Urogynecology (Hagerstown, Md.)最新文献

Importance: Racial inequity elevates risk for certain diagnoses and health disparities. Current data show disparities for Black women when comparing open versus minimally invasive hysterectomy. It is unknown if a similar disparity exists in surgical management of pelvic organ prolapse.

Objective: The objective of this study was to determine whether racial or ethnic disparities exist for open abdominal versus minimally invasive sacrocolpopexy.

Study design: Cross-sectional data of the Healthcare Cost and Utilization Project National Inpatient Sample and the Nationwide Ambulatory Surgery Sample for the year 2019 was used. Bivariate analysis identified demographic and perioperative differences between abdominal versus minimally invasive sacrocolpopexy, which were compared in a multivariable logistic regression.

Results: Forty-one thousand eight hundred thirty-seven patients underwent sacrocolpopexy: 35,820 (85.6%), minimally invasive sacrocolpopexy, and 6,016, (14.4%) abdominal sacrocolpopexy. In an unadjusted analysis, Black patients were more likely to undergo an abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 2.14, 95% CI 1.16-3.92, P <0.01). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to non-Hispanic White patients (OR 1.69, 95% CI 1.26-2.26, P <0.001). Other factors associated with abdominal sacrocolpopexy are zip code quartile, payer status, composite comorbidity score, hospital control, and hospital bed size. In the regression model, Black patients remained more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 2, 95% CI 1.26-3.16, P < 0.003). Hispanic patients were more likely to undergo abdominal sacrocolpopexy compared to those who identified as White (aOR 1.73, 95% CI 1.31-2.28, P < 0.001).

Conclusion: Abdominal sacrocolpopexy was more likely to occur in patients who identified as Black or Hispanic.

Importance: Patients with pelvic organ prolapse are often tasked with deciding between treatments. Decisional conflict is a measure of factors that go into effective decision making.

Objective: This study aimed to compare prolapse treatment-related decisional conflict reported by underrepresented patients (URPs) to non-URPs after new patient visits.

Study design: A multicenter cohort study of new patients counseled regarding management of prolapse from July 2021 to December 2022 was performed. Participants completed the Decisional Conflict Scale (DCS), a validated measure of modifiable factors in decision making. Higher scores indicate feeling less comfortable with decisions. Race and ethnicity were viewed as social constructs. A URP was defined as self-identification with a non-White race or Hispanic ethnicity. Alpha was set at 0.05, power 80%, to detect an effect size of 0.4 between mean DCS scores.

Results: A total of 207 participants (103 URPs, 49.8%), with a mean age of 63.4 ± 11.9 years and mean body mass index of 29.7 ± 6.9 (calculated as weight in kilograms divided by height in meters squared), completed the study. Much of the URP group self-identified as Hispanic (50/103, 48.5%) and/or Black (39/103, 37.9%), and 30 of 103 (29.1%) had an interpreter at their visit. A greater proportion of non-URPs had a prior hysterectomy (16.1% difference; P = 0.017) and prolapse surgery (18/204, 10.5% difference; P = 0.020). A greater proportion of URPs had hypertension (23.6% difference; P = <0.001). There were no differences in the other pelvic floor disorders, prolapse stage, or treatments selected (all P > 0.05). The mean DCS scores were not different between groups (URP, 12.9 ± 12.3 vs non-URP, 11.6 ± 14.9; P = 0.31). Household income, education, and insurance were not associated with DCS scores (all P > 0.05).

Conclusions: Decisional Conflict Scale scores were not significantly different between groups. Possible differences between subgroups warrant further investigation.

Importance: This is the first systematic review on female sexual dysfunction (FSD) in patients who sustained obstetric anal sphincter injury (OASI).

Objective: The aim of the study was to characterize FSD following OASI.

Study design: Between January and April 2024, we conducted a literature search of studies that explored outcomes of FSD following OASI, reporting on rates of dyspareunia and/or using questionnaires that measured female sexual function.

Results: Fourteen studies with 1,907 OASI patients met inclusion criteria. Rates of dyspareunia in the first year after OASI ranged from 27% to 35% with only 40%-57% of women having resumed sexual activity at 3 months postpartum. The Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were the most utilized questionnaires. Using the FSFI, the range of FSD was 47%-81% among patients with OASI. The FSFI subdomain scores (maximum 6) for desire and arousal had the least improvement with time, ranging from 1.3-2.1 at 2 months to 3-3.1 at 4 months. Pain, lubrication, and orgasm domains showed greater improvement with time, ranging from 1.4-1.6 at 2 months and up to 3.5-3.8 at 4 months. Five studies used the PISQ-12 with mean scores of 34.1-39 (range 0-48), 3 of which included a non-OASI control group and found similar PISQ-12 scores between groups. Physical therapy did not significantly impact FSD.

Conclusions: One-third of patients with OASI experience dyspareunia in the first year postpartum, 1in 2 patients do not resume intercourse at 3 months postpartum, and FSD, measured by the FSFI, may be present in 80% of women with OASI at 3 months postpartum.

Importance: The American Urogynecologic Society's Prolapse pERFORmance Measure (AUGS-PERFORM) patient-reported outcome measure contains 11 items designed to assess symptoms relevant for assessing the quality of treatment for pelvic organ prolapse.

Objective: The aim of the study was to test AUGS-PERFORM's construct validity and test-retest reliability.

Study design: For this prospective validation study, we recruited English-speaking adult participants, at a single academic institution, seeking care for pelvic organ prolapse. Participants completed AUGS-PERFORM, the Pelvic Floor Distress Inventory, and several Patient-Reported Outcomes Measurement Information System short forms at baseline. We compared the 11 AUGS-PERFORM items against items testing the same concepts on other questionnaires using percent agreement, kappa statistics, and linear regression to determine construct validity. Two weeks later and before any pelvic organ prolapse therapy, participants completed AUGS-PERFORM a second time. Test-retest reliability was assessed using intraclass correlation coefficients.

Results: We enrolled 148 participants between 27 and 86 years of age: 81% self-identified as White, 56% were sexually active, and 84% elected surgery for treatment. The AUGS-PERFORM items assessing bulge presence and bother had a high percent agreement with the Pelvic Floor Distress Inventory item #3 (83.5 and 70%, respectively). The percent agreement ranged from 69% to 75% for items assessing urinary and defecatory symptoms and from 49% to 56% for pain-related questions. Sexual function items had a strong negative correlation (expected direction based on scoring) with validated sexual function questionnaires. The intraclass correlation coefficient was estimated to be 0.86, indicating excellent test-retest reliability.

Conclusions: The AUGS-PERFORM demonstrated good construct validity for prolapse, urinary incontinence, defecatory dysfunction, and sexual function questions, and moderate construct validity for pain-related questions. There was excellent test-retest reliability.

Importance: Recent articles have highlighted the existence of pelvic floor myofascial dysfunction in women presenting with pelvic floor disorders.

Objective: The aim of the study was to evaluate whether younger age is associated with pelvic floor muscle dysfunction in women with lower urinary tract symptoms, including urinary urgency, frequency, nocturia, and urinary incontinence.

Study design: This retrospective cohort study included women seeking an initial outpatient urogynecology evaluation for urinary symptoms from 8/2018 to 2/2022. The primary outcome was the presence of pelvic floor muscle dysfunction, defined as a diagnosis of levator myalgia/spasm. Multivariable logistic regression was used to evaluate the association.

Results: Four hundred twenty-one women with lower urinary tract symptoms were included, and 115 (27.3%) were diagnosed with pelvic floor muscle dysfunction. Women with pelvic floor dysfunction were 13 years younger, less likely to report any incontinence (60% vs 71.9%, P = 0.026) and urgency incontinence (8.7% vs 17.3%, P = 0.04). There was no difference in reported urgency, frequency, or nocturia. Women with pelvic floor dysfunction were more likely to report dysuria (19.1% vs 9.5%, P = 0.012), dyspareunia (39% vs 7.5%, P < 0.001), vulvodynia (11.3% vs 2.3%, P < 0.001), and pelvic pain (25.2% vs 7.2%, P < 0.001). The odds of pelvic floor muscle dysfunction in women <40 years old was 2.34 times greater than women ≥40 years old, after adjusting for other factors (adjusted odds ratio 2.341, 95% confidence interval [1.102, 4.972]).

Conclusions: Younger women with lower urinary tract symptoms were significantly more likely to have pelvic floor muscle dysfunction compared to older women with similar symptoms, even after controlling for other associated characteristics.

Importance: Interstitial cystitis/bladder pain syndrome (IC/BPS) presents as a complex heterogeneous disorder that poses a significant clinical challenge both for diagnosis and treatment. The identification of patient subgroups with significant overlap in their nonurological associated symptoms, including endometriosis, may enable a more targeted therapeutic approach.

Objective: This study investigated the prevalence, clinical correlates, and clinical sequelae associated with concurrent endometriosis in patients with IC/BPS.

Study design: Demographic, clinical, surgical, and questionnaire data from female patients (n = 533) with a diagnosis of IC/BPS were evaluated in this retrospective cohort study. Surgical history was obtained from patient electronic medical records, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Data from participants with and without concurrent endometriosis were compared using univariate analysis, followed by binary logistic regression to identify associated variables.

Results: Of 533 participants, 108 (20.3%) reported a history of endometriosis. Those with concurrent endometriosis were younger, had a larger bladder capacity, and had a higher number of nonurological associated symptoms. Patients with concurrent endometriosis were less likely to have a history of cystectomy (the surgical removal of the bladder) and report allergies but more prone to report comorbidities such as chronic pelvic pain, chronic fatigue, fibromyalgia, migraines, and pelvic floor dysfunction. Binary logistic regression identified a positive association between endometriosis and chronic pelvic pain, and a negative association between allergies and low bladder capacity for those with concurrent endometriosis.

Conclusions: Endometriosis is common in younger female patients with IC/BPS and is associated with a non-bladder-centric (ie, systemic pain disorder) phenotype.

Importance: Understanding treatment impact on quality of life of patients with stress urinary incontinence (SUI) in the short- and long-term is vital to optimizing treatment success.

Objectives: This study aimed to report 36-month patient satisfaction and quality of life results from a 522 study of single-incision and full-length slings in SUI.

Study design: This was a secondary analysis of the Altis 522 study, a prospective, multicenter, nonrandomized, noninferiority cohort study comparing the Altis single-incision sling to full-length slings for the treatment of SUI. The current study endpoints are patient-reported outcomes on quality of life related to continence status at 6, 12, 18, 24, and 36 months, measured through patient-reported, validated questionnaires: Urogenital Distress Inventory, Incontinence Impact Questionnaire, Patient Global Impression of Improvement, and Surgical Satisfaction Questionnaire.

Results: A total of 355 women underwent the sling procedure (184, Altis group; 171, comparator group). At 36 months, 140 (76.0%) of Altis and 101 (59.1%) of comparator group patients were assessed. Patient Global Impression of Improvement at 36 months indicated that 92.9% of Altis and 90.1% of comparator patients reported that their condition was "very much better" or "much better" (P = 0.444). Urogenital Distress Inventory at 36 months indicated improvement in quality of life in both groups with a mean change from baseline of 41.7 ± 19.3 (Altis group; n = 140) versus 44.4 ± 22.2 (comparator group; n = 101) (P = 0.305). The Incontinence Impact Questionnaire indicated average quality-of-life improvement of 50% in both groups from presurgery to 36 months, with a mean change from baseline of 51.8 ± 25.8 (Altis group) versus 50.2 ± 25.1 (comparator group) (P = 0.619).

Conclusions: This 36-month study demonstrated the lasting, positive effect that surgical intervention can have on patients with SUI.

Importance: Proper training is necessary to develop the highly specialized skills required to safely perform laparoscopic sacrocolpopexy. Currently, there is no validated training model for laparoscopic sacrocolpopexy that includes dissection of the presacral space, both vaginal and presacral mesh attachments, and peritoneal closure.

Objectives: This study aimed to create a procedure specific hierarchical task analysis for laparoscopic sacrocolpopexy and then develop and validate a corresponding laparoscopic sacrocolpopexy pelvic training model for the simulation environment.

Study design: This was an observational simulation study that was divided into 5 phases: (1) development of hierarchical task analysis, (2) model construction, (3) participant recruitment and simulation testing, (4) reliability and validity testing, and (5) creation of a standard passing performance measure.

Results: Construct, face, and content validity were established for this model. According to the participating experts, the model was able to replicate the steps of presacral dissection, anterior vaginal and sacral mesh attachment, and peritoneal closure. Thirteen trainees and 5 experts completed the simulation, and all "agreed" or "strongly agreed" that the model seemed useful for improving suturing technique and learning the procedure. Additionally, a passing performance measure was determined through contrasting groups methodology.

Conclusions: We developed a novel, reusable, and validated training model that can be utilized as a training resource for the many critical skills necessary to safely and efficiently perform laparoscopic sacrocolpopexy.