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Female Pelvic Medicine & Reconstructive Surgery

Elishia R Mckay, Lisbet S Lundsberg, Devin T Miller, Ashley Draper, Jamie Chao, Judy Yeh, Sabrina Rangi, Priscilla Torres, Michelle Stoltzman, Marsha K Guess
OBJECTIVES: The aim of this study was to investigate knowledge and demographic factors associated with a lack of knowledge proficiency about urinary incontinence (UI) and pelvic organ prolapse (POP) among pregnant and postpartum women. METHODS: This was a cross-sectional survey of women receiving antepartum and postpartum care at 9 Connecticut sites. Knowledge was assessed using the validated Prolapse and Incontinence Knowledge Questionnaire. Lack of knowledge proficiency was defined as less than 80% and less than 50% correct responses on the Prolapse and Incontinence Knowledge Questionnaire UI and POP subscales...
August 2, 2018: Female Pelvic Medicine & Reconstructive Surgery
Brittni Boyd, Toya Pratt, Kavita Mishra
Sacral osteomyelitis is a rare complication after robotic sacrocolpopexy, with previous reports of enteric and skin flora as inciting organisms. We report a patient who presented with severe low back pain and fever 6 weeks after a robotic sacrocolpopexy, who was subsequently diagnosed as having lumbosacral discitis and osteomyelitis with thoracic intervertebral extension. Empiric antibiotic therapy was initially administered. After laparoscopic mesh excision and abdominal wash out, Candida albicans was isolated from the excised mesh...
July 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
Amy D Dobberfuhl, Amandeep Mahal, Kai B Dallas, Katherine M Choi, Craig V Comiter, Christopher S Elliott
PURPOSE: Sacral neuromodulation (SNS) is approved by the Food and Drug Administration as a third-line treatment for refractory overactive bladder, idiopathic urinary retention, and fecal incontinence. Prior to implantation of an implantable pulse generator, all patients undergo a trial phase to ensure symptom improvement. The published success rates of progression from the test phase to permanent implant vary widely (range, 24% to >90%). We sought to characterize success rates using a statewide registry...
July 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
William D Winkelman, Miriam J Haviland, Eman A Elkadry
There are insufficient studies on long-term outcomes following colpocleisis, which limits physicians' ability to effectively counsel patients. The purpose of this study was to assess pelvic floor symptoms, recurrence, satisfaction, and regret among patients who underwent colpocleisis procedures. METHODS: This is an ambidirectional cohort study involving patients who underwent a colpocleisis at a single institution from 2002 to 2012. Medical records were reviewed, and patients were contacted by telephone in order to complete questionnaires...
July 27, 2018: Female Pelvic Medicine & Reconstructive Surgery
Nemi M Shah, Lindsey A Jackson, John N Phelan, Marlene M Corton
BACKGROUND: Mesh resection for refractory pain after transobturator midurethral sling may require exploration of structures different than those involved in insertion. Our objective was to describe the muscular and neurovascular anatomy of the medial thigh compartment. METHODS: Dissections were performed in unembalmed female cadavers. Relationships of medial thigh structures were evaluated relative to the midpubic arch and obturator nerve. An out-to-in transobturator tape was passed in a subset of cadavers, and its relationships to the obturator nerve and adductor muscles were examined...
July 24, 2018: Female Pelvic Medicine & Reconstructive Surgery
Alexandra M Schefter, John Fischer, Britt K Erickson
BACKGROUND: Transvaginal bowel evisceration is an exceptionally rare event. Most reported cases are of small bowel evisceration in postmenopausal women who have undergone hysterectomy. CASE: Here, we report an isolated case of complete procidentia and spontaneous sigmoid colon evisceration leading to sepsis in an 89-year-old woman with no surgical history. CONCLUSIONS: We highlight the risk factors, clinical presentation, and treatment options for this unique multidisciplinary emergency...
July 24, 2018: Female Pelvic Medicine & Reconstructive Surgery
Kavita Mishra, Natalie C Locci-Molina, Bhavya Chauhan, Christina A Raker, Vivian W Sung
OBJECTIVE: In 2015, 44 million adults were informal, unpaid caregivers to an adult or child. Caregiving (CG) is associated with poor self-care, higher depression rates, and decreased quality of life. Our primary objective was to determine if CG is associated with a delay in seeking care for pelvic floor disorders (PFDs). METHODS: We performed a cross-sectional survey of new urogynecology patients from September 2015 to January 2016. Subjects completed the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, Patient Reported Outcomes Measurement Information System-Depression surveys, and a survey of care-seeking practices...
July 24, 2018: Female Pelvic Medicine & Reconstructive Surgery
Pakeeza A Alam, Jim C Huang, Brett A Clark, Linda S Burkett, Lee A Richter
OBJECTIVE: The objective of this study was to perform a cost analysis assessing the economic feasibility of reusable underwear as alternative for disposable pads for women with mild to moderate urinary incontinence. METHODS: A consumer-perspective cost analysis was performed with the following assumptions: (1) consumers have mild to moderate urinary incontinence and use 2 pads per day (PPD); (2) consumers have a 2-week supply of underwear; (3) there is no difference in laundering cost between 2 incontinence options; (4) there is no difference in use of labor/other accessories of care; (5) there is no difference in skin complaints/associated cost; (6) cost of products are nonfluctuant with time; and (7) all incontinence products were purchased online...
July 12, 2018: Female Pelvic Medicine & Reconstructive Surgery
Lin Li Ow, Nishamini Subramaniam, Ixora Kamisan Atan, Talia Friedman, Andrew Martin, Hans Peter Dietz
OBJECTIVE: Genital hiatus (Gh) and perineal body (Pb) are part of the Pelvic Organ Prolapse Quantification assessment system, but it is unclear whether measurements should be taken at rest or on Valsalva. This study was designed to assess the predictive value of Gh and Pb measurements obtained at rest and on Valsalva for signs and symptoms of pelvic organ prolapse (POP). METHODS: This is a retrospective study involving 416 women who presented to a tertiary urogynecology unit with symptoms of pelvic floor dysfunction...
July 3, 2018: Female Pelvic Medicine & Reconstructive Surgery
Julia Geynisman-Tan, Katarzyna Bochenska, Akira Gillingham, Sarah Collins, Christina Lewicky-Gaupp, Margaret Mueller, Kimberly Kenton
OBJECTIVE: The objective of this study was to determine the incidence of newly diagnosed, clinically meaningful laboratory abnormalities on routine preoperative laboratory testing in women undergoing urogynecologic surgery. METHODS: All urogynecologic cases performed at a single institution over a 3-year period were reviewed. Women undergoing major surgery routinely had a basic metabolic panel, complete blood count (CBC), and type and screen, whereas women undergoing minor surgery had testing at the surgeon's discretion...
July 3, 2018: Female Pelvic Medicine & Reconstructive Surgery
Megan B Shannon, Neil Gupta, Joshua Eberhardt, Ahmer V Farooq
Sacral neuromodulation is an effective treatment of urinary incontinence, fecal incontinence, and idiopathic urinary retention. The procedure is considered low risk with overall low complication rates. This report describes a 40-year-old woman who underwent sacral neuromodulation explant and full-system implant for weaning efficacy of her device. During device removal, the tined lead broke and was left in situ. Four months later, she was diagnosed as having a wound infection at the site of the retained lead...
July 3, 2018: Female Pelvic Medicine & Reconstructive Surgery
Avita K Pahwa, Kavita D Khanijow, Heidi S Harvie, Lily A Arya, Uduak U Andy
OBJECTIVE: To determine if categorizing fecal incontinence (FI) as urgency or passive FI is clinically meaningful, we compared clinical severity, quality of life, physical examination findings, and functional and anatomic deficits between women with urgency and passive FI. METHODS: This study is a prospective cross-sectional study of women with at least monthly FI. All women completed the St Mark's Vaizey and the Fecal Incontinence Quality of Life questionnaires and underwent anorectal manometry and endoanal ultrasound...
July 3, 2018: Female Pelvic Medicine & Reconstructive Surgery
Michael Heit, Janet S Carpenter, Chen X Chen, Ryan Stewart, Jennifer Hamner, Kevin L Rand
OBJECTIVES: Our aim was to identify sociodemographic/clinical, surgical, and psychosocial predictors of postdischarge surgical recovery after laparoscopic sacrocolpopexy. METHODS: Study participants (N = 171) with at least stage 2 pelvic organ prolapse completed a preoperative survey measuring hypothesized sociodemographic/clinical, surgical, and psychosocial recovery predictors followed by a postoperative survey at 4 time points (days 7, 14, 42, and 90) that included the Postdischarge Surgical Recovery 13 scale...
June 19, 2018: Female Pelvic Medicine & Reconstructive Surgery
Lauren E Stewart, Michelle A Eston, Rebecca G Symons, Michael F Fialkow, Anna C Kirby
OBJECTIVES: Mesh midurethral slings (MUSs) are safe, effective treatments for female stress urinary incontinence (SUI), but many companies have ceased production because of controversies surrounding transvaginal mesh. To determine if introduction of MUS has increased the complication rate associated with SUI surgery, we compared women undergoing SUI surgery in the MUS era to those who had surgery prior its introduction. METHODS: This was a retrospective cohort study of a statewide hospital discharge database...
June 12, 2018: Female Pelvic Medicine & Reconstructive Surgery
Ghazaleh Rostaminia, Charbel Awad, Cecilia Chang, Siddhartha Sikdar, Qi Wei, S Abbas Shobeiri
OBJECTIVES: The objective of this study was to evaluate perineal body stiffness intrapartum using shear wave elastography ultrasound and to study its association with maternal and labor characteristics. METHODS: This was a prospective observational study. Pregnant women with term pregnancy who had been admitted for labor management were recruited into the study. Transperineal shear wave elastography of perineal body was performed. Maternal and labor data were retrieved from electronic medical charts...
May 22, 2018: Female Pelvic Medicine & Reconstructive Surgery
Rui Wang, Djøra I Soeteman, Michele R Hacker, Roger Lefevre
OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of retrograde voiding trials in the management of postoperative voiding dysfunction. METHODS: We developed a disease simulation model to assess under which conditions routine retrograde voiding trial is the optimal strategy in terms of cost per quality-adjusted life-year and cost per case of chronic voiding dysfunction avoided. We varied the incidence of voiding dysfunction between 2% and 60%...
May 22, 2018: Female Pelvic Medicine & Reconstructive Surgery
Alice Drain, Ekene Enemchukwu, Nihar Shah, Raveen Syan, Nirit Rosenblum, Victor W Nitti, Benjamin M Brucker
OBJECTIVES: Stress urinary incontinence is highly prevalent and sling surgery has increased since 2000. Urethrolysis traditionally had been standard management of complications after anti-incontinence surgery; however, partial excision is a less aggressive option. This study describes the different populations in a contemporary cohort that undergo sling excision and urethrolysis and their surgical outcomes. METHODS: Chart analysis was performed on patients assigned Current Procedural Terminology codes for removal or revision of sling for stress incontinence, urethrolysis, or revision of graft at our institution from 2010 to 2015...
May 21, 2018: Female Pelvic Medicine & Reconstructive Surgery
Dina Bastawros, Hamza Beano, Michael J Kennelly, Kevin J E Stepp
Fistulas are defined as abnormal connections between 2 organ, vessels, or structures. They can often present in the genitourinary tract as a result of iatrogenic injury during pelvic surgery. A 46-year-old female presents many years after a hysterectomy for persistent vaginal leakage with concern for a vesicovaginal fistula. Computed tomography urogram, intravenous retrograde pyelogram, and cystoscopy were negative for vesicovaginal fistula; however, a vaginal sinus tract was noted and further explored. This case report will describe the use of both laparoscopy and concomitant vaginoscopy to diagnose and, ultimately, surgically excise a salpingovaginal fistula...
July 2018: Female Pelvic Medicine & Reconstructive Surgery
Jenny Y Mei, My-Linh T Nguyen, Shlomo Raz
Caudal duplication syndrome is an exceedingly rare condition that manifests as duplicative anomalies of the gastrointestinal and genitourinary systems. We present a case of an adult patient born with multiple congenital anomalies including duplicated reproductive and urinary systems. She presented to our center for initial evaluation 11 years ago largely experiencing right-sided pelvic organ prolapse and bilateral urinary tract voiding dysfunction. She underwent successful surgical management and presented several years later for recurrent symptoms...
July 2018: Female Pelvic Medicine & Reconstructive Surgery
Xiaoting Lin, Pei Du, Liquan Chen, Yaping Gan, Xiaowei Zhang
Sacrocolpopexy has long been the preferred surgical procedure for the management of apical vaginal prolapse. The published literature regarding rectal mesh erosion after sacrocolpopexy includes only 6 cases in MEDLINE. We report a case of sigmoid vaginal fistula identified 4 years after laparoscopic sacrocolpopexy, along with an analysis of the follow-up of 140 patients over 12 months or more.
July 2018: Female Pelvic Medicine & Reconstructive Surgery
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