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Balgobin S, Balk EM, Porter AE, Misal M, Grisales T, Meriwether KV, Jeppson PC, Doyle PJ, Aschkenazi SO, Miranne JM, Hobson DT, Howard DL, Mama S, Gupta A, Antosh DD. Enabling Technologies for Gynecologic Vaginal Surgery: A Systematic Review. Obstet Gynecol 2024; 143:524-537. [PMID: 38301255 DOI: 10.1097/aog.0000000000005522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures. DATA SOURCES We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022. METHODS OF STUDY SELECTION Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated. TABULATION, INTEGRATION, AND RESULTS The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, -23.3 to -85), blood loss by 36.9 mL (95% CI, -56.9 to -17.0), hospital stay by 0.2 days (95% CI, -0.4 to -0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, -1.7 to -1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity. CONCLUSION Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327490.
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Affiliation(s)
- Sunil Balgobin
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio; the Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California; the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico; the Woman's Center for Advanced Pelvic Surgery, Phoenix, Arizona; the Departments of Obstetrics and Gynecology and Urology, School of Medicine & Dentistry, University of Rochester, Rochester, New York; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Waukesha, Wisconsin; the Division of Urogynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan; the Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, and the Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey; and the Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, Louisville, Kentucky
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Miranne JM, Courtepatte A, Schatzman-Bone S, Minassian VA. Risk Factors for Missed Appointments at a Multisite Academic Urban Urogynecology Practice. Urogynecology (Phila) 2024; 30:406-412. [PMID: 37737743 DOI: 10.1097/spv.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
IMPORTANCE Missed appointments lead to decreased clinical productivity and poor health outcomes. OBJECTIVES The objectives of this study were to describe sociodemographic and clinical characteristics of patients who miss urogynecology appointments and identify risk factors for missed appointments. STUDY DESIGN We conducted an institutional review board-approved case-control study of women 18 years or older scheduled for a urogynecology appointment at 1 of 4 sites associated with an urban academic tertiary care center over 4 months. Patients were included in the missed appointment group if they canceled their appointments the same day or did not show up for them. For comparison, we included a control group consisting of patients immediately preceding or following the ones who missed their appointments with the same visit type. Logistic regression was used to identify risk factors for missed appointments. RESULTS Four hundred twenty-six women were included: 213 in the missed appointment group and 213 in the control group. Women who missed appointments were younger (60 years [interquartile range (IQR), 47-72 years] vs 69 years [IQR, 59-78 years], P < 0.0001). More women in the missed appointment group were Hispanic (24.4% vs 13.1%) and non-Hispanic Black (7.5% vs 3.8%, P = 0.009), had Medicaid (17.4% vs 6.57%, P = 0.0006), missed previous appointments (24.9% vs 11.7% P = 0.0005), waited longer for appointments (39 days [IQR, 23.5-55.5 days] vs 30.5 days [IQR, 12.8-47.0 days], P = 0.002), and made appointments for urinary incontinence (44.1% vs 26.8%, P = 0.0002). On multivariate logistic regression, women with Medicaid had significantly higher odds of missing appointments (adjusted OR, 2.11 [1.04-4.48], P = 0.044). CONCLUSIONS Women with Medicaid were more likely to miss urogynecology appointments. Further research is needed to address barriers this group faces when accessing care.
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Affiliation(s)
- Jeannine M Miranne
- From the Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alexa Courtepatte
- Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, Boston, MA
| | | | - Vatche A Minassian
- From the Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Markert T, Courtepatte A, Farah S, Miranne JM. Number of patients with interstitial cystitis/bladder pain syndrome seen before versus during the COVID-19 pandemic at an academic, urban, multisite urogynecology practice. Low Urin Tract Symptoms 2023; 15:247-255. [PMID: 37700527 DOI: 10.1111/luts.12502] [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: 05/23/2023] [Revised: 07/21/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Little is known about the impact of the COVID-19 pandemic on interstitial cystitis/bladder pain syndrome (IC/BPS). We aim to compare the number of newly diagnosed IC/BPS cases and number of patients with flares prior to and during the pandemic. METHODS We conducted a retrospective cohort study of women ≥18 years who were diagnosed with or treated for IC/BPS between March 2019 and March 2021 at an academic, urban, multisite urogynecology practice. The primary outcome was the number of IC/BPS cases from March 1, 2019 to February 29, 2020 (pre-pandemic) compared with March 1, 2020 to February 28, 2021 (during pandemic). The secondary outcome was the number of patients with flares during those same two time periods. Demographic and clinical characteristics were compared using nonparametric tests and interrupted time series (ITS) was used to evaluate our outcomes of interest. p-Value <.05 was considered significant. RESULTS Fifty-four women (4.87% of new patients) were diagnosed with IC/BPS during the pandemic compared with 40 women pre-pandemic (4.05% of new patients). The median age was 35.0. Seventy-two percent were premenopausal, 75% sexually active, and 31% had anxiety, and there were no significant differences between groups. Although the number of patients newly diagnosed with IC/BPS was higher during the pandemic, the diagnosis rates between time periods were not statistically different. Thirty-five patients experienced flares during the pandemic compared with 49 patients the year prior (p = .43). This difference was also not statistically significant on ITS analysis. CONCLUSIONS Although more patients were diagnosed with IC/BPS during versus before the pandemic, the difference in diagnosis rates was not different between these periods.
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Affiliation(s)
| | - Alexa Courtepatte
- Division of Urogynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Jeannine M Miranne
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Urogynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Courtepatte A, Miranne JM, Murray T, Kelly M, Minassian VA. Voiding Trial Outcomes After Prolapse Surgery: Before Versus During the COVID-19 Pandemic. Urogynecology (Phila) 2023; 29:836-843. [PMID: 37093571 DOI: 10.1097/spv.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
IMPORTANCE Coronavirus disease 2019 (COVID-19) has changed practice patterns resulting in same-day discharge after most urogynecologic surgical procedures. OBJECTIVE We aimed to determine if COVID-19 practice patterns changed patients' voiding trial (VT) results after surgery. STUDY DESIGN This is a retrospective cohort study of women undergoing urogynecologic surgery at an academic tertiary care center. We compared patients who had surgery between January 1, 2019, and February 28, 2020, (pre-COVID, discharged on postoperative day [POD] 1) with those who underwent surgery between January 1, 2021, and February 28, 2022, (during COVID, discharged on POD 0 or POD 1). Demographics, surgical characteristics, and VT results were compared using nonparametric tests. A logistic regression was performed to adjust for confounders. P value <0.05 was considered statistically significant. RESULTS A total of 237 patients were included. Patients were mostly White, older than 65 years (interquartile range, 56-73 years), and had a median parity of 2 (interquartile range, 2-3). Approximately 31% of patients in the pre-COVID group failed their VT, whereas 38% in the during-COVID group failed ( P = 0.275). Moreover, 40.5% of women discharged the day of surgery failed their VT ( P = 0.172). Compared with the pre-COVID group, more patients in the during-COVID group and those discharged on POD 0 contacted their surgeons with questions postoperatively (20.5% vs 35.0% and 35.4%, P = 0.014 and 0.022, respectively). Rates of urinary tract infection were similar by period and discharge day ( P > 0.05). There was no statistical association between day of discharge or the COVID-19 pandemic and VT results. CONCLUSIONS Neither day of discharge nor the presence of the COVID-19 pandemic had a significant effect on postoperative outcomes, including urinary retention, after urogynecologic surgery. Same-day discharge is appropriate for most patients.
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Affiliation(s)
- Alexa Courtepatte
- From the Division of Urogynecology, Department of OB/GYN, Brigham and Women's Hospital, Boston, MA
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Mazloomdoost D, Kanter G, Chan RC, Deveaneau N, Wyman AM, Von Bargen EC, Chaudhry Z, Elshatanoufy S, Miranne JM, Chu CM, Pauls RN, Arya LA, Antosh DD. Social networking and Internet use among pelvic floor patients: a multicenter survey. Am J Obstet Gynecol 2016; 215:654.e1-654.e10. [PMID: 27319368 DOI: 10.1016/j.ajog.2016.06.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/28/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Internet resources are becoming increasingly important for patients seeking medical knowledge. It is imperative to understand patient use and preferences for using the Internet and social networking websites to optimize patient education. OBJECTIVES The purpose of this study was to evaluate social networking and Internet use among women with pelvic floor complaints to seek information for their conditions as well as describe the likelihood, preferences, and predictors of website usage. STUDY DESIGN This was a cross-sectional, multicenter study of women presenting to clinical practices of 10 female pelvic medicine and reconstructive surgery fellowship programs across the United States, affiliated with the Fellows' Pelvic Research Network. New female patients presenting with pelvic floor complaints, including urinary incontinence, pelvic organ prolapse, and fecal incontinence were eligible. Participants completed a 24 item questionnaire designed by the authors to assess demographic information, general Internet use, preferences regarding social networking websites, referral patterns, and resources utilized to learn about their pelvic floor complaints. Internet use was quantified as high (≥4 times/wk), moderate (2-3 times/wk), or minimal (≤1 time/wk). Means were used for normally distributed data and medians for data not meeting this assumption. Fisher's exact and χ2 tests were used to evaluate the associations between variables and Internet use. RESULTS A total of 282 surveys were analyzed. The majority of participants, 83.3%, were white. The mean age was 55.8 years old. Referrals to urogynecology practices were most frequently from obstetrician/gynecologists (39.9%) and primary care providers (27.8%). Subjects were well distributed geographically, with the largest representation from the South (38.0%). Almost one third (29.9%) were most bothered by prolapse complaints, 22.0% by urgency urinary incontinence, 20.9% by stress urinary incontinence, 14.9% by urgency/frequency symptoms, and 4.1% by fecal incontinence. The majority, 75.0%, described high Internet use, whereas 8.5% moderately and 4.8% minimally used the Internet. Women most often used the Internet for personal motivations including medical research (76.4%), and 42.6% reported Google to be their primary search engine. Despite this, only 4.9% primarily used the Internet to learn about their pelvic floor condition, more commonly consulting an obstetrician-gynecologist for this information (39.4%). The majority (74.1%) held a social networking account, and 45.9% visited these daily. Nearly half, 41.7%, expressed the desire to use social networking websites to learn about their condition. Women <65 years old were significantly more likely to have high Internet use (83.4% vs 68.8%, P = .018) and to desire using social networking websites to learn about their pelvic floor complaint (P = .008). The presenting complaint was not associated with Internet use (P = .905) or the desire to use social networking websites to learn about pelvic floor disorders (P = .201). CONCLUSION Women presenting to urogynecology practices have high Internet use and a desire to learn about their conditions via social networking websites. Despite this, obstetrician-gynecologists remain a common resource for information. Nonetheless, urogynecology practices and national organizations would likely benefit from increasing their Internet resources for patient education in pelvic floor disorders, though patients should be made aware of available resources.
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Abstract
AIM OF VIDEO/INTRODUCTION Female genital cosmetic surgery is performed for aesthetic reasons as well as for medical and functional indications, such as congenital labia minora hypertrophy. The purpose of this video is to teach vulvar anatomy and review labia minorplasty techniques. METHODS We demonstrate one technique in this video. CONCLUSIONS There are a variety of different techniques for labia minorplasty. When deciding the most appropriate technique to use, the patient's goals must be considered.
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Affiliation(s)
- Ladin A Yurteri-Kaplan
- Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, 106 Irving Street NW POB Suite 405 South, Washington, DC, 20010, USA,
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Miranne JM, Lopes V, Carberry CL, Sung VW. The effect of pelvic organ prolapse severity on improvement in overactive bladder symptoms after pelvic reconstructive surgery. Int Urogynecol J 2012; 24:1303-8. [PMID: 23229418 DOI: 10.1007/s00192-012-2000-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study evaluates the effect of baseline pelvic organ prolapse (POP) severity on improvement in overactive bladder (OAB) symptoms after pelvic reconstructive surgery. METHODS We performed a retrospective cohort study of women with POP and OAB who underwent surgical correction of symptomatic apical and/or anterior POP. OAB was defined as an affirmative response to item #15 (urinary frequency) and/or item #16 (urge incontinence) of the Pelvic Floor Distress Inventory (PFDI). POP severity was dichotomized as Pelvic Organ Prolapse Quantification (POP-Q) stage 1-2 versus stage 3-4. Our primary outcome was complete resolution or improvement of urinary frequency or urge incontinence on the PFDI 12 months postoperatively. RESULTS At 12 months postoperative, 41 (89%) women with stage 1-2 POP versus 47 (85 %) with stage 3-4 POP reported improvement in urinary frequency (p = 0.58). Thirty five (90 %) with stage 1-2 and 34 (85 %) with stage 3-4 POP reported improvement in urge incontinence (p = 0.74). On multiple logistic regression, women with stage 3-4 POP had a decreased odds of improvement in frequency or urge incontinence compared with women with stage 1-2 POP (adjusted odds ration [AOR] = 0.06 [95 % CI 0.01-0.67]), after adjusting for confounders. CONCLUSIONS Women with coexisting POP and OAB who undergo surgical correction of POP experience improvement in OAB symptoms after surgery, although women with more severe POP may be at a higher risk of persistent frequency or urge incontinence.
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Affiliation(s)
- Jeannine M Miranne
- Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC 20010, USA.
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Miranne JM, Hampton BS, Sung VW. Midurethral sling shortening for persistent stress urinary incontinence. Int Urogynecol J 2011; 23:805-7. [DOI: 10.1007/s00192-011-1617-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 11/15/2011] [Indexed: 10/15/2022]
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Miranne JM, Yavagal S, Hernandez-Silen A, Feustel PJ, De EJ. HIGHER INDEX OF SUSPICION FOR NEUROLOGIC DISEASE IS WARRANTED IF RECTAL CONTRACTIONS OCCUR DURING URODYNAMIC TESTING. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61528-1] [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: 11/29/2022]
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