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Orejuela FJ, Aschkenazi SO, Howard DL, Jeppson PC, Balgobin S, Walter AJ, White A, Olivera CK, Sanses TV, Thompson J, Gala RB, Matteson K, Balk EM, Meriwether KV, Rahn DD. Gynecologic surgical skill acquisition through simulation with outcomes at the time of surgery: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 227:29.e1-29.e24. [PMID: 35120886 DOI: 10.1016/j.ajog.2022.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/26/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effect of simulation training vs traditional hands-on surgical instruction on learner operative skills and patient outcomes in gynecologic surgeries. DATA SOURCES PubMed, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from inception to January 12, 2021. STUDY ELIGIBILITY CRITERIA Randomized controlled trials, prospective comparative studies, and prospective single-group studies with pre- and posttraining assessments that reported surgical simulation-based training before gynecologic surgery were included. METHODS Reviewers independently identified the studies, obtained data, and assessed the study quality. The results were analyzed according to the type of gynecologic surgery, simulation, comparator, and outcome data, including clinical and patient-related outcomes. The maximum likelihood random effects model meta-analyses of the odds ratios and standardized mean differences were calculated with estimated 95% confidence intervals. RESULTS Twenty studies, including 13 randomized controlled trials, 1 randomized crossover trial, 5 nonrandomized comparative studies, and 1 prepost study were identified. Most of the included studies (14/21, 67%) were on laparoscopic simulators and had a moderate quality of evidence. Meta-analysis showed that compared with traditional surgical teaching, high- and low-fidelity simulators improved surgical technical skills in the operating room as measured by global rating scales, and high-fidelity simulators decreased the operative time. Moderate quality evidence was found favoring warm-up exercises before laparoscopic surgery. There was insufficient evidence to conduct a meta-analysis for other gynecologic procedures. CONCLUSION Current evidence supports incorporating simulation-based training for a variety of gynecologic surgeries to increase technical skills in the operating room, but data on patient-related outcomes are lacking.
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Affiliation(s)
- Francisco J Orejuela
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
| | | | - David L Howard
- Department of Obstetrics and Gynecology, University of Nevada, Las Vegas, NV
| | - Peter C Jeppson
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM
| | - Sunil Balgobin
- Department of Obstetrics and Gynecology, The University of Texas, Southwestern, Dallas, TX
| | - Andrew J Walter
- Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, Roseville, CA
| | - Amanda White
- Department of Obstetrics and Gynecology, Dell Medical Center, The University of Texas at Austin, Austin, TX
| | - Cedric K Olivera
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tatiana V Sanses
- Department of Obstetrics and Gynecology, Howard University College of Medicine, Washington, DC
| | - Jennifer Thompson
- Department of Obstetrics and Gynecology, Northwest Kaiser Permanente, Portland, OR
| | - Rajiv B Gala
- Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA
| | - Kristen Matteson
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ethan M Balk
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | - Kate V Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM
| | - David D Rahn
- Department of Obstetrics and Gynecology, The University of Texas, Southwestern, Dallas, TX
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Sammarco AG, Sheyn DD, Krantz TE, Olivera CK, Rodrigues AA, Kobernik MEK, Masteling M, Delancey JO. A novel measurement of pelvic floor cross-sectional area in older and younger women with and without prolapse. Am J Obstet Gynecol 2019; 221:521.e1-521.e7. [PMID: 31401263 PMCID: PMC6829060 DOI: 10.1016/j.ajog.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/30/2019] [Accepted: 08/03/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND An increase in size of the aperture of the pelvis that must be spanned by pelvic floor support structures translates to an increase in the force on these structures. Prior studies have measured the bony dimensions of the pelvis, but the effect of changes in muscle bulk that may affect the size of this area are unknown. OBJECTIVES To develop a technique to evaluate the aperture size in the anterior pelvis at the level of the levator ani muscle attachments, and to identify age-related changes in women with and without prolapse. MATERIALS AND METHODS This was a technique development and pilot case-control study evaluating pelvic magnetic resonance imaging from 30 primiparous women from the Michigan Pelvic Floor Research Group MRI Data Base: 10 younger women with normal support, 10 older women with prolapse, and 10 older menopausal women without prolapse. Anterior pelvic area measurements were made in a plane that included the bilateral ischial spines and the inferior pubic point, approximating the level of the arcus tendineus fascia pelvis. Measurements of the anterior pelvic area, obturator internus muscles, and interspinous diameter were made by 5 independent raters from the Society of Gynecologic Surgeons Pelvic Anatomy Group who focused on developing pelvic imaging techniques, and evaluating interrater reliability. Demographic characteristics were compared across groups of interest using the Wilcoxon rank sum test, χ2, or Fisher exact test where appropriate. Multiple linear regression models were created to identify independent predictors of anterior pelvic area. RESULTS Per the study design, groups differed in age and prolapse stage. There were no differences in race, height, body mass index, gravidity, or parity. Patients with prolapse had a significantly longer interspinous diameter, and more major (>50% of the muscle) levator ani defects when compared to both older and younger women without prolapse. Interrater reliability was high for all measurements (intraclass correlation coefficient = 0.96). The anterior pelvic area (cm2) was significantly larger in older women with prolapse compared to older (60 ± 5.1 vs 53 ± 4.9, P = .004) and younger (60 ± 5.1 vs 52 ± 4.6, P = .001) women with normal support. The younger and older women with normal support did not differ in anterior pelvic area (52 ± 4.6 vs 53 ± 4.9, P = .99). After adjusting for race and body mass index, increased anterior pelvic area was significantly associated with the following: being an older woman with prolapse (β = 6.61 cm2, P = .004), and interspinous diameter (β = 4.52 cm2, P = .004). CONCLUSION Older women with prolapse had the largest anterior area, suggesting that the anterior pelvic area is a novel measure to consider when evaluating women with prolapse. Interspinous diameter, and being an older woman with prolapse, were associated with a larger anterior pelvic area. This suggests that reduced obturator internus muscle size with age may not be the primary factor in determining anterior pelvic area, but that pelvic dimensions such as interspinous diameter could play a role. The measurements were highly repeatable. The high intraclass correlation coefficient indicates that all raters were able to successfully learn the imaging software and to perform measurements with high reproducibility.
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Affiliation(s)
- Anne G Sammarco
- Female Pelvic Medicine and Reconstructive Surgery, Michigan Medicine, Ann Arbor, MI; Female Pelvic Medicine and Reconstructive Surgery, Rush University Medical Center, Chicago, IL; Society for Gynecologic Surgeons Pelvic Anatomy Group.
| | - David D Sheyn
- Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center/Metro Health Medical Center, Cleveland, OH; Society for Gynecologic Surgeons Pelvic Anatomy Group
| | - Tessa E Krantz
- Female Pelvic Medicine and Reconstructive Surgery, University of New Mexico, Albuquerque, NM; Society for Gynecologic Surgeons Pelvic Anatomy Group
| | - Cedric K Olivera
- Female Pelvic Medicine and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Society for Gynecologic Surgeons Pelvic Anatomy Group
| | - Antonio A Rodrigues
- Urology, Surgery and Anatomy, Ribeirao Preto School of Medicine, Sao Paulo University, Sao Paulo, Brazil; Society for Gynecologic Surgeons Pelvic Anatomy Group
| | - Ms Emily K Kobernik
- Female Pelvic Medicine and Reconstructive Surgery, Michigan Medicine, Ann Arbor, MI; Society for Gynecologic Surgeons Pelvic Anatomy Group
| | - Mariana Masteling
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI; Society for Gynecologic Surgeons Pelvic Anatomy Group
| | - John O Delancey
- Female Pelvic Medicine and Reconstructive Surgery, Michigan Medicine, Ann Arbor, MI; Society for Gynecologic Surgeons Pelvic Anatomy Group
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Meriwether KV, Balk EM, Antosh DD, Olivera CK, Kim-Fine S, Murphy M, Grimes CL, Sleemi A, Singh R, Dieter AA, Crisp CC, Rahn DD. Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines. Int Urogynecol J 2019; 30:505-522. [DOI: 10.1007/s00192-019-03876-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 01/09/2019] [Indexed: 12/29/2022]
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Meriwether KV, Antosh DD, Olivera CK, Kim-Fine S, Balk EM, Murphy M, Grimes CL, Sleemi A, Singh R, Dieter AA, Crisp CC, Rahn DD. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol 2018; 219:129-146.e2. [PMID: 29353031 DOI: 10.1016/j.ajog.2018.01.018] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We aimed to systematically review the literature on apical pelvic organ prolapse surgery with uterine preservation compared with prolapse surgeries including hysterectomy and provide evidence-based guidelines. DATA SOURCES The sources for our data were MEDLINE, Cochrane, and clinicaltrials.gov databases from inception to January 2017. STUDY ELIGIBILITY CRITERIA We accepted randomized and nonrandomized studies of uterine-preserving prolapse surgeries compared with those involving hysterectomy. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were extracted for participant information, intervention, comparator, efficacy outcomes, and adverse events, and they were individually and collectively assessed for methodological quality. If 3 or more studies compared the same surgeries and reported the same outcome, a meta-analysis was performed. RESULTS We screened 4467 abstracts and identified 94 eligible studies, 53 comparing uterine preservation to hysterectomy in prolapse surgery. Evidence was of moderate quality overall. Compared with hysterectomy plus mesh sacrocolpopexy, uterine preservation with sacrohysteropexy reduces mesh exposure, operative time, blood loss, and surgical cost without differences in prolapse recurrence. Compared with vaginal hysterectomy with uterosacral suspension, uterine preservation in the form of laparoscopic sacrohysteropexy improves the C point and vaginal length on the pelvic organ prolapse quantification exam, estimated blood loss, postoperative pain and functioning, and hospital stay, but open abdominal sacrohysteropexy worsens bothersome urinary symptoms, operative time, and quality of life. Transvaginal mesh hysteropexy (vs with hysterectomy) decreases mesh exposure, reoperation for mesh exposure, postoperative bleeding, and estimated blood loss and improves posterior pelvic organ prolapse quantification measurement. Transvaginal uterosacral or sacrospinous hysteropexy or the Manchester procedure compared with vaginal hysterectomy with native tissue suspension both showed improved operative time and estimated blood loss and no worsening of prolapse outcomes with uterine preservation. However, there is a significant lack of data on prolapse outcomes >3 years after surgery, the role of uterine preservation in obliterative procedures, and longer-term risk of uterine pathology after uterine preservation. CONCLUSION Uterine-preserving prolapse surgeries improve operating time, blood loss, and risk of mesh exposure compared with similar surgical routes with concomitant hysterectomy and do not significantly change short-term prolapse outcomes. Surgeons may offer uterine preservation as an option to appropriate women who desire this choice during apical prolapse repair.
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Affiliation(s)
- Kate V Meriwether
- Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY.
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
| | - Cedric K Olivera
- Department of Obstetrics and Gynecology, New York University, New York, NY
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI
| | - Miles Murphy
- The Institute for Female Pelvic Medicine and Reconstructive Surgery, North Wales, PA
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | | | - Ruchira Singh
- Department of Obstetrics and Gynecology, University of Florida Health, Jacksonville, FL
| | - Alexis A Dieter
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | | | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX
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Olivera CK, Ascher-Walsh CJ, Gligorov N. Erratum to ‘Fistula Experience in Niger: How We Overcame an Ethical
Dilemma’ [Mount Sinai Journal of Medicine 76 (2009) 71–74]. Ann Glob Health 2017; 82:950. [DOI: 10.1016/j.aogh.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Olivera CK, Meriwether K, El-Nashar S, Grimes CL, Chen CCG, Orejuela F, Antosh D, Gleason J, Kim-Fine S, Wheeler T, McFadden B, Balk EM, Murphy M. Nonantimuscarinic treatment for overactive bladder: a systematic review. Am J Obstet Gynecol 2016; 215:34-57. [PMID: 26851599 DOI: 10.1016/j.ajog.2016.01.156] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
The purpose of the study was to determine the efficacy and safety of nonantimuscarinic treatments for overactive bladder. Medline, Cochrane, and other databases (inception to April 2, 2014) were used. We included any study design in which there were 2 arms and an n > 100, if at least 1 of the arms was a nonantimuscarinic therapy or any comparative trial, regardless of number, if at least 2 arms were nonantimuscarinic therapies for overactive bladder. Eleven reviewers double-screened citations and extracted eligible studies for study: population, intervention, outcome, effects on outcome categories, and quality. The body of evidence for categories of interventions were summarized and assessed for strength. Ninety-nine comparative studies met inclusion criteria. Interventions effective to improve subjective overactive bladder symptoms include exercise with heat and steam generating sheets (1 study), diaphragmatic (1 study), deep abdominal (1 study), and pelvic floor muscle training exercises (2 studies). Pelvic floor exercises are more effective in subjective and objective outcomes with biofeedback or verbal feedback. Weight loss with diet and exercise, caffeine reduction, 25-50% reduction in fluid intake, and pelvic floor muscle exercises with verbal instruction and or biofeedback were all efficacious. Botulinum toxin A improves urge incontinence episodes, urgency, frequency, quality of life, nocturia, and urodynamic testing parameters. Acupuncture improves quality of life and urodynamic testing parameters. Extracorporeal magnetic stimulation improves urodynamic parameters. Mirabegron improves daily incontinence episodes, nocturia, number of daily voids, and urine volume per void, whereas solabegron improves daily incontinence episodes. Short-term posterior tibial nerve stimulation is more efficacious than pelvic floor muscle training exercises and behavioral therapy for improving: urgency, urinary incontinence episodes, daily voids, volume per void, and overall quality of life. Sacral neuromodulation is more efficacious than antimuscarinic treatment for subjective improvement of overactive bladder and quality of life. Transvaginal electrical stimulation demonstrates subjective improvement in overactive bladder symptoms and urodynamic parameters. Multiple therapies, including physical therapy, behavioral therapy, botulinum toxin A, acupuncture, magnetic stimulation, mirabegron, posterior tibial nerve stimulation, sacral neuromodulation, and transvaginal electrical stimulation, are efficacious in the treatment of overactive bladder.
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Siddiqui NY, Grimes CL, Casiano ER, Abed HT, Jeppson PC, Olivera CK, Sanses TV, Steinberg AC, South MM, Balk EM, Sung VW. Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol 2015; 125:44-55. [PMID: 25560102 PMCID: PMC4352548 DOI: 10.1097/aog.0000000000000570] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To systematically review outcomes after mesh sacrocolpopexy compared with native tissue vaginal repairs in women with apical prolapse. DATA SOURCES We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through June 4, 2012. METHODS OF STUDY SELECTION For anatomic and functional analyses, we included studies comparing mesh sacrocolpopexy to native tissue vaginal repairs with at least 6 months follow-up. The primary outcome was anatomic "success" after surgery. Secondary outcomes were reoperation and symptom outcomes. We included large case series and comparative studies with shorter follow-up to increase power for adverse event analyses. TABULATION, INTEGRATION, AND RESULTS Evidence quality was assessed with the Grades for Recommendation, Assessment, Development and Evaluation system. Meta-analyses were performed when at least three studies reported the same outcome. We included 13 comparative studies for anatomic success, reoperation, and symptom outcomes. Moderate-quality evidence supports improved anatomic outcomes after mesh sacrocolpopexy; very low-quality evidence shows no differences in reoperation between sacrocolpopexy and native tissue vaginal repairs. Evidence was insufficient regarding which procedures result in improved bladder or bowel symptoms. Low-quality evidence showed no differences in postoperative sexual function. Adverse event data were compiled and meta-analyzed from 79 studies. When including larger noncomparative studies, ileus or small bowel obstruction (2.7% compared with 0.2%, P<.01), mesh or suture complications (4.2% compared with 0.4%, P<.01), and thromboembolic phenomena (0.6% compared with 0.1%, P=.03) were more common after mesh sacrocolpopexy compared with native tissue vaginal repairs. CONCLUSION When anatomic durability is a priority, we suggest that mesh sacrocolpopexy may be the preferred surgical option. When minimizing adverse events or reoperation is the priority, there is no strong evidence supporting one approach over the other.
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Affiliation(s)
- Nazema Y Siddiqui
- Departments of Obstetrics and Gynecology, Duke University, Durham, North Carolina, Columbia University Medical Center and Icahn School of Medicine at Mount Sinai, New York, New York, University of Texas Health Science Center, San Antonio, Texas, Henry Ford Health System, Detroit, Michigan, University of New Mexico, Albuquerque, New Mexico, University of Maryland Medical Center, Baltimore, Maryland, Hartford Hospital, Hartford, Connecticut, Summa Health System, Akron, Ohio, and Alpert Medical School of Brown University, Providence, Rhode Island; and the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Olivera CK, Herron DM, Kini SU, Vardy MD, Ascher-Walsh CJ, Garely AD, Ginath S, Brodman ML. Long-term quality of life and pelvic floor dysfunction after bariatric surgery. Am J Obstet Gynecol 2012; 207:431.e1-4. [PMID: 22892188 DOI: 10.1016/j.ajog.2012.06.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 05/15/2012] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate effects of bariatric surgery on pelvic floor mediated quality of life in morbidly obese women. STUDY DESIGN Prospective cohort study of 44 women undergoing bariatric surgery. RESULTS Thirty-six women gave data at baseline and at mean follow-up of 3.15 years following bariatric surgery. Although urinary impact questionnaire scores improved (-34.92, P = .0020), colorectal-anal impact questionnaire and pelvic organ prolapse impact questionnaire scores did not improve despite significant weight loss. Baseline female sexual function index scores were low (17.70 ± 8.38) and did not improve with weight loss (16.91 ± 9.75, P = .5832). Pelvic organ prolapse/urinary incontinence sexual questionnaire scores did improve (35.78 ± 6.06 preoperatively vs 38.22 ± 6.03 postoperatively, P = .0193). CONCLUSION Bariatric surgery is associated with significant improvement in the impact of urinary incontinence on quality of life. Sexual function was poor, and improved only on the pelvic organ prolapse/urinary incontinence sexual questionnaire that evaluated urinary incontinence.
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Fashokun TBO, Harvie HS, Schimpf MO, Olivera CK, Epstein LB, Jean-Michel M, Rooney KE, Balgobin S, Ibeanu OA, Gala RB, Rogers RG. Sexual activity and function in women with and without pelvic floor disorders. Int Urogynecol J 2012; 24:91-7. [PMID: 22744621 DOI: 10.1007/s00192-012-1848-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 05/26/2012] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We describe differences in sexual activity and function in women with and without pelvic floor disorders (PFDs). METHODS Heterosexual women ≥40 years of age who presented to either urogynecology or general gynecology clinics at 11 clinical sites were recruited. Women were asked if they were sexually active with a male partner. Validated questionnaires and Pelvic Organ Prolapse Quantification (POP-Q) examinations assessed urinary incontinence (UI), fecal incontinence (FI), and/or pelvic organ prolapse (POP). Sexual activity and function was measured by the Female Sexual Function Index (FSFI). Student's t test was used to assess continuous variables; categorical variables were assessed with Fisher's exact test and logistic regression. Univariate and multivariate analyses were used to assess the impact of pelvic floor disorders (PFDs) on FSFI total and domain scores. RESULTS Five hundred and five women met eligibility requirements and gave consent for participation. Women with and without PFDs did not differ in race, body mass index (BMI), comorbid medical conditions, or hormone use. Women with PFDs were slightly older than women without PFDs (55.6 + 10.8 vs. 51.6 + 8.3 years, P <0.001); all analyses were controlled for age. Women with PFDs were as likely to be sexually active as women without PFDs (61.6 vs. 75.5 %, P = 0.09). There was no difference in total FSFI scores between cohorts (23.2 + 8.5 vs. 24.4 + 9.2, P = 0.23) or FSFI domain scores (all P = NS). CONCLUSION Rates of sexual activity and function are not different between women with and without PFDs.
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Ginath S, Garely AD, Luchs JS, Shahryarinejad A, Olivera CK, Zhou S, Ascher-Walsh CJ, Condrea A, Brodman ML, Vardy MD. Magnetic resonance imaging of abdominal versus vaginal prolapse surgery with mesh. Int Urogynecol J 2012; 23:1569-76. [PMID: 22543549 DOI: 10.1007/s00192-012-1783-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 03/25/2012] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We compared two surgical approaches in patients with symptomatic prolapse of the vaginal apex with normal controls by analyzing pelvic landmark relationships measured using magnetic resonance imaging (MRI) before and after surgery. METHODS In this prospective multicenter pilot study involving 16 participants, nulliparous controls (n = 6) were compared with ten parous (3.0 ± 1.0) women with uterine apical prolapse equal to or greater than stage 2. Group A (n = 5) underwent abdominal sacral colpopexy with monofilament polypropylene mesh and group B (n = 5) with vaginal mesh kit repair (Total ProLift). Subtotal hysterectomy was performed in all group A and no group B women. All patients underwent preoperative and 3-month postoperative Pelvic Organ Prolapse Quantification (POP-Q) and dynamic MRI. Comparison of MRI pelvic angles and distances was performed and analyzed by Mann-Whitney rank sum test and chi-square test. RESULTS Vaginal apical support is similar at 3 months for abdominal sacral colpopexy (ASCP) and ProLift by POP-Q examination and MRI analysis. In both treatment groups, the postoperative POP-Q point C and MRI parameters were similar to nulliparous controls at 3 months. CONCLUSIONS Anatomic outcomes for ASCP compared with ProLift were similar at 3 months in terms of vaginal apical support by POP-Q and MRI analysis. Continued comparative analysis of postoperative support with objective imaging seems warranted.
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Affiliation(s)
- Shimon Ginath
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, NY, USA.
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Schimpf MO, Harvie HS, Omotosho TB, Epstein LB, Jean-Michel M, Olivera CK, Rooney KE, Balgobin S, Ibeanu OA, Gala RB, Rogers RG. Does vaginal size impact sexual activity and function? Int Urogynecol J 2009; 21:447-52. [PMID: 19960183 DOI: 10.1007/s00192-009-1051-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 11/01/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study seeks to determine if total vaginal length (TVL) or genital hiatus (GH) impact sexual activity and function. METHODS Heterosexual women >or= 40 years were recruited from urogynecology and gynecology offices. TVL and GH were assessed using the Pelvic Organ Prolapse Quantification exam. Women completed the Female Sexual Function Index (FSFI) and were dichotomized into either normal function (FSFI total > 26) or sexual dysfunction (FSFI <or= 26). RESULTS Five hundred five women were enrolled; 333 (67%) reported sexual activity. While sexually active women had longer vaginas than women who were not active (9.1 cm +/- 1.2 versus 8.9 cm +/- 1.3, p = 0.04), significance was explained by age differences. GH measurements did not differ (3.2 cm +/- 1.1 versus 3.1 cm +/- 1.1, p = 0.58). In sexually active women, TVL was weakly correlated with FSFI total score, but GH was not. TVL and GH did not differ between women with normal FSFI scores and those with sexual dysfunction. CONCLUSIONS Vaginal size did not affect sexual activity or function.
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Affiliation(s)
- Megan O Schimpf
- Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA.
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Olivera CK, Ascher-Walsh CJ, Gligorov N. Fistula experience in Niger: how we overcame an ethical dilemma. Mt Sinai J Med 2009; 76:71-74. [PMID: 19170220 DOI: 10.1002/msj.20047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Vardy MD, Brodman M, Olivera CK, Zhou HS, Flisser AJ, Bercik RS. Anterior intravaginal slingplasty tunneller device for stress incontinence and posterior intravaginal slingplasty for apical vault prolapse: a 2-year prospective multicenter study. Am J Obstet Gynecol 2007; 197:104.e1-8. [PMID: 17618778 DOI: 10.1016/j.ajog.2007.03.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 01/09/2007] [Accepted: 03/13/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to report the outcome for (1) anterior intravaginal slingplasty in the treatment of urodynamic stress incontinence and (2) posterior intravaginal slingplasty for apical prolapse (> or = stage II). STUDY DESIGN This was a 2-year prospective multicenter study: patients, 430; anterior intravaginal slingplasty, 144; posterior intravaginal slingplasty, 164; both procedures, 122 (552 tapes total). At 6 and 12 months, the results of the Pelvic Floor Impact Questionnaire, cough stress test, and Pelvic Organ Prolapse Quantitation were assessed. Statistical analyses used paired t-tests. RESULTS Of the women in the study, 95% (42 women) had a negative cough stress test result through 12 months (n = 44 women), and 96% (127 women) had a negative cough stress test result at 6 months (n = 132). At 6 months, apical support was optimal in 95.3% (143/150 women) and was satisfactory in 2.7% (4/150 women) and at 12 months, 98.1% (52/53 women), 1.9% (1/53 women). Seventeen of 430 patients (4.0%) had vaginal mesh extrusion. Pelvic Floor Impact Questionnaire scores significantly improved (P < .0001). CONCLUSION Anterior intravaginal slingplasty and posterior intravaginal slingplasty are safe and effective when performed with other procedures. For anterior intravaginal slingplasty, the rates of perforation and retention are low, but early extrusions are seen. Patients showed improvements in the Pelvic Floor Impact Questionnaire, regardless of extrusion.
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Affiliation(s)
- Michael D Vardy
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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