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Female Pelvic Medicine & Reconstructive Surgery

Beau Y Park, Kevin O Leslie, Longwen Chen, Laszlo T Vaszar, Jeffrey L Cornella
Extrauterine spread of leiomyomas is rare and most commonly occurs in the lungs. We present a case of simultaneous metastatic leiomyomatosis to the lungs and peritoneal cavity following laparoscopic myomectomy with power morcellation. The patient presented to our institution for further management where she underwent a robotically assisted hysterectomy with bilateral salpingo-oophorectomy. Leiomyomatous implants measuring up to 2.4 cm were resected from bowel mesentery and bladder peritoneum. Subsequent serial computed tomography imaging confirmed stable pulmonary nodules without new intraperitoneal lesions...
September 29, 2016: Female Pelvic Medicine & Reconstructive Surgery
Jonathan Shaw, Kyle Wohlrab, Charles Rardin
OBJECTIVES: The primary objective is to determine the relative risk (RR) of reoperation for stress urinary incontinence (SUI) recurrence after midurethral sling (MUS) division or excision. Our secondary objective is to determine the RR of SUI symptom recurrence according to differing techniques of revision. METHODS: This is a retrospective cohort study of all women who underwent surgical revision of an MUS by the Division of Urogynecology at the Women & Infants' Hospital during a 10-year period between October 1, 2004, and October 1, 2014...
September 29, 2016: Female Pelvic Medicine & Reconstructive Surgery
Omar Felipe Dueñas-Garcia, Danielle Patterson, Maria De la Luz Nieto, Katherine Leung, Michael Kevin Flynn
OBJECTIVES: This study aimed to compare the effect of periurethral infiltration of bupivacaine versus normal saline on postoperative voiding function and pain in patients undergoing retropubic midurethral sling METHODS: A randomized double-blind placebo-controlled study was performed at the University of Massachusetts from March 2012 to June 2015. Ninety patients were randomized to receive 0.5% bupivacaine with epinephrine or normal saline with epinephrine solution for periurethral hydrodissection...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Casey L Kinman, Anubhav Agrawal, Nicolette E Deveneau, Kate V Meriwether, Nicole R Herring, Sean L Francis
OBJECTIVES: The prevalent use of minimally invasive midurethral slings for the treatment of stress urinary incontinence in the last several decades has resulted in fewer Burch procedures being performed and diminished surgical experience in performing the Burch colposuspension. However, recent antimesh media has resulted in more patients requesting nonmesh anti-incontinence procedures and a subsequent need for surgeons to refamiliarize themselves with the Burch procedure and its relevant anatomy...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Mallika Anand, Amy L Weaver, Kristin M Fruth, Bijan J Borah, Christopher J Klingele, John B Gebhart
OBJECTIVES: To determine the rate of perioperative complications and cost associated with Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), and robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse. METHODS: We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery (MMC, ASC, or RSC) between January 1, 2000, and June 30, 2012, at our institution. For all patients identified, perioperative complications, length of hospital stay, and inpatient costs to patients were abstracted from the medical records and compared by procedure...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Jeannine Marie Miranne, Robert Eric Gutman, Andrew Ian Sokol, Amy Josephine Park, Cheryl Bernadette Iglesia
OBJECTIVE: To determine whether use of a new personalized risk calculator increases patient satisfaction with the decision whether or not to have a prophylactic midurethral sling (MUS) during pelvic organ prolapse (POP) surgery. METHODS: We performed a randomized controlled trial involving English-speaking women without symptoms of stress urinary incontinence (SUI) with ≥ stage 2 POP who planned to undergo POP surgery with 1 of 4 fellowship-trained urogynecologists at a single academic center...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Carolyn Weaver Swenson, Neil S Kamdar, Helen Levy, Darrell A Campbell, Daniel M Morgan
OBJECTIVES: The aim of this study was to investigate the relationship between primary insurance type and major complications after hysterectomy. METHODS: A retrospective analysis was performed on women with Medicaid, Medicare, and private insurance who underwent hysterectomy from January 1, 2012, to July 1, 2014, and were included in the Michigan Surgical Quality Collaborative. Major complications within 30 days of surgery included the following: deep/organ space surgical site infection, deep venous and pulmonary thromboembolism, myocardial infarction or stroke, pneumonia or sepsis, blood transfusion, readmission, and death...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Ka Lai Shek, Ixora Kamisan Atan, Hans Peter Dietz
OBJECTIVES: The aim of this study was to correlate clinical findings of anal sphincter defects and function with a sonographic diagnosis of significant sphincter defects. METHODS: This is an observational cross-sectional study on women seen 6 to 10 weeks after primary repair of obstetric anal sphincter injuries (OASIs). All patients underwent a standardized interview including the St Mark incontinence score, a digital rectal examination, and 3-/4-dimensional transperineal ultrasound imaging...
September 26, 2016: Female Pelvic Medicine & Reconstructive Surgery
Abigail Shatkin-Margolis, Maqdooda Merchant, Rebecca U Margulies, Olga Ramm
OBJECTIVES: Minimally invasive approaches to sacrocolpopexy have transformed it into a primary procedure for treatment of pelvic organ prolapse. Certain modifications are commonly used to facilitate the laparoscopic approach, but have not yet been widely studied. In this study, we investigated the efficacy and safety of titanium surgical tacks for the attachment of mesh to the anterior longitudinal ligament in laparoscopic sacrocolpopexy. METHODS: This retrospective cohort study involved all patients within 1 health care system who underwent laparoscopic sacrocolpopexy between January 2009 and December 2012...
September 21, 2016: Female Pelvic Medicine & Reconstructive Surgery
Patricia L Hardré, Mikio Nihira, Edgar LeClaire, Michael Moen
OBJECTIVE: The aim of this study was to describe how professional expertise is defined and understood among gynecologic surgeons and what experiential factors contribute to that understanding. METHODS: Semistructured interviews with 16 experts in Female Pelvic Medicine and Reconstructive Surgery were conducted to identify how expertise in their field is defined, recognized, and assessed. Independent thematic analysis of the interview transcripts was performed by each member of the research team and then distilled and synthesized into convergent themes...
September 21, 2016: Female Pelvic Medicine & Reconstructive Surgery
Gena C Dunivan, Katherine E Lyons, Peter C Jeppson, Cara S Ninivaggio, Yuko M Komesu, Frances M Alba, Rebecca G Rogers
OBJECTIVES: This study aimed to describe the relationship between genital hiatus (GH) and perineal body (PB) measurements with increasing pelvic organ prolapse (POP) stage in a large cohort of women referred to Urogynecology clinic for pelvic floor disorders. METHODS: Retrospective chart review of all new patients seen in an academic Urogynecology clinic between January 2007 and September 2011 was performed. Data were extracted from a standardized intake form. All patients underwent a Pelvic Organ Prolapse Quantification (POPQ) examination...
September 21, 2016: Female Pelvic Medicine & Reconstructive Surgery
Padma Kandadai, Samantha Mcvay, Jean-Robert Larrieux, Katharine OʼDell
OBJECTIVE: This study aimed to determine factors associated with perceived comfort with pessary management among obstetrics and gynecology (OB/GYN) residents in the United States. METHODS: A 31-item anonymous electronic survey regarding experience with, attitudes toward, and comfort with pessary management was distributed to US OB/GYN residents in all postgraduate years (PGYs). Demographic and program-specific data on pessary education were collected. Descriptive statistical analyses were performed...
September 21, 2016: Female Pelvic Medicine & Reconstructive Surgery
Brian J Linder, Mallika Anand, Christopher J Klingele, Emanuel C Trabuco, John B Gebhart, John A Occhino
OBJECTIVE: The optimal suture selection for mesh attachment during robotic sacrocolpopexy (RSC) is currently unknown. Here, we sought to evaluate the outcomes of RSC using absorbable sutures for vaginal and sacral mesh attachment. METHODS: We retrospectively reviewed 132 RSC surgeries that were performed for vaginal vault prolapse in the Division of Gynecologic Surgery at our institution from February 2007 to December 2013. All cases were performed with absorbable suture (polyglactin) for vaginal and sacral mesh fixation...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Lee A Richter, Quinn K Lippmann, Karl Jallad, Joelle Lucas, Jennifer Yeung, Tanaka Dune, Erin Mellano, Steven Weissbart, Mihriye Mete, Ja-Hong Kim, Robert Gutman
OBJECTIVES: The objective of this study was to determine the risk factors that may contribute to the diagnosis of microscopic hematuria (MH) in women. METHODS: This multicenter case-control study reviewed cases of women presenting to Female Pelvic Medicine & Reconstructive Surgery sites with MH from 2010 to 2014. Microscopic hematuria was defined as 3 or more red blood cells per high power field in the absence of infection as indicated in the American Urologic Association guidelines...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Zaid Chaudhry, Seth Ashley Cohen, Christopher Tarnay
OBJECTIVE: The aim of the study was to assess the impact of age on 30-day perioperative complications and length of stay (LOS) for minimally invasive sacrocolpopexy (MISC) using a national database. METHODS: We performed an institutional review board-exempt retrospective analysis of prospectively collected data, using the National Surgical Quality Improvement Program database to analyze MISC performed at participating hospitals from 2010 to 2013. Age was stratified into the following 5 categories: younger than 60, 60 to 64, 65 to 69, 70 to 74, and 75 years or older...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Emily E Weber LeBrun, Hazel Asumu, Anne M Richardson, LouAnn A Cooper, John D Davis
OBJECTIVE: This study aims to determine the expectations of Obstetrics and Gynecology (ObGyn) residency and Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship program directors (FPDs) for the independent performance of urogynecologic procedures during residency and to compare these expectations with the Council on Resident Education in Obstetrics and Gynecology (CREOG) educational objectives. MATERIALS AND METHODS: Two parallel, anonymous surveys were distributed simultaneously to all directors of accredited ObGyn residency and FPMRS fellowship programs in the United States...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Dani Zoorob, Mickey Karram, Anna Stecher, Rose Maxwell, James Whiteside
OBJECTIVES: To identify litigation predictors among women with complications of transvaginal mesh. METHODS: Chart review and patient survey were conducted among women who had undergone a complication-related explant of a transvaginal prolapse or incontinence sling mesh. Trained study personnel administered a 57-question survey addressing subjective complaints related to bowel, bladder, sexual dysfunction, and development of pain or recurrent prolapse. These data were analyzed with respect to the subject's reported pursuit of litigation related to the mesh complication...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Alexandriah N Alas, Gena C Dunivan, Cecelia K Wieslander, Claudia Sevilla, Biatris Barrera, Rezoana Rashid, Sally Maliski, Karen Eilber, Rebecca G Rogers, Jennifer Tash Anger
OBJECTIVES: The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP). METHODS: Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Alexis A Dieter, Jennifer M Wu, Nazema Y Siddiqui, Danielle J Degoski, Jillene M Brooks, Paul C Dolber, Matthew O Fraser
OBJECTIVES: The aim of this study was to characterize the response of the rat bladder neuromuscular system to intramural injection of onabotulinum toxin type A (BoNT/A) over 9 weeks using in vivo cystometry (CMG) and in vitro contractility (IVC). METHODS: Chronic bladder catheters were implanted in female Sprague-Dawley rats, and either (1) BoNT/A (10 units in 20 μL saline) or (2) saline (20 μL) was injected in 5 × 4 μL doses throughout the bladder wall. At 1, 3, 6, and 9 weeks after injection, conscious restrained CMG was performed...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
Corina Christmann-Schmid, Annemijn Philine Annette Wierenga, Eveline Frischknecht, Christopher Maher
OBJECTIVE: The aim of this prospective observational study was to obtain a better understanding of the anatomy and to classify the observed different perineal presentations at the time of posterior colporrhaphy and to describe specific surgical techniques used. METHODS: To classify the observed perineal findings, the Pelvic Organ Prolapse Quantification System with a newly introduced additional measurement of the perineal ridge (PR) was taken intraoperatively and postoperatively in 121 consecutive women undergoing posterior colporrhaphy...
September 16, 2016: Female Pelvic Medicine & Reconstructive Surgery
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