title":"Assessment of Level of Fear in Adult Patients Undergoing Elective Urogynecologic and Gynecologic Procedures and Surgeries During the COVID-19 Pandemic Using the Validated Surgical Fear Questionnaire","authors":"E. Lai, C. Grimes, M. Kasoff, Yaniv Brailovschi, Tudi-Max Brown-Thomas, H. Winkler, D. Pape, Soo-Hyeon Kwon","doi":"10.1097/SPV.0000000000001162","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001162","url":null,"abstract":"Objective This study aimed to assess and trend fears surrounding elective surgery and office procedures in benign gynecologic and urogynecologic patients during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a multicenter, prospective, observational study. Recruitment occurred from June 23, 2020, to March 23, 2021. Females 18 years or older presenting for elective benign gynecologic or urogynecologic surgery or office procedures were eligible. Patients were excluded if non-English speaking or undergoing an emergent procedure or surgery. Fear was assessed by the Surgical Fear Questionnaire (SFQ), which was also modified to include 2–4 additional questions pertaining to COVID-19 (modified version of the Surgical Fear Questionnaire [mSFQ]). Total SFQ scores and short- and long-term fear scores were compared between procedures and surgery and to historic data. Results A total of 209 patients undergoing 107 procedures or 102 surgical procedures completed the questionnaire. Participants were separated into subgroups determined by the timing of questionnaire completion related to phases of the pandemic. The most common procedure was urodynamics (n = 59 [55%]). The most common elective surgical procedure was hysterectomy (n = 59 [57.8%]). Furthermore, 72.5% of surgical procedures were for urogynecologic indications. Fear levels were low and not different in patients undergoing procedures versus surgery (12.38 ± 12.44 vs 12.03 ± 16.01, P = 0.958). There was no difference between procedures versus surgery for short- (6.21 ± 8.38 vs 6.81 ± 8.44, P = 0.726) or long-term fear (6.18 ± 8.89 vs 5.22 ± 8.20, P = 0.683). Compared with historic data, our hysterectomy patients had less surgical fear. The mSFQ demonstrated higher fear scores for both procedures and surgery (mSFQ, 20.57 ± 20.55 for procedures; 28.78 ± 28.51 for surgery). There were no significant fluctuations in SFQ score in relation to critical COVID-19 events. Conclusions Fear of surgery and office procedures was low and consistent throughout the COVID-19 pandemic and lower than historic data.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e88 - e92"},"PeriodicalIF":1.6,"publicationDate":"2022-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49018247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-16DOI: 10.1097/SPV.0000000000001158
K. Woodburn, O. Cardenas-Trowers, J. Fitzgerald
Supplemental digital content is available in the text. Importance A sequelae of the removal of pelvic organ prolapse (POP) transvaginal mesh products from the U.S. market is that current and future women's health providers may be unfamiliar with mesh products historically used to treat pelvic floor disorders. Objectives Our goal was to create an easily accessible resource to address this knowledge gap. Study Design An online database of mesh products used to treat POP and urinary incontinence was created with information, photographs, and videos collated from internet searches; manufacturer materials; and other primary sources. The database was then linked to a free smartphone application. Results This smartphone application includes, to the best of our knowledge, all mesh products used in the United States for the treatment of POP and stress urinary incontinence through December 2020. Included in the application are product descriptions of mesh color, size, design, and attachment points. Photographs and videos, when available, are included. The application is organized by mesh product name, but it is also searchable by other categories, such as manufacturer name and color. To download the application to a smart phone, go to vaginalmeshcatalogue.glideapp.io/ on a web browser or access via the QR code. Once the website is loaded, you can interact with the mesh catalog as a website or save it to the phone's home screen as an application. Conclusions Health care providers of all experience levels can use this free application for educational and clinical purposes to better understand patients' histories, improve preoperative planning, and enhance patient counseling.
{"title":"Mix and Mesh: An Electronic Database of FPMRS Mesh Products Through 2020","authors":"K. Woodburn, O. Cardenas-Trowers, J. Fitzgerald","doi":"10.1097/SPV.0000000000001158","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001158","url":null,"abstract":"Supplemental digital content is available in the text. Importance A sequelae of the removal of pelvic organ prolapse (POP) transvaginal mesh products from the U.S. market is that current and future women's health providers may be unfamiliar with mesh products historically used to treat pelvic floor disorders. Objectives Our goal was to create an easily accessible resource to address this knowledge gap. Study Design An online database of mesh products used to treat POP and urinary incontinence was created with information, photographs, and videos collated from internet searches; manufacturer materials; and other primary sources. The database was then linked to a free smartphone application. Results This smartphone application includes, to the best of our knowledge, all mesh products used in the United States for the treatment of POP and stress urinary incontinence through December 2020. Included in the application are product descriptions of mesh color, size, design, and attachment points. Photographs and videos, when available, are included. The application is organized by mesh product name, but it is also searchable by other categories, such as manufacturer name and color. To download the application to a smart phone, go to vaginalmeshcatalogue.glideapp.io/ on a web browser or access via the QR code. Once the website is loaded, you can interact with the mesh catalog as a website or save it to the phone's home screen as an application. Conclusions Health care providers of all experience levels can use this free application for educational and clinical purposes to better understand patients' histories, improve preoperative planning, and enhance patient counseling.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"e154 - e156"},"PeriodicalIF":1.6,"publicationDate":"2022-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49213475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-16DOI: 10.1097/SPV.0000000000001132
Madeleine Coulter, D. Diamond, C. Estrada, F. Grimstad, R.K. Yu, P. Doyle
PURPOSE This report reviews the various techniques for vaginal obliterative surgery in the transmasculine patient population, including advantages and drawbacks with differing methods and reflects on the focus of future research and surgical efforts. FINDINGS Existing techniques for vaginal obliterative surgery by vaginectomy or colpocleisis vary without strong evidence to identify a superior approach. SUMMARY The increasing number of transmasculine patients seeking vaginectomy as a part of gender-affirming surgery must be matched by evidence-based techniques that provide a safe, long-term outcome.
{"title":"Vaginectomy in Transmasculine Patients: A Review of Techniques in an Emerging Field.","authors":"Madeleine Coulter, D. Diamond, C. Estrada, F. Grimstad, R.K. Yu, P. Doyle","doi":"10.1097/SPV.0000000000001132","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001132","url":null,"abstract":"PURPOSE\u0000This report reviews the various techniques for vaginal obliterative surgery in the transmasculine patient population, including advantages and drawbacks with differing methods and reflects on the focus of future research and surgical efforts.\u0000\u0000\u0000FINDINGS\u0000Existing techniques for vaginal obliterative surgery by vaginectomy or colpocleisis vary without strong evidence to identify a superior approach.\u0000\u0000\u0000SUMMARY\u0000The increasing number of transmasculine patients seeking vaginectomy as a part of gender-affirming surgery must be matched by evidence-based techniques that provide a safe, long-term outcome.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47110994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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