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Das D, Squires N, Mueller M, Collins S, Lewicky-Gaupp C, Bretschneider CE, Geynisman-Tan J, Kenton K. Suture-Needle Management Device and Novel Port Configuration for Robotic Sacrocolpopexy. Urogynecology (Phila) 2024:02273501-990000000-00216. [PMID: 38657626 DOI: 10.1097/spv.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
IMPORTANCE Robot-assisted sacrocolpopexy (SCP) is a commonly performed procedure for the repair of apical pelvic organ prolapse; therefore, novel devices and techniques to improve safety and efficacy of this procedure should be explored. OBJECTIVE The objective of this study was to assess safety and efficacy of 8-mm trocar site for use of a disposable suture/needle management device (StitchKit; Origami Surgical, Madison, NJ) for robot-assisted SCP with a 4-arm configuration and no assistant port. STUDY DESIGN This is a retrospective case series of patients undergoing robot-assisted SCP at a tertiary center from 2018 to 2021. All surgical procedures were performed using four 8-mm robotic trocars and StitchKit device. Our objective was to review all cases in which this technique was used to determine whether the approach resulted in a safely completed procedure and any complications or adverse events. Secondary objectives were to describe patient and operative characteristics. RESULTS In total, 422 patients underwent robot-assisted SCP for pelvic organ prolapse. The mean age was 60 ± 10 years, and mean body mass index was 27 ± 6 (calculated as weight in kilograms divided by height in meters squared). Most patients had stage 3 prolapse (73%) and underwent concomitant hysterectomy (70%). Ninety-nine percent (n = 416) of cases were completed robotically. StitchKit was successfully inserted and removed in all robotic cases with correct needle counts. All patients had postoperative visits, and 80% followed up at 3 months. No umbilical/port site hernias, operative site infections, or adverse events were reported. CONCLUSIONS Robot-assisted SCP can be performed safely using a 4-arm robotic configuration and suture kit device. This setup eliminates incisions greater than 8 mm and an assistant port, allowing for surgical efficiency without compromising patient outcomes.
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Affiliation(s)
- Deepanjana Das
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University, Chicago, IL
| | - Natalie Squires
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University, Chicago, IL
| | - Margaret Mueller
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL
| | - Sarah Collins
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL
| | - Christina Lewicky-Gaupp
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL
| | - C Emi Bretschneider
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University, Chicago, IL
| | - Julia Geynisman-Tan
- From the Division of Urogynecology and Reconstructive Pelvic Surgery, Northwestern University, Chicago, IL
| | - Kimberly Kenton
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago, Chicago, IL
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Nguyen H, Brown O, Bretschneider CE, Mueller M, Geynisman-Tan J, Lewicky-Gaupp C, Kenton K, Collins S. Use of a Computerized Decisional Analysis Tool in Patients With Urgency Urinary Incontinence. Urogynecology (Phila) 2023; 29:757-762. [PMID: 37607310 DOI: 10.1097/spv.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
IMPORTANCE Decision analysis tools (DAT) are shared decision making instruments that include patient input on treatment goals and values that have been shown to decrease decisional regret in women's health care. OBJECTIVE We describe a novel, computerized DAT for patients with urinary incontinence (UI), and our primary aim was to assess the concordance between treatment fit as determined by the DAT and treatment selected after physician counseling in patients with urgency urinary incontinence and urgency predominant mixed urinary incontinence. STUDY DESIGN We partnered with a health care startup to develop a computerized DAT incorporating evidence about UI and patient input about treatment goals and personal values. This is a retrospective cohort study examining the concordance of DAT-predicted treatments identified before consultation with the physician and those chosen after counseling. Electronic medical records were reviewed to abstract demographic, clinical data, and treatments chosen at the initial physician consultation. Because it was possible to pursue concurrent treatment options (ie, pelvic floor physical therapy and medications), the first 2 modalities identified in the treatment plan at consultation were abstracted. Descriptive statistics were conducted using SPSS®, we did not adjust for multiple comparisons. RESULTS Four hundred eighty-nine patients met the inclusion criteria for our study, and 65% of the cohort chose treatment options after counseling that were concordant with their DAT best treatment fit. CONCLUSION Patients choosing treatment for urgency urinary incontinence and urgency predominant mixed urinary incontinence using a novel, computer-based DAT to prepare for shared decision making with their physicians often choose to proceed with their top DAT-determined treatment fit after counseling.
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Affiliation(s)
- Hoa Nguyen
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL
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Mou T, Nelson L, Lewicky-Gaupp C, Brown O. Opportunities to Advance Postpartum Pelvic Floor Care With a Health Equity-based Conceptual Framework. Clin Obstet Gynecol 2023; 66:86-94. [PMID: 36657047 DOI: 10.1097/grf.0000000000000757] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
An essential part of postpartum care includes the evaluation and treatment of pelvic floor disorders (PFDs). Postpartum PFDs are common and occur in over 40% of postpartum women. Despite significant advancements in urogynecology to understand postpartum PFDs and their treatments, there has been a lack of attention to addressing equity in postpartum pelvic floor care. In this article, we address the current scientific understanding of postpartum PFDs while adapting a health equity-based conceptual framework to highlight areas of opportunity in optimizing postpartum pelvic floor care.
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Affiliation(s)
- Tsung Mou
- Division of Urogynecology and Pelvic Reconstructive Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
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Das D, Squires N, Mueller M, Collins S, Lewicky-Gaupp C, Bretschneider C, Geynisman-Tan J, Kenton K. Use of Novel Configuration with Suture Kit Device for Robotic-assisted Minimally Invasive Sacrocolpopexy. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Das D, Carroll A, Mueller M, Kenton K, Lewicky-Gaupp C, Collins S, Geynisman-Tan J, Bretschneider CE. Mesh complications after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy. Int Urogynecol J 2022; 33:2507-2514. [PMID: 35666287 DOI: 10.1007/s00192-022-05251-0] [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: 01/17/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our objective was to compare mesh exposure rates (4 months and 1 year) after total (TLH) vs supracervical (SLH) laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy (SCP). Secondary outcomes included 30-day complications and midurethral mesh exposure rates. METHODS This a retrospective cohort study at a tertiary care referral center from 2011 to 2018. Subjects were identified using Current Procedural Terminology codes. Demographics, operative characteristics, and perioperative complications were abstracted from medical records. RESULTS Four hundred three women met the inclusion criteria: 91 SLH+SCP and 312 TLH+SCP. Median follow-up was 52 weeks with an overall mesh exposure rate of 1.5%. Follow-up was available for 90% of patients at 4 months and 51% at 1 year. Half of patients had lightweight mesh (n = 203), and half had ultralightweight mesh (n = 200). Vaginal mesh fixation was performed with permanent suture in 86% (n = 344) and delayed absorbable suture in 14% (n = 56) of patients. At 4 months, vaginal mesh exposure rates did not differ between groups (0% SLH vs 1% TLH, p = 1.00). All mesh exposures in the study period occurred with lightweight mesh in the TLH arm. No differences were noted in 1-year mesh exposure rates, 30-day perioperative complications (p = 0.57), or midurethral mesh exposure rates at 4 months (p = 0.35) and 1 year (p = 1.00) between groups. CONCLUSIONS Short-term mesh exposure following SCP with ultralightweight and lightweight polypropylene mesh is rare regardless of type of hysterectomy and much lower than reported in earlier studies with heavier weight mesh. These data suggest TLH at the time of SCP is a safe option in appropriately counseled patients.
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Affiliation(s)
- Deepanjana Das
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA.
| | - Allison Carroll
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA
| | - Margaret Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA
| | - Sarah Collins
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA
| | - Julia Geynisman-Tan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, 250 E Superior St, 5th Floor, Suite 05-2113, Chicago, IL, 60611, USA
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Brown O, Luchristt D, Miller ES, Pidaparti M, Geynisman-Tan J, Kenton K, Lewicky-Gaupp C. Is there an Association between Vaginal Birth after Cesarean Prediction and Obstetric Anal Sphincter Injury? Am J Perinatol 2022; 39:750-758. [PMID: 32992349 DOI: 10.1055/s-0040-1717099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to estimate whether there is an association between the predicted probability of vaginal birth after cesarean delivery (VBAC) and the occurrence of obstetric anal sphincter injuries (OASIS). STUDY DESIGN This was a single-site retrospective cohort study of all women with a singleton vaginal birth after a previous cesarean section between January 2011 and December 2016. Women were divided into four ordinal groupings by the predicted probability of achieving vaginal birth after cesarean using the Maternal-Fetal Medicine Units Network VBAC calculator (less than 41%, 40.1-60%, 60.1-80%, and greater than 80%). The primary outcome was OASIS, defined as a 3rd or 4th degree perineal laceration. Bivariable and multivariable analyses were used to examine the association between predicted VBAC probability and OASIS. RESULTS In total, 1,411 women met inclusion criteria and 73 (5.2%) sustained OASIS. The median predicted probability of VBAC was lower in women with OASIS compared with those without OASIS (60% [interquartile range {IQR}: 48-70%] vs. 66% (IQR: 52-80%), p = 0.02]. On bivariable and multivariable logistic regression, predicted probability of VBAC was associated with increased odds of OASIS (less than 41% probability: adjusted odds ratio [aOR]: 3.18, 95% confidence interval [CI]: 0.90-11.21; 41-60% probability: aOR: 3.76, 95% CI: 1.34-10.57; 61-80% probability aOR: 3.47, 95% CI: 1.25-9.69) relative to women with a predicted probability of VBAC of greater than 80%. CONCLUSION Having a lower predicted probability of VBAC is associated with an increased risk of OASIS at the time of a VBAC relative to those with greater than 80% predicted probability. Incorporation of this aspect of maternal morbidity may inform risk-stratification at the time of trial of labor after cesarean, as well as the choice of performing an operative vaginal delivery. KEY POINTS · Predicted probability of VBAC is associated with OASIS.. · Low predicted probability of VBAC is associated with increased odds of OASIS.. · Forceps delivery was associated with the highest odds of OASIS..
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Affiliation(s)
- Oluwateniola Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Douglas Luchristt
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Emily S Miller
- Division of Maternal Fetal Medicine, Northwestern University, Chicago, Illinois
| | - Mahati Pidaparti
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julia Geynisman-Tan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, Illinois
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Das D, Carroll A, Mueller M, Kenton K, Lewicky-Gaupp C, Collins S, Geynisman-Tan J, Bretschneider C. Recurrence of prolapse after total vs supracervical laparoscopic hysterectomy at time of minimally invasive sacrocolpopexy. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Pelvic organ prolapse (POP) is defined as the descent of one or more of the anterior and posterior vaginal walls, uterus (cervix), or apex of the vagina (vaginal vault or cuff scar after hysterectomy). Although POP can be asymptomatic, if the bulge extends beyond the opening of the vagina, it can have a significant impact on a woman's quality of life. Findings include vaginal bulging toward or through the vaginal introitus that the patient may feel, palpate, or see with a mirror. If a woman is bothered by her prolapse, she should be offered both nonsurgical and surgical treatments.
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Affiliation(s)
- Sarah Collins
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and reconstructive Surgery Northwestern University, Feinberg School of Medicine Chicago, 250 E. Superior, Chicago, IL 60611, USA
| | - Christina Lewicky-Gaupp
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and reconstructive Surgery Northwestern University, Feinberg School of Medicine Chicago, 250 E. Superior, Chicago, IL 60611, USA.
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Luchristt D, Brown O, Pidaparti M, Kenton K, Lewicky-Gaupp C, Miller ES. Predicting obstetrical anal sphincter injuries in patients who undergo vaginal birth after cesarean delivery. Am J Obstet Gynecol 2021; 225:173.e1-173.e8. [PMID: 33617798 DOI: 10.1016/j.ajog.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Women with a history of previous cesarean delivery must weigh the numerous potential risks and benefits of elective repeat cesarean delivery or trial of labor after cesarean delivery. Notably, 1 important risk of vaginal delivery is obstetrical anal sphincter injuries. Furthermore, the rate of obstetrical anal sphincter injuries is high among women undergoing vaginal birth after cesarean delivery. However, the risk of obstetrical anal sphincter injuries is not routinely included in the trial of labor after cesarean delivery counseling, and there is no tool available to risk stratify obstetrical anal sphincter injuries among women undergoing vaginal birth after cesarean delivery. OBJECTIVE This study aimed to develop and validate a predictive model to estimate the risk of obstetrical anal sphincter injuries in the setting of vaginal birth after cesarean delivery population to improve antenatal counseling of patients regarding risks of trial of labor after cesarean delivery. STUDY DESIGN This study was a secondary subgroup analysis of the Maternal-Fetal Medicine Units Network Trial of Labor After Cesarean Delivery prospective cohort (1999-2002). We identified women within the Maternal-Fetal Medicine Units Network cohort with 1 previous cesarean delivery followed by a term vaginal birth after cesarean delivery. This Maternal-Fetal Medicine Units Network Vaginal Birth After Cesarean Delivery cohort was stratified into 2 groups based on the presence of obstetrical anal sphincter injuries, and baseline characteristics were compared with bivariate analysis. Significant covariates in bivariate testing were included in a backward stepwise logistic regression model to identify independent risk factors for obstetrical anal sphincter injuries and generate a predictive model for obstetrical anal sphincter injuries in the setting of vaginal birth after cesarean delivery. Internal validation was performed using bootstrapped bias-corrected estimates of model concordance indices, Brier scores, Hosmer-Lemeshow chi-squared values, and calibration plots. External validation was performed using data from a single-site retrospective cohort of women with a singleton vaginal birth after cesarean delivery from January 2011 to December 2016. RESULTS In this study, 10,697 women in the Maternal-Fetal Medicine Units Network Trial of Labor After Cesarean Delivery cohort met the inclusion criteria, and 669 women (6.3%) experienced obstetrical anal sphincter injuries. In the model, factors independently associated with obstetrical anal sphincter injuries included use of forceps (adjusted odds ratio, 5.08; 95% confidence interval, 4.10-6.31) and vacuum assistance (adjusted odds ratio, 2.64; 95% confidence interval, 2.02-3.44), along with increasing maternal age (adjusted odds ratio, 1.05; 95% confidence interval, 1.04-1.07 per year), body mass index (adjusted odds ratio, 0.99; 95% confidence interval, 0.97-1.00 per unit kg/m2), previous vaginal delivery (adjusted odds ratio, 0.19; 95% confidence interval, 0.15-0.23), and tobacco use during pregnancy (adjusted odds ratio, 0.59; 95% confidence interval, 0.43-0.82). Internal validation demonstrated appropriate discrimination (concordance index, 0.790; 95% confidence interval, 0.771-0.808) and calibration (Brier score, 0.047). External validation used data from 1266 women who delivered at a tertiary healthcare system, with appropriate model discrimination (concordance index, 0.791; 95% confidence interval, 0.735-0.846) and calibration (Brier score, 0.046). The model can be accessed at oasisriskscore.xyz. CONCLUSION Our model provided a robust, validated estimate of the probability of obstetrical anal sphincter injuries during vaginal birth after cesarean delivery using known antenatal risk factors and 1 modifiable intrapartum risk factor and can be used to counsel patients regarding risks of trial of labor after cesarean delivery compared with risks of elective repeat cesarean delivery.
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Bochenska K, Kujawa S, Zhao H, Kenton K, Bulun SE, Lewicky-Gaupp C. Molecular Effects of Topical Estrogen on Vaginal Granulation Tissue in Postpartum Women. Female Pelvic Med Reconstr Surg 2021; 27:521-526. [PMID: 34261104 DOI: 10.1097/spv.0000000000001076] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of this study were to evaluate the biomolecular properties of vaginal and perineal granulation tissue in postpartum women and assess the potential impact of vaginal estrogen application. METHODS We prospectively identified women referred to a subspecialty peripartum clinic between September 2016 and April 2018 who developed symptomatic perineal or vaginal granulation tissue. As part of routine clinical care, granulation tissue was excised from each participant by a urogynecologist and subjected to RNA extraction, real-time quantitative polymerase chain reaction, histologic evaluation, and immunohistochemistry. Serum steroid hormone levels were measured. Comparisons were made between participants who used topical vaginal estradiol (E2) and those who did not (non-E2 controls). RESULTS Sixteen postpartum women were recruited for this pilot study. More than 30% of patients (n = 5, 31%) had used topical vaginal estradiol (E2) during their postpartum recovery. Histological appearance of granulation tissue evaluated by hematoxylin and eosin staining was similar in women treated with vaginal E2 and non-E2 controls. Both estrogen receptor α (ERα) and ERβ mRNA and ERα protein were readily detectable in the granulation tissue of E2-treated women. Although not statistically significant, participants who used topical E2 developed granulation tissue that exhibited local estrogen-responsive gene upregulation. Serum levels of estrone, E2, dehydroepiandrosterone, progesterone, and testosterone did not differ between vaginal E2-treated patients and controls. CONCLUSIONS Estrogen receptor α seems to be the predominant receptor mediating estrogen action in postpartum perineal and vaginal granulation tissue. Vaginal E2 use does not seem to affect serum levels of estrone, E2, dehydroepiandrosterone, progesterone, and testosterone in postpartum women.
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Affiliation(s)
| | - Stacy Kujawa
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Hong Zhao
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kimberly Kenton
- From the Division of Female Pelvic Medicine and Reconstructive Surgery
| | - Serdar E Bulun
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Mou T, Brown O, Das D, Lewicky-Gaupp C, Kenton K, Bretschneider C. 20 Safety of abdominoplasty with concomitant hysterectomy: Do routes matter? Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gillingham A, Kenton K, Geynisman-Tan J, Brown O, Collins SA, Lewicky-Gaupp C, Mueller MG. Does a Hysterectomy Hurt? Comparing Narcotic Requirements and Pain Scores in Patients Undergoing Apical Prolapse Repair With or Without Hysterectomy. Female Pelvic Med Reconstr Surg 2021; 27:356-359. [PMID: 32487885 DOI: 10.1097/spv.0000000000000860] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of the study was to compare narcotic requirements with early postoperative pain scores in women undergoing apical prolapse surgery with or without hysterectomy. METHODS All cases of apical prolapse repair at our institution in 2016 were identified. The following was abstracted from the health record: demographics, comorbidities, procedure details, baseline and postoperative care unit (PACU) pain scores, and operating room (OR) and PACU narcotic doses. Doses were converted to morphine milligram equivalents (MME) for analysis. Correlations are reported using Pearson ρ. RESULTS One hundred fifty-six cases were identified. Seventy-eight percent of participants were white and the mean ± SD age was 59 ± 11 years. One hundred seventeen patients (75%) underwent laparoscopic/robotic sacrocolpopexy, 35 (22%) native tissue vaginal repairs, and 4 (3%) open sacrocolpopexy. One hundred twenty-two patients (78%) underwent concomitant hysterectomy: 93 (76%) were laparoscopic, 25 (20%) vaginal, and 4 (4%) abdominal.The groups were similar, with the exception of younger age and longer OR time in the hysterectomy group. Hysterectomy by any route was not associated with increased OR MMEs (29 vs 22, P = 0.22), PACU MMEs (13 vs 13, P = 0.54), 4-hour PACU pain scores (2.5 vs 2.0, P = 0.22), or 6-hour PACU pain scores (2.6 vs 2.3, P = 0.54). After controlling for age and OR time, there remained no differences in these variables. Likewise, when analyzing laparoscopic or vaginal groups separately on multivariate regression, there were no differences in MMEs or postoperative pain scores in patients with and without concomitant hysterectomy. CONCLUSIONS Concomitant hysterectomy at the time of prolapse repair does not increase pain medication requirements or patient-reported postoperative pain scores.
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Affiliation(s)
- Akira Gillingham
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL
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O'Shea M, Zandi R, Kamat N, Warner K, Collins S, Mueller M, Kenton K, Lewicky-Gaupp C. Postpartum contraceptive uptake and fertility desires following obstetric anal sphincter injury. Int Urogynecol J 2021; 32:1833-1838. [PMID: 33751154 DOI: 10.1007/s00192-021-04760-8] [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: 12/18/2020] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our primary objective was to compare rates of contraceptive use among postpartum heterosexual primiparous women with and without obstetric anal sphincter injury (OASIS). The secondary objective was to compare fertility desires among women with and without OASIS. METHODS This was a planned secondary analysis of a prospective cohort study of postpartum sexual function among primiparous postpartum women. Women with a history of vaginal delivery with and without OASIS completed online surveys at baseline and 3 months postpartum. RESULTS Sixty-nine women completed baseline and 3-month surveys. Forty-one percent of women with OASIS and 36% without OASIS were not using contraception at 3 months postpartum. One-third of women in either group reported using at least moderately effective contraception (P = 0.9), defined as using hormonal contraception or an intrauterine contraceptive device, and excluding condoms. Most women with OASIS (54%) desired to wait 1 to 2 years before attempting another pregnancy. One fifth of women with and without OASIS desired another pregnancy within the next year (P = 0.4). CONCLUSIONS A minority of postpartum primiparous women in the present cohort reported using moderately effective contraception 3 months postpartum, regardless of whether they sustained OASIS. The discrepancy between current contraceptive use and desired birth spacing suggests an unmet contraceptive need within our population and an opportunity for improved contraceptive counseling consistent with patients' family planning goals, as well as national and international guidelines on birth spacing. Larger prospective studies are needed to further understand the unmet contraceptive need among women with OASIS.
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Affiliation(s)
- Michele O'Shea
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Duke University, NC, Durham, USA.
| | - Roya Zandi
- Feinberg School of Medicine, Northwestern University, IL, Chicago, USA
| | - Natasha Kamat
- Feinberg School of Medicine, Northwestern University, IL, Chicago, USA
| | - Kristina Warner
- Department of Obstetrics and Gynecology, Northwestern University, IL, Chicago, USA
| | - Sarah Collins
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, IL, Chicago, USA
| | - Margaret Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, IL, Chicago, USA
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, IL, Chicago, USA
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, IL, Chicago, USA
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Geynisman-Tan J, Helmuth M, Smith AR, Lai HH, Amundsen CL, Bradley CS, Mueller MG, Lewicky-Gaupp C, Harte SE, Jelovsek JE. Prevalence of childhood trauma and its association with lower urinary tract symptoms in women and men in the LURN study. Neurourol Urodyn 2021; 40:632-641. [PMID: 33508156 DOI: 10.1002/nau.24613] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/07/2020] [Accepted: 12/24/2020] [Indexed: 11/12/2022]
Abstract
AIMS To describe the association between childhood traumas (death of a family member, severe illness, sexual trauma, parental separation) reported by women and men and lower urinary tract symptoms (LUTS). METHODS In this secondary analysis of the Lower Urinary Tract Research Network Observational Cohort Study, participants completed the LUTS tool, childhood trauma events scale (CTES), PROMIS depression and anxiety and perceived stress scale. LUTS tool responses were combined to quantify urinary urgency, frequency, incontinence, and overall LUTS severity. Multivariable linear regression tested associations between trauma and LUTS; mental health scores were tested for potential mediation. RESULTS In this cohort (n = 1011; 520 women, 491 men), more women reported experiencing at least one trauma (75% vs. 64%, p < .001), greater than three traumas (26% vs. 15%, p < .001), and childhood sexual trauma (23% vs. 7%, p < .001), and reported higher impact from traumatic events compared with men (median [interquartile rnage] CTES score = 10 [5-15] vs. 6 [4-12], p < .001). The number of childhood traumatic events was not associated with severity of overall LUTS (p = .79), urinary frequency (p = .75), urgency (p = .61), or incontinence (p = .21). Childhood sexual trauma was significantly associated with higher incontinence severity (adjusted mean difference 4.5 points, 95% confidence interval= 1.11-7.88, p = .009). Mental health was a mediator between trauma and LUTS among those with at least one childhood trauma. CONCLUSION Although total childhood trauma is not associated with LUTS, childhood sexual trauma is associated with urinary incontinence severity. For patients with childhood trauma, half of the effect of CTE Impact score on overall LUTS severity is mediated through the association between trauma and the patient's mental health.
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Affiliation(s)
- Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | - Margaret Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - H Henry Lai
- Departments of Surgery (Urology) and Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
| | - Margaret G Mueller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
| | | | - Steven E Harte
- Departments of Anesthesiology and Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - J Eric Jelovsek
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
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Brown O, Geynisman-Tan J, Gillingham A, Collins S, Lewicky-Gaupp C, Kenton K, Mueller M. Minimizing Risks in Minimally Invasive Surgery: Rates of Surgical Site Infection Across Subtypes of Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2020; 27:1370-1376.e1. [DOI: 10.1016/j.jmig.2019.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/30/2022]
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Young K, Mou T, Geynisman-Tan J, Tavathia M, Collins S, Mueller M, Lewicky-Gaupp C, Kenton K. Truth or Myth: Intra-abdominal Pressure Increases in the Lithotomy Position. J Minim Invasive Gynecol 2020; 28:26-29. [PMID: 32229258 DOI: 10.1016/j.jmig.2020.03.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/14/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions. DESIGN Prospective cohort study. SETTING University medical center. PATIENTS Twenty-nine women undergoing surgery for prolapse or stress incontinence. INTERVENTIONS Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients' medical charts. IAP was measured in centimeters of water (cmH2O) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse). MEASUREMENTS AND MAIN RESULTS IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmH2O ± 7.6; low lithotomy, 17.7 cmH2O ± 6.6; and high lithotomy, 17.1 cmH2O ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmH2O ± 3.7, p = .05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmH2O ± 1.5, p = .004). Neither change is clinically significant based on previous research that suggests 5 cmH2O is a clinically significant change. CONCLUSION Placing patients' legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients' lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.
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Affiliation(s)
- Karen Young
- Northwestern Prentice Women's Hospital, and Northwestern University Feinberg School of Medicine (Ms. Young), Chicago, Illinois
| | - Tsung Mou
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Julia Geynisman-Tan
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia).
| | - Meera Tavathia
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Sarah Collins
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Margaret Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
| | - Kimberly Kenton
- Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia)
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Squires N, Mueller M, Lewicky-Gaupp C, Collins S, Kenton K, Geynisman-Tan J. 45: The first injection: Rates of urinary retention in women with urgency incontinence treated with intravesical onabotulinumtoxinA (Botox) injection. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Young K, Mou T, Tavathia M, Geynisman-Tan J, Collins S, Mueller M, Lewicky-Gaupp C, Kenton K. 87: Truth or myth: Intraabdominal pressure increases in the lithotomy position. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brown O, Dave B, Geynisman J, Warner K, Gillingham A, Kenton K, Mueller M, Collins S, Lewicky-Gaupp C. 12: Vaginal electrical stimulation for postpartum neuromuscular recovery: The VESPR study. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gillingham A, Kenton K, Geynisman J, Mueller M, Lewicky-Gaupp C, Collins S. 50: The influence of patients’ goals on surgical satisfaction. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2019.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gillingham A, Geynisman J, Brown O, Kenton K, Collins S, Lewicky-Gaupp C, Reynolds M, Mueller M. 54: Pediatric vaginoplasty with extracellular matrix graft augmentation. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Collins S, Mueller M, Geynisman J, Lewicky-Gaupp C, Kenton K. 100: Impact of a web-based decisional aid on satisfaction in women undergoing prolapse surgery. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Brown O, Geynisman-Tan J, Gillingham A, Collins S, Lewicky-Gaupp C, Kenton K, Mueller M. 68: Surgical site infection after laparoscopic hysterectomy. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Geynisman-Tan J, Milewski A, Dahl C, Collins S, Mueller M, Kenton K, Lewicky-Gaupp C. Lower Urinary Tract Symptoms in Women With Female Genital Mutilation. Female Pelvic Med Reconstr Surg 2019; 25:157-160. [DOI: 10.1097/spv.0000000000000649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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25
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Bochenska K, Milad MP, DeLancey JO, Lewicky-Gaupp C. Instructional Video and Medical Student Surgical Knot-Tying Proficiency: Randomized Controlled Trial. JMIR Med Educ 2018; 4:e9. [PMID: 29650503 PMCID: PMC5920196 DOI: 10.2196/mededu.9068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Many senior medical students lack simple surgical and procedural skills such as knot tying. OBJECTIVE The aim of this study was to determine whether viewing a Web-based expert knot-tying training video, in addition to the standard third-year medical student curriculum, will result in more proficient surgical knot tying. METHODS At the start of their obstetrics and gynecology clerkship, 45 students were videotaped tying surgical knots for 2 minutes using a board model. Two blinded female pelvic medicine and reconstructive surgery physicians evaluated proficiency with a standard checklist (score range 0-16) and anchored scoring scale (range 0-20); higher numbers represent better skill. Students were then randomized to either (1) expert video (n=26) or (2) nonvideo (n=24) groups. The video group was provided unlimited access to an expert knot-tying instructional video. At the completion of the clerkship, students were again videotaped and evaluated. RESULTS At initial evaluation, preclerkship cumulative scores (range 0-36) on the standard checklist and anchored scale were not significantly different between the nonvideo and video groups (mean 20.3, SD 7.1 vs mean 20.2, SD 9.2, P=.90, respectively). Postclerkship scores improved in both the nonvideo and video groups (mean 28.4, SD 5.4, P<.001 and mean 28.7, SD 6.5, P=.004, respectively). Increased knot board practice was significantly correlated with higher postclerkship scores on the knot-tying task, but only in the video group (r=.47, P<.05). CONCLUSIONS The addition of a Web-based expert instructional video to a standard curriculum, coupled with knot board practice, appears to have a positive impact on medical student knot-tying proficiency.
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Affiliation(s)
- Katarzyna Bochenska
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Magdy P Milad
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - John Ol DeLancey
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States
| | - Christina Lewicky-Gaupp
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Bochenska K, Mueller M, Lewicky-Gaupp C, Kenton K. 12: Vaginal agenesis and the modified laparoscopic Vecchietti procedure. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Geynisman-Tan J, Bochenska K, Gillingham A, Collins S, Mueller M, Lewicky-Gaupp C, Kenton K. 02: Clinical utility of routine preoperative laboratory assessment. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Geynisman-Tan J, Brown O, Bochenska K, Leader-Cramer A, Dave B, Collins S, Mueller M, Lewicky-Gaupp C, Kenton K. Operating Room Efficiency: Examining the Impact of Personnel Handoffs. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.151] [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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29
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Cameron AP, Lewicky-Gaupp C, Smith AR, Helfand BT, Gore JL, Clemens JQ, Yang CC, Siddiqui NY, Lai HH, Griffith JW, Andreev VP, Liu G, Weinfurt K, Amundsen CL, Bradley CS, Kusek JW, Kirkali Z. Baseline Lower Urinary Tract Symptoms in Patients Enrolled in LURN: A Prospective, Observational Cohort Study. J Urol 2017; 199:1023-1031. [PMID: 29111381 DOI: 10.1016/j.juro.2017.10.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 10/24/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We described and compared the frequency and type of lower urinary tract symptoms reported by men and women at the time that they were recruited from urology and urogynecology clinics into the Symptoms of Lower Urinary Tract Dysfunction Research Network multicenter, prospective, observational cohort study. MATERIALS AND METHODS At 6 research sites treatment seeking men and women were enrolled who reported any lower urinary tract symptoms at a frequency more than rarely during the last month on the LUTS (Lower Urinary Tract Symptoms) Tool. At baseline the study participants underwent a standardized clinical evaluation and completed validated questionnaires. Urological tests were performed, including pelvic/rectal examination, post-void residual urine measurement and urinalysis. RESULTS A total of 545 women and 519 men were enrolled in the study. Mean ± SD age was 58.8 ± 14.1 years. At baseline nocturia, frequency and a sensation of incomplete emptying were similar in men and women but men experienced more voiding symptoms (90% vs 85%, p = 0.007) and women reported more urgency (85% vs 66%, p <0.001). Women also reported more of any type of urinary incontinence than men (82% vs 51% p <0.001), which was mixed incontinence in 57%. Only 1% of men reported stress incontinence but they had other urinary incontinence, including post-void dribbling in 44% and urgency incontinence in 46%. Older participants had higher odds of reporting symptoms of nocturia and urgency. CONCLUSIONS In this large, treatment seeking cohort of men and women lower urinary tract symptoms varied widely by gender and age. Men reported more voiding symptoms and nonstress or urgency urinary incontinence while women reported more incontinence overall and urgency. Older participants had greater odds of urgency and nocturia.
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Affiliation(s)
- Anne P Cameron
- Michigan Medicine Urology Clinic, University of Michigan, Ann Arbor, Michigan.
| | | | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - John L Gore
- Urology Clinic, University of Washington Medical Center, Seattle, Washington
| | - J Quentin Clemens
- Michigan Medicine Urology Clinic, University of Michigan, Ann Arbor, Michigan
| | - Claire C Yang
- Urology Clinic, University of Washington Medical Center, Seattle, Washington
| | - Nazema Y Siddiqui
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - H Henry Lai
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - James W Griffith
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Gang Liu
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Cindy L Amundsen
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Catherine S Bradley
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Bochenska K, LeWitt T, Marsh E, Pidaparti M, Mendoza G, Lewicky-Gaupp C, Mueller M, Kenton K. 74: Fibroids and urinary symptoms study (FUSS). Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.12.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brown O, Geynisman-Tan J, Dave B, Bochenska K, Leader-Cramer A, Lewicky-Gaupp C, Mueller M, Collins S, Kenton K. 39: Changing referral patterns to urogynecology. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Geynisman-Tan J, Leader-Cramer A, Dave B, Bochenska K, Mueller M, Collins S, Kenton K, Lewicky-Gaupp C. 46: Anal penetrative intercourse and pelvic floor symptoms. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.12.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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Swenson CW, Kolenic GE, Trowbridge ER, Berger MB, Lewicky-Gaupp C, Margulies RU, Morgan DM, Fenner DE, DeLancey JO. Obesity and stress urinary incontinence in women: compromised continence mechanism or excess bladder pressure during cough? Int Urogynecol J 2017; 28:1377-1385. [PMID: 28150033 DOI: 10.1007/s00192-017-3279-6] [Citation(s) in RCA: 21] [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: 11/08/2016] [Accepted: 01/16/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. METHODS A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9 kg/m2); overweight (25.0-29.9 kg/m2); and obese (≥30 kg/m2). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. RESULTS The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410). CONCLUSIONS Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.
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Affiliation(s)
- Carolyn W Swenson
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA.
| | - Giselle E Kolenic
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | - Mitchell B Berger
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | | | | | - Daniel M Morgan
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - Dee E Fenner
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
| | - John O DeLancey
- Department of Obstetrics and Gynecology, L4000 Women's Hospital, University of Michigan, 1500 E. Medical Center Dr., SPC 5276, Ann Arbor, MI, 48109-5276, USA
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Liu JS, Vo AX, Doolittle J, Hamoui N, Lewicky-Gaupp C, Kielb SJ. Characterizing Pelvic Organ Prolapse in Adult Spina Bifida Patients. Urology 2016; 97:273-276. [PMID: 27349528 DOI: 10.1016/j.urology.2016.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/10/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report the distribution of pelvic organ prolapse (POP) stages in adult spina bifida (SB) patients. The severity of POP in the SB population has not been previously reported. MATERIALS AND METHODS Retrospective review of SB patients ≥18 years with a documented POP quantification examination between 2006 and 2014 were included. Patient demographics, gestation, parity, POP quantification examinations and prolapse symptoms were obtained. RESULTS Thirty-three SB patients were identified with a mean age of 33.2 years. Five patients (15.2%) had stage 0 prolapse, 12 (36.4%) had stage 1, 12 (36.4%) had stage 2, 3 (9.1%) had stage 3, and 1 (3.0%) had stage 4. Of the 16 patients with advanced POP (stage 2 prolapse or greater), only 6 patients (37.5%) reported symptoms related to POP. All 6 symptomatic patients endorsed sensation of a vaginal bulge. Two of the 6 patients also reported dyspareunia. Additionally, 1 patient with advanced POP presented with vaginal bulge, noted by a caregiver, and cervical bleeding, but was otherwise asymptomatic. Twenty-four patients (72.7%) were nulliparous, and 12 of the 24 nulliparous patients (50%) demonstrated prolapse. CONCLUSION Despite young age and frequent nulliparity, patients with SB are more likely to have POP than the general population. Additionally, the majority of SB patients with prolapse are asymptomatic. Assessment of pelvic organ prolapse should be included in the evaluation of adult SB females due to the low rate of symptoms even in the setting of advanced stage prolapse and potential impact on both urinary and bowel function.
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Affiliation(s)
- Joceline S Liu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda X Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Johnathan Doolittle
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nabeel Hamoui
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christina Lewicky-Gaupp
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stephanie J Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Bochenska K, Leader-Cramer A, Mueller M, Dave B, Lewicky-Gaupp C, Alverdy A, Kenton K. 48: Perioperative complications following colpocleisis with concomitant vaginal hysterectomy. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dave B, Leader-Cramer A, Bochenska K, Alverdy A, Mueller M, Lewicky-Gaupp C, Kenton K. 9: The wasted vaginal hysterectomy—an argument for tracking in obstetrics and gynecology residency programs. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Davé BA, Jaber C, Leader-Cramer A, Higgins N, Mueller M, Lewicky-Gaupp C, Kenton K. Effect of anesthesia type on perioperative outcomes with a midurethral sling. Int Urogynecol J 2016; 27:1327-32. [DOI: 10.1007/s00192-016-2950-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
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Johnson L, Davé B, Jaber C, Leader-Cramer A, Lewicky-Gaupp C, Mueller M, Kenton K. Duration of Catheterization following Retropubic Midurethral Sling Surgery. J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mueller M, Elborno D, Davé B, Leader-Cramer A, Lewicky-Gaupp C, Johnson L, Kenton K. Postoperative Appointments: Which Ones Count? J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.052] [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: 10/23/2022]
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Leader-Cramer A, Kenton K, Dave B, Gossett D, Johnson L, Mueller M, Lewicky-Gaupp C. Timing of Return to Intercourse after Obstetric Anal Sphincter Injuries: Results from the Forcast Trial (for Optimal Recovery: Care after Severe Tears). J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Davé B, Jaber C, Leader-Cramer A, Higgins N, Mueller M, Johnson L, Lewicky-Gaupp C, Kenton K. Effect of Anesthesia Type on Perioperative Outcomes for Midurethral Sling. J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lewicky-Gaupp C, Leader-Cramer A, Labin Johnson L, Kyriacou D, Prendergast E, Kenton K, Gossett D. Wound Complications and Depression after Obstetric Anal Sphincter Injuries (OASIS); The FORCAST Study: For Optimal Recovery, Care after Severe Tears. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2013.12.107] [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: 10/25/2022]
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Stock L, Basham E, Gossett DR, Lewicky-Gaupp C. Factors associated with wound complications in women with obstetric anal sphincter injuries (OASIS). Am J Obstet Gynecol 2013; 208:327.e1-6. [PMID: 23262251 DOI: 10.1016/j.ajog.2012.12.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/19/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to determine factors associated with perineal wound complications in women with obstetric anal sphincter injuries (OASIS). STUDY DESIGN A retrospective chart review of women who sustained an OASIS from Nov. 2, 2005, through March 1, 2010, was performed. RESULTS In all, 1629 women sustained an OASIS; 909 had follow-up data. Wound complications (infection, breakdown, packing, operative intervention, secondary repair) occurred in 7.3% (n = 66) of patients. Smoking (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.4-12.2; P = .01), increasing body mass index (OR, 1.06; 95% CI, 1.01-1.12; P = .04), fourth-degree laceration (OR, 1.89; 95% CI, 0.99-3.61; P = .05), operative vaginal delivery (OR, 1.76; 95% CI, 1.15-2.68; P = .009), and use of postpartum antibiotics (OR, 2.46; 95% CI, 1.11-5.63; P = .03) were associated with complications; intrapartum antibiotics were protective (OR, 0.29; 95% CI, 0.14-0.59; P = .001). In all, 44% of patients with a complication (n = 29) required hospital readmission; most (72%) were in the first 2 postpartum weeks. CONCLUSION Wound complications after OASIS are associated with modifiable factors and often require hospital readmission.
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Affiliation(s)
- Laura Stock
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Nash K, Feinglass J, Zei C, Lu G, Mengesha B, Lewicky-Gaupp C, Lin A. Robotic-Assisted Laparoscopic Myomectomy Versus Abdominal Myomectomy: A Comparative Analysis of Short-Term Surgical and Efficiency Outcomes. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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DeLancey JOL, Sørensen HC, Lewicky-Gaupp C, Smith TM. Comparison of the puborectal muscle on MRI in women with POP and levator ani defects with those with normal support and no defect. Int Urogynecol J 2011; 23:73-7. [PMID: 21822711 DOI: 10.1007/s00192-011-1527-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to compare puborectal muscle integrity and bulk in women with both major levator ani (LA) defects on MRI and pelvic organ prolapse (POP) to women with normal LA muscle and normal support. METHODS This is a case-control study comparing 24 cases with known major LA defects and POP to 24 controls with normal LA and normal support. Axial T-2 weighted MRI scans of the pelvis were evaluated for integrity of the puborectal muscle and degree of muscle bulk. RESULTS There were no significant group differences in age, body mass index, vaginal deliveries, or hysterectomy status. In all 48 subjects, the puborectal muscle was visible and had no disruption noted. There was no difference in muscle bulk between groups (control/case, thin 42% vs. 25%, average 42% vs. 38%, thick-17% vs. 38%; P = 0.47). CONCLUSIONS Defects and loss of muscle bulk in the puborectal muscle are not seen on MRI in women with major LA defects and POP.
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Affiliation(s)
- John O L DeLancey
- Pelvic Floor Research Group, Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, SPC 5276, Ann Arbor, MI 48109, USA
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Nash K, Feinglass J, Zei C, Lu G, Mengesha B, Lewicky-Gaupp C, Lin A. Robotic-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparative analysis of surgical outcomes and costs. Arch Gynecol Obstet 2011; 285:435-40. [PMID: 21779774 DOI: 10.1007/s00404-011-1999-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 07/07/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare clinical and effectiveness outcomes between robotic-assisted laparoscopic myomectomy (RALM) and abdominal myomectomy (AM). STUDY DESIGN Records were reviewed for the first 27 RALM procedures at our institution. Age, BMI, insurance status, race, uterine size, and operative indication were used to select comparable patients who had undergone AM. Clinical and efficiency outcomes were compared stratifying for uterine size, specimen weight, and matched propensity scores. RESULTS IV hydromorphone use was significantly lower for RALM (P < 0.01), with no significant differences in blood loss or complications. RALM patients had significantly shorter hospital stays; however, total hospital charges were higher (P < 0.0001). This likely reflects longer operating room time (P < 0.0001), which was magnified as specimen size increased (P < 0.0001). CONCLUSION RALM patients require less IV hydromorphone, have shorter hospital stays, and have generally equivalent clinical outcomes compared with AM patients. Additionally, as specimen size increased, the operative efficiency of RALM decreased compared with AM.
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Affiliation(s)
- Kate Nash
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Morgan DM, Larson K, Lewicky-Gaupp C, Fenner DE, DeLancey JOL. Vaginal support as determined by levator ani defect status 6 weeks after primary surgery for pelvic organ prolapse. Int J Gynaecol Obstet 2011; 114:141-4. [PMID: 21669431 DOI: 10.1016/j.ijgo.2011.02.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/14/2011] [Accepted: 04/27/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether major levator ani muscle defects were associated with differences in postoperative vaginal support after primary surgery for pelvic organ prolapse (POP). METHODS A retrospective chart review of a subgroup of patients in the Organ Prolapse and Levator (OPAL) study. Of the 247 women recruited into OPAL, 107 underwent surgery for prolapse and were the cohort for the present analysis. Major levator ani defects were diagnosed when more than 50% of the pubovisceral muscle was missing on MRI. Postoperative vaginal support was assessed via POP-quantification system. Postoperative anatomic outcome was analyzed according to levator ani defect status, as determined by MRI. RESULTS Support of the anterior vaginal wall 2 cm above the hymen occurred among 62% of women with normal levator ani muscles/minor defects and 35% of those with major defects. Support of the anterior wall 1cm above the hymen occurred among 32% women with normal muscles /minor defects and 59% of those with major defects. Levator ani defects were not associated with differences in postoperative apical/posterior vaginal support. CONCLUSION Six weeks after primary surgery for prolapse, women with normal levator ani muscles/minor defects had better anterior vaginal support than those with major levator defects.
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Affiliation(s)
- Daniel M Morgan
- Department of Obstetrics and Gynecology, Division of Gynecology, Pelvic Floor Research Group, University of Michigan Medical School, Ann Arbor, USA.
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Larson KA, Yousuf A, Lewicky-Gaupp C, Fenner DE, DeLancey JO. Perineal body anatomy in living women: 3-dimensional analysis using thin-slice magnetic resonance imaging. Am J Obstet Gynecol 2010; 203:494.e15-21. [PMID: 21055513 DOI: 10.1016/j.ajog.2010.06.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/26/2010] [Accepted: 06/07/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of the study was to describe a framework for visualizing the perineal body's complex anatomy using thin-slice magnetic resonance (MR) imaging. STUDY DESIGN Two millimeter thick MR images were acquired in 11 women with normal pelvic support and no incontinence/prolapse symptoms. Anatomic structures were analyzed in axial, sagittal, and coronal slices. Three-dimensional (3-D) models were generated from these images. RESULTS Three distinct perineal body regions are visible on MR imaging: (1) a superficial region at the level of the vestibular bulb, (2) a midregion at the proximal end of the superficial transverse perineal muscle, and (3) a deep region at the level of the midurethra and puborectalis muscle. Structures are best visualized on axial scans, whereas craniocaudal relationships are appreciated on sagittal scans. The 3-D model further clarifies interrelationships. CONCLUSION Advances in MR technology allow visualization of perineal body anatomy in living women and development of 3-D models that enhance our understanding of its 3 different regions: superficial, mid, and deep.
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Lewicky-Gaupp C, Yousuf A, Larson KA, Fenner DE, Delancey JOL. Structural position of the posterior vagina and pelvic floor in women with and without posterior vaginal prolapse. Am J Obstet Gynecol 2010; 202:497.e1-6. [PMID: 20452497 DOI: 10.1016/j.ajog.2010.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [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: 07/06/2009] [Revised: 10/08/2009] [Accepted: 01/04/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to compare pelvic structure location on magnetic resonance imaging (MRI) during maximal Valsalva among women with posterior prolapse and those with normal support. STUDY DESIGN Subjects (n=37) had posterior vaginal wall (PVW) prolapse of +1 cm or greater. All underwent midsagittal, dynamic MRI. Structure locations (distal vagina, apex, perineal body, external anal sphincter) were determined. PVW length, levator and urogenital hiatus diameters, and prolapse diameter were measured. RESULTS Subjects had more caudal structures (P<.001) and larger hiatus diameters (P<.005); the posterior wall was longer, whereas the straight-line distance between the apex and distal vagina was shorter. In enteroceles, the apex was more ventrally displaced compared with rectoceles (P=.003). Unlike apical descent (r=-0.3; P=.1), PVW length and point Bp were correlated with MRI prolapse size (r=0.5; P=.002; r=0.7; P<.001, respectively). CONCLUSION At maximal Valsalva on MRI, structures are more caudal in women with posterior prolapse. The posterior vaginal wall is longer; this length strongly correlates with prolapse size.
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Affiliation(s)
- Christina Lewicky-Gaupp
- Pelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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