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Geoffrion R, Koenig NA, Cundiff GW, Flood C, Hyakutake MT, Schulz J, Brennand EA, Lee T, Singer J, Todd NJ. Procedure-specific simulation for vaginal surgery training: A randomized controlled trial. Acta Obstet Gynecol Scand 2024. [PMID: 38382912 DOI: 10.1111/aogs.14810] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Vaginal surgery has a superior outcome profile compared with other surgical routes, yet skills are declining because of low case volumes. Graduating residents' confidence and preparedness for vaginal surgery has plummeted in the past decade. The objective of the present study was to investigate whether procedure-specific simulation skills, versus usual training, result in improved operative competence. MATERIAL AND METHODS We completed a randomized controlled trial of didactic and procedural training via low fidelity vaginal surgery models for anterior repair, posterior repair (PR), vaginal hysterectomy (VH), recruiting novice gynecology residents at three academic centers. We evaluated performance via global rating scale (GRS) in the real operating room and for corresponding procedures by attending surgeon blinded to group. Prespecified secondary outcomes included procedural steps knowledge, overall performance, satisfaction, self-confidence and intraoperative parameters. A priori sample size estimated 50 residents (20% absolute difference in GRS score, 25% SD, 80% power, alpha 0.05). CLINICALTRIALS gov: Registration no. NCT05887570. RESULTS We randomized 83 residents to intervention or control and 55 completed the trial (2011-23). Baseline characteristics were similar, except for more fourth-year control residents. After adjustment of confounders (age, level, baseline knowledge), GRS scores showed significant differences overall (mean difference 8.2; 95% confidence interval [CI]: 0.2-16.1; p = 0.044) and for VH (mean difference 12.0; 95% CI: 1.8-22.3; p = 0.02). The intervention group had significantly higher procedural steps knowledge and self-confidence for VH and/or PR (p < 0.05, adjusted analysis). Estimated blood loss, operative time and complications were similar between groups. CONCLUSIONS Compared to usual training, procedure-specific didactic and low fidelity simulation modules for vaginal surgery resulted in significant improvements in operative performance and several other skill parameters.
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Affiliation(s)
- Roxana Geoffrion
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole A Koenig
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey W Cundiff
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine Flood
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Momoe T Hyakutake
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Jane Schulz
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Erin A Brennand
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Terry Lee
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Joel Singer
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Nicole J Todd
- Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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Scime NV, Brown HK, Metcalfe A, Simpson AN, Brennand EA. Bilateral salpingo-oophorectomy at the time of benign hysterectomy among females with disabilities: a population-based cross-sectional study. Am J Obstet Gynecol 2023; 229:658.e1-658.e17. [PMID: 37544349 DOI: 10.1016/j.ajog.2023.08.001] [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: 01/06/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Up to 40% of patients aged ≤55 years undergo concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy, with practice variation in bilateral salpingo-oophorectomy occurring along the lines of patient health and social factors. Disability is common in premenopausal women and is an important determinant of reproductive health more broadly; however, studies on bilateral salpingo-oophorectomy rates among women with disabilities are lacking. OBJECTIVE This study aimed to examine whether the use of concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy differs by preexisting disability status in adult females aged ≤55 years. STUDY DESIGN This population-based cross-sectional study used data from the 2016-2019 US National Inpatient Sample. Females undergoing inpatient hysterectomy for a benign gynecologic indication (n=74,315) were classified as having physical (6.1%), sensory (0.1%), intellectual or developmental (0.2%), or multiple (0.2%) disabilities and compared with those without a disability. Logistic regression was used to estimate risk ratios for differences in bilateral salpingo-oophorectomy rates by disability status, adjusted for patient and clinical factors. Models were stratified by potentially avoidable or potentially appropriate bilateral salpingo-oophorectomy based on the presence of clinical indications for ovarian removal and by age group. RESULTS Bilateral salpingo-oophorectomy at the time of benign hysterectomy occurred in 26.0% of females without a disability, with rates clearly elevated in those with a physical (33.2%; adjusted risk ratio, 1.10; 95% confidence interval, 1.05-1.14) or intellectual or developmental (31.1%; adjusted risk ratio, 1.32; 95% confidence interval, 1.02-1.64) disability, possibly elevated in those with multiple disabilities (38.2%; adjusted risk ratio, 1.20; 95% confidence interval, 0.94-1.45), and similar in those with a sensory disability (31.2%; adjusted risk ratio, 0.98; 95% confidence interval, 0.83-1.13). The results were similar but with lower statistical precision for potentially avoidable and potentially appropriate bilateral salpingo-oophorectomy, which occurred in 9.1% and 17.0% of females without a disability, respectively. The largest differences in bilateral salpingo-oophorectomy rates among women with any disability were observed in the perimenopausal 45- to 49-year age group. CONCLUSION Females with disabilities experienced elevated concomitant bilateral salpingo-oophorectomy rates at the time of benign hysterectomy, particularly those with an intellectual or developmental disability and those of perimenopausal age, although some estimates were imprecise. Equity-focused physician training in surgical counseling and research into the epidemiology and experiences of gynecologic conditions among females with a disability may be beneficial.
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Affiliation(s)
- Natalie V Scime
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea N Simpson
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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Chang DH, Dumanski SM, Brennand EA, Ruzycki SM, Ramage K, Gantar T, Shah S, Ahmed SB. Female Reproductive Health and Contraception Use in CKD: An International Mixed-Methods Study. Kidney Med 2023; 5:100713. [PMID: 37719717 PMCID: PMC10502408 DOI: 10.1016/j.xkme.2023.100713] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Rationale & Objective Female reproductive health is recognized as a predictor of morbidity, mortality, and quality of life, although data in the setting of chronic kidney disease (CKD) are limited. Study Design A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey. Phase 2 was semistructured interviews offered to all respondents upon survey completion. Setting & Participants The survey was disseminated internationally from October 4, 2021, to January 7, 2022, to individuals aged 18-50 years with both a uterus and CKD diagnosis. Outcomes Menstrual health and contraceptive use by CKD stage (dialysis, nondialysis CKD, and transplant). Analytical Approach Survey data were analyzed using descriptive statistics. Interview data were analyzed using the framework method of analysis. Results Of 152 respondents, 98 (mean age 33 ± 0.7 years; n = 20 dialysis, n = 59 nondialysis CKD, n = 19 transplant) satisfied the inclusion criteria, representing 3 continents. The most common causes of CKD among survey respondents were hereditary causes in dialysis (n = 6, 30%) and glomerulonephritis in nondialysis CKD (n = 22, 37%) and transplant (n = 6, 32%). The majority reported heavy menstrual bleeding (n = 12, 86% dialysis; n = 46, 94% nondialysis CKD; n = 14, 100% transplant). Less than half of participants were consistently able to afford period products. Condoms were the most common contraceptive reported. Most participants reported no contraceptive use (n = 10, 50% dialysis; n = 37, 63% nondialysis CKD; n = 7, 37% transplant), primarily because of "fear". Interviews (n = 6) revealed a perception of a relationship between kidney function and menstrual health, concerns about contraceptive use, and a desire for greater multidisciplinary care to improve kidney and reproductive health. Limitations Self-reported outcomes, need for internet access and a device. Conclusions Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population. Plain-Language Summary Chronic kidney disease (CKD) in female individuals is accompanied by menstrual disorders and low contraceptive use. However, most data are limited to the dialysis and transplant populations. Therefore, this mixed-methods study aimed to describe self-assessed menstruation and contraceptive use across all stages of CKD. People aged 18-50 years with a uterus and CKD diagnosis were invited to participate in an online survey shared internationally as well as an optional telephone interview. Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population.
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Affiliation(s)
- Danica H. Chang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Sandra M. Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Shannon M. Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Kaylee Ramage
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taryn Gantar
- Kidney Health Strategic Clinical Network, Alberta, Canada
| | - Silvi Shah
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Sofia B. Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
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Cummings S, Scime NV, Brennand EA. Age and postoperative opioid use in women undergoing pelvic organ prolapse surgery. Acta Obstet Gynecol Scand 2023; 102:1371-1377. [PMID: 37587619 PMCID: PMC10540930 DOI: 10.1111/aogs.14638] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Our objective was to explore the relation between patient age and postoperative opioid use up to 24 hours following pelvic organ prolapse (POP) surgery. MATERIAL AND METHODS We conducted a prospective cohort study following 335 women ranging in age from 26 to 82 years who underwent surgery for multi-compartment POP at a tertiary center in Alberta, Canada. Patient characteristics were measured using baseline questionnaires. Perioperative data were collected from medical chart review during and up to 24 hours following surgery. We used logistic regression to analyze the odds of being opioid-free and linear regression to analyze mean differences in opioid dose, measured as total morphine equivalent daily dose, exploring for a potential non-linear effect of age. Adjusted models controlled for preoperative pain, surgical characteristics and patient health factors. RESULTS Overall, age was positively associated with greater odds of being opioid-free in the first 24 hours after surgery (adjusted odds ratio per increasing year of age = 1.07, 95% confidence interval [CI] 1.04-1.09, n = 332 women). Among opioid users, age was inversely associated with total opioid dose (adjusted mean difference per increasing year of age = 0.71 mg morphine equivalent daily dose, 95% CI -0.99 to -0.44, n = 204 women). There was no evidence of a non-linear relation between age and postoperative opioid use or dose. CONCLUSIONS In the context of POP surgery, we found that younger women were more likely to use opioids after surgery and to use a higher dose in the first 24 hours when compared with older women. These findings support physicians to consider age when counseling POP patients regarding pain management after surgery, and to direct resources aimed at opioid-free pain control towards younger patients.
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Affiliation(s)
- Shannon Cummings
- Department of Obstetrics and Gynecology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Natalie V. Scime
- Department of Health and SocietyUniversity of Toronto ScarboroughScarboroughOntarioCanada
| | - Erin A. Brennand
- Department of Obstetrics and Gynecology, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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Scime NV, Brown HK, Shea AK, Brennand EA. Association of infertility with type and timing of menopause: a prospective cohort study. Hum Reprod 2023; 38:1843-1852. [PMID: 37451681 PMCID: PMC10477942 DOI: 10.1093/humrep/dead143] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
STUDY QUESTION What is the association between past infertility and the type and timing of menopause in midlife women? SUMMARY ANSWER Women with a history of infertility were more likely to experience surgical menopause overall and had elevated risk of earlier surgical menopause until age 43 years but experienced no differences in the timing of natural menopause. WHAT IS KNOWN ALREADY Infertility is experienced by 12-25% of women and is thought to reveal a propensity for poor health outcomes, such as chronic illness, later in life. However, little is known about whether infertility is linked with characteristics of the menopausal transition as women age, despite possible shared underlying pathways involving ovarian function and gynecologic disease. STUDY DESIGN, SIZE, DURATION Secondary analysis of a prospective cohort study of 13 243 midlife females recruited in Phase 1 of the Alberta's Tomorrow Project (Alberta, Canada) and followed approximately every 4 years (2000-2022). PARTICIPANTS/MATERIALS, SETTING, METHODS Data were collected through standardized self-report questionnaires. History of infertility, defined as ever trying to become pregnant for more than 1 year without conceiving, was measured at baseline. Menopause characteristics were measured at each study follow-up. Menopause type was defined as premenopause, natural menopause, surgical menopause (bilateral oophorectomy), or indeterminate menopause (premenopausal hysterectomy with ovarian conservation). Timing of natural menopause was defined as the age at 1 full year after the final menstrual period, and timing of surgical and indeterminate menopause was defined as the age at the time of surgery. We used flexible parametric survival analysis for the outcome of menopause timing with age as the underlying time scale and multinomial logistic regression for the outcome of menopause type. Multivariable models controlled for race/ethnicity, education, parity, previous pregnancy loss, and smoking. Sensitivity analyses additionally accounted for birth history, menopausal hormone therapy, body mass index, chronic medical conditions, and age at baseline. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 18.2% of women reported a history of infertility. Past infertility was associated with earlier timing of surgical menopause exclusively before age 43 years (age 35: adjusted hazard ratio 3.13, 95% CI 1.95-5.02; age 40: adjusted hazard ratio 1.83, 95% CI 1.40-2.40; age 45: adjusted hazard ratio 1.13, 95% CI 0.87-1.46) as well as greater odds of experiencing surgical menopause compared to natural menopause (adjusted odds ratio 1.40, 95% CI 1.18-1.66). Infertility was not associated with the timing of natural or indeterminate menopause. LIMITATIONS, REASONS FOR CAUTION Information on the underlying cause of infertility and related interventions was not collected, which precluded us from disentangling whether associations differed by infertility cause and treatment. Residual confounding is possible given that some covariates were measured at baseline and may not have temporally preceded infertility. WIDER IMPLICATIONS OF THE FINDINGS Women with a history of infertility were more likely to experience early surgical menopause and may therefore benefit from preemptive screening and treatment for gynecologic diseases to reduce bilateral oophorectomy, where clinically appropriate, and its associated health risks in midlife. Moreover, the lack of association between infertility and timing of natural menopause adds to the emerging knowledge that diminishing ovarian reserve does not appear to be a primary biological mechanism of infertility nor its downstream implications for women's health. STUDY FUNDING/COMPETING INTEREST(S) Alberta's Tomorrow Project is only possible due to the commitment of its research participants, its staff and its funders: Alberta Health, Alberta Cancer Foundation, Canadian Partnership Against Cancer and Health Canada, and substantial in-kind funding from Alberta Health Services. The views expressed herein represent the views of the author(s) and not of Alberta's Tomorrow Project or any of its funders. This secondary analysis is funded by Project Grant Priority Funding in Women's Health Research from the Canadian Institutes of Health Research (Grant no. 491439). N.V.S. is supported by a Banting Postdoctoral Fellowship from the Canadian Institutes of Health Research. H.K.B. is supported by the Canada Research Chairs Program. E.A.B. is supported by an Early Career Investigator Award in Maternal, Reproductive, Child and Youth Health from the Canadian Institutes of Health Research. A.K.S. has received honoraria from Pfizer, Lupin, Bio-Syent, and Eisai and has received grant funding from Pfizer. N.V.S., H.K.B., and E.A.B. have no conflicts of interest to report. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Natalie V Scime
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alison K Shea
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging (MIRA), McMaster University, Hamilton, ON, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
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Chaikof M, Cundiff GW, Mohtashami F, Millman A, Larouche M, Pierce M, Brennand EA, McDermott C. Surgical sexism in Canada: structural bias in reimbursement of surgical care for women. Can J Surg 2023; 66:E341-E347. [PMID: 37402558 PMCID: PMC10322158 DOI: 10.1503/cjs.022121] [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] [Accepted: 10/12/2022] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND It is well established that female physicians in Canada are reimbursed at lower rates than their male counterparts. To explore if a similar discrepancy exists in reimbursement for care provided to female and male patients, we addressed this question: Do Canadian provincial health insurers reimburse physicians at lower rates for surgical care provided to female patients than for similar care provided to male patients? METHODS Using a modified Delphi process, we generated a list of procedures performed on female patients, which we paired with equivalent procedures performed on male patients. We then collected data from provincial fee schedules for comparison. RESULTS In 8 out of 11 Canadian provinces and territories studied, we found that surgeons were reimbursed at significantly lower rates (28.1% [standard deviation 11.1%]) for procedures performed on female patients than for similar procedures performed on male patients. CONCLUSION The lower reimbursement of the surgical care of female patients than for similar care provided to male patients represents double discrimination against both female physicians and their female patients, as female providers predominate in obstetrics and gynecology. We hope our analysis will catalyze recognition and meaningful change to address this systematic inequity, which both disadvantages female physicians and threatens the quality of care for Canadian women.
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Affiliation(s)
- Michael Chaikof
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Geoffrey W Cundiff
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Fariba Mohtashami
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Alexi Millman
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Maryse Larouche
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Marianne Pierce
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Erin A Brennand
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
| | - Colleen McDermott
- From the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand)
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Ramage K, Ducey A, Scime NV, Knox E, Brennand EA. Factors affecting women's decision between uterine-preserving versus hysterectomy-based surgery for pelvic organ prolapse. Womens Health (Lond) 2023; 19:17455057231181015. [PMID: 37387264 DOI: 10.1177/17455057231181015] [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] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Given the prevalence of women seeking surgical treatment for pelvic organ prolapse (POP), there is a need to understand women's decision-making regarding uterine-preserving versus hysterectomy-based surgeries. Historically, hysterectomy-based surgeries have been the preferred treatment for pelvic organ prolapse; however, contemporary evidence supports uterine-preserving surgeries as equivalent. At present, the lack of information available to the general public and limited options presented at surgical consultation for pelvic organ prolapse may hinder women's autonomy as they navigate surgical treatment. OBJECTIVES To examine the factors affecting women's decision-making processes regarding uterine-preserving or hysterectomy-based surgery for pelvic organ prolapse. DESIGN This is a qualitative study. METHODS We conducted semi-structured, qualitative interviews with women seeking surgery for pelvic organ prolapse to explore the factors affecting women's decision-making between hysterectomy-based and uterine-preserving surgeries. RESULTS Women (n = 26) used clinical and personal factors to determine which surgery was best. Women noted that the lack of evidence (clinical and/or anecdotal) available to them hindered their decision-making, causing them to rely more on their own interpretations of the evidence, what they perceived to be "normal," and what their surgeon recommended. Even with standardized discussion regarding the existing clinical equipoise between surgeries at the clinical consultation, some women still had misperceptions that hysterectomy-based surgery would convey the lowest risk of prolapse recurrence and be best for severe prolapse. CONCLUSION There is a need for more transparency in discussions about prolapse and the factors affecting women's decision-making for surgical repair of pelvic organ prolapse. Clinicians should be prepared to offer the option of hysterectomy-based or uterine-preserving surgeries and to clearly explain the clinical equipoise between these procedures.
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Affiliation(s)
- Kaylee Ramage
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ariel Ducey
- Department of Sociology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Natalie V Scime
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erin Knox
- Department of Sociology, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Scime NV, Shea AK, Faris P, Brennand EA. Impact of lifetime lactation on the risk and duration of frequent vasomotor symptoms: A longitudinal dose-response analysis. BJOG 2023; 130:89-98. [PMID: 35993429 PMCID: PMC9729369 DOI: 10.1111/1471-0528.17274] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the association between lifetime lactation and risk and duration of frequent vasomotor symptoms (VMS). DESIGN Prospective cohort. SETTING USA, 1995-2008. SAMPLE 2356 parous midlife women in the Study of Women's Health Across the Nation. METHODS Lifetime lactation was defined as the duration of breastfeeding across all births in months. We used generalised estimating equations to analyse risk of frequent VMS and Cox regression to analyse duration of frequent VMS in years. MAIN OUTCOME MEASURES Frequent VMS (hot flashes and night sweats) were measured annually for 10 years, defined as occurring ≥6 days in the past 2 weeks. RESULTS Overall, 57.1% of women reported hot flashes and 43.0% reported night sweats during follow-up. Lifetime lactation was inversely associated with hot flashes plateauing at 12 months of breastfeeding (6 months: adjusted odds ratio [AOR] 0.85, 95% confidence interval (CI) 0.75-0.96; 12 months: AOR 0.78, 95% CI 0.65-0.93) and was inversely associated with night sweats in a downward linear fashion (6 months: AOR 0.93, 95% CI 0.81-1.08; 18 months: AOR 0.82, 95% CI 0.67-1.02; 30 months: AOR 0.73, 95% CI 0.56-0.97). Lifetime lactation was associated with shorter duration of hot flashes and night sweats in a quadratic (bell-shaped) fashion. The association was strongest at 12-18 months of breastfeeding and significant for hot flashes (6 months: adjusted hazard ratio [AHR] 1.35, 95% CI 1.11-1.65; 18 months: AHR 1.54, 95% CI 1.16-2.03; 30 months: AHR 1.18, 95% CI 0.83-1.68). CONCLUSIONS Longer lifetime lactation is associated with decreased risk and duration of frequent VMS.
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Affiliation(s)
- Natalie V. Scime
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Alison K. Shea
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging (MIRA), McMaster University, Hamilton, ON, Canada
| | - Peter Faris
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Data & Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Erin A. Brennand
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
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Carter Ramirez A, Scime NV, Brennand EA. Development of symptomatic pelvic organ prolapse over 10 years of mid-life follow-up is affected by occupational lifting and/or pushing for parous women. Maturitas 2022; 164:9-14. [PMID: 35751986 DOI: 10.1016/j.maturitas.2022.05.006] [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] [Received: 02/14/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To document the risk of new-onset symptomatic pelvic organ prolapse (POP) among perimenopausal women and examine whether occupational lifting and/or pushing is a risk factor in the development of POP over a 10-year follow-up window. STUDY DESIGN Secondary analysis of prospective, longitudinal data from the Study of Women's Health Across the Nation (SWAN) cohort study. MAIN OUTCOME MEASURES We analyzed women with current employment at the start of SWAN who were followed annually during mid-life. At baseline, women self-reported the frequency of occupational lifting and pushing, which was classified as Never, Infrequent (less than half the time), or Frequent (half the time or more) occupational lifting and/or pushing. Women were asked about new-onset symptomatic POP from the second to tenth annual follow-up. Modified Poisson regression was used to quantify crude and adjusted risk ratios (RRs) and 95 % confidence intervals (CIs) for POP according to load-bearing categories. Parous women were modelled separately, as initial analyses suggested effect modification by parity status. RESULTS In our sample of 1590 parous women, 8.2 % reported new-onset symptomatic POP over 10 years of follow-up. Multivariable analysis revealed that Infrequent (aRR 1.51, 95 % CI 1.04-2.20) and Frequent (aRR 2.03, 95 % CI 1.29-3.17) occupational lifting and/or pushing were associated with the development of POP. CONCLUSION Frequent occupational lifting and/or pushing significantly increased parous women's risk of developing POP symptoms. This strengthens existing evidence that occupational exposures can be risk factors for POP. Gender-based education and prevention strategies in the workplace and in primary health care are necessary to reduce the burden of this condition for mid-life women.
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Affiliation(s)
- Alison Carter Ramirez
- Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Natalie V Scime
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
| | - Erin A Brennand
- Department of Obstetrics & Gynecology, University of Calgary, 4th floor, North Tower, Foothills Hospital, 1403-29 Street NW, Calgary, Alberta T2N 2T9, Canada; Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada
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Chai J, Nayakarathna R, Brennand EA. Contraception Patterns Among Immigrant and Non-Immigrant Females in Canada: Findings from a National, Cross-Sectional Survey. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Scime NV, Hetherington E, Metcalfe A, Chaput KH, Dumanski SM, Seow CH, Brennand EA. Association between chronic conditions and urinary incontinence in females: a cross-sectional study using national survey data. CMAJ Open 2022; 10:E296-E303. [PMID: 35383034 PMCID: PMC9259416 DOI: 10.9778/cmajo.20210147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Urinary incontinence affects up to half of women, yet few speak to their health care provider about or receive treatment for the condition. To aid with identifying subpopulations at risk for urinary incontinence, we examined the associations between 10 chronic health conditions and urinary incontinence among Canadian adult females. METHODS We conducted a cross-sectional analysis of survey data from the Canadian Community Health Survey (2013-2014) involving female respondents aged 25 years or older living in a private dwelling. Presence of chronic conditions and urinary incontinence were measured by self-report. We used logistic regression modelling with sampling weights, controlling for age, income, ethnicity, body mass index and smoking. Multiple imputation and probabilistic bias analysis were used to address missing covariate data and unmeasured confounding from parity. RESULTS Our analysis included 60 186 respondents representing more than 12 million Canadian females, of whom 45.8% (95% confidence interval [CI] 45.0%-46.6%) reported at least 1 chronic condition. Chronic conditions were associated with more than twice the odds of urinary incontinence (adjusted odds ratio [OR] 2.42, 95% CI 2.02-2.89). Associations were largest for bowel disorders (adjusted OR 2.92, 95% CI 2.44-3.49); modest for chronic obstructive pulmonary disease (adjusted OR 2.00, 95% CI 1.63-2.45), asthma (adjusted OR 1.82, 95% CI 1.52-2.19), arthritis (adjusted OR 1.98, 95% CI 1.74-2.24) and heart disease (adjusted OR 1.73, 95% CI 1.48-2.02); and smallest for diabetes (adjusted OR 1.20, 95% CI 1.02-1.41) and high blood pressure (adjusted OR 1.27, 95% CI 1.12-1.44). Results slightly attenuated but did not substantively change after imputation and bias analysis. INTERPRETATION We found that chronic conditions are associated with significantly higher odds of comorbid urinary incontinence among Canadian adult females, which is consistent with previous research. Our findings support routine inquiry regarding urinary incontinence symptoms among women accessing health care for chronic conditions.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin Hetherington
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Amy Metcalfe
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Kathleen H Chaput
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Sandra M Dumanski
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Cynthia H Seow
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta
| | - Erin A Brennand
- Department of Community Health Sciences (Scime, Metcalfe, Seow, Brennand), University of Calgary, Calgary, Alta.; Department of Epidemiology, Biostatistics and Occupational Health (Hetherington), McGill University, Montréal, Que.; Department of Obstetrics and Gynecology (Metcalfe, Chaput, Brennand), University of Calgary; Division of Nephrology (Dumanski), Division of Gastroenterology & Hepatology (Seow), Department of Medicine, University of Calgary, Calgary, Alta.
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Cummings S, Ramage K, Scime NV, Ahmed SB, Brennand EA. Gender expression is associated with selection of uterine preservation or hysterectomy for pelvic organ prolapse surgery: Novel methodology for sex- and gender-based analysis in gynecologic research. Int J Gynaecol Obstet 2022; 159:522-529. [PMID: 35262193 DOI: 10.1002/ijgo.14169] [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] [Received: 10/14/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore whether patient characteristics were associated with gender expression, and to further determine impact of gender expression on patient selection of hysterectomy or uterine-preservation in pelvic organ prolapse (POP) surgery. METHODS Within a prospective cohort, a self-reported gender expression tool classified patients as expressing gender polar (i.e., reporting only feminine traits) or non-polar gender scores (i.e., reporting feminine and masculine traits). Multivariate modeling explored associations of gender expression with traditional socio-demographic variables, and with selection of hysterectomy or uterine-preserving surgery. Descriptive statistics of socio-demographic variables were reported by frequency, proportion and mean (SD). RESULTS 177 participants completed the gender score questionnaire. Overall, the sample had a more feminine gender expression with the majority of respondents classified as gender polar (67.23%, n = 119). Participants with non-polar gender scores were 2.53 times (95% 1.05-6.09) more likely to choose uterine preservation versus hysterectomy-based surgery. Gender polarity was weakly associated with age, but no other sociodemographic variables. CONCLUSION Gender expression is not tightly associated with socio-demographic variables, and is thus a novel measurement in gynecologic research. Gender polarity appears to be associated with choice to undergo hysterectomy. Further research is required to understand this relationship and implications in clinical outcomes.
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Affiliation(s)
- Shannon Cummings
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaylee Ramage
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Department of Medicine, 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.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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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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Edwards A, Ramirez AC, Scime NV, Kim-Fine S, Brennand EA. Authors' Reply. J Minim Invasive Gynecol 2022; 29:576-577. [PMID: 35101630 DOI: 10.1016/j.jmig.2022.01.013] [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: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Allison Edwards
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
| | - Alison Carter Ramirez
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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Edwards A, Ramirez AC, Scime NV, Kim-Fine S, Brennand EA. Does size matter? Opioid use after laparoscopy for apical pelvic organ prolapse using an 8mm versus 10-12mm accessory port. J Minim Invasive Gynecol 2021; 29:528-534. [PMID: 34929399 DOI: 10.1016/j.jmig.2021.12.007] [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: 10/07/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To determine if a change in lateral accessory port (LAP) size from 10-12mm to 8mm among women undergoing laparoscopic native tissue pelvic organ prolapse (POP) surgery was effective at reducing opioid use after surgery. DESIGN Prospective cohort of women taking part in a POP surgical registry. SETTING Tertiary academic hospital in Calgary, Canada. PATIENTS Women undergoing laparoscopic uterosacral ligament apical suspensions for stage ≥2 POP with either uterine preservation or concomitant hysterectomy. 92 women were included during a 15-month study period from June 2020 to September 2021. INTERVENTIONS Laparoscopic apical suspension using either a 10-12mm or 8mm LAP, with the change occurring at the mid-point of the study period. Fascial defects from 10-12mm ports were closed with a fascial closure device. Perioperative care and technique were otherwise unchanged. MEASUREMENTS AND MAIN RESULTS Post-operative opioid use was measured by mean morphine equivalent daily dose (MEDD), accounting for all oral and intravenous opioids used in the first 24-hours post-surgery. 50 cases (54.3%) used a 10-12mm LAP, 42 cases (45.7%) used an 8mm LAP. Mean MEDD after surgery with a 10-12mm LAP was significantly higher than with an 8mm LAP (35.3 (95% CI 24.9-45.6) vs. 13.6 (95% CI 8.0-19.2), p<0.001). Proportion of women who did not require opioids post-operatively was higher in the 8mm group (45.2%, n=19) than the 10-12mm group (18.0%, n=9) (cOR 3.76, 95% CI 1.47-9.66). Similarly, the proportion of women who did not fill an opioid prescription after discharge was higher in the 8mm group (35.7%, n=15) than the 10-12mm group (16.0%, n=8) (cOR 2.92, 95% CI 1.09-7.81). These results remained statistically significant after adjustment for age, body mass index, race/ethnicity, length of procedure, and concomitant procedures performed. CONCLUSION Compared to 10-12mm port, use of an 8mm LAP during laparoscopic native-tissue apical POP surgery is associated with decreased opioid use in the first 24 hours after surgery.
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Affiliation(s)
- Allison Edwards
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
| | - Alison Carter Ramirez
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Shunaha Kim-Fine
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Erin A Brennand
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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Scime NV, Brown HK, Metcalfe A, Brennand EA. Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey. Women's Health Reports 2021; 2:557-565. [PMID: 34909762 PMCID: PMC8665278 DOI: 10.1089/whr.2021.0069] [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] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/25/2022]
Abstract
Introduction: Our objective was to investigate differences in prevalence of hysterectomy by self-reported disability status among Canadian women. Materials and Methods: We analyzed cross-sectional data from the Canadian Community Health Survey 2012 on 30,170 women aged ≥20 years. Disability was defined as reports of sometimes or often (vs. never) experiencing functional limitations or reduction in daily activities at home, school, or work. Frequency of these limitations was used as a proxy for disability severity. The outcome was self-reported hysterectomy status. Modified Poisson regression was used to quantify the prevalence ratio (PR) and 95% confidence interval (CI) for hysterectomy according to any, functional, or activity-limiting disability, after adjustment for household income, employment, education, ethnicity, and marital status. Results were stratified by age at time of data collection, categorized as childbearing (20–44 years), perimenopausal (45–59 years), and postmenopausal (60 years and older). Results: Disability was significantly and consistently associated with higher prevalence of hysterectomy in women. The strength of association was inversely related to age category, and PRs for a given age category were similar across disability types and severity levels. PRs for the association between any disability and hysterectomy were 2.18 (95% CI 1.36–3.50) for childbearing-aged women, 1.48 (95% CI 1.21–1.80) for perimenopausal women, and 1.12 (95% CI 1.02–1.24) for postmenopausal women. Conclusions: Prevalence of hysterectomy is disproportionately higher among women with self-reported disabilities compared with women without disabilities, with these differences most pronounced in women of childbearing age.
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Affiliation(s)
- Natalie V. Scime
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hilary K. Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
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Scime NV, Ramage K, Brennand EA. Protocol for a prospective multisite cohort study investigating hysterectomy versus uterine preservation for pelvic organ prolapse surgery: the HUPPS study. BMJ Open 2021; 11:e053679. [PMID: 34607873 PMCID: PMC8491422 DOI: 10.1136/bmjopen-2021-053679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is the descent of pelvic organs into the vagina resulting in bulge symptoms and occurs in approximately 50% of women. Almost 20% of women will elect surgical correction of this condition by age 85. Removal of the uterus (hysterectomy) with concomitant vaginal vault suspension is a long-standing practice in POP surgery to address apical (uterine) prolapse. Yet, contemporary evidence on the merits of this approach relative to preservation of the uterus through suspension is needed to better inform surgical decision making by patients and their healthcare providers. The objective of this study is to evaluate POP-specific health outcomes and service utilisation of women electing uterine suspension compared with those electing hysterectomy and vaginal vault suspension for POP surgery up to 1-year postsurgery. METHODS AND ANALYSIS This is a prospective cohort study planning to enrol 321 adult women with stage ≥2 POP from multiple sites in Alberta, Canada. Following standardised counselling from study surgeons, participants self-select either a hysterectomy based or uterine preservation surgical group. Data are being collected through participant questionnaires, medical records and administrative data linkage at four time points spanning from the presurgical consultation to 1-year postsurgery. The primary outcome is anatomic failure to correct POP, and secondary outcomes include changes in positioning of pelvic structures, retreatment, subjective report of bulge symptoms, pelvic floor distress and impact, sexual function and health service use. Data will be analysed using inverse probability weighting of propensity scores and generalised linear models. ETHICS AND DISSEMINATION This study is approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB19-2134). Results will be disseminated via peer-reviewed publications, presentations at national and international conferences, and educational handouts for patients. TRIAL REGISTRATION NUMBER NCT04890951.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kaylee Ramage
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Erin A Brennand
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Walter JE, Brennand EA, Lemos N, Cundiff GW. Corrigendum to 'Canadian Society of Pelvic Medicine Response to the Collège des Médecins du Québec Rapport d'Enquête' [Journal of Obstetrics and Gynaecology Canada 43/3 (2021) 298-299]. J Obstet Gynaecol Can 2021; 43:650. [PMID: 33992128 DOI: 10.1016/j.jogc.2021.03.008] [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: 11/18/2022]
Affiliation(s)
- Jens-Erik Walter
- Department of Obstetrics and Gynaecology, McGill University, Royal Victoria Hospital-Glen Site, Montréal, QC
| | - Erin A Brennand
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB
| | - Nucelio Lemos
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON
| | - Geoffrey W Cundiff
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
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Anglim BC, Ramage K, Sandwith E, Brennand EA. Postoperative urinary retention after pelvic organ prolapse surgery: influence of peri-operative factors and trial of void protocol. BMC Womens Health 2021; 21:195. [PMID: 33975584 PMCID: PMC8111911 DOI: 10.1186/s12905-021-01330-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/23/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Transient postoperative urinary retention (POUR) is common after pelvic floor surgery. We aimed to determine the association between peri-operative variables and POUR and to determine the number of voids required for post-void residuals (PVRs) to normalize postoperatively. METHODS We conducted a retrospective cohort study of 992 patients undergoing pelvic floor surgery at a tertiary referral centre from January 2015 to October 2017. Variables assessed included: age, BMI, ASA score, anaesthesia type, type of surgery, length of postoperative stay, surgeon, bladder protocol used, and number of PVRs required to "pass" the protocol. RESULTS Significant risk factors for POUR included: placement of MUS during POP surgery, anterior repair and hysterectomy with concomitant sacrospinous vault suspension. A total of 25.1% were discharged requiring catheterization. Patients receiving a concomitant mid-urethral sling (MUS) were 2.2 (95% CI1.6-2.9) and 2.3 (95% CI 1.8-3.1) times more likely to have elevated PVR after their second TOV and third TOV (p < 0.0001), respectively, compared with those without concomitant MUS. Permitting a third TOV allowed an additional 10% of women to pass the voiding protocol before discharge. The median number of voids to pass protocol was 2. An ASA > 2 and placement of MUS were associated with increasing number of voids needed to pass protocol. CONCLUSIONS While many women passed protocol by the second void, using the 3rd void as a cut point to determine success would result in fewer women requiring catheterization after discharge. Prior to pelvic floor surgery, women should be counselled regarding POUR probability to allow for management of postoperative expectations.
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Affiliation(s)
- B C Anglim
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada.
| | - K Ramage
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada
| | - E Sandwith
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada
| | - E A Brennand
- Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaeacology, Foothills Medical Centre, School of Medicine, University of Calgary, 1403 29 Street Northwest, Calgary, AB, T2N 2T9, Canada
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Brennand EA, Wu G, Houlihan S, Globerman D, Gagnon LH, Birch C, Hyakutake M, Carlson KV, Al-Shankiti H, Robert M, Lazare D, Kim-Fine S. Two Intraoperative Techniques for Midurethral Sling Tensioning: A Randomized Controlled Trial. Obstet Gynecol 2020; 136:471-481. [PMID: 32769657 PMCID: PMC7431154 DOI: 10.1097/aog.0000000000004027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/29/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate whether the use of a Mayo Scissor as a suburethral spacer compared with a Babcock clamp holding a loop of tape under the urethra results in different rates of abnormal bladder outcomes 12 months after retropubic midurethral sling surgery. METHODS The MUST (Mid-Urethral Sling Tensioning) trial was a block-randomized, double-blind, multicenter clinical trial that allocated women to have their retropubic midurethral slings tensioned by Scissor or Babcock technique. The primary outcome (abnormal bladder) was a composite of persistent stress urinary incontinence (SUI), overactive bladder, and urinary retention. Secondary outcomes included outcomes of the composite, postoperative catheterization, incontinence-related questionnaires, repeat incontinence treatment, and uroflowmetry. Sample size of 159 in each arm (N=318) was planned for a superiority trial, hypothesizing a 10% difference in primary outcome. RESULTS From September 2015 to December 2017, 506 women were screened and 318 were randomized. Baseline characteristics were similar in each arm. At 12 months, 253 (79.6%) women provided information on primary outcome: 40 of 128 (31.3%) patients with midurethral slings tensioned by Scissor experienced abnormal bladder, compared with 23 of 125 (18.4%) of those with midurethral slings tensioned by Babcock (P=.018, relative difference 12.9%). Secondary analyses favored Babcock for median duration of catheterization and the proportions of women experiencing urinary retention requiring sling lysis. Uroflowmetry parameters suggest the Scissor technique is more restrictive. Rates of mesh erosion were lower for the Scissor arm. No differences occurred in proportions of women experiencing patient reported persistent SUI after surgery. CONCLUSION Abnormal bladder outcomes were 12.9% less frequent for women with midurethral slings tensioned by Babcock. Both techniques provided a comparable patient reported cure for SUI at 12 months. Women with midurethral slings tensioned by Scissors experienced more intervention for obstruction, whereas those with midurethral slings tensioned by Babcock experienced higher rates of mesh erosion. This information about how the postoperative courses differ allows surgeons to better counsel patients preoperatively or tailor their choice of technique. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02480231. FUNDING SOURCE Boston Scientific.
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Affiliation(s)
- Erin A Brennand
- Department of Obstetrics & Gynecology, the Department of Community Health Sciences, the Division of Urology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, the Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, British Columbia, the Department of Obstetrics & Gynecology, University of Manitoba, Winnipeg, Manitoba, the Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, the Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada; and the Department of Obstetrics & Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Chung DE, Yurteri-Kaplan LA, Asatiani T, Brennand EA, Wang A, Grimes CL. Female Pelvic Medicine & Reconstructive Surgery (FPMRS) challenges on behalf of the collaborative research in pelvic surgery consortium (CoRPS): managing complicated cases series 2: management of urinary incontinence in a neurogenic patient. Int Urogynecol J 2018; 30:193-196. [PMID: 30406416 DOI: 10.1007/s00192-018-3806-0] [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] [Received: 07/15/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
Discussion and management of incontinence in a patient with spina bifida by four international experts followed by a literature review.
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Affiliation(s)
- Doreen E Chung
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion-11th Floor, New York, NY, 10032, USA.
| | - Ladin A Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Tengiz Asatiani
- Department of Reproductive Health, State Medical University, Tbilisi, Georgia
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Audrey Wang
- Department of Urology, The University of Sydney, Westmead Clinical School, Sydney, Australia
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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Houlihan S, Kim-Fine S, Birch C, Tang S, Brennand EA. Uterosacral vault suspension (USLS) at the time of hysterectomy: laparoscopic versus vaginal approach. Int Urogynecol J 2018; 30:611-621. [PMID: 30393822 DOI: 10.1007/s00192-018-3801-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/19/2018] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To compare laparoscopic and vaginal approaches to uterosacral ligament vault suspension (USLS) by perioperative data, short-term complications, rates of successful concomitant adnexal surgery and procedural efficacy. METHODS Retrospective cohort of USLS procedures performed at the time of hysterectomy at a tertiary care center over a 3-year period. Patient demographics, surgical data, concomitant adnexal procedures and complications were abstracted from a surgical database and compared using parametric or non-parametric tests as appropriate. Validated questionnaires (POPDI-6, UDI-6, PROMIS) were used to collect information on recurrence and long-term complications. Patients were analyzed according to both intention-to-treat analysis based on the intended approach and the completed route of surgery to deal with intraoperative conversions. RESULTS Two hundred six patients met the criteria for inclusion; 152 underwent vaginal USLS (V-USLS) and 54 laparoscopic USLS (L-USLS). No statistically significant differences in mean case time, postoperative length of stay or perioperative infection were found. While no ureteric obstructions occurred in the L-USLS group, in the V-USLS group 14 (9%) obstructions occurred (p = 0.023). Postoperative urinary retention was higher with V-USLS (31% vs. 15%, p = 0.024). Rates of successfully completed adnexal surgery differed (56% vs. 98%, p < 0.001) in favor of L-USLS. Patient-reported symptomatic recurrence of prolapse was higher in the V-USLS group (41% vs. 24%, p = 0.046); despite this, re-treatment did not differ between the groups (0% vs. 7%, p = 0.113). CONCLUSIONS Perioperative case time and complications did not differ between approaches. However, rates of completed adnexal surgery were significantly higher in the laparoscopic group, which could influence surgical decisions concerning approaches to prolapse surgery.
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Affiliation(s)
- Sara Houlihan
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 4th Floor North Tower, Room 432, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 4th Floor North Tower, Room 432, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Colin Birch
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 4th Floor North Tower, Room 432, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Selphee Tang
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 4th Floor North Tower, Room 432, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 4th Floor North Tower, Room 432, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
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Brennand EA, Kim-Fine S. Comment on “A constricted midurethral sling needs loosening within 48–72 hours”. Int Urogynecol J 2018; 29:611-612. [DOI: 10.1007/s00192-018-3572-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
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Brennand EA, Tang S, Birch C, Robert M, Kim-Fine S. Early voiding dysfunction after midurethral sling surgery: comparison of two management approaches. Int Urogynecol J 2017; 28:1515-1526. [DOI: 10.1007/s00192-017-3302-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
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Abstract
Simulation in surgical training is playing an increasingly important role as postgraduate medical education programs navigate an environment of increasing costs of education, increased attention on patient safety, and new duty hour restrictions. In obstetrics and gynecology, simulation has been used to teach many procedures; however, it lacks a standardized curriculum. Several different simulators exist for teaching various routes and aspects of hysterectomy. This article describes how a formal framework of increasing levels of competencies can be applied to simulation in teaching the procedure of hysterectomy.
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Affiliation(s)
- Shunaha Kim-Fine
- Department of Obstetrics and Gynecology, University of Calgary, 29 Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, University of Calgary, 29 Street NW, Calgary, Alberta T2N 2T9, Canada
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Brennand EA, Kim-Fine S. A randomized clinical trial of how to best position retropubic slings for stress urinary incontinence: Development of a study protocol for the mid-urethral sling tensioning (MUST) trial. Contemp Clin Trials Commun 2016; 3:60-64. [PMID: 29736458 PMCID: PMC5935876 DOI: 10.1016/j.conctc.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/04/2016] [Revised: 03/28/2016] [Accepted: 04/11/2016] [Indexed: 11/21/2022] Open
Abstract
The goal of this trial is to compare two techniques for tensioning retropubic midurethral slings: a Mayo scissor between the tape and urethra vs. a Babcock clamp creating a measured loop underneath the urethra. The primary outcome is a composite of abnormal bladder function at 12 months post surgery. Abnormal bladder function is defined as bothersome stress incontinence or worsening over active bladder symptoms, a positive cough stress test, re-treatment of stress urinary incontinence, post-operative urinary retention requiring either catheterization beyond 6 weeks or surgical intervention. Secondary outcomes include the duration of post operative urinary retention, quality of life scores, and physical examination. This article describes the rationale and design of this clinical trial, which will be of interest to those who care for patient with pelvic floor disorders such as stress urinary incontinence.
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Affiliation(s)
- Erin A. Brennand
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, AB, Canada
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Brennand EA, Banerjee RN. Letter to the Editor regarding: “Treatment patterns and survival outcomes in patients with cervical cancer complicated by complete uterine prolapse: a systematic review of literature”. Int Urogynecol J 2016; 27:1283. [DOI: 10.1007/s00192-016-3062-0] [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] [Indexed: 11/24/2022]
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Brennand EA, Robert M, Ross S. Authors' reply re: Twelve-month outcomes following midurethral sling procedures for stress incontinence: impact of obesity. BJOG 2016; 123:1404. [PMID: 27272304 DOI: 10.1111/1471-0528.13894] [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] [Accepted: 12/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Erin A Brennand
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, AB, Canada
| | - Magali Robert
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, AB, Canada
| | - Sue Ross
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, AB, Canada
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Brennand EA, Tang S, Williamson T, Birch C, Murphy M, Robert M, Ross S. Twelve-month outcomes following midurethral sling procedures for stress incontinence: impact of obesity. BJOG 2014; 122:1705-12. [PMID: 25316484 DOI: 10.1111/1471-0528.13132] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate impact of body mass index (BMI) ≥30 on objective and subjective cure rates 12 months after midurethral sling surgery. DESIGN Secondary analysis. SETTING Three hospitals in Calgary, Canada, 2005-07. POPULATION A total of 182 women enrolled in a randomised control trial of tension-free vaginal tape versus transobturator tape. METHODS Women were classified as obese or nonobese from height and weight on day of surgery. Women underwent postoperative standardised pad tests, self-reporting of urinary incontinence, and quality of life scores. Categorical data compared with chi-square or Fisher's exact, continuous data compared with Mann-Whitney U test. MAIN OUTCOME MEASURES Primary outcome was objective cure, defined as <1 g urine loss on postoperative 1-hour pad test. Secondary outcomes were subjective cure of incontinence (no stress incontinence in previous 7 days), presence of urinary urgency in previous 7 days, Urogenital Distress Inventory (UDI-6) scores, Incontinence Impact Questionnaire (IIQ-7) scores, and surgical complication rates. RESULTS Objective cure differed, with 85.6% of nonobese women leaking <1 g on 1-hour pad test, versus 67.8% of obese women (P = 0.006, risk difference [RD] 17.8%, 95% confidence interval [95% CI] 4.2-31.4%). Subjective cure was 85.8% for nonobese women versus 70.7% for obese women (P = 0.016, RD 15.1%, 95% CI 1.9-28.4%). For both groups, improvement was seen for postoperative UDI-6 (median -33.3 [-44.4 to -22.2] and -27.2 [-44.4 to -16.7]) and IIQ-7 scores (median -26.2 [-45.2 to -14.3] and -23.8 [-42.9 to -14.3]). No differences existed in rates of operative complications between the two groups. CONCLUSION Twelve months after midurethral sling surgery, obese women experience lower rates of cure than those who are nonobese.
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Affiliation(s)
- E A Brennand
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
| | - S Tang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - T Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - C Birch
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
| | - M Murphy
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
| | - M Robert
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
| | - S Ross
- Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB, Canada
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Brennand EA, Bhayana D, Tang S, Birch C, Murphy M, Cenaiko D, Ross S, Robert M. Anchor placement and subsequent movement in a mesh kit with self-fixating tips: 6-month follow-up of a prospective cohort. BJOG 2014; 121:634-40. [PMID: 24621073 DOI: 10.1111/1471-0528.12536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the initial placement of Elevate single-incision mesh kit device tips relative to the sacrospinous ligament, and to measure tip movement over a 6-month period from initial placement. DESIGN Prospective cohort. SETTING Tertiary care urogynaecology centre in Calgary, Canada. POPULATION Women electing for surgical management of anterior vaginal wall prolapse. METHODS Ten women underwent anterior prolapse repair using the Elevate single-incision mesh kit with a metallic fiducial marker attached to the tips of the surgical device. Women were imaged by magnetic resonance imaging (MRI) within 48 hours of surgery, and again 6 months later to investigate the position of the device tips and change ≥4 mm over the 6-month postoperative period. MAIN OUTCOME MEASURE(S) Position of self-fixating tips within 48 hours of surgery, and at six months post-operative. RESULTS Anchor insertion was directly into the sacrospinous ligament in 10 of 20 insertion points (50%, 95% CI 27-73%). Movement was most often noted in the cranial-caudal direction: a change in location of ≥4 mm was observed for 8/20 anchors (40%, 95% CI 19-64%). Cranial-caudal movement was observed less frequently among sacrospinous anchors than among anchors inserted into other pelvic structures (1/10 versus 7/10, P = 0.020, difference in proportion -60%, 95% CI -94 to -26%). PFDI-20 scores improved statistically significantly by 6 months (P = 0.008, mean change -62.9%, 95% CI -105.1 to -20.7%), but PFIQ-7 scores did not change statistically significantly over the same time period (P = 0.523, mean change -12.4%, 95% CI -54.5 to 29.8%). CONCLUSIONS The novel self-fixating anchoring tips of this single-incision mesh kit do not reliably anchor into the sacrospinous ligament. The tips have been shown to move with time, although not all cases of anchor movement were associated with recurrent prolapse.
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Affiliation(s)
- E A Brennand
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, AB, Canada
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Vallianatos H, Brennand EA, Raine K, Stephen Q, Petawabano B, Dannenbaum D, Willows ND. Cree Women Speak: Intergenerational Perspectives on Weight Gain during Pregnancy and Weight Loss after Pregnancy. IJIH 2013. [DOI: 10.18357/ijih41200812310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Obesity is prevalent among the First Nations population in Canada, with serious associated health risks. Recent studies also indicate that a high percentage of First Nations women are overweight or obese at the start of their pregnancies, with a tendency to retain weight after their children are born. In response to these concerns, a community-based study was conducted in two Cree communities, using qualitative methods to investigate young mothers’ perceptions and concerns about weight gain during pregnancy and challenges to postpartum weight loss. Female Elders were also interviewed to provide some historical context and to give some insight into culturally appropriate responses to the current weight-related health challenges being faced by young mothers. Overall, the study showed that most of the participants—young and old— associated “healthy foods” with traditional foods and “healthy living” with bush life. However, while Elders recounted staying active and eating traditional foods throughout their pregnancies, the younger women tended not to put their knowledge of what constitutes a healthy lifestyle into practice, mainly due to various individual and societal barriers. Some of the barriers identified related to lifestyle changes, including increased consumption of “white man’s foods” and decreased physical activity, as well as to larger social changes, such as the medicalization of pregnancy and diminished community support networks for young mothers. Participants provided insight into how traditional practices could be intertwined with the benefits of contemporary life to help address some of the health issues currently affecting young Cree mothers.
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Abstract
OBJECTIVE To determine the effect of pregravid weight and pregnancy weight gain on pregnancy outcomes in Cree women. METHODS We reviewed maternal and infant outcomes of the first pregnancy in Cree women living in James Bay, Quebec, from 1994 to 2000. We examined data from women who had a full-term singleton birth and a maternal pregravid body mass index (BMI) > or = 18.5 kg/m2 and whose weight had been recorded in the first trimester and within one month prior to delivery. Weight in the first trimester was used to estimate pregravid BMI. RESULTS Data were available for 603 women. At the beginning of pregnancy, 23.1% of the women had normal weight (BMI 18.5-24.9 kg/m2), 27.9% were overweight (BMI 25-29.9 kg/m2), and 49.1% were obese (BMI > or = 30 kg/m2). Nearly one-half of the women gained excessive weight in pregnancy. Adverse outcomes were less common in women with a normal pregravid BMI than in women with a pregravid BMI in the overweight or obese range. Obese women with excessive weight gain had a higher prevalence of preeclampsia (14.9%) than obese women with low (3.7%) or acceptable (6.3%) weight gain; however, obese women with excessive weight gain had a lower prevalence of gestational diabetes mellitus. CONCLUSION Interventions must be developed to prevent pregravid obesity and excessive weight gain in pregnancy in Cree women to improve maternal and fetal outcomes.
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Affiliation(s)
- Erin A Brennand
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton AB
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Vallianatos H, Brennand EA, Raine K, Stephen Q, Petawabano B, Dannenbaum D, Willows ND. Beliefs and practices of First Nation women about weight gain during pregnancy and lactation: implications for women's health. Can J Nurs Res 2006; 38:102-19. [PMID: 16671283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Many Cree women in northern Quebec experience excessive weight gain during pregnancy and retain the weight between pregnancies. This contributes to poor maternal-fetal outcomes and increased rates of obesity-related health problems. The purpose of this qualitative descriptive study was to explore (a) Cree women's perceptions of weight gain in pregnancy and weight loss following pregnancy, (b) the barriers that women face in maintaining a healthy body weight, and (c) the sociocultural context of health. Semi-structured interviews were conducted with 30 women who had given birth within the preceding 12 months. Many women spoke of the negative health consequences of excessive weight gain, yet they found it difficult to lose weight due to individual constraints such as lack of time, cultural beliefs about diet while breastfeeding, and community constraints including lack of child care and lack of community programs for mothers.
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Affiliation(s)
- Helen Vallianatos
- Centre for Health Promotion Studies, University of Alberta, Edmonton, Canada
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