Pub Date : 2024-07-01DOI: 10.1097/SPV.0000000000001439
Emily Edwards, Sarah Boyles, Claire Gould, Blake Osmundsen
Importance It has not yet been determined whether there is an effect of the initial urogynecologic consultation and resultant management plan on the patient’s bother from her pelvic floor condition. Objective The aim of the study was to see whether patient-reported outcomes of bother were different before and after consultation with a specialist. Study Design Fifty patients completed both preconsultation and postconsultation Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). Patients were eligible if they were naive to urogynecology care and had never had treatment for the chief complaint in the past. They were not eligible if they received treatment at their consultation visits. A paired t test was used for comparison. A linear model determined whether baseline PFDI-20 and PFIQ-7 scores as explanatory variables had an effect on the pre-post delta as outcome variable. Results There was no statistically significant difference between PFDI-20 scores before (mean, 86.5) and after (mean, 83.1) consultation. There was additionally no difference between PFIQ-7 scores before (mean, 61.1) and after (mean, 65.4) consultation. There was, however, a greater degree of change in scores if the patient presented with little bother versus large bother at the initial consultation. Conclusions For the new urogynecologic patients, those with lower baseline bother showed higher change (improvement) in scores after the consultation.
{"title":"The Effect of a Physician Consultation on Patient Reported Outcomes in Urogynecology","authors":"Emily Edwards, Sarah Boyles, Claire Gould, Blake Osmundsen","doi":"10.1097/SPV.0000000000001439","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001439","url":null,"abstract":"Importance It has not yet been determined whether there is an effect of the initial urogynecologic consultation and resultant management plan on the patient’s bother from her pelvic floor condition. Objective The aim of the study was to see whether patient-reported outcomes of bother were different before and after consultation with a specialist. Study Design Fifty patients completed both preconsultation and postconsultation Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). Patients were eligible if they were naive to urogynecology care and had never had treatment for the chief complaint in the past. They were not eligible if they received treatment at their consultation visits. A paired t test was used for comparison. A linear model determined whether baseline PFDI-20 and PFIQ-7 scores as explanatory variables had an effect on the pre-post delta as outcome variable. Results There was no statistically significant difference between PFDI-20 scores before (mean, 86.5) and after (mean, 83.1) consultation. There was additionally no difference between PFIQ-7 scores before (mean, 61.1) and after (mean, 65.4) consultation. There was, however, a greater degree of change in scores if the patient presented with little bother versus large bother at the initial consultation. Conclusions For the new urogynecologic patients, those with lower baseline bother showed higher change (improvement) in scores after the consultation.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"31 3","pages":"637 - 641"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141702804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/spv.0000000000001521
{"title":"16th EUGA Annual Congress 19-21 October 2023, Varese – Palais des Congrès","authors":"","doi":"10.1097/spv.0000000000001521","DOIUrl":"https://doi.org/10.1097/spv.0000000000001521","url":null,"abstract":"","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141233633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1097/SPV.0000000000001514
Micah G Pascual, Atieh Novin, M. Corbisiero, S. Unciano, Y. Hachicha, N. Shelden, Wyanet Bresnitz, Tanaz R. Ferzandi, Tyler M Muffly
IMPORTANCE Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs. OBJECTIVES This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services. STUDY DESIGN A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired. RESULTS A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%). CONCLUSION The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.
{"title":"Access to Urogynecologic Care in Federally Qualified Health Centers: A Mystery Caller Study.","authors":"Micah G Pascual, Atieh Novin, M. Corbisiero, S. Unciano, Y. Hachicha, N. Shelden, Wyanet Bresnitz, Tanaz R. Ferzandi, Tyler M Muffly","doi":"10.1097/SPV.0000000000001514","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001514","url":null,"abstract":"IMPORTANCE\u0000Federally Qualified Health Centers (FQHCs) play an important role in providing care to underserved populations. However, little is known about the availability of urogynecology services at FQHCs.\u0000\u0000\u0000OBJECTIVES\u0000This study aimed to assess the availability of appointments for urogynecology care and to determine the prevalence of FQHCs offering urogynecologic services.\u0000\u0000\u0000STUDY DESIGN\u0000A total of 362 FQHCs across the United States were randomly selected from the Health Resources and Services Administration website, based on specific inclusion criteria. Researchers called the FQHCs and requested the earliest available appointment for pelvic organ prolapse. The availability of urogynecologic services such as pessary fittings, pelvic floor physical therapy, and urodynamic studies was also inquired.\u0000\u0000\u0000RESULTS\u0000A total of 362 FQHCs located in 46 states and the District of Columbia were called. On average, the 362 FQHCs had been established for 19.9 (SD ±15) years, were located in urban areas, and served a median county population of 24,573. Of the 220 FQHCs successfully contacted, 81% (180/220) reported that they could provide care for a patient with pelvic organ prolapse at an appointment 29.1 business days (SD ±30 days) from the date of the call, on average. However, only a small percentage of these FQHCs offered in-office pessary fittings (11%), complex multichannel urodynamics testing (8.6%), or pelvic floor physical therapy (5%).\u0000\u0000\u0000CONCLUSION\u0000The availability of treatments for pelvic floor disorders at FQHCs is limited. These findings highlight a potential disparity in access to urogynecology services for individuals with public insurance.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"48 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140656863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1097/SPV.0000000000001516
Samantha Conde Rocha-Rangel, Gláucia Miranda Varella Pereira, C. Juliato, L. G. O. Brito
IMPORTANCE Pelvic floor muscle training (PFMT) is considered the first option as a conservative treatment for female stress urinary incontinence (SUI). However, there is still debate whether energy-based devices are effective for treating SUI. OBJECTIVE The objective of this study was to assess whether PFMT and fractional CO2 laser therapy may improve symptoms in women with SUI. STUDY DESIGN A parallel, randomized, nonblinded, noninferiority trial included 94 of 144 women 18 years or older with SUI randomized into 2 groups. The CO2 laser group (n = 47) received 3 vaginal applications at monthly intervals. The PFMT group (n = 47) underwent 2 weekly sessions. Primary outcome was the mean difference of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short-Form (ICIQ-UI-SF) total scores between groups after 3 and 6 months. Main secondary outcomes were questionnaires for assessment of pelvic floor symptoms (Pelvic Floor Impact Questionnaire-Short Form 7 [PFIQ-7]), sexual function (Female Sexual Function Index [FSFI]), and improvement after treatment (Patient Global Impression of Improvement [PGI-I]). RESULTS A reduction in the ICIQ-UI-SF total score, PFIQ total score, and the Urinary Impact Questionnaire score was perceived between baseline and 3-6 months in both groups. CO2 laser did not reach the noninferiority margin when compared with PFMT in both follow-up periods and analyses. Pelvic floor muscle training has improved the FSFI desire domain between baseline and 3-6 months, whereas CO2 laser improved the FSFI orgasm, pain, and total score after 3 months and FSFI orgasm and total score after 6 months. PGI-I assessment has shown an improvement in both groups. CONCLUSION Fractional CO2 laser therapy was noninferior to PFMT after 3-6 months of treatment. Both groups presented a reduction in the ICIQ-UI-SF scores, and both methods could be considered for women with SUI.
重要意义盆底肌肉训练（PFMT）被认为是保守治疗女性压力性尿失禁（SUI）的首选方法。本研究的目的是评估 PFMT 和点阵式 CO2 激光疗法是否能改善 SUI 女性患者的症状。研究设计包括一项平行、随机、非盲、非劣效试验，144 名 18 岁或以上 SUI 女性患者中的 94 人被随机分为两组。CO2 激光组（47 人）每月接受 3 次阴道激光治疗。PFMT 组（47 人）每周接受 2 次治疗。主要结果是3个月和6个月后两组尿失禁国际咨询问卷-尿失禁简表（ICIQ-UI-SF）总分的平均差异。主要次要结果是盆底症状评估问卷（盆底影响问卷-简表 7 [PFIQ-7]）、性功能（女性性功能指数 [FSFI]）以及治疗后的改善情况（患者总体改善印象 [PGI-I]）。在两个随访期和分析中，CO2 激光与盆底肌肉运动疗法相比均未达到非劣效区。盆底肌肉训练改善了基线至 3-6 个月期间的 FSFI 欲望域，而 CO2 激光则改善了 3 个月后的 FSFI 性高潮、疼痛和总分，以及 6 个月后的 FSFI 性高潮和总分。结论在治疗 3-6 个月后，点阵 CO2 激光疗法的效果不逊于 PFMT。两组患者的 ICIQ-UI-SF 评分均有所下降，患有 SUI 的女性可考虑采用这两种方法。
{"title":"Laser and Pelvic Floor Muscle Training for Urinary Incontinence: A Randomized Clinical Trial.","authors":"Samantha Conde Rocha-Rangel, Gláucia Miranda Varella Pereira, C. Juliato, L. G. O. Brito","doi":"10.1097/SPV.0000000000001516","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001516","url":null,"abstract":"IMPORTANCE\u0000Pelvic floor muscle training (PFMT) is considered the first option as a conservative treatment for female stress urinary incontinence (SUI). However, there is still debate whether energy-based devices are effective for treating SUI.\u0000\u0000\u0000OBJECTIVE\u0000The objective of this study was to assess whether PFMT and fractional CO2 laser therapy may improve symptoms in women with SUI.\u0000\u0000\u0000STUDY DESIGN\u0000A parallel, randomized, nonblinded, noninferiority trial included 94 of 144 women 18 years or older with SUI randomized into 2 groups. The CO2 laser group (n = 47) received 3 vaginal applications at monthly intervals. The PFMT group (n = 47) underwent 2 weekly sessions. Primary outcome was the mean difference of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short-Form (ICIQ-UI-SF) total scores between groups after 3 and 6 months. Main secondary outcomes were questionnaires for assessment of pelvic floor symptoms (Pelvic Floor Impact Questionnaire-Short Form 7 [PFIQ-7]), sexual function (Female Sexual Function Index [FSFI]), and improvement after treatment (Patient Global Impression of Improvement [PGI-I]).\u0000\u0000\u0000RESULTS\u0000A reduction in the ICIQ-UI-SF total score, PFIQ total score, and the Urinary Impact Questionnaire score was perceived between baseline and 3-6 months in both groups. CO2 laser did not reach the noninferiority margin when compared with PFMT in both follow-up periods and analyses. Pelvic floor muscle training has improved the FSFI desire domain between baseline and 3-6 months, whereas CO2 laser improved the FSFI orgasm, pain, and total score after 3 months and FSFI orgasm and total score after 6 months. PGI-I assessment has shown an improvement in both groups.\u0000\u0000\u0000CONCLUSION\u0000Fractional CO2 laser therapy was noninferior to PFMT after 3-6 months of treatment. Both groups presented a reduction in the ICIQ-UI-SF scores, and both methods could be considered for women with SUI.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1097/SPV.0000000000001517
Deepanjana Das, Natalie Squires, Margaret G. Mueller, Sarah Collins, C. Lewicky-Gaupp, C. Bretschneider, J. Geynisman-Tan, Kimberly S Kenton
IMPORTANCE Robot-assisted sacrocolpopexy (SCP) is a commonly performed procedure for the repair of apical pelvic organ prolapse; therefore, novel devices and techniques to improve safety and efficacy of this procedure should be explored. OBJECTIVE The objective of this study was to assess safety and efficacy of 8-mm trocar site for use of a disposable suture/needle management device (StitchKit; Origami Surgical, Madison, NJ) for robot-assisted SCP with a 4-arm configuration and no assistant port. STUDY DESIGN This is a retrospective case series of patients undergoing robot-assisted SCP at a tertiary center from 2018 to 2021. All surgical procedures were performed using four 8-mm robotic trocars and StitchKit device. Our objective was to review all cases in which this technique was used to determine whether the approach resulted in a safely completed procedure and any complications or adverse events. Secondary objectives were to describe patient and operative characteristics. RESULTS In total, 422 patients underwent robot-assisted SCP for pelvic organ prolapse. The mean age was 60 ± 10 years, and mean body mass index was 27 ± 6 (calculated as weight in kilograms divided by height in meters squared). Most patients had stage 3 prolapse (73%) and underwent concomitant hysterectomy (70%). Ninety-nine percent (n = 416) of cases were completed robotically. StitchKit was successfully inserted and removed in all robotic cases with correct needle counts. All patients had postoperative visits, and 80% followed up at 3 months. No umbilical/port site hernias, operative site infections, or adverse events were reported. CONCLUSIONS Robot-assisted SCP can be performed safely using a 4-arm robotic configuration and suture kit device. This setup eliminates incisions greater than 8 mm and an assistant port, allowing for surgical efficiency without compromising patient outcomes.
{"title":"Suture-Needle Management Device and Novel Port Configuration for Robotic Sacrocolpopexy.","authors":"Deepanjana Das, Natalie Squires, Margaret G. Mueller, Sarah Collins, C. Lewicky-Gaupp, C. Bretschneider, J. Geynisman-Tan, Kimberly S Kenton","doi":"10.1097/SPV.0000000000001517","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001517","url":null,"abstract":"IMPORTANCE\u0000Robot-assisted sacrocolpopexy (SCP) is a commonly performed procedure for the repair of apical pelvic organ prolapse; therefore, novel devices and techniques to improve safety and efficacy of this procedure should be explored.\u0000\u0000\u0000OBJECTIVE\u0000The objective of this study was to assess safety and efficacy of 8-mm trocar site for use of a disposable suture/needle management device (StitchKit; Origami Surgical, Madison, NJ) for robot-assisted SCP with a 4-arm configuration and no assistant port.\u0000\u0000\u0000STUDY DESIGN\u0000This is a retrospective case series of patients undergoing robot-assisted SCP at a tertiary center from 2018 to 2021. All surgical procedures were performed using four 8-mm robotic trocars and StitchKit device. Our objective was to review all cases in which this technique was used to determine whether the approach resulted in a safely completed procedure and any complications or adverse events. Secondary objectives were to describe patient and operative characteristics.\u0000\u0000\u0000RESULTS\u0000In total, 422 patients underwent robot-assisted SCP for pelvic organ prolapse. The mean age was 60 ± 10 years, and mean body mass index was 27 ± 6 (calculated as weight in kilograms divided by height in meters squared). Most patients had stage 3 prolapse (73%) and underwent concomitant hysterectomy (70%). Ninety-nine percent (n = 416) of cases were completed robotically. StitchKit was successfully inserted and removed in all robotic cases with correct needle counts. All patients had postoperative visits, and 80% followed up at 3 months. No umbilical/port site hernias, operative site infections, or adverse events were reported.\u0000\u0000\u0000CONCLUSIONS\u0000Robot-assisted SCP can be performed safely using a 4-arm robotic configuration and suture kit device. This setup eliminates incisions greater than 8 mm and an assistant port, allowing for surgical efficiency without compromising patient outcomes.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"33 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.1097/SPV.0000000000001448
Michele Torosis, Morgan Fullerton, Daniela Kaefer, Victor Nitti, A. L. Ackerman, T. Grisales
IMPORTANCE The utility of pudendal nerve blocks (PNBs) at the time of transvaginal surgery is mixed in the literature. No published study has evaluated the efficacy of PNB since the widespread adoption of Enhanced Recovery After Surgery (ERAS) pathways. OBJECTIVE This study aimed to determine if PNB, in addition to ERAS measures, at the time of vaginal reconstructive surgery reduces opioid use in the immediate postoperative period. STUDY DESIGN In this randomized, blinded, controlled trial, women scheduled for transvaginal multicompartment prolapse repair were randomized to bilateral PNB before incision with 20 mL of 0.5% bupivacaine versus usual care. Primary outcome was opioid use in morphine milligram equivalents (MME) for the first 24 hours. The study was powered to detect a 5.57-MME difference in opioid use in the first 24 hours between groups. RESULTS Forty-four patients were randomized from January 2020 to April 2022. The PNB and control groups were well matched in demographic and surgical data. There was no difference in opioid use in first 24 hours between the control and PNB groups (8 [0-20] vs 6.7 [0-15]; P = 0.8). Median pain scores at 24 and 48 hours did not differ between groups (4 ± 2 vs 3 ± 3; P = 0.44) and 90% of participants were satisfied with pain control across both groups. Time to return to normal activities (median, 10 days) was also not different between the groups. CONCLUSIONS Because pain satisfaction after transvaginal surgery in the era of ERAS is high, with overall low opioid requirements, PNB provides no additional benefit.
{"title":"Pudendal Block at the Time of Transvaginal Prolapse Repair: A Randomized Controlled Trial.","authors":"Michele Torosis, Morgan Fullerton, Daniela Kaefer, Victor Nitti, A. L. Ackerman, T. Grisales","doi":"10.1097/SPV.0000000000001448","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001448","url":null,"abstract":"IMPORTANCE\u0000The utility of pudendal nerve blocks (PNBs) at the time of transvaginal surgery is mixed in the literature. No published study has evaluated the efficacy of PNB since the widespread adoption of Enhanced Recovery After Surgery (ERAS) pathways.\u0000\u0000\u0000OBJECTIVE\u0000This study aimed to determine if PNB, in addition to ERAS measures, at the time of vaginal reconstructive surgery reduces opioid use in the immediate postoperative period.\u0000\u0000\u0000STUDY DESIGN\u0000In this randomized, blinded, controlled trial, women scheduled for transvaginal multicompartment prolapse repair were randomized to bilateral PNB before incision with 20 mL of 0.5% bupivacaine versus usual care. Primary outcome was opioid use in morphine milligram equivalents (MME) for the first 24 hours. The study was powered to detect a 5.57-MME difference in opioid use in the first 24 hours between groups.\u0000\u0000\u0000RESULTS\u0000Forty-four patients were randomized from January 2020 to April 2022. The PNB and control groups were well matched in demographic and surgical data. There was no difference in opioid use in first 24 hours between the control and PNB groups (8 [0-20] vs 6.7 [0-15]; P = 0.8). Median pain scores at 24 and 48 hours did not differ between groups (4 ± 2 vs 3 ± 3; P = 0.44) and 90% of participants were satisfied with pain control across both groups. Time to return to normal activities (median, 10 days) was also not different between the groups.\u0000\u0000\u0000CONCLUSIONS\u0000Because pain satisfaction after transvaginal surgery in the era of ERAS is high, with overall low opioid requirements, PNB provides no additional benefit.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":" 49","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140685267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.1097/SPV.0000000000001458
Rahul Dutta, Raymond Xu, D. Wolff, Gopal Badlani, C. Matthews
IMPORTANCE Since transvaginal mesh (VM) kits for apical pelvic organ prolapse (APOP) were labeled "high-risk" in 2016 and subsequently banned in 2019 by the U.S. Food and Drug Administration, the most common remaining surgical options include abdominal mesh-augmented sacrocolpopexy (AS) and transvaginal native tissue suspension (VN). OBJECTIVE The objective of this study was to determine temporal trends in APOP procedures for urologists and gynecologists. STUDY DESIGN Between 2011 and 2020, the American College of Surgeons National Surgical Quality Improvement Program database was queried for AS, VM, and VN. RESULTS There were 26,477 cases of APOP repair (32% AS, 6% VM, 62% VN) included, 9% by urologists. Urologists operated on older (65 vs 61 years) patients with more medical comorbidities. Urologists performed significantly higher proportion of AS (65% vs 29%) and VM (8% vs 6%) relative to VN (27% vs 65%) than gynecologists (P < 0.0001). Transvaginal mesh utilization has decreased over time for both specialties (P < 0.05); nonsignificant trends toward increasing AS (P = 0.1646) in urologists and VN (P = 0.0913) in gynecologists concurrently occurred. Significant independent predictors of the operating surgeon being a urologist were surgery being performed in the latter half of the cohort (2016-2020; odds ratio [OR], 1.22), non-White patient race (OR < 1 for all), a concomitant sling being placed (OR = 0.89), the surgery being VM (OR = 2.95) or AS (OR = 4.36), the patient being older (OR > 1 for each age range), and having a higher frailty index score (OR = 1.16). CONCLUSIONS Significant differences in APOP repair choices exist between specialties. Urologists operate on older, more medically complex patients while demonstrating a strong preference for mesh-augmented compared with transvaginal native tissue repairs.
{"title":"Specialty-Specific Trends in Surgery for Apical Pelvic Organ Prolapse Post Vaginal Mesh.","authors":"Rahul Dutta, Raymond Xu, D. Wolff, Gopal Badlani, C. Matthews","doi":"10.1097/SPV.0000000000001458","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001458","url":null,"abstract":"IMPORTANCE\u0000Since transvaginal mesh (VM) kits for apical pelvic organ prolapse (APOP) were labeled \"high-risk\" in 2016 and subsequently banned in 2019 by the U.S. Food and Drug Administration, the most common remaining surgical options include abdominal mesh-augmented sacrocolpopexy (AS) and transvaginal native tissue suspension (VN).\u0000\u0000\u0000OBJECTIVE\u0000The objective of this study was to determine temporal trends in APOP procedures for urologists and gynecologists.\u0000\u0000\u0000STUDY DESIGN\u0000Between 2011 and 2020, the American College of Surgeons National Surgical Quality Improvement Program database was queried for AS, VM, and VN.\u0000\u0000\u0000RESULTS\u0000There were 26,477 cases of APOP repair (32% AS, 6% VM, 62% VN) included, 9% by urologists. Urologists operated on older (65 vs 61 years) patients with more medical comorbidities. Urologists performed significantly higher proportion of AS (65% vs 29%) and VM (8% vs 6%) relative to VN (27% vs 65%) than gynecologists (P < 0.0001). Transvaginal mesh utilization has decreased over time for both specialties (P < 0.05); nonsignificant trends toward increasing AS (P = 0.1646) in urologists and VN (P = 0.0913) in gynecologists concurrently occurred. Significant independent predictors of the operating surgeon being a urologist were surgery being performed in the latter half of the cohort (2016-2020; odds ratio [OR], 1.22), non-White patient race (OR < 1 for all), a concomitant sling being placed (OR = 0.89), the surgery being VM (OR = 2.95) or AS (OR = 4.36), the patient being older (OR > 1 for each age range), and having a higher frailty index score (OR = 1.16).\u0000\u0000\u0000CONCLUSIONS\u0000Significant differences in APOP repair choices exist between specialties. Urologists operate on older, more medically complex patients while demonstrating a strong preference for mesh-augmented compared with transvaginal native tissue repairs.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"319 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-11DOI: 10.1097/SPV.0000000000001480
Jaclyn M Muñoz, Molly Groskreutz, Charlene Compher, U. Andy
IMPORTANCE Older women with fecal incontinence (FI) who underwent diet modification intervention (DMI) showed significant improvement in FI symptoms. It is unclear whether improvement in symptoms was associated with objective changes in dietary intake quality. OBJECTIVES The primary aim was to determine if improvement in overall dietary intake quality was associated with improvement in FI symptoms. Our secondary aim was to evaluate whether individual food group consumption changes were associated with changes in FI symptoms. STUDY DESIGN This was an ancillary analysis of a prospective cohort study of women aged 65 years and older with FI who underwent DMI. Seven-day diet-and-bowel diaries at baseline and 6 weeks after DMI were examined for how frequently participants consumed food categories and FI triggers. Adherence to recommended dietary guidelines was assessed between 2 and 4 weeks using a 24-hour diet recall. Baseline and postintervention consumption were compared using the Wilcoxon signed rank test. Spearman correlation was used to compare dietary intake changes with FI symptom changes. RESULTS Twenty-four women completed the 24-hour diet recalls, and 17 women completed the 7-day diet-and-bowel diaries at baseline and 6 weeks. More participants who were adherent had clinically significant improvement in symptoms compared with those who were not adherent (70% vs 30%, P=0.57). Decreased consumption of saturated fats (P=0.01) and fried foods (P<0.001) was associated with improvement in FI symptoms. CONCLUSIONS In this small population, overall dietary intake quality was not associated with change in FI symptom improvement. Decreased intake of saturated fat and fried food was associated with FI symptom improvement.
主要内容患有大便失禁（FI）的老年妇女接受饮食调整干预（DMI）后，FI症状有明显改善。目前还不清楚症状的改善是否与膳食摄入质量的客观变化有关。目标：我们的首要目标是确定总体膳食摄入质量的改善是否与大便失禁症状的改善有关。我们的次要目的是评估单个食物组摄入量的变化是否与 FI 症状的变化有关。研究设计这是一项前瞻性队列研究的辅助分析，研究对象是 65 岁及以上患有 FI 并接受了 DMI 的女性。在基线和DMI后6周，研究人员通过七天饮食和肠道日记来了解参与者摄入食物种类和FI诱发因素的频率。在2周至4周期间，采用24小时饮食回忆法对推荐饮食指南的遵守情况进行评估。使用 Wilcoxon 符号秩检验比较基线和干预后的消耗量。结果24名妇女完成了24小时饮食回顾，17名妇女完成了基线和6周的7天饮食和肠道日记。与未坚持饮食的参与者相比，更多坚持饮食的参与者症状得到了明显改善（70% 对 30%，P=0.57）。饱和脂肪（P=0.01）和油炸食品（P<0.001）摄入量的减少与肠梗阻症状的改善有关。饱和脂肪和油炸食品摄入量的减少与FI症状的改善有关。
{"title":"Diet Intake After Diet Modification Intervention in Women With Fecal Incontinence.","authors":"Jaclyn M Muñoz, Molly Groskreutz, Charlene Compher, U. Andy","doi":"10.1097/SPV.0000000000001480","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001480","url":null,"abstract":"IMPORTANCE\u0000Older women with fecal incontinence (FI) who underwent diet modification intervention (DMI) showed significant improvement in FI symptoms. It is unclear whether improvement in symptoms was associated with objective changes in dietary intake quality.\u0000\u0000\u0000OBJECTIVES\u0000The primary aim was to determine if improvement in overall dietary intake quality was associated with improvement in FI symptoms. Our secondary aim was to evaluate whether individual food group consumption changes were associated with changes in FI symptoms.\u0000\u0000\u0000STUDY DESIGN\u0000This was an ancillary analysis of a prospective cohort study of women aged 65 years and older with FI who underwent DMI. Seven-day diet-and-bowel diaries at baseline and 6 weeks after DMI were examined for how frequently participants consumed food categories and FI triggers. Adherence to recommended dietary guidelines was assessed between 2 and 4 weeks using a 24-hour diet recall. Baseline and postintervention consumption were compared using the Wilcoxon signed rank test. Spearman correlation was used to compare dietary intake changes with FI symptom changes.\u0000\u0000\u0000RESULTS\u0000Twenty-four women completed the 24-hour diet recalls, and 17 women completed the 7-day diet-and-bowel diaries at baseline and 6 weeks. More participants who were adherent had clinically significant improvement in symptoms compared with those who were not adherent (70% vs 30%, P=0.57). Decreased consumption of saturated fats (P=0.01) and fried foods (P<0.001) was associated with improvement in FI symptoms.\u0000\u0000\u0000CONCLUSIONS\u0000In this small population, overall dietary intake quality was not associated with change in FI symptom improvement. Decreased intake of saturated fat and fried food was associated with FI symptom improvement.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"48 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140713620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1097/SPV.0000000000001506
Alexandra C Nutaitis, Cecile A Ferrando, Katie Propst
IMPORTANCE An obstetric anal sphincter injury can significantly affect patients. Support for these patients is both limited and not well understood. OBJECTIVE The aim of this study was to describe patient experiences after an obstetric anal sphincter injury. STUDY DESIGN This is a prospective cross-sectional qualitative study of patients who experienced an obstetric anal sphincter injury within a tertiary care network between May and June of 2022. Demographic data, clinical data regarding the delivery, and the Edinburgh Postnatal Depression Scale were collected. Prospective semistructured interviews were conducted approximately 5-12 weeks postpartum to address opportunities to improve obstetric anal sphincter injury care. Qualitative analysis was performed using a grounded theory approach. RESULTS Fifteen women with a mean age of 31 (±3.93) years participated. The majority identified as White (93.3%) and non-Hispanic (100%). All participants identified as being married to men and completing undergraduate education; 9 (60%) also received postgraduate education. Five participants (33.3%) screened positive (score of 10 or greater) for postnatal depression on the Edinburgh Postnatal Depression Scale. Thematic saturation was reached with 3 major themes identified: (1) pain control, (2) desire for multifactorial support, and (3) obstetric anal sphincter injury knowledge and awareness. CONCLUSIONS Experiencing an obstetric anal sphincter injury represents a great unknown to most women. This study identifies opportunities for improved postpartum care through education, pain control, and patient support. Interventions are needed to improve the postpartum experience for women who experience an obstetric anal sphincter injury with childbirth.
{"title":"Patient Perspectives Following Obstetric Anal Sphincter Injury.","authors":"Alexandra C Nutaitis, Cecile A Ferrando, Katie Propst","doi":"10.1097/SPV.0000000000001506","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001506","url":null,"abstract":"IMPORTANCE\u0000An obstetric anal sphincter injury can significantly affect patients. Support for these patients is both limited and not well understood.\u0000\u0000\u0000OBJECTIVE\u0000The aim of this study was to describe patient experiences after an obstetric anal sphincter injury.\u0000\u0000\u0000STUDY DESIGN\u0000This is a prospective cross-sectional qualitative study of patients who experienced an obstetric anal sphincter injury within a tertiary care network between May and June of 2022. Demographic data, clinical data regarding the delivery, and the Edinburgh Postnatal Depression Scale were collected. Prospective semistructured interviews were conducted approximately 5-12 weeks postpartum to address opportunities to improve obstetric anal sphincter injury care. Qualitative analysis was performed using a grounded theory approach.\u0000\u0000\u0000RESULTS\u0000Fifteen women with a mean age of 31 (±3.93) years participated. The majority identified as White (93.3%) and non-Hispanic (100%). All participants identified as being married to men and completing undergraduate education; 9 (60%) also received postgraduate education. Five participants (33.3%) screened positive (score of 10 or greater) for postnatal depression on the Edinburgh Postnatal Depression Scale. Thematic saturation was reached with 3 major themes identified: (1) pain control, (2) desire for multifactorial support, and (3) obstetric anal sphincter injury knowledge and awareness.\u0000\u0000\u0000CONCLUSIONS\u0000Experiencing an obstetric anal sphincter injury represents a great unknown to most women. This study identifies opportunities for improved postpartum care through education, pain control, and patient support. Interventions are needed to improve the postpartum experience for women who experience an obstetric anal sphincter injury with childbirth.","PeriodicalId":517282,"journal":{"name":"Urogynecology","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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