Urogynecology (Hagerstown, Md.)最新文献

Importance: This research describes which articles published in Urogynecology are garnering the most attention online. Understanding which articles are having the largest impact in the online community has become increasingly important due to the exponential increase in the use of social media on the internet.

Objective: The Altmetric Attention Score (AAS) is a quantitative and qualitative measure of the articles' online attention in social media and news outlets, blogs, and reference managers. The aim of this study was to provide an analysis of those accessing and sharing the 100 most popular articles published in Urogynecology.

Study design: This was a retrospective descriptive analysis. Using Dimensions, a "linked research knowledge system," data about each article's demographics on Twitter and other media sources was extracted from each of the articles within Urogynecology with the highest AAS. No articles were excluded. The articles were categorized by topic and metrics of online sharing were compared among categories.

Results: Fifteen categories were created. Sexual health and education articles had the highest average Altmetric scores per article and reached the highest impressions per article and had the highest average follower count per Twitter user. On average, social justice in medicine had the highest number of tweets per article. Tweets were most often composed by members of the public (58%) compared with health care practitioners (14%), researchers (13%), and science communicators (12%).

Conclusions: Sexual health and education articles had the highest average AAS and impressions on Twitter. We observed a difference in which articles are being shared most among the general public and health care professionals. The general public comprised a majority of those sharing articles online regardless of category. Additionally, there may be a disparity in research, its funding, and online scientific communications within the field of urogynecology.

Importance: Evidence regarding the effect of pudendal nerve blockade during vaginal surgery is conflicting. Previous studies compared pudendal nerve blockade to either normal saline placebo injection or no injection, demonstrating small or no difference in pain outcomes. Studies investigating nerve blocks at the time of vaginal surgery have not evaluated the effect of infiltration of the space around the pudendal nerve.

Objective: The aim of the study was to determine whether intraoperative pudendal nerve injection (bupivacaine or normal saline) will result in improved pain scores and satisfaction compared with patients who receive no pudendal injection.

Study design: We performed a secondary analysis of 2 randomized controlled trials investigating postoperative pain after vaginal reconstructive surgery, comparing the outcomes of the following 3 groups: control (no pudendal injection), intervention (bilateral pudendal nerve blockade), and placebo (bilateral normal saline pudendal injections). The primary outcome was postoperative pain scores. Secondary outcomes were opioid use, patient satisfaction, and postoperative complications. Linear mixed effects models were applied to outcomes, and treatment effects with 95% confidence intervals were estimated at each time point from the model.

Results: One hundred four patients who underwent vaginal surgery were included: 36 pudendal nerve block, 35 normal saline pudendal injection, and 33 no injection. The groups were well-matched. Linear mixed effects models demonstrated no significant differences between treatment groups for postoperative pain severity scores, opioid use, and patient-reported satisfaction at each time point.

Conclusions: Normal saline injection and no injection seem to have no clinically meaningful difference in effect, and either could reasonably serve as control for pudendal blockade during vaginal surgery.

Importance: There is limited understanding of the relationship between social determinants of health (SDOH) and types of overactive bladder/urgency urinary incontinence (OAB/UUI) treatments.

Objectives: Our objective was to determine if OAB/UUI treatment type differs by SDOH, including insurance and estimated median household income (EMHI).

Study design: This was a cross-sectional study of adult patients assigned female at birth with OAB/UUI, identified from 2017 to 2022 within a tertiary academic health system. The primary outcome was any OAB/UUI treatment provision. Secondary outcomes included specific treatments and specialty care. We examined associations between SDOH and OAB/UUI treatments using univariable analysis and multivariable logistic regression.

Results: Among 33,002 patients with OAB/UUI, 15.4% received treatment. Treatment provision was associated with American Indian/Alaska Native or Black/African American race, Latina ethnicity, Medicaid, low-income Medicare, or Medicare Advantage (vs private insurance) and EMHI ranging from $26,500 to $100,000 (compared with EMHI >$100,000). Patients with Black/African American race, Medicaid or no insurance, and EMHI ≤$80,000 had higher odds of anticholinergic prescription and lower odds of β3-agonist prescription. Advanced therapy was associated with traditional Medicare, Medicare Advantage, and EMHI $26,500-$100,000 and negatively associated with Asian race. Specialty care was associated with Black/African American race, Medicaid, Medicare Advantage, no insurance, and EMHI ≤$80,000.

Conclusions: Overactive bladder/urgency urinary incontinence treatment provision was associated with American Indian/Alaska Native and Black/African American race, Latina ethnicity, Medicaid, low-income Medicare, or Medicare Advantage insurance. Patients with Black/African American race and with lower EMHI had higher odds of receiving anticholinergic therapy and lower odds of receiving β3-agonist medication, despite higher likelihood of specialty care.

Importance: This review aimed to describe research initiatives, evolution, and processes of the Eunice Kennedy Shriver National Institute of Child Health and Human Development-supported Pelvic Floor Disorders Network (PFDN). This may be of interest and inform researchers wishing to conduct multisite coordinated research initiatives as well as to provide perspective to all urogynecologists regarding how the PFDN has evolved and functions.

Study design: Principal investigators of several PFDN clinical sites and Data Coordinating Center describe more than 20 years of development and maturation of the PFDN.

Results: Over two decades, the PFDN used an intentionally driven approach to answering clinically important questions to inform the surgical and nonsurgical care of women with pelvic floor disorders (PFDs) including pelvic organ prolapse, urinary incontinence, and fecal incontinence. From its inception, the PFDN refined network procedures and processes affecting trial design, protocol development, and standardization of outcomes and publications. This strategy resulted in a credible, robust, and productive portfolio of randomized clinical trials, secondary analyses, prospective cohort, and supplementary studies emphasizing the use of validated patient-reported outcomes, longer-term outcomes, an increase in translational science aims, and standardized long-term collection of adverse events.

Conclusions: The processes the PFDN has developed and implemented have led to impactful research initiatives in women's PFDs. Patient participants and research coordinators have been an integral part of this contribution. Through consistent funding and committed investigators, the state of science in the surgical and nonsurgical care and understanding of PFD pathophysiology has been advanced.

Importance: Approximately 15-45% of female patients develop transient postoperative urinary retention (POUR) following pelvic reconstructive surgery. Catheter options for bladder drainage include transurethral indwelling catheter (TIC), intermittent self-catheterization (ISC), and suprapubic tube (SPT). Each strategy has risks and benefits; none have been shown to be clinically superior, and to date, no comprehensive comparative economic analysis has been published.

Objective: The objective of this study was to evaluate the cost of these different bladder catheterization strategies after transvaginal pelvic surgery.

Study design: A Canadian universal single-payer (government funded) health system perspective was taken, and a decision tree model was constructed to evaluate the costs associated with each catheterization strategy over a 6-week horizon. Base-cases were set based on recently published clinical data of our institutions, 2 academic tertiary care centers, and based on systematic reviews and meta-analyses. Costs were established in consultation with process stakeholders, in addition to published values.

Results: The average cost calculated for management of transient POUR after outpatient pelvic reconstructive surgery was 150.69 CAD (median 154.86; interquartile range [IQR] 131.30-176.33) for TIC, 162.28 CAD (median 164.72; IQR 144.36-189.39) for ISC and 255.67 CAD (median 270.63; IQR 234.32-276.82) for SPT. In costing inpatient surgical data, the average cost calculated was 134.22 CAD (median 123.61; IQR 108.87-151.85) for TIC and 224.61 CAD (median 216.07; IQR 203.86-231.23) for SPT.

Conclusion: TIC and ISC were found to be significantly less costly than SPT in managing transient POUR following transvaginal pelvic reconstructive surgery.

Importance: Limited data exist comparing total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LSCH) at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse.

Objectives: The objective of this study was to compare TLH versus LSCH at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse, hypothesizing that LSCH would demonstrate a higher proportion of recurrent prolapse, but a lower proportion of mesh exposures.

Study design: This was a retrospective, secondary analysis comparing a prospective cohort of patients undergoing TLH sacrocolpopexy versus a retrospective cohort of patients who had undergone LSCH sacrocolpopexy. Our primary outcome was composite anatomic pelvic organ prolapse recurrence (prolapse beyond hymen, apical descent > half vaginal length, retreatment). Secondary outcomes included vaginal mesh exposures.

Results: There were 733 procedures: 184 (25.1%) TLH sacrocolpopexy and 549 (74.9%) LSCH sacrocolpopexy. Median follow-up was longer in the TLH cohort (369 [IQR 354-386] vs 190 [IQR 63-362] days, P < 0.01). There was no difference in composite prolapse recurrence between groups on bivariable analysis (3.3% vs 4.7%, P = 0.40). However, multivariable logistic regression demonstrated that TLH sacrocolpopexy had lower odds of composite pelvic organ prolapse recurrence than LSCH sacrocolpopexy (OR 0.21, 95% CI 0.05-0.82, P = 0.02). Among procedures with lightweight mesh types, TLH demonstrated a higher proportion of mesh exposures compared to LSCH (10 [5.4%] vs 4 [1.1%], P < 0.01); however, this was not significant after controlling for confounders (OR 4.51, 95% CI 0.88-39.25, P = 0.08). There were no differences in retreatment or reoperation.

Conclusion: For the treatment of uterovaginal prolapse, both TLH and LSCH are acceptable methods of concomitant hysterectomy at the time of minimally invasive sacrocolpopexy, albeit with likely different risk profiles.

Importance: Although access to urogynecologic care is known to influence patient outcomes, less is known regarding geographic access to care and how it may vary by population characteristics.

Objective: The primary objective of this study was to estimate geographic accessibility of urogynecologic services in terms of drive time and by population demographics.

Study design: We performed a descriptive study using practice location data by zip code for all board-certified urogynecologists who are American Urogynecologic Society members (n = 497) and pelvic floor physical therapists (n = 985). Drive times from each zip code to the nearest health care professional zip code were calculated. These data were then overlaid onto a map of the continental United States. Race/ethnicity, age, education, poverty status, disability status, health insurance coverage, and rurality were compared across travel times.

Results: Of the 31,754 zip codes of the continental United States, 389 (1.23%) had at least 1 urogynecologist, and 785 (2.47%) had at least 1 pelvic floor physical therapist; 92.29 million women older than 35 years were represented in the demographic analyses. Seventy-nine percent of the studied population live within 1 hour of a urogynecologist, and 85% live within 1 hour of a pelvic floor physical therapist. Seven percent and 3% live >2 hours from urogynecologic services, respectively. Values for drive times to all health care professionals indicate that American Indian/Alaska Native individuals have a much greater travel burden than other racial/ethnic groups.

Conclusions: There are population groups with limited geographic access to urogynecologic services. Pelvic floor physical therapists are more geographically accessible to the population studied than urogynecologists.

Importance: Although surgery for pelvic organ prolapse (POP) is generally associated with an improvement in sexual function, knowledge on specific changes is limited.

Objectives: The aim of this study was to describe and compare changes in sexual activity and function during a 5-year follow-up period after POP surgery.

Study design: This was a nationwide cohort study of 3,515 women operated on for POP in 2015 in Finland. Sexual activity and function were assessed preoperatively and 6 months, 2 years, and 5 years after native tissue and mesh-augmented surgery using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12).

Results: The PISQ-12 score improved significantly at 6-month follow-up, regardless of surgical approach. Negative emotional reactions (relative risk [RR], 0.21; 95% confidence interval [CI], 0.13-0.36), orgasm intensity (RR, 4.23; 95% CI, 2.94-6.07), and avoidance of sexual intercourse due to fear of incontinence (RR, 0.25; 95% CI, 0.15-0.43) or bulging (RR, 0.11; 95% CI, 0.07-0.17) improved remarkably at 6 months and remained up to 5 years after surgery. Satisfaction (RR, 1.10; 95% CI, 1.04-1.18), coital pain (RR, 0.71; 95% CI, 0.51-0.99), and coital incontinence (RR, 0.48; 95% CI, 0.15-0.43) improved only at 6-month follow-up. Among women with deteriorated sexual function, the decline was associated with loss of excitement and satisfaction, increased coital pain, and partner's erectile problems. Partner-related factors and lack of sexual desire were main reasons for sexual inactivity both preoperatively and postoperatively.

Conclusions: Considering patient's sexual wellbeing and informing them of the expected changes in individual sexual function items are important aspects of preoperative counseling. This may reduce false hopes regarding the effect of surgery on sexual function and improve postoperative patient satisfaction.