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Ntakwinja M, Werth A, Borazjani A, Iglesia C, Williams KJ, Mukwege D. Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo. Int Urogynecol J 2024; 35:103-108. [PMID: 37897521 DOI: 10.1007/s00192-023-05670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/15/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC. METHODS We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages. RESULTS A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment. CONCLUSIONS This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP.
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Affiliation(s)
- Mukanire Ntakwinja
- Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
| | - Adrienne Werth
- Global Innovations for Reproductive Health & Life, Chicago, IL, USA.
- Hartford Healthcare, Hartford, CT, USA.
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Chicago, IL, USA
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cheryl Iglesia
- Departments of Obstetrics & Gynecology and Urology, MedStar Heath, Georgetown University School of Medicine, Washington, DC, USA
| | | | - Denis Mukwege
- Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
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2
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Maliakal C, Dieter A, Iglesia C, Davenport A. Tags for Tears: The Obstetric Anal Sphincter Injury Hashtag Ontology Project. Urogynecology (Phila) 2023:02273501-990000000-00149. [PMID: 37903386 DOI: 10.1097/spv.0000000000001429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
IMPORTANCE Social media is a powerful outlet for the dissemination of health care information. Adoption of a hashtag ontology-a standardized list of terms-may help better organize information and improve access to educational materials for health care providers (HCPs) and patients. OBJECTIVES The primary objective was to create a hashtag ontology specific to obstetric anal sphincter injuries (OASIS) based on Twitter usage. Secondary objectives included (1) performing a thematic analysis of OASIS-related tweet content and (2) reporting the type of users posting about OASIS. STUDY DESIGN This study was an analysis of tweets related to OASIS posted between June 1, 2019, and June 1, 2022. Symplur Signals (a Twitter analytics software) (Symplur LLC, Los Angeles, CA) was used to identify relevant tweets based on predetermined search terms. Hashtags were reviewed by social media influencers to create a finalized ontology list. The top 100 tweets underwent thematic analysis and were grouped based on emergent themes. Types of users posting about OASIS were also analyzed. RESULTS Symplur identified 660 tweets related to OASIS. The final ontology included the following 8 hashtags: #OASIS, #perinealtrauma, #birthtrauma, #3rddegreetear, #4thdegreetear, #episiotomy, #operativedelivery, and #postpartumbody. Major tweet content themes included education, self-promotion, patient experience, medical-legal, research, and opinions. Educational tweets surrounded prevention, risk factors, complications, and educational events related to OASIS and perineal trauma. Of the educational tweets, only 30% were posted by HCPs. CONCLUSION This study created a standardized hashtag ontology related to OASIS. Less than one third of educational tweets were posted by HCPs.
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Affiliation(s)
- Cima Maliakal
- From the MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC
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3
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Grimes CL, Halder G, Beckham AJ, Kim-Fine S, Rogers R, Iglesia C. Anticipated Impact of Dobbs v Jackson Women's Health Organization on Training of Residents in Obstetrics and Gynecology: A Qualitative Analysis. J Grad Med Educ 2023; 15:339-347. [PMID: 37363665 PMCID: PMC10286908 DOI: 10.4300/jgme-d-22-00885.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/06/2023] [Accepted: 04/14/2023] [Indexed: 06/28/2023] Open
Abstract
Background On June 24, 2022, the Supreme Court of the United States in the case of Dobbs v Jackson Women's Health Organization ended constitutional protection for abortion, thus severely restricting access to reproductive health care for millions of individuals. Concerns have arisen about the potential impact on medical students, residents, and fellows training in restricted areas and the effect on gynecologic training and the future provision of competent comprehensive women's health care in the United States. Objective To qualitatively explore the anticipated impacts of the Dobbs ruling on training in obstetrics and gynecology (OB/GYN). Methods A participatory action research approach employing methods of qualitative analysis was used. Trainees and leaders in national OB/GYN professional and academic organizations with missions related to clinical care and training of medical students, residents, and fellows in OB/GYN participated. Two focus groups were held via Zoom in July 2022. Using an iterative process, transcripts underwent coding by 2 independent researchers to identify categories and common themes. Themes were organized into categories and subcategories. An additional reviewer resolved discrepancies. Results Twenty-six OB/GYN leaders/stakeholders representing 14 OB/GYN societies along with 4 trainees participated. Eight thematic categories were identified: competency, provision of reproductive health care, residency selection, inequity in training, alternative training, law-based vs evidence-based medicine, morality and ethics, and uncertainty about next steps. Conclusions This qualitative study of leaders and learners in OB/GYN identified 8 themes of potential impacts of the Dobbs ruling on current and future training in OB/GYN.
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Affiliation(s)
- Cara L. Grimes
- Cara L. Grimes, MD, MAS, is Associate Professor of Obstetrics and Gynecology (OB/GYN) and Urology, and Associate Chair of Research in OB/GYN, New York Medical College
| | - Gabriela Halder
- Gabriela Halder, MD, MPH, is Assistant Professor of OB/GYN, University of Texas Medical Branch
| | - A. Jenna Beckham
- A. Jenna Beckham, MD, MSPH, is Assistant Professor of OB/GYN, WakeMed Health and Hospitals
| | - Shunaha Kim-Fine
- Shunaha Kim-Fine, MD, MS, is Clinical Associate Professor of OB/GYN, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Rogers
- Rebecca Rogers, MD, is Professor of OB/GYN, Albany Medical Center
| | - Cheryl Iglesia
- Cheryl Iglesia, MD, FACOG, is President, Society of Gynecologic Surgeons (on behalf of the Society for Gynecologic Surgeons Collaborative Research in Pelvic Surgery Consortium)
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4
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Getaneh F, Ringel N, Kolm P, Iglesia C, Dieter A. The effect of postoperative weight change on outcomes following midurethral sling for stress urinary incontinence. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.053] [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: 03/10/2023]
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Meriwether K, Krashin J, Kim-Fine S, Ablove T, Dale L, Orejuela F, Mazloomdoost D, Beckham A, Probst K, Crisp C, Winkelman W, Florian-Rodriguez M, Grimes C, Turk J, Ollendorff A, Ros S, Chang O, Horvath S, Iglesia C. Trainee opinions regarding the effect of the dobbs v. jackson women’s health organization supreme court decision on obstetrics and gynecology training. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.12.045] [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: 03/10/2023]
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6
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Davenport A, Elissa T, Kingsberg S, Iglesia C. #Menopause: The Menopause Ontology Project. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.05.046] [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: 11/28/2022]
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7
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Johnson B, Sanchez C, Woodburn K, Iglesia C. A walk through history: eponyms in gynecology- part 1. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.209] [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: 11/17/2022]
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Duong V, Iwamoto A, Pennycuff J, Kudish B, Iglesia C. A systematic review of neurocognitive dysfunction with overactive bladder medications. Int Urogynecol J 2021; 32:2693-2702. [PMID: 34213600 DOI: 10.1007/s00192-021-04909-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to report cognitive dysfunction with commonly used antimuscarinic overactive bladder medications in patients suffering from overactive bladder disorder with and without baseline neurologic conditions. METHODS We conducted an Ovid MEDLINE, Embase, and PsycINFO search from January 1998 to December 2018 using PRISMA guidelines. Eighteen studies met the inclusion criteria, including 5 randomized controlled trials and 13 observational studies. RESULTS Cognitive decline was reported with oxybutynin use (5 of 8 studies) and tolterodine use (4 of 7 studies) among patients with and without baseline cognitive impairment. Oxybutynin use was linked to functional, mental, and behavioral decline among patients with Alzheimer's disease (2 studies). No cognitive decline was detected among patients with and without baseline cognitive impairment taking trospium (6 studies), darifenacin (3 studies), imidafenacin (2 studies), and fesoterodine (1 study). Solifenacin was not associated with cognitive decline (2 studies) but was linked to an increased risk of dementia among patients with diabetes (1 study). CONCLUSION In this review, cognitive decline was reported with oxybutynin and tolterodine use and should be used with caution in adults over 65 years of age. Solifenacin, fesoterodine, and imidafenacin showed mixed results related to central nervous system effect. Trospium and darifenacin were not associated with cognitive decline among patients with and without baseline cognitive impairment.
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Affiliation(s)
- Vi Duong
- Department of Obstetrics and Gynecology, Medstar Washington Hospital Center/Georgetown University School of Medicine, 110 Irving St. NW, Washington, DC, 20010, USA.
| | - Aya Iwamoto
- Department of Obstetrics and Gynecology, University of Iowa Hospitals, 5 Boyd Tower, Iowa City, IA, 52242, USA
| | - Jon Pennycuff
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, 106 Irving St. NW, 405 POB-S, Washington, DC, 20010, USA
| | - Bela Kudish
- Department of Obstetrics and Gynecology, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Cheryl Iglesia
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, 106 Irving St. NW, 405 POB-S, Washington, DC, 20010, USA
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Grimes C, Meriwether K, Antosh D, Brown H, Weber LeBrun E, Raman S, Lozo S, Iglesia C, Keltz J, Geynisman-Tan J, Kim-Fine S, Brennand E, Rogers R. 04 Reporting information about race and ethnicity of participants in research presented at the society of gynecologic surgeons (SGS). Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Davenport A, Hoang E, Brunn E, Hazen N, Jallad K, Iglesia C. 114 #MIGS tag ontology project. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.139] [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: 10/21/2022]
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11
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Bauer SR, Kenfield SA, Sorensen M, Subak LL, Phelan S, Gupta LR, Chen B, Suskind AM, Park AJ, Iglesia C, Gass M, Hohensee C, Breyer BN. Physical Activity, Diet, and Incident Urinary Incontinence in Postmenopausal Women: Women's Health Initiative Observational Study. J Gerontol A Biol Sci Med Sci 2021; 76:1600-1607. [PMID: 33963837 DOI: 10.1093/gerona/glab118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI). METHODS We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food-frequency questionnaire, with incident UI subtypes after 3 years among 19,741 post-menopausal women in the Women's Health Initiative Observational Study. Odds ratios (OR) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression. RESULTS Women who reported total physical activity (MET-hours/week) ≥30 vs <0.1 were 16% less likely to develop urgency UI (OR=0.84; 95% CI 0.70, 1.00) and 34% less likely for mixed UI (OR=0.66; 0.46, 0.95), although linear trends were no longer statistically significant after adjusting for baseline weight and weight change (P-trend=0.15 and 0.16, respectively). The association between physical activity and incident stress UI was less consistent. Higher uncalibrated protein intake was associated with increased odds of incident urgency UI (≥19.4% versus <14.1% of energy intake OR=1.14; 95% CI 0.99, 1.30; P-trend=0.02), while confidence intervals were wide and included 1.0 for calibrated protein intake. Other macronutrients were not associated with urgency UI and macronutrient intake was not associated with incident stress or mixed UI (P-trend>0.05 for all). CONCLUSIONS Among post-menopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increase urgency UI, but no associations were observed between other macronutrient and UI subtypes.
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Affiliation(s)
- Scott R Bauer
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA.,San Francisco Veterans Affairs Healthcare System, San Francisco, CA.,Department of Urology, University of California, San Francisco, California
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, California.,Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Mathew Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Leslee L Subak
- Department of Obstetrics & Gynecology, Stanford University, Menlo Park, CA
| | - Suzanne Phelan
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, CA
| | - Lisa Rogo Gupta
- Department of Obstetrics & Gynecology, Stanford University, Menlo Park, CA
| | - Bertha Chen
- Department of Obstetrics & Gynecology, Stanford University, Menlo Park, CA
| | - Anne M Suskind
- Department of Urology, University of California, San Francisco, California
| | - Amy J Park
- Department of Obstetrics & Gynecology, Georgetown University School of Medicine, Washington DC
| | - Cheryl Iglesia
- MedStar Health, Columbia, MD (CI); University of Cincinnati, Cincinnati, OH
| | - Margery Gass
- MedStar Health, Columbia, MD (CI); University of Cincinnati, Cincinnati, OH
| | | | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, California.,Department of Epidemiology & Biostatistics, University of California, San Francisco, California
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Ringel NE, Iglesia C. Common Benign Chronic Vulvar Disorders. Am Fam Physician 2020; 102:550-557. [PMID: 33118795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Common benign chronic vulvar conditions include genitourinary syndrome of menopause (formerly called vulvovaginal atrophy), lichen sclerosus, lichen planus, lichen simplex chronicus, and vulvodynia. Genitourinary syndrome of menopause results from the hypoestrogenic state that leads to atrophy of normal vulvar and vaginal tissues. It is typically treated with lubricants, moisturizers, and intravaginal estrogen. Lichen sclerosus is an inflammatory condition characterized by intense vulvar itching. It is treated with topical steroids or, in some cases, topical calcineurin inhibitors. Patients with lichen sclerosus are at risk of vulvar squamous cell carcinoma and should be monitored closely for malignancy. Lichen planus is an inflammatory autoimmune disorder that can affect the vulva and vagina in addition to other skin and mucosal surfaces. The first-line treatment is topical steroids, and significant scarring can occur if left untreated. Lichen simplex chronicus manifests as persistent itching and scratching of the vulvar skin that leads to thickened epithelium. Breaking the itch-scratch cycle, often with topical steroids, is the key to treatment. Vulvodynia is a common vulvar pain disorder and is a diagnosis of exclusion. A multimodal treatment approach typically includes vulvar hygiene, physical therapy, psychosocial interventions, and antineuropathy medications.
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Grimes CL, Balk EM, Crisp CC, Antosh DD, Murphy M, Halder GE, Jeppson PC, Weber LeBrun EE, Raman S, Kim-Fine S, Iglesia C, Dieter AA, Yurteri-Kaplan L, Adam G, Meriwether KV. A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence. Int Urogynecol J 2020; 31:1063-1089. [PMID: 32342112 PMCID: PMC7185267 DOI: 10.1007/s00192-020-04314-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
Introduction and hypothesis The COVID-19 pandemic and the desire to “flatten the curve” of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic. Methods We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19. Results Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission. Conclusions We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.
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Affiliation(s)
- Cara L Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, 19 Bradhurst Avenue, Suite 2700 South Hawthorne, Valhalla, NY, 10532, USA.
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Catrina C Crisp
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, TriHealth, Cincinnati, OH, USA
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Miles Murphy
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Gabriela E Halder
- Department of Women's Health, Dell Medical School, University of Texas Austin, Austin, TX, USA
| | - Peter C Jeppson
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Emily E Weber LeBrun
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Sonali Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, KY, USA
| | - Shunaha Kim-Fine
- Section of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Iglesia
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC, USA
| | - Alexis A Dieter
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ladin Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Gaelen Adam
- Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, RI, USA
| | - Kate V Meriwether
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
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Polland A, Fitzgerald J, Iwamoto A, Furuya R, Duong V, Bradley S, Wang H, Iglesia C. 11: DEVELOPS: Description of vaginal laxity and prolapse and correlation with sexual function. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.050] [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: 11/16/2022]
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15
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Ringel N, Bradley S, Iglesia C. 04: National trends in readmission rates for sling procedures by hospital type and synthetic vs autologous grafts. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.043] [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: 10/24/2022]
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Burkett L, Siddique M, Zeymo A, Gutman R, Park A, Iglesia C. 09: A randomized controlled trial of clobetasol propionate versus fractionated CO2 laser for the treatment of lichen sclerosus (CURLS). Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Pennycuff J, Wu C, Iglesia C. 104: Systematic review and meta-analysis of commercially-available at-home pelvic floor training devices that provide biofeedback for treatment of urinary incontinence. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.144] [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: 11/26/2022]
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18
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Ringel N, Iglesia C, Henshaw R, Bradley S. 06: Tips and tricks: a novel approach to complete trans-obturator sling mesh removal. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.140] [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: 10/27/2022]
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Fitzgerald J, Pennycuff J, White J, Davitt J, Iglesia C. 64: Performing the pelvic organ prolapse quantification system exam: a modern update. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.200] [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: 10/27/2022]
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Tadir Y, Iglesia C, Alexiades M, Davila GW, Guerette N, Gaspar A. Energy‐based treatment for gynecologic conditions including genitourinary syndrome of menopause: Consensus, controversies, recommendations, and FDA clearance. Lasers Surg Med 2018; 51:315-317. [DOI: 10.1002/lsm.23031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Yona Tadir
- Beckman Laser Institute and Medical ClinicUniversity of CaliforniaIrvineCalifornia
| | - Cheryl Iglesia
- Departments of Obstetrics, Gynecology and UrologyGeorgetown University School of Medicine, Washington, District of Columbia; Section of Female Pelvic Medicine and Re‐constructive Surgery, MedStar Washington Hospital CenterWashingtonDistrict of Columbia
| | - Macrene Alexiades
- Department of DermatologyYale University School of Medicine, New Haven, Connecticut Siggrou Hospital, University of Athens, Athens, Greece Dermatology and Laser Surgery Center of New YorkNew YorkNew York
| | - G Willy Davila
- Women's and Children's Center, Female Pelvic Medicine and Re‐constructive SurgeryHoly Cross Medical CenterFort LauderdaleFlorida
| | - Nathan Guerette
- The Female Pelvic Medicine Institute, Division of Female Pelvic Medicine and Reconstructive SurgeryVirginia Commonwealth UniversityNorth ChesterfieldVirginia
| | - Adrian Gaspar
- Department of GynecologyUroclinica, Mendoza, Argentina Department of Laser Surgery, Palmares HospitalMendozaArgentina
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Alam P, Jones T, Baxter B, Siddique M, Tefera E, Gutman R, Iglesia C. 14: Perioperative outcomes in patients with autoimmune connective tissue disorders (AICTDs). Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.198] [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: 12/01/2022]
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Shah N, Andriani L, Howard J, Mahoney L, Yurteri-Kaplan L, Tefera E, Iglesia C. 8: The power of Healing statements In Post-operative Pain control (HIPP): A randomized controlled trial. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.12.132] [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]
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Burkett L, Iglesia C, Velasco B, Duong V. 14: Advances in ablative and non-ablative lasers in gynecology: A clinician's guide. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.12.065] [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]
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Siddique M, Shah N, Park A, Chen B, Emery S, Falcone T, Margulies R, Rardin C, Iglesia C. Core Privileging and Credentialing: Hospitals' Approach to Gynecologic Surgery. J Minim Invasive Gynecol 2016; 23:1088-1106.e1. [DOI: 10.1016/j.jmig.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/31/2016] [Accepted: 08/02/2016] [Indexed: 11/26/2022]
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Miranne J, Gutman R, Sokol A, Park A, Iglesia C. 32: Effect of a new risk calculator on patient satisfaction with the decision for concomitant midurethral sling during prolapse surgery: A randomized controlled trial. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.063] [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: 11/26/2022]
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Siddique M, Shah N, Park A, Chen B, Emery S, Falcone T, Margulies R, Rardin C, Iglesia C. 54: Core privileging: Hospitals’ approach to gynecologic surgery. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.085] [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: 10/22/2022]
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Smithling K, Iglesia C. 16: Tips and tricks for open laparoscopy. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.129] [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: 11/30/2022]
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Miranne J, Melson V, Iglesia C, Sokol A. Do Patients' Surgical Goals Vary Based on the Type of Prolapse Repair Selected? J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.086] [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: 11/28/2022]
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Meriwether K, Rogers R, Gutman R, Peterson S, Craig E, Rode M, Iglesia C. The Effect of TrimoSan© Gel on the Rate of Pessary-associated Bacterial Vaginosis: A Multicenter, Randomized, Controlled Trial. J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.032] [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: 11/28/2022]
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Richter L, Park A, Boileau J, Janni M, Desale S, Iglesia C. Does Pelvic Organ Prolapse Quantification Exam (POPQ) D-Point Predict Uterosacral Ligament Suspension Outcomes? J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.037] [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: 10/24/2022]
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Smithling K, Antosh D, Tefera E, Iglesia C. De Novo Dyspareunia and Sexual Function Assessment using Two Sexual Questionnaires. J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.051] [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: 11/16/2022]
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Spies J, Shveiky D, Iglesia C, Lee J, Jones M, Peterson J, Huang C. Abstract No. 168: The impact of uterine fibroid embolization (UFE) on lower urinary tract symptoms. J Vasc Interv Radiol 2011. [DOI: 10.1016/j.jvir.2011.01.185] [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: 11/26/2022] Open
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Yeung P, Sokol A, Walton B, Iglesia C. Thigh abscess mistaken for sarcoma following transobturator tape: a case report and literature review. J Minim Invasive Gynecol 2007; 14:657-9. [PMID: 17848332 DOI: 10.1016/j.jmig.2007.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 02/22/2007] [Accepted: 04/17/2007] [Indexed: 10/22/2022]
Abstract
A 44-year-old female, 1 year status-post ObTape transobturator mid-urethral sling, was evaluated by orthopaedic oncology and urology for persistent thigh pain and a left thigh mass. Multiple muscle biopsies were inconclusive, raising concern for inflammatory sarcoma. After serial débridements of the thigh abscess, sling material was found in the obturator space, which gave the diagnosis. Health care providers, both gynecologic and nongynecologic, need to be aware of serious complications of transobturator slings that may present in atypical ways.
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Affiliation(s)
- Patrick Yeung
- Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC 20007, USA.
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Hendrix SL, Cochrane BB, Nygaard IE, Handa VL, Barnabei VM, Iglesia C, Aragaki A, Naughton MJ, Wallace RB, McNeeley SG. Effects of estrogen with and without progestin on urinary incontinence. JAMA 2005; 293:935-48. [PMID: 15728164 DOI: 10.1001/jama.293.8.935] [Citation(s) in RCA: 290] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Menopausal hormone therapy has long been credited with many benefits beyond the indications of relieving hot flashes, night sweats, and vaginal dryness, and it is often prescribed to treat urinary incontinence (UI). OBJECTIVE To assess the effects of menopausal hormone therapy on the incidence and severity of symptoms of stress, urge, and mixed UI in healthy postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS Women's Health Initiative multicenter double-blind, placebo-controlled, randomized clinical trials of menopausal hormone therapy in 27,347 postmenopausal women aged 50 to 79 years enrolled between 1993 and 1998, for whom UI symptoms were known in 23,296 participants at baseline and 1 year. INTERVENTIONS Women were randomized based on hysterectomy status to active treatment or placebo in either the estrogen plus progestin (E + P) or estrogen alone trials. The E + P hormones were 0.625 mg/d of conjugated equine estrogen plus 2.5 mg/d of medroxyprogesterone acetate (CEE + MPA); estrogen alone consisted of 0.625 mg/d of conjugated equine estrogen (CEE). There were 8506 participants who received CEE + MPA (8102 who received placebo) and 5310 who received CEE alone (5429 who received placebo). MAIN OUTCOME MEASURES Incident UI at 1 year among women without UI at baseline and severity of UI at 1 year among women who had UI at baseline. RESULTS Menopausal hormone therapy increased the incidence of all types of UI at 1 year among women who were continent at baseline. The risk was highest for stress UI (CEE + MPA: relative risk [RR], 1.87 [95% confidence interval {CI}, 1.61-2.18]; CEE alone: RR, 2.15 [95% CI, 1.77-2.62]), followed by mixed UI (CEE + MPA: RR, 1.49 [95% CI, 1.10-2.01]; CEE alone: RR, 1.79 [95% CI, 1.26-2.53]). The combination of CEE + MPA had no significant effect on developing urge UI (RR, 1.15; 95% CI, 0.99-1.34), but CEE alone increased the risk (RR, 1.32; 95% CI, 1.10-1.58). Among women experiencing UI at baseline, frequency worsened in both trials (CEE + MPA: RR, 1.38 [95% CI, 1.28-1.49]; CEE alone: RR, 1.47 [95% CI, 1.35-1.61]). Amount of UI worsened at 1 year in both trials (CEE + MPA: RR, 1.20 [95% CI, 1.06-1.36]; CEE alone: RR, 1.59 [95% CI, 1.39-1.82]). Women receiving menopausal hormone therapy were more likely to report that UI limited their daily activities (CEE + MPA: RR, 1.18 [95% CI, 1.06-1.32]; CEE alone: RR, 1.29 [95% CI, 1.15-1.45]) and bothered or disturbed them (CEE + MPA: RR, 1.22 [95% CI, 1.13-1.32]; CEE alone: RR, 1.50 [95% CI, 1.37-1.65]) at 1 year. CONCLUSIONS Conjugated equine estrogen alone and CEE + MPA increased the risk of UI among continent women and worsened the characteristics of UI among symptomatic women after 1 year. Conjugated equine estrogen with or without progestin should not be prescribed for the prevention or relief of UI.
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Affiliation(s)
- Susan L Hendrix
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine/Hutzel Women's Hospital, Detroit, Mich 48201, USA.
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Abstract
We have studied the recovery of microvascular function in ischemic epigastric skin flaps by characterizing the regional hemodynamics in the axial and random portions of double- and single-pedicle island skin flaps in the rat. Blood flows were measured with radiolabeled microspheres 1 day after bipedicle flaps were elevated and at 4 hr, 72 hr, and 1 week after ligation of one of the pedicles. These hemodynamic measurements were correlated with assessments of angiogenesis and skin necrosis performed by lectin histochemistry and histopathology. Twenty-four hours after the skin flap elevation, the mean blood flow was 0.26 ml.min-1.g-1. After the ligation of one pedicle, the blood flow in the axial portion of the skin flap was unchanged at 4 hr (0.22 ml.min-1.g-1), declined insignificantly at 72 hr (0.15 ml.min-1.g-1), and remained normal at 1 week. In the random portion of the skin flap very little collateral blood flow was present at 4 hr (0.06 ml.min-1.g-1) and 72 hr (0.09 ml.min-1.g-1). Blood flow in the random skin flap returned to normal by 1 week (0.27 ml.min-1.g-1). Reelevation of the skin flap at 1 week caused an insignificant decline (10%) in total blood flow to the skin flap. Skin necrosis was detected histologically at 72 hr only in the lateral portion of the random skin flap, where blood flow was less than 0.03 ml.min-1.g-1. Increased areas of lectin binding to vascular endothelium were seen in the subdermal layers of the skin flap by 1 week, presumably due to angiogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Marzella
- Maryland Institute for Emergency Medical Services Systems, Baltimore
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