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Balgobin S, Balk EM, Porter AE, Misal M, Grisales T, Meriwether KV, Jeppson PC, Doyle PJ, Aschkenazi SO, Miranne JM, Hobson DT, Howard DL, Mama S, Gupta A, Antosh DD. Enabling Technologies for Gynecologic Vaginal Surgery: A Systematic Review. Obstet Gynecol 2024; 143:524-537. [PMID: 38301255 DOI: 10.1097/aog.0000000000005522] [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] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures. DATA SOURCES We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022. METHODS OF STUDY SELECTION Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated. TABULATION, INTEGRATION, AND RESULTS The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity. CONCLUSION Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327490.
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Affiliation(s)
- Sunil Balgobin
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio; the Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; the Departments of Obstetrics and Gynecology and Urology, School of Medicine & Dentistry, University of Rochester, Rochester, New York; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Division of Urogynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, and the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; and the Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, Louisville, Kentucky
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Ringel NE, Lenger SM, High R, Alas A, Houlihan S, Chang OH, Pennycuff J, Singh R, White A, Lipitskaia L, Behbehani S, Sheyn D, Kudish B, Nihira M, Sleemi A, Grimes C, Gupta A, Balk EM, Antosh DD. Effects of Obesity on Urogynecologic Prolapse Surgery Outcomes: A Systematic Review and Meta-analysis. Obstet Gynecol 2024; 143:539-549. [PMID: 38330397 DOI: 10.1097/aog.0000000000005525] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To systematically review the literature on outcomes of pelvic organ prolapse (POP) surgery in patients from various body mass index (BMI) categories to determine the association between obesity and surgical outcomes. DATA SOURCES PubMed, EMBASE, and Cochrane databases were searched from inception to April 12, 2022; ClinicalTrials.gov was searched in September 2022 (PROSPERO 2022 CRD42022326255). Randomized and nonrandomized studies of urogynecologic POP surgery outcomes were accepted in which categories of BMI or obesity were compared. METHODS OF STUDY SELECTION In total, 9,037 abstracts were screened; 759 abstracts were identified for full-text screening, and 31 articles were accepted for inclusion and data were extracted. TABULATION, INTEGRATION, AND RESULTS Studies were extracted for participant information, intervention, comparator, and outcomes, including subjective outcomes, objective outcomes, and complications. Outcomes were compared among obesity categories (eg, BMI 30-34.9, 35-40, higher than 40), and meta-analysis was performed among different surgical approaches. Individual studies reported varying results as to whether obesity affects surgical outcomes. By meta-analysis, obesity (BMI 30 or higher) is associated with an increased odds of objective prolapse recurrence after vaginal prolapse repair (odds ratio [OR] 1.38, 95% CI, 1.14-1.67) and after prolapse repair from any surgical approach (OR 1.31, 95% CI, 1.12-1.53) and with complications such as mesh exposure after both vaginal and laparoscopic POP repair (OR 2.10, 95% CI, 1.01-4.39). CONCLUSION Obesity is associated with increased likelihood of prolapse recurrence and mesh complications after POP repair. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022326255.
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Affiliation(s)
- Nancy E Ringel
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville, Louisville, Kentucky; the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist, Houston, the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, and the Department of Obstetrics and Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas; the Department of Obstetrics and Gynecology, Royal Columbian Hospital, University of British Columbia, Vancouver, British Columbia, Canada; the Division of Female Urology and Pelvic Reconstructive Surgery, Department of Urology, University of California, Irvine, Orange, the Department of Obstetrics and Gynecology, University of California, Riverside School of Medicine, Riverside, and KPC Healthcare, Hemet, California; the Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; the Department of Obstetrics and Gynecology, University of Florida Health, Jacksonville, and Bela Vida Urogynecology, Celebration, Florida; the Division of Urogynecology, Department of Obstetrics and Gynecology, Cooper Health University, Camden, New Jersey; the Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, Ohio; the International Medical Response Foundation, Brooklyn, and the Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York; and the Center for Evidence Synthesis in Health, Brown School of Public Health, Brown University, Providence, Rhode Island
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Miceli LM, Antosh DD, Nisar T, Stewart J, Rutledge EC, Khavari R. Pain Related to Intradetrusor BotulinumtoxinA: A Randomized Clinical Trial. Urogynecology (Phila) 2024; 30:337-344. [PMID: 38484251 DOI: 10.1097/spv.0000000000001487] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE OnabotulinumtoxinA (BTX-A) is an effective treatment for overactive bladder (OAB), but few studies have been done to evaluate injection techniques. OBJECTIVE The primary objective was to evaluate procedural discomfort between 2 commonly used injection techniques for BTX-A. STUDY DESIGN This was a single-blinded, randomized clinical trial of women undergoing injection of 100 U BTX-A for idiopathic OAB. Patients were randomized to 5 mL/5 injection or 10 mL/10 injection groups. Bladder pain was assessed by a validated Numeric Pain Rating Scale. Overactive bladder symptoms were assessed with a standardized questionnaire (Overactive Bladder Questionnaire Short Form). Patient satisfaction, treatment efficacy, and adverse events were assessed at 30 days after procedure. RESULTS One hundred eight patients were randomized to 52 in the 5 mL/5 injection arm and 56 in the 10 mL/10 injection arm. Mean procedural pain scores were 3.2 (±2.3) in the 5 mL/5 injection group versus 3.6 (±2.1) in the 10 mL/10 injection group (P = 0.21). No difference was found when categorizing pain scores into ordinal outcomes of low (P = 0.55), medium (P = 0.70), and high (P = 1.0) or a binary outcome of low (P = 0.55) versus medium + high (P = 0.55). Multivariate analyses did not effect statistical significance between the 2 groups for the ordinal outcome (odds ratio = 1.86; 95% confidence interval = 0.77 = 4.52; P = 0.17) or the binary outcome (odds ratio = 1.81; 95% confidence interval = 0.68-4.77; P = 0.28). No difference was observed between overall patient satisfaction, global impression of improvement, Overactive Bladder Questionnaire Short Form scores, or adverse outcomes. CONCLUSIONS Procedural discomfort related to BTX-A injection for idiopathic OAB was not different between 2 injection protocols. Overall satisfaction was high for both groups, and there was no difference in symptom scores or adverse events.
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Affiliation(s)
- Lia M Miceli
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Houston Methodist Department of Obstetrics and Gynecology
| | - Danielle D Antosh
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Houston Methodist Department of Obstetrics and Gynecology
| | - Tariq Nisar
- Houston Methodist Research Institute, Center for Health Data Science & Analytics
| | - Julie Stewart
- Division of Female Pelvic Medicine and Reconstructive Surgery, Houston Methodist Department of Urology, Houston, TX
| | - Emily C Rutledge
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Houston Methodist Department of Obstetrics and Gynecology
| | - Rose Khavari
- Division of Female Pelvic Medicine and Reconstructive Surgery, Houston Methodist Department of Urology, Houston, TX
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Thompson JC, Halder GE, Jeppson PC, Alas A, Balgobin S, Dieter AA, Houlihan S, Miranne J, Sleemi A, Balk EM, Mama S, Meriwether KV, Antosh DD. Repair of Vesicovaginal Fistulae: A Systematic Review. Obstet Gynecol 2024; 143:229-241. [PMID: 38033311 DOI: 10.1097/aog.0000000000005468] [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] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck-vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analyses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021214948.
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Affiliation(s)
- Jennifer C Thompson
- Northwest Kaiser Permanente, Portland, Oregon; the University of Texas Medical Branch, Galveston, the University of Texas at San Antonio, San Antonio, UT Southwestern Medical Center, Dallas, and the Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; MedStar Washington Hospital Center, Washington, DC; the Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the International Medical Response Foundation, Brooklyn, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; Cooper Medical School of Rowan University, Cooper University Health Care, Camden, New Jersey; and the Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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Rozycki SK, Rutledge EC, Nisar T, Yadav GS, Antosh DD. Healthcare disparities and pelvic organ prolapse operative complications: a nationwide analysis. Int Urogynecol J 2023; 34:2893-2899. [PMID: 37548744 DOI: 10.1007/s00192-023-05620-3] [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: 03/29/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to evaluate the differences in the incidence of peri-operative complications at the time of pelvic organ prolapse (POP) repair based on health care disparities such as race and socioeconomic status. METHODS The National Inpatient Sample (NIS) database was queried using ICD-9/-10 codes for patients aged >18 years undergoing POP repair in 2008-2018. Demographic information, Elixhauser Comorbidity Index (ECI), insurance status, and peri-operative complications were extracted. Multivariate weighted logistic regression using the discharge weights from NIS were constructed on binary outcomes. Complications with at least 1% incidence were included in the analysis. RESULTS A total of 172,483 POP repair patients were analyzed: 130,022 (75.4%) were white, 10,561 (6.1%) were Black, 21,915 (12.7%) were Hispanic, and 9,985 (5.8%) were of other races. Patients with Medicaid as well as Black, Hispanic, and other races had higher odds of developing postoperative complications such as urinary tract infections, sepsis, and acute renal failure (p value <0.001-0.02). These were also more common in smaller, rural hospitals and with patients with an annual income of $45,999 or less (p value <0.001-0.03). Black and Hispanic patients had lower odds of intraoperative complications such as hemorrhage (aOR 0.77, 95% CI 0.71-0.84; aOR 0.75, 95% CI 0.7-0.8 respectively) or abdominopelvic injury (aOR 0.86, 95% CI 0.81-0.92; aOR 0.93, 95% CI 0.79-0.88 respectively) compared with white patients. CONCLUSION Nonwhite patients with lower socioeconomic status had increased postoperative complications and fewer intraoperative complications from POP surgery, whereas white patients with higher socioeconomic status had more intraoperative complications.
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Affiliation(s)
- Sarah K Rozycki
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA.
| | - Emily C Rutledge
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Tariq Nisar
- Houston Methodist Research Institute, Center for Outcomes Research, Houston, TX, 77030, USA
| | - Ghanshyam S Yadav
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of California San Diego, La Jolla, CA, 92093, USA
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, TX, 77030, USA
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Wieslander CK, Grimes CL, Balk EM, Hobson DTG, Ringel NE, Sanses TVD, Singh R, Richardson ML, Lipetskaia L, Gupta A, White AB, Orejuela F, Meriwether K, Antosh DD. Health Care Disparities in Patients Undergoing Hysterectomy for Benign Indications: A Systematic Review. Obstet Gynecol 2023; 142:1044-1054. [PMID: 37826848 DOI: 10.1097/aog.0000000000005389] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/30/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To explore how markers of health care disparity are associated with access to care and outcomes among patients seeking and undergoing hysterectomy for benign indications. DATA SOURCES PubMed, EMBASE, and ClinicalTrials.gov were searched through January 23, 2022. METHODS OF STUDY SELECTION The population of interest included patients in the United States who sought or underwent hysterectomy by any approach for benign indications. Health care disparity markers included race, ethnicity, geographic location, insurance status, and others. Outcomes included access to surgery, patient level outcomes, and surgical outcomes. Eligible studies reported multivariable regression analyses that described the independent association between at least one health care disparity risk marker and an outcome. We evaluated direction and strengths of association within studies and consistency across studies. TABULATION, INTEGRATION, AND RESULTS Of 6,499 abstracts screened, 39 studies with a total of 46 multivariable analyses were included. Having a Black racial identity was consistently associated with decreased access to minimally invasive, laparoscopic, robotic, and vaginal hysterectomy. Being of Hispanic ethnicity and having Asian or Pacific Islander racial identities were associated with decreased access to laparoscopic and vaginal hysterectomy. Black patients were the only racial or ethnic group with an increased association with hysterectomy complications. Medicare insurance was associated with decreased access to laparoscopic hysterectomy, and both Medicaid and Medicare insurance were associated with increased likelihood of hysterectomy complications. Living in the South or Midwest or having less than a college degree education was associated with likelihood of prior hysterectomy. CONCLUSION Studies suggest that various health care disparity markers are associated with poorer access to less invasive hysterectomy procedures and with poorer outcomes for patients who are undergoing hysterectomy for benign indications. Further research is needed to understand and identify the causes of these disparities, and immediate changes to our health care system are needed to improve access and opportunities for patients facing health care disparities. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021234511.
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Affiliation(s)
- Cecilia K Wieslander
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California; the Division of Urogynecology & Reconstructive Pelvic Surgery, Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Yale School of Medicine, New Haven, Connecticut; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Howard University College of Medicine, Washington, DC; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Florida Health, Jacksonville, Florida; Occom Health, Newton, Massachusetts; the Division of Urogynecology & Reconstructive Pelvic Surgery, Cooper Health University, Cooper Medical School at Rowan University, Camden, New Jersey; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Louisville Health, Louisville, Kentucky; the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of Texas at Austin Dell Medical School, Austin, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, Baylor College of Medicine, the Division of Urogynecology, Department of Obstetrics & Gynecology, Houston Methodist Hospital, Houston, Texas; and the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology, University of New Mexico, Albuquerque, New Mexico
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Rutledge E, Spiers A, Vardeman J, Griffin N, Nisar T, Muir T, Antosh DD. Educating Women About Pelvic Floor Disorders During Pregnancy From the First to the "Fourth Trimester": A Randomized Clinical Trial. Urogynecology (Phila) 2023; 29:770-776. [PMID: 37607311 DOI: 10.1097/spv.0000000000001341] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
IMPORTANCE Pregnancy and childbirth are risk factors for developing pelvic floor disorders (PFDs), and this continues postpartum ("fourth trimester"). Knowledge of PFDs among women of childbearing age is lacking and presents an opportunity for education. OBJECTIVES The aim of this study was to compare the increase in knowledge of PFDs in patients who received written handouts versus interactive workshops as measured by the Prolapse and Incontinence Knowledge Questionnaire (PIKQ). STUDY DESIGN This was a randomized clinical trial of pregnant patients 18 years or older. Patients either received written handouts only or received handouts and attended an interactive workshop. Handouts were created in collaboration with communication specialists focusing on risk factors and prevention strategies. The primary outcome was the change in PIKQ score. Secondary outcomes were Pelvic Floor Distress Inventory score and postpartum phone interviews of workshop group participants. Questionnaires were assessed at recruitment and 6 weeks postpartum. The nonparametric Wilcoxon test compared continuous variables, and the Fisher exact test compared categorical variables. RESULTS One hundred twenty patients were randomized. Demographics were similar between groups. Median PIKQ score change showed no difference between groups (P = 0.37). Pelvic Floor Distress Inventory-20 scores were similar between groups at baseline (P = 0.78) and postpartum (P = 0.82). Quantile regression showed posteducation PIKQ scores were significantly higher in the workshop (21.00 vs 17.00; P = 0.011) and written (21.00 vs 17.00; P < 0.001) groups. Phone interviews showed consistent themes: (1) greater awareness of PFDs, (2) more likely to discuss PFDs, and (3) relief that PFDs are treatable. Fifty-nine percent of patients preferred learning through workshops compared with the handouts. CONCLUSIONS Both groups showed improvement in knowledge of PFDs. Well-written, illustrated handouts were effective in increasing patient knowledge of PFDs.
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Affiliation(s)
- Emily Rutledge
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
| | - Alaina Spiers
- College of Communications, University of Houston, Houston, TX
| | | | - Nickie Griffin
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
| | - Tariq Nisar
- Houston Methodist Research Institute, Center for Outcomes Research, Houston, TX
| | - Tristi Muir
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
| | - Danielle D Antosh
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX
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Caldwell L, Kim-Fine S, Antosh DD, Husk K, Meriwether KV, Long JB, Heisler CA, Hudson PL, Lozo S, Iyer S, Rogers RG. Surgeon Counseling Regarding Return to Sexual Activity After Pelvic Reconstructive Surgery. Urogynecology (Phila) 2023; 29:725-731. [PMID: 37607308 DOI: 10.1097/spv.0000000000001338] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
IMPORTANCE Patients highly value surgeon counseling regarding the first sexual encounters after pelvic reconstructive surgery. OBJECTIVES We performed a qualitative analysis of usual surgeon counseling regarding return to sexual activity after surgery for pelvic organ prolapse and/or urinary incontinence. METHODS Participating surgeons provided a written description of their usual patient counseling regarding return to sexual activity after pelvic organ prolapse or urinary incontinence surgery. Counseling narratives were coded for major themes by 2 independent reviewers; disagreements were arbitrated by the research team. Analysis was performed utilizing Dedoose software and continued until thematic saturation was reached. RESULTS Twenty-two surgeons participated, and thematic saturation was reached. Six major themes were identified: "Safety of Intercourse," "Specific Suggestions," "Surgical Sequelae," "Patient Control," "Partner Related," "Changes in Experience," and "No Communication." Nearly all participating surgeons included counseling on the safety of intercourse and reassurance that intercourse would not harm the surgical repair. Specific suggestions included different positions, use of lubrication, vaginal estrogen use, specific products/vendors, alternatives to (vaginal) intercourse, and the importance of foreplay. Surgical sequelae discussion included possible interventions for complications, such as persistent sutures in the vagina, abnormal bleeding, or de novo dyspareunia. Counseling regarding changes to the patient's sexual experience ranged from suggestion of improvement to an anticipated negative experience. Surgeons more commonly advised patients that their sexual experience would be worsened or different from baseline; discussion of improvement was less frequent. CONCLUSIONS Surgeon counseling regarding the postoperative return to sexual activity varies among pelvic reconstructive surgeons. Most reassure patients that intercourse is safe after surgery.
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Affiliation(s)
- Lauren Caldwell
- From the The University of Texas at Austin Dell Medical School, Austin, TX
| | | | | | | | | | | | | | - Patricia L Hudson
- Wellspan Urogynecology and Pelvic Reconstructive Surgery, WellSpan Health, York, PA
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Gupta A, Balk EM, Lenger SM, Yang LC, Misal M, Balgobin S, Chang OH, Sharma V, Stuparich M, Behbehani S, Nihira M, Alas A, Jampa A, Sheyn D, Meriwether K, Antosh DD. Changes in Pelvic Floor Symptoms After Procedural Interventions for Uterine Leiomyomas: A Systematic Review. Obstet Gynecol 2023; 142:319-329. [PMID: 37411023 DOI: 10.1097/aog.0000000000005260] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To conduct a systematic review to evaluate the effect of procedural interventions for leiomyomas on pelvic floor symptoms. DATA SOURCES PubMed, EMBASE, and ClinicalTrials.gov were searched from inception to January 12, 2023, searching for leiomyoma procedures and pelvic floor disorders and symptoms, restricted to primary study designs in humans. METHODS OF STUDY SELECTION Double independent screening for studies of any study design in all languages that reported pelvic floor symptoms before and after surgical (hysterectomy, myomectomy, radiofrequency volumetric thermal ablation) or radiologic (uterine artery embolization, magnetic resonance-guided focused ultrasonography, high-intensity focused ultrasonography) procedures for management of uterine leiomyomas. Data were extracted, with risk-of-bias assessment and review by a second researcher. Random effects model meta-analyses were conducted, as feasible. TABULATION, INTEGRATION, AND RESULTS Six randomized controlled trials, one nonrandomized comparative study, and 25 single-group studies met criteria. The overall quality of the studies was moderate. Only six studies, reporting various outcomes, directly compared two procedures for leiomyomas. Across studies, leiomyoma procedures were associated with decreased symptom distress per the UDI-6 (Urinary Distress Inventory, Short Form) (summary mean change -18.7, 95% CI -25.9 to -11.5; six studies) and improved quality of life per the IIQ-7 (Incontinence Impact Questionnaire, Short Form) (summary mean change -10.7, 95% CI -15.8 to -5.6; six studies). There was a wide range of resolution of urinary symptoms after procedural interventions (7.6-100%), and this varied over time. Urinary symptoms improved in 19.0-87.5% of patients, and the definitions for improvement varied between studies. Bowel symptoms were inconsistently reported in the literature. CONCLUSION Urinary symptoms improved after procedural interventions for uterine leiomyomas, although there is high heterogeneity among studies and few data on long-term outcomes or comparing different procedures. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021272678.
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Affiliation(s)
- Ankita Gupta
- Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, and the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics, Gynecology, & Women's Health, University of Louisville School of Medicine, Louisville, Kentucky; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, Illinois; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, Ohio; the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of OBGYN, Division of Urogynecology, UT Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; the Department of Obstetrics and Gynecology, Jacobi Medical Center, and the Albert Einstein College of Medicine, Bronx, New York; the Department of Obstetrics and Gynecology, University of California, Riverside School of Medicine, Riverside, and KPC Healthcare, Hemet, California; the Jawaharlal Nehur Medical College, Belgaum, India; and the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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Dieter AA, Halder GE, Pennycuff JF, Singh R, El-Nashar SA, Lipetskaia L, Orejuela FJ, Jeppson PC, Sleemi A, Raman SV, Balk EM, Rogers RG, Antosh DD. Patient-Reported Outcome Measures for Use in Women With Pelvic Organ Prolapse: A Systematic Review. Obstet Gynecol 2023; 141:1098-1114. [PMID: 37073897 PMCID: PMC10524573 DOI: 10.1097/aog.0000000000005212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To describe the psychometric properties of existing patient-reported outcome measures for women with prolapse using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) framework. Additional objectives were to describe the patient-reported outcome scoring method or interpretation, methods of administration, and to compile a list of the non-English languages in which the patient-reported outcomes are reportedly validated. DATA SOURCES PubMed and EMBASE was searched through September 2021. Study characteristics, patient-reported outcome details, and psychometric testing data were extracted. Methodologic quality was assessed with COSMIN guidelines. METHODS OF STUDY SELECTION Studies reporting the validation of a patient-reported outcome in women with prolapse (or women with pelvic floor disorders that included a prolapse assessment) and reporting psychometric testing data on English-language patient-reported outcome for at least one measurement property per COSMIN and the U.S. Department of Health and Human Services definitions were included, as well as studies reporting the translation of an existing patient-reported outcome into another language, a new method of patient-reported outcome administration, or a scoring interpretation. Studies reporting only pretreatment and posttreatment scores, only content or face validity, or only findings for nonprolapse domains of the patient-reported outcome were excluded. TABULATION, INTEGRATION, AND RESULTS Fifty-four studies covering 32 patient-reported outcomes were included; 106 studies assessing translation into a non-English language were excluded from the formal review. The number of validation studies per patient-reported outcome (one version of one questionnaire) ranged from 1 to 11. Reliability was the most reported measurement property, and most measurement properties received an average rating of sufficient. The condition-specific patient-reported outcomes had on average more studies and reported data across more measurement properties compared with adapted and generic patient-reported outcomes. CONCLUSION Although measurement property data vary on patient-reported outcomes for women with prolapse, most data were of good quality. Overall, condition-specific patient-reported outcomes had more studies and reported data across more measurement properties. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021278796.
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11
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Rohr J, Vahidy FS, Bartek N, Bourassa KA, Nanavaty NR, Antosh DD, Harms KP, Stanley JL, Madan A. Reducing psychiatric illness in the perinatal period: A review and commentary. World J Psychiatry 2023; 13:149-160. [PMID: 37123098 PMCID: PMC10130961 DOI: 10.5498/wjp.v13.i4.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.
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Affiliation(s)
- Jessica Rohr
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Farhaan S Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX 77030, United States
| | - Nicole Bartek
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Katelynn A Bourassa
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Namrata R Nanavaty
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Konrad P Harms
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Jennifer L Stanley
- Department of Obstetrics and Gynecology, Houston Methodist, Houston, TX 77030, United States
| | - Alok Madan
- Department of Psychiatry and Behavioral Health, Houston Methodist, Houston, TX 77030, United States
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12
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Agu I, Smith FK, Murarka S, Xu J, Siddiqui G, Orejuela F, Muir TW, Antosh DD. An evaluation of pelvic floor disorders in a public and private healthcare setting. Int Urogynecol J 2023; 34:693-699. [PMID: 35503122 DOI: 10.1007/s00192-022-05215-4] [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: 02/11/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objectives were to determine whether a difference exists in the duration of pelvic floor disorder (PFD) symptoms among patients presenting to urogynecologists in two healthcare systems: private and county; and to elucidate differences in baseline characteristics, type of PFDs, symptom severity and management, stratified by healthcare plans. METHODS A multi-center retrospective study was conducted including new patients presenting to three urogynecology clinics between March 2016 and May 2018: one private clinic (site A) and two public clinics in the same county healthcare system (sites B and C). Baseline data included age, race, BMI, parity, and comorbidities. Primary outcome was "time to presentation" defined as PFD duration in months. Secondary outcomes were symptom severity and PFD management, analyzed by healthcare setting and insurance type. RESULTS A total of 1,055 private and 439 public patients were included. Patients in the public setting were younger (54 vs 61 years, p<0.001), largely Hispanic (76% vs 14%, p<0.001), of higher parity (4 vs 3, p=0.001), and had more comorbidities, with a predominance of county-funded healthcare plans. There was no difference in duration of symptoms between the public and private groups respectively (54 vs 56 months, p=0.94). Patients in the public setting had more severe urinary incontinence (3 vs 2 pads/day, p<0.001) and prolapse (stages 3-4, 71% vs 61%, p=0.004); however, they had lower rates of surgical management for stress incontinence and prolapse. Differences in fecal incontinence could not be evaluated owing to small sample size. CONCLUSIONS Public patients presented younger with more severe symptoms but had lower rates of surgery for PFDs traditionally managed surgically.
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Affiliation(s)
- Ijeoma Agu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA.
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA.
| | - Fiona K Smith
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Shivani Murarka
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Jiaqiong Xu
- Center for Outcome Research, Houston Methodist Hospital Research Institute, Houston, TX, USA
| | - Gazala Siddiqui
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Francisco Orejuela
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Tristi W Muir
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Danielle D Antosh
- Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
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de Tayrac R, Antosh DD, Baessler K, Cheon C, Deffieux X, Gutman R, Lee J, Nager C, Schizas A, Sung V, Maher C. Summary: 2021 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse. J Clin Med 2022; 11:jcm11206106. [PMID: 36294427 PMCID: PMC9605527 DOI: 10.3390/jcm11206106] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There is wide variation in the reported prevalence rates for pelvic organ prolapse (POP). There is also wide variation in the rate at which surgical interventions for pelvic organ prolapse are performed, as well as the type of interventions undertaken. As part of the International Consultation on Incontinence (ICI), our committee was tasked to produce evidence-based pathways for the surgical management of POP, any associated stress urinary incontinence (SUI), and bowel dysfunction. (2) Methods: To enable us to generate such evidence, we undertook a thorough search for the POP surgery-related, English-language scientific literature published up to April 2021. (3) Results: The committee evaluated the literature and made recommendations based on the Oxford grading system. (4) Conclusions: This review serves to provide a summary of the 2021 ICI surgical management of an evidence-based prolapse pathway and outline the evidence used to inform this guidance.
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Affiliation(s)
- Renaud de Tayrac
- Service de Gynécologie-Obstétrique, CHU de Nîmes, Université de Montpellier, 34000 Nîmes, France
- Correspondence:
| | - Danielle D. Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Kaven Baessler
- Pelvic Floor Centre, Franziskus and St. Joseph Hospitals, Budapester Str. 15-19, 10787 Berlin, Germany
| | - Cecilia Cheon
- Urogynaecology Section of Queen Elizabeth Hospital, Hong Kong and Shenzhen Hong Kong University Hospital, Shenzhen 518009, China
| | - Xavier Deffieux
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, 92140 Clamart, France
| | - Robert Gutman
- Urogynecology & Pelvic Reconstructive Surgery, MedStar Washington Hospital Center, 106 Irving St. NW 405 S, Washington, DC 20010, USA
| | - Joseph Lee
- St. Vincents Clinic, UNSW University of New South Wales, Sydney, NSW 2010, Australia
| | - Charles Nager
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego Health, San Diego, CA 92037, USA
| | - Alexis Schizas
- General Surgery Department, Guy’s and St. Thomas’ NHS Foundation Trust, Monkton Street, London SE11 4TX, UK
| | - Vivian Sung
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christopher Maher
- Royal Brisbane and Womens Hospital, Urogynaecology University QLD, Herston, QLD 4029, Australia
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Grimes CL, Clare CA, Meriwether KV, Geynisman-Tan J, Lozo S, Antosh DD, Brown HW, LeBrun EEW, Raman SV, Iglesia CB, Keltz J, Kim-Fine S, Brennand EA, Rogers R. Reporting Race and Ethnicity In Research Presented at the Society of Gynecologic Surgeons' Annual Meeting. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cara L. Grimes
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Camille A. Clare
- Department of Obstetrics and Gynecology, State University of New York-Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kate V. Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Svjetlana Lozo
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York, USA
| | - Danielle D. Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Medical Center, Houston, Texas, USA
| | - Heidi W. Brown
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Emily E. Weber LeBrun
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Sonali V. Raman
- Department of Women's Health, Female Pelvic Medicine and Reconstructive Surgery, St. Elizabeth Healthcare, Fort Thomas, Kentucky, USA
| | - Cheryl B. Iglesia
- Department of Obstetrics and Gynecology, MedStar Health and Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Julia Keltz
- Departments of Obstetrics and Gynecology and Urology, New York Medical College, Valhalla, New York, USA
| | - Shunaha Kim-Fine
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca Rogers
- Department of Obstetrics and Gynecology, Albany Medical College, Albany, New York, USA
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Antosh DD, Dieter AA, Balk EM, Kanter G, Kim-Fine S, Meriwether KV, Mamik MM, Good MM, Singh R, Alas A, Foda MA, Rahn DD, Rogers RG. Sexual function after pelvic organ prolapse surgery: a systematic review comparing different approaches to pelvic floor repair. Am J Obstet Gynecol 2021; 225:475.e1-475.e19. [PMID: 34087227 DOI: 10.1016/j.ajog.2021.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Women consider preservation of sexual activity and improvement of sexual function as important goals after pelvic organ prolapse surgery. This systematic review aimed to compare sexual activity and function before and after prolapse surgery among specific approaches to pelvic organ prolapse surgery including native tissue repairs, transvaginal synthetic mesh, biologic grafts, and sacrocolpopexy. DATA SOURCES MEDLINE, Embase, and ClinicalTrials.gov databases were searched from inception to March 2021. STUDY ELIGIBILITY CRITERIA Prospective comparative cohort and randomized studies of pelvic organ prolapse surgeries were included that reported the following specific sexual function outcomes: baseline and postoperative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Notably, the following 4 comparisons were made: transvaginal synthetic mesh vs native tissue repairs, sacrocolpopexy vs native tissue repairs, transvaginal synthetic mesh vs sacrocolpopexy, and biologic graft vs native tissue repairs. METHODS Studies were double screened for inclusion and extracted for population characteristics, sexual function outcomes, and methodological quality. Evidence profiles were generated for each surgery comparison by grading quality of evidence for each outcome across studies using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Screening of 3651 abstracts was performed and identified 77 original studies. The overall quality of evidence was moderate to high. There were 26 studies comparing transvaginal synthetic mesh with native tissue repairs, 5 comparing sacrocolpopexy with native tissue repairs, 5 comparing transvaginal synthetic mesh with sacrocolpopexy, and 7 comparing biologic graft with native tissue repairs. For transvaginal synthetic mesh vs native tissue repairs, no statistical differences were found in baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, persistent dyspareunia, and de novo dyspareunia. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form change scores were not different between transvaginal synthetic mesh and native tissue repairs (net difference, -0.3; 95% confidence interval, -1.4 to 0.8). For sacrocolpopexy vs native tissue repairs, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, de novo dyspareunia, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form score differences were not different. For biologic graft vs native tissue repairs, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form changes were also not different. For transvaginal synthetic mesh vs sacrocolpopexy, there was no difference in sexual activity and sexual function score change. Based on 2 studies, postoperative total dyspareunia was more common in transvaginal synthetic mesh than sacrocolpopexy (27.5% vs 12.2%; odds ratio, 2.72; 95% confidence interval, 1.33-5.58). The prevalence of postoperative dyspareunia was lower than preoperative dyspareunia after all surgery types. CONCLUSION Sexual function comparisons are most robust between transvaginal synthetic mesh and native tissue repairs and show similar prevalence of sexual activity, de novo dyspareunia, and sexual function scores. Total dyspareunia is higher after transvaginal synthetic mesh than sacrocolpopexy. Although sexual function data are sparse in the other comparisons, no other differences in sexual activity, dyspareunia, and sexual function score change were found.
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16
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Antosh DD, Megahed NN. Sexual Function After Pelvic Reconstructive Surgery. Obstet Gynecol Clin North Am 2021; 48:639-651. [PMID: 34416942 DOI: 10.1016/j.ogc.2021.05.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Improvement in sexual function is an important goal for many women undergoing surgery for pelvic organ prolapse, and patient counseling regarding changes in sexual function and activity is necessary prior to pelvic reconstructive surgery. Based on validated questionnaires, sexual function either remains unchanged or improves after pelvic reconstructive surgery for prolapse, while dyspareunia prevalence is reduced. De novo dyspareunia ranges from 0% to 9% after various types of prolapse surgery, with the exception of posterior repair.
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Affiliation(s)
- Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, 6550 Fannin Street, Suite 2221, Houston, TX 77030, USA.
| | - Nadia N Megahed
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, 6550 Fannin Street, Suite 2221, Houston, TX 77030, USA
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Kim-Fine S, Antosh DD, Balk EM, Meriwether KV, Kanter G, Dieter AA, Mamik MM, Good M, Singh R, Alas A, Foda M, Rahn DD, Rogers RG. Relationship of postoperative vaginal anatomy and sexual function: a systematic review with meta-analysis. Int Urogynecol J 2021; 32:2125-2134. [PMID: 33988785 DOI: 10.1007/s00192-021-04829-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This was a planned secondary analysis of a systematic review that described sexual function outcomes following pelvic organ prolapse (POP) surgery. We aimed to describe the relationship of pre- and postoperative vaginal anatomic measures with sexual function outcomes. Data Sources included the Medline, Embase, and clinicaltrials.gov databases from inception to April 2018. METHODS The original systematic review included prospective, comparative studies that reported sexual function outcomes before and following POP surgery. Studies were extracted for population characteristics, sexual function outcomes, and vaginal anatomy, including total vaginal length (TVL) and genital hiatus. By meta-regression, we analyzed associations across studies between vaginal anatomic measurements and sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) and dyspareunia outcomes. RESULTS We screened 3124 abstracts and identified 74 papers representing 67 original studies. Among these, 14 studies reported TVL and PISQ-12 outcomes. Nine studies reported TVL and dyspareunia outcomes, eight studies reported GH and PISQ-12 outcomes, and seven studies reported GH and dyspareunia outcomes. We found no associations between anatomic measures and PISQ-12 or dyspareunia, although, we found a statistically significant association found between preoperative TVL and change in PISQ-12. CONCLUSION Across studies, the evidence does not support an association between vaginal anatomy and either validated, condition-specific sexual function questionnaires or dyspareunia. However, no study has directly analyzed these associations in the setting of pelvic floor reconstructive surgery.
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Affiliation(s)
- Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 4th Floor North Tower, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Ethan M Balk
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Kate V Meriwether
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Gregg Kanter
- Department of Obstetrics and Gynecology, Salinas Valley Memorial Healthcare System, Salinas, CA, USA
| | - Alexis A Dieter
- Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington, Hospital Center/Georgetown University School of Medicine, Washington, DC, USA
| | - Mamta M Mamik
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Meadow Good
- Obstetrics and Gynecology, University of Florida, Jacksonville, FL, USA
| | - Ruchira Singh
- Obstetrics and Gynecology, University of Florida, Jacksonville, FL, USA
| | - Alexandriah Alas
- Department of Obstetrics and Gynecology, UT Health, San Antonio, TX, USA
| | - Mohamed Foda
- Department of Obstetrics and Gynecology, HCA/UCF Consortium, Gainesville, FL, USA
| | - David D Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca G Rogers
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
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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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Chung DE, Antosh DD, Umpierrez D, Barbosa Z, Yurteri-Kaplan L, Grimes CL. Differences between mid-urethral sling outcomes in diabetic and nondiabetic women. Neurourol Urodyn 2020; 39:738-743. [PMID: 31899822 DOI: 10.1002/nau.24268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/15/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
AIMS The aim is to assess whether subjects with diabetes mellitus (DM) have greater urinary retention and increased post-void residual volume (PVR) following mid-urethral sling (MUS) surgery. METHODS This multi-center retrospective study included patients who underwent MUS (2012-2016). Baseline data included demographics, comorbidities, urinary symptoms, urodynamics data, PVR, and responses to validated questionnaires (UDI6 and IIQ7). Intraoperative data, postoperative voiding trial results, postop questionnaires, and complications were also noted. Patients with and without DM were compared. Significance was defined as P < .05. RESULTS A total of 605 MUS were included, 538(89%) without DM and 67(11%) with DM, of which 69% were transobturator and 31% retropubic. No differences were seen in urinary retention and passing void trial(79% DM vs 81% non-DM; P = .72). Mean PVR at discharge was similar between groups (136 mL DM vs 139 mL non-DM; P = .922). There were no differences between groups in UDI6 and IIQ7 sum scores at baseline and 1 month. DM subjects reported more bother at baseline on certain UDI-6 and IIQ-7 items including frequent urination, leakage related to urgency, and feeling frustrated. At 3 months postop, all subjects demonstrated improvement in scores. Interestingly, patients with DM reported worse quality of life on the IIQ7 sum. CONCLUSIONS Among subjects with well-controlled diabetes and more comorbidities who underwent MUS there were few differences in postoperative voiding dysfunction or PVR compared to nondiabetic women. DM patients were more bothered at baseline by urge-related symptoms. Quality of life following sling surgery appears to be worse in patients with DM at 3 months based on IIQ7. This data suggests that diabetic women with lower HbA1C can be counseled similarly to these complication rates and voiding dysfunction after MUS.
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Affiliation(s)
- Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, Texas
| | - Denise Umpierrez
- Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia
| | - Zonia Barbosa
- Department of Pediatrics, BronxCare Health System, Bronx, New York
| | - Ladin Yurteri-Kaplan
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
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Antosh DD, Yurteri-Kaplan LA, Shveiky D, Liu M, Heisler C, Hegde A, Grimes CL. FPMRS challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium (CoRPS): managing complicated cases : Series 3: Challenging recurrent prolapse in a medically complicated patient. Int Urogynecol J 2019; 30:1039-1043. [PMID: 31037413 DOI: 10.1007/s00192-019-03955-4] [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: 02/15/2019] [Accepted: 04/11/2019] [Indexed: 11/26/2022]
Abstract
This case presents the work-up and management of a spina bifida patient with recurrent prolapse. Four international experts also provide their evaluation of and approach to this complex case. According to the literature, little is known regarding the approach to the management of this specific patient population.
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Affiliation(s)
- Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Ladin A Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| | - David Shveiky
- Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - Madalena Liu
- Department of Urology, Monash University, Melborune, Australia
| | - Chris Heisler
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison School of Medicine & Public Health, Madison, WI, USA
| | - Aparna Hegde
- Tata Center for Urogynecology and Pelvic Health, Cama Hospital, Grant Government Medical College, Mumbai, India
- Center for Urogynecology and Pelvic Health, New Delhi, India
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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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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Yurteri-Kaplan LA, Antosh DD, Bortolini MA, Umek W, Kim-Fine S, Grimes CL. FPMRSChallenges on behalf of the Collaborative Research in Pelvic Surgery Consortium (CoRPS): managing complicated cases : Series 1: Adverse events after a sacrocolpopexy: management and recommendations on treatment of a vesicovaginal fistula. Int Urogynecol J 2018; 29:929-932. [PMID: 29610940 DOI: 10.1007/s00192-018-3642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Ladin A Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10032, USA.
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA
| | - Maria A Bortolini
- Department of Gynecology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Wolfgang Umek
- Department of Obstetrics and Gynecology, Medical University Vienna, Wien, Austria
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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Mazloomdoost D, Kanter G, Chan RC, Deveaneau N, Wyman AM, Von Bargen EC, Chaudhry Z, Elshatanoufy S, Miranne JM, Chu CM, Pauls RN, Arya LA, Antosh DD. Social networking and Internet use among pelvic floor patients: a multicenter survey. Am J Obstet Gynecol 2016; 215:654.e1-654.e10. [PMID: 27319368 DOI: 10.1016/j.ajog.2016.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/28/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Internet resources are becoming increasingly important for patients seeking medical knowledge. It is imperative to understand patient use and preferences for using the Internet and social networking websites to optimize patient education. OBJECTIVES The purpose of this study was to evaluate social networking and Internet use among women with pelvic floor complaints to seek information for their conditions as well as describe the likelihood, preferences, and predictors of website usage. STUDY DESIGN This was a cross-sectional, multicenter study of women presenting to clinical practices of 10 female pelvic medicine and reconstructive surgery fellowship programs across the United States, affiliated with the Fellows' Pelvic Research Network. New female patients presenting with pelvic floor complaints, including urinary incontinence, pelvic organ prolapse, and fecal incontinence were eligible. Participants completed a 24 item questionnaire designed by the authors to assess demographic information, general Internet use, preferences regarding social networking websites, referral patterns, and resources utilized to learn about their pelvic floor complaints. Internet use was quantified as high (≥4 times/wk), moderate (2-3 times/wk), or minimal (≤1 time/wk). Means were used for normally distributed data and medians for data not meeting this assumption. Fisher's exact and χ2 tests were used to evaluate the associations between variables and Internet use. RESULTS A total of 282 surveys were analyzed. The majority of participants, 83.3%, were white. The mean age was 55.8 years old. Referrals to urogynecology practices were most frequently from obstetrician/gynecologists (39.9%) and primary care providers (27.8%). Subjects were well distributed geographically, with the largest representation from the South (38.0%). Almost one third (29.9%) were most bothered by prolapse complaints, 22.0% by urgency urinary incontinence, 20.9% by stress urinary incontinence, 14.9% by urgency/frequency symptoms, and 4.1% by fecal incontinence. The majority, 75.0%, described high Internet use, whereas 8.5% moderately and 4.8% minimally used the Internet. Women most often used the Internet for personal motivations including medical research (76.4%), and 42.6% reported Google to be their primary search engine. Despite this, only 4.9% primarily used the Internet to learn about their pelvic floor condition, more commonly consulting an obstetrician-gynecologist for this information (39.4%). The majority (74.1%) held a social networking account, and 45.9% visited these daily. Nearly half, 41.7%, expressed the desire to use social networking websites to learn about their condition. Women <65 years old were significantly more likely to have high Internet use (83.4% vs 68.8%, P = .018) and to desire using social networking websites to learn about their pelvic floor complaint (P = .008). The presenting complaint was not associated with Internet use (P = .905) or the desire to use social networking websites to learn about pelvic floor disorders (P = .201). CONCLUSION Women presenting to urogynecology practices have high Internet use and a desire to learn about their conditions via social networking websites. Despite this, obstetrician-gynecologists remain a common resource for information. Nonetheless, urogynecology practices and national organizations would likely benefit from increasing their Internet resources for patient education in pelvic floor disorders, though patients should be made aware of available resources.
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Jenson AV, Scranton R, Antosh DD, Simpson RK. Lumbosacral Osteomyelitis and Discitis with Phlegmon Following Laparoscopic Sacral Colpopexy. Cureus 2016; 8:c5. [PMID: 27766189 PMCID: PMC5065115 DOI: 10.7759/cureus.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Lumbosacral osteomyelitis and discitis are usually a result of hematogenous spread; rarely it can result from direct inoculation during a surgical procedure. Bacteria may also track along implanted devices to a different location. This is a rare complication seen from pelvic organ prolapse surgery with sacral colpopexy. A 67-year-old female developed increasing lower back pain four months following a laparoscopic sacral colpopexy. Imaging revealed lumbar 5-sacral 1 (L5-S1) osteomyelitis and discitis with associated phlegmon confirmed by percutaneous biopsy and culture. The patient was treated conservatively with antibiotics, but required laparoscopic removal of the pelvic and vaginal mesh followed by twelve weeks of intravenous antibiotics. The patient has experienced clinical improvement of her back pain. This is an uncommon complication of sacral colpopexy, but physicians must be vigilant and manage aggressively to avoid more serious complications and permanent deficit.
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Affiliation(s)
| | - Robert Scranton
- Department of Neurosurgery, Houston Methodist Neurological Institute
| | | | - Richard K Simpson
- Department of Neurosurgery, Houston Methodist Neurological Institute
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Yurteri-Kaplan LA, Antosh DD, Iglesia CB, Sokol AI, Shveiky D, Gutman RE. Significance of cystoscopic bladder trabeculations in women undergoing midurethral sling. Can J Urol 2015; 22:7890-7895. [PMID: 26267027] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION To determine the significance of bladder trabeculations seen on preoperative cystoscopy prior to midurethral sling surgery with respect to lower urinary tract symptoms and sling outcomes. MATERIALS AND METHODS This retrospective study included women with preoperative cystoscopy who underwent midurethral slings for urinary incontinence from 2006-2009. Cystoscopic findings of bladder trabeculations, as well as pre and postoperative urinary symptoms were recorded. Patients with and without bladder trabeculations were compared with respect to baseline characteristics, lower urinary tract symptoms, and sling outcomes. RESULTS Of the 241 women included in the study, 14.9% had trabeculations on preoperative cystoscopy. At baseline, women with trabeculations were more likely to be older (64.8 years versus 57.8 years, p < 0.01), and have lower mean maximum cystometric capacity (341 mL +/- 136 versus 436 mL +/- 148, p < 0.01), compared to those without trabeculations. More women with trabeculations had mixed incontinence (p < 0.01) and less pure stress incontinence (p < 0.01) preoperatively. There was no difference between women with and without trabeculations with respect to pre and postoperative symptoms of urgency, frequency, and nocturia. Women with preoperative trabeculations were more likely to have preoperative treatment with anticholinergics (p = 0.02) and had a three times higher risk of postoperative sling failure (HR 2.95 [CI 1.11-7.85], p = 0.03). CONCLUSIONS Preoperative cystoscopic bladder trabeculations are associated with significantly higher rate of midurethral sling failure. Trabeculations were not associated with pre or postoperative lower urinary tract symptoms.
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Affiliation(s)
- Ladin A Yurteri-Kaplan
- Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center/ Georgetown University School of Medicine, Washington, DC, USA
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Antosh DD, Auguste T, George EA, Sokol AI, Gutman RE, Iglesia CB, Desale SY, Park AJ. Blinded Assessment of Operative Performance After Fundamentals of Laparoscopic Surgery in Gynecology Training. J Minim Invasive Gynecol 2013; 20:353-9. [DOI: 10.1016/j.jmig.2012.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 12/07/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
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Meriwether KV, Antosh DD, Knoepp LR, Chen CCG, Mete M, Gutman RE. Increased morbidity in combined abdominal sacrocolpopexy and abdominoplasty procedures. Int Urogynecol J 2013; 24:385-91. [PMID: 22814931 PMCID: PMC10013994 DOI: 10.1007/s00192-012-1857-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/13/2011] [Accepted: 06/03/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was performed to determine whether abdominoplasty combined with abdominal sacrocolpopexy (ASC + A) increases perioperative morbidity compared with ASC alone. We hypothesized that patients undergoing combined procedures would have increased complications. METHODS This was a multicenter, retrospective cohort study of all women undergoing ASC + A from 2002 to 2010 at Washington Hospital Center and Johns Hopkins University. We selected two women undergoing ASC alone for comparison with each ASC + A patient. Baseline demographics, surgical data, length of hospitalization, and perioperative complications were recorded. The primary outcome was any major complication within 6 weeks of surgery, including intraoperative complications, pulmonary embolism (PE), deep venous thrombosis (DVT), cardiac compromise, intensive care unit (ICU) admission, reoperation, and readmission. Surgical data and minor complications were also compared. RESULTS Twenty-six ASC + A patients and 52 ASC patients were identified. There were no significant differences in baseline characteristics between groups. Patients with ASC + A had longer operating times (337 vs 261 min, p < 0.01), more intravenous fluid administration intraoperatively (4,665 vs 3181 ml, p < 0.01), and longer hospital stays (3.7 vs 2.7 days, p < 0.01). Major complications occurred in 23 % of the ASC + A group compared with 12 % of the ASC group (p = 0.20). The ASC + A group had greater declines in hematocrit levels and higher rates of PE, ICU admission, and blood transfusion, all of which were statistically significant. CONCLUSIONS ASC + A increases length of stay and perioperative complications, such as PE, ICU admission, and blood transfusion, compared with ASC alone. Surgeons should consider recommending interval abdominoplasty due to increased morbidity risk with a combined procedure.
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Affiliation(s)
- K V Meriwether
- Department of Obstetrics and Gynecology, Section of Female Pelvic Medicine and Reconstructive Surgery, Washington Hospital Center, Washington, DC, USA.
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Antosh DD, Whyte T, Ezzell A, Chen BA, Sokol AI, Park AJ. Incidence of corneal abrasions during pelvic reconstructive surgery. Eur J Obstet Gynecol Reprod Biol 2013; 166:226-8. [DOI: 10.1016/j.ejogrb.2012.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 10/24/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
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Yurteri-Kaplan LA, Antosh DD, Sokol AI, Park AJ, Gutman RE, Kingsberg SA, Iglesia CB. Interest in cosmetic vulvar surgery and perception of vulvar appearance. Am J Obstet Gynecol 2012; 207:428.e1-7. [PMID: 22858236 DOI: 10.1016/j.ajog.2012.06.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/14/2012] [Accepted: 06/27/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether reproductive-age women are more likely to perceive their vulva as abnormal compared with older-aged women. STUDY DESIGN Women aged 18-44 years (group 1) and 45-72 years (group 2) completed a survey on demographics, grooming patterns, vulvar perceptions, and source of information about the vulva. RESULTS There was no difference between group 1 and group 2 in how often women looked at their vulva or their perception of having a normal vulva (91% vs 93%, P = .76). Both groups were satisfied with the appearance of their vulva (81% vs 82%, P = .71). A higher percentage in group 2 would consider cosmetic surgery if cost were not an issue versus group 1 (15% vs 8%, P = .05). CONCLUSION A woman's age does not have an impact on her perception of a normal vulva. The majority of women perceived their vulva to be normal and were satisfied with its appearance. However, older women are more interested in cosmetic vulvar surgery.
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Antosh DD, Iglesia CB, Vora S, Sokol AI. Outcome assessment with blinded versus unblinded POP-Q exams. Am J Obstet Gynecol 2011; 205:489.e1-4. [PMID: 21907962 DOI: 10.1016/j.ajog.2011.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 05/25/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine whether blinded and unblinded Pelvic Organ Prolapse Quantification (POP-Q) examinations differ in a randomized trial. STUDY DESIGN Blinded POP-Q examinations performed at 3 months and 1 year were compared with unblinded examinations performed by the surgeon in a randomized trial of vaginal mesh for pelvic organ prolapse. RESULTS Sixty-five patients were included in the study. Correlations between the blinded and unblinded POP-Q points and stages varied from low to moderate (rho = 0.29-0.78). At 3 months, the blinded overall prolapse recurrence rate was 45.3% compared with 39.1% based on unblinded staging (P = .34). At 1 year, the blinded overall recurrence rate was significantly higher than the unblinded recurrence rate: 68.3% vs 53.3% (P = .004). The 1-year blinded anterior wall recurrence rate was also higher than the recurrence based on unblinded staging: 56.7% vs 43.3% (P = .021). CONCLUSION Use of unblinded POP-Q staging resulted in underestimation of 1-year overall recurrence after prolapse repair.
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