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IMPORTANCE: Urinary tract infections (UTIs) are common in older-aged women. Our study examined bacterial persistence with commonly prescribed antibiotics. Bacterial growth was demonstrated despite antibiotic treatment. OBJECTIVES: The aims of this study were to quantify the bacterial persister phenotype in urine collected from postmenopausal women with acute and recurrent UTI and to determine the capabilities of first-line antibiotics to effectively treat persister cells. STUDY DESIGN: This was an institutional review board-approved cross-sectional analysis within a large academic referral center. Uropathogens were cultured from postmenopausal women with acute or recurrent UTI and screened for persister cells using persistence assays. Demographic and clinical variables were collected and analyzed. The entire experimental process was repeated in triplicate. Data were analyzed for significance (P < 0.05) between the persister culture and antibiotic treatments using a 1-way analysis of variance with multiple comparisons in Prism 9.3.0. RESULTS: Forty participants were included: 62.5% White, 22.5% Black, 3% Asian, and 2% Hispanic with a mean age of 72.3 ± 11.62 years. The persister phenotype was demonstrated in all of Escherichia coli isolates. Treatment with fosfomycin demonstrated reduced colony-forming units per milliliter compared with control (P < 0.01). Among recurrent isolates, there was a statistically significant decrease in colony-forming units per milliliter after antibiotic treatment with all 4 antibiotics (P < 0.05). CONCLUSIONS: This study demonstrated in vitro bacterial persistence in uropathogens from urogynecology patients despite treatment with commonly prescribed antibiotics. Fosfomycin generated the least amount of persister cells. Results suggest that persistence may be one bacterial defense mechanism involved in UTIs. Further research is needed to understand the clinical implications.
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Fosfomicina , Infecciones Urinarias , Humanos , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Fosfomicina/farmacología , Estudios Transversales , Posmenopausia , Infecciones Urinarias/tratamiento farmacológico , Antibacterianos/farmacología , Escherichia coli/genéticaRESUMEN
OBJECTIVE(S): To compare the safety and effectiveness of dermal bovine transvaginal graft, Xenform, to native tissue in the surgical treatment of anterior and/or apical pelvic organ prolapse. This study was designed in conjunction with Food and Drug Administration requirements. METHODS: This was a prospective, non-randomized, parallel cohort, multi-center trial. The primary objective was to demonstrate noninferiority between transvaginal graft and native tissue repair at 36 months compared to baseline. Treatment success was based on a composite of objective and subjective measures. The co-primary outcome was the rate of serious device- or procedure-related adverse events. A total of 228 patients at 25 sites were included in the study arm and 485 patients underwent native tissue repair. Propensity score stratification was applied to achieve balance between treatment groups. Study outcomes were compared in per protocol and intent-to-treat analysis. RESULTS: The primary outcome, treatment success at 36 months, was 83.6% (191/228) for transvaginal graft and 80.5% (390/485) native tissue repair (0.2%, 90% confidence interval [-5.6% to 5.9%]), demonstrating noninferiority at a preset margin of -12%. The overall rate of severe adverse events was 5.3% (12/228) in transvaginal graft vs 2.7% (13/485) in native tissue repair groups. The study group demonstrated noninferiority in serious adverse events at the preset margin of 11.6% (2.0%, 90% confidence interval [-0.8% to 4.7%]). There were no reports of graft erosion, and graft exposure rates were low (0.9% [2/228]). CONCLUSIONS: Transvaginal repair of anterior and/or apical prolapse with a biological graft is noninferior to traditional native tissue repair in effectiveness and safety at 36 months.
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Prolapso de Órgano Pélvico , Prolapso Uterino , Animales , Bovinos , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Humanos , Prolapso de Órgano Pélvico/cirugía , Estudios Prospectivos , Mallas Quirúrgicas , Resultado del Tratamiento , Prolapso Uterino/cirugíaRESUMEN
ABSTRACT: The American Urogynecologic Society (AUGS) identified diversity, equity, and inclusion as the cornerstone of excellence in governance and operations. Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs. In June 2020, the AUGS President, Dr Shawn Menefee, and Board of Directors called for a Presidential Task Force on Diversity, Equity, and Inclusion to study the current state of our society and make recommendations for future directions. The charge was intentionally broad. In review of the literature, there was little to inform the best means to proceed aside from administering climate surveys to gauge the current culture of inclusion and bias. The task force believed that the challenge was not only to describe the problem but also to articulate solutions. We ultimately moved to rewrite the Diversity and Inclusion and Code of Conduct Statements and develop an Action Plan that would accelerate the efforts of AUGS to foster inclusion and improve equity through the existing governance structure. In this document, we describe how the task force was organized and conducted the work to develop strategies that were aligned with the AUGS mission: "As the leader in female pelvic medicine and reconstructive surgery, AUGS drives excellence in care for women through education, research, advocacy, and interdisciplinary collaboration."
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Sociedades , Diversidad Cultural , Femenino , Equidad de Género , Humanos , Estados UnidosRESUMEN
OBJECTIVES: Anticholinergic medications are a core treatment strategy for overactive bladder (OAB). There is evidence that exposure to anticholinergic medications is associated with an increased risk of developing dementia. We launched an initiative to inform our patients of this risk and give them an opportunity to engage in shared decision-making about their treatment. This quality improvement initiative encompassed 3 aims: (1) to evaluate the feasibility of 2 different routes to deliver the written outreach; (2) to evaluate if and how patients changed their OAB treatment; and (3) to assess satisfaction with the outreach initiative. METHODS: A query was performed via the electronic medical record for all patients who had been prescribed an anticholinergic for treatment of OAB. We sent either electronic messages or traditional mail to patients. We contacted patients by telephone to assess if they received the message, were satisfied with their respective method of communication, and decided for ongoing treatment. Health care provider satisfaction was also measured. RESULTS: Of the 231 patients sent the outreach, 32 were still taking the anticholinergic at the time they received the communication. The majority of patients, 84.38%, were satisfied with the initiative and elected to change therapy after learning about the increased risk of dementia. The physicians also uniformly reported satisfaction with the initiative. CONCLUSIONS: Overall, this outreach initiative resulted in an increase in patient counseling that led to a change in treatment for most patients. This initiative was received favorably by patients and health care providers.
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Demencia , Médicos , Vejiga Urinaria Hiperactiva , Antagonistas Colinérgicos/efectos adversos , Comunicación , Demencia/inducido químicamente , Femenino , Humanos , Masculino , Vejiga Urinaria Hiperactiva/tratamiento farmacológicoRESUMEN
OBJECTIVES: The aims of this study were to assess the in vitro biofilm-producing capabilities of uropathogens grown from a postmenopausal urogynecologic population with isolated and recurrent urinary tract infection (UTI) and to determine whether the biofilm-producing bacterial phenotype was associated with recurrent infection. METHODS: This was an institutional review board-approved cross-sectional analysis within a large academic referral center. Uropathogens were cultured from postmenopausal women with either isolated or recurrent acute UTI and then screened for in vitro biofilm formation using crystal violet microtiter assays. Demographic and clinical variables, including pelvic floor symptoms and surgical history were collected and analyzed. A multivariate model was developed to determine whether recurrent UTI was independently associated with biofilm production. RESULTS: Eighty-nine women were included: 67.4% White, 25.8% Black, 3.4% Asian, and 1.1% Hispanic with a mean age of 72 ± 10.5 years. Ninety-five uropathogen strains were isolated. Most uropathogens produced biofilm (n = 53, 55.8%). Uropathogens from women with recurrent UTI were significantly more likely to produce biofilm (70%) than uropathogens collected from women with isolated UTI (38.6%, P = 0.0033). Adjusting for age, prior pelvic reconstructive surgery, and body mass index, recurrent UTI bacteria were more likely to produce biofilm, compared with isolated UTI (odds ratio, 5.37; 95% confidence interval, 2.0-14.4; P = 0.001). CONCLUSIONS: In this cohort of postmenopausal urogynecology patients, in vitro biofilm formation was more frequently observed in uropathogens isolated from women with recurrent UTI compared with women with isolated UTI. Further study is needed to assess the role of biofilms in recurrent UTIs in postmenopausal women.
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Posmenopausia , Infecciones Urinarias , Antibacterianos/uso terapéutico , Bacterias , Biopelículas , Estudios Transversales , Femenino , Humanos , Masculino , Infecciones Urinarias/diagnósticoRESUMEN
INTRODUCTION AND HYPOTHESIS: We hypothesized obesity increases the risk of pelvic organ prolapse recurrence (POP-R) after primary apical prolapse repair. METHODS: We conducted a retrospective cohort study of 353 women who underwent primary apical prolapse surgery from 2011 to 2016. Demographic and clinical data were abstracted from medical records. Multivariable Cox proportional hazard models were used to generate hazard ratios (HR) for association between obesity (BMI ≥ 30 kg/m2) and POP-R (leading edge > 0), adjusting for potential confounders. Given the potential for outcome ascertainment bias due to differential loss to follow-up, a sensitivity analysis was performed assuming all patients with < 6 months of follow-up developed POP-R. RESULTS: Ten percent of women developed POP-R. The median follow-up time was 7 months (range 1.4, 63.9). Twenty-four percent of patients were Black and 70% were White; 37% were obese. After controlling for confounders, obese women did not have an increased risk of POP-R (aHR 1.39; 95% CI 0.67, 2.86, p = 0.38). Although only marginally statistically significant, patients who developed POP-R were more likely to be current smokers (aHR 3.48, 95% CI 1.14, 10.67; p = 0.06) or previous smokers (aHR 1.86, 95% CI 0.82, 4.24, p = 0.06) in comparison to non-smokers. Sensitivity analysis showed loss to follow-up had the potential to influence our results. CONCLUSIONS: Obesity was not a risk factor for POP-R in our cohort. Larger, prospective studies with longer postoperative follow-up time are needed to fully elucidate the relationship between obesity and POP-R.
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Prolapso de Órgano Pélvico , Estudios de Cohortes , Femenino , Humanos , Obesidad/complicaciones , Prolapso de Órgano Pélvico/epidemiología , Prolapso de Órgano Pélvico/etiología , Prolapso de Órgano Pélvico/cirugía , Estudios Prospectivos , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
STUDY OBJECTIVE: To determine the incidence of perioperative coronavirus disease (COVID-19) in women undergoing benign gynecologic surgery and to evaluate perioperative complication rates in patients with active, previous, or no previous severe acute respiratory syndrome coronavirus 2 infection. DESIGN: A multicenter prospective cohort study. SETTING: Ten institutions in the United States. PATIENTS: Patients aged >18 years who underwent benign gynecologic surgery from July 1, 2020, to December 31, 2020, were included. All patients were followed up from the time of surgery to 10 weeks postoperatively. Those with intrauterine pregnancy or known gynecologic malignancy were excluded. INTERVENTIONS: Benign gynecologic surgery. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the incidence of perioperative COVID-19 infections, which was stratified as (1) previous COVID-19 infection, (2) preoperative COVID-19 infection, and (3) postoperative COVID-19 infection. Secondary outcomes included adverse events and mortality after surgery and predictors for postoperative COVID-19 infection. If surgery was delayed because of the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) had a history of COVID-19. The majority (182, 96.3%) had no sequelae attributed to surgical postponement. After hospital discharge to 10 weeks postoperatively, 39 patients (1.1%) became infected with severe acute respiratory syndrome coronavirus 2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range, 4-50 days). Eleven (31.4% of postoperative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjusted odds ratio, 6.8) and single-unit increase in age-adjusted Charlson comorbidity index (adjusted odds ratio, 1.2) increased the odds of postoperative COVID-19 infection. Perioperative complications were not significantly higher in patients with a history of positive COVID-19 than those without a history of COVID-19, although the mean duration of time between previous COVID-19 diagnosis and surgery was 97 days (14 weeks). CONCLUSION: In this large multicenter prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a postoperative COVID-19 infection, with 0.3% of infection in the immediate 14 days after surgery. The incidence of postoperative complications was not different in those with and without previous COVID-19 infections.
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COVID-19 , Pandemias , Adolescente , Prueba de COVID-19 , Femenino , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Humanos , Embarazo , Estudios Prospectivos , Estudios Retrospectivos , SARS-CoV-2 , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
AIM: To determine the feasibility of commercially available multielectrode cardiac electrophysiology catheters to detect electrical activity in the human bladder. METHODS: Ten subjects requiring cystoscopy for the evaluation of lower urinary tract pathology were eligible for participation in our study. After routine rigid cystoscopy with a 70° cystoscope, various multielectrode cardiac electrophysiology catheters were introduced into the bladder. One of three catheters with different electrode configurations was used per subject. Electroanatomical images of the bladder were created and spontaneous electrical activity was recorded. Subjective response to electrical stimuli delivered across the electrodes (20 mA at 5 ms pulse width, rate 100 ms) was also recorded. The responses were qualitatively compared with that from a prior study. RESULTS: Electrical activity recorded at the dome of the bladder was less than 0.5 mV and low frequency. Myopotentials resembling smooth muscle were detected at electrodes near or within the trigone. A sensory response was reported with the use of pacing stimuli, with the sensation in the trigone being reported more often than the dome of the bladder. Stimulation in the trigone triggered sensory urgency and voiding in a patient with a history of overactive bladder. CONCLUSIONS: The use of multielectrode catheters to measure human bladder electrophysiologic activity is feasible. Issues with noise reduction still exist, though to a lesser extent with the multielectrode basket design than simple quadripolar one. Sensory responses to pacing stimuli may be useful for diagnostic and therapeutic purposes in the future.
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Catéteres Cardíacos/normas , Fenómenos Electrofisiológicos/fisiología , Vejiga Urinaria/fisiopatología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: The aim of this study was to determine if there is a difference in Pelvic Floor Disability Index Questionnaire (PFDI-20) scores between black and white women seeking surgical management for pelvic organ prolapse (POP). METHODS: A retrospective cohort study of 232 women who underwent pelvic reconstructive surgery with apical suspension for POP was performed. Demographic and clinical data were collected. All women completed the PFDI-20 and had a Pelvic Organ Prolapse Quantification examination at the initial consultation. Appropriate statistical tests were used to compare black and white women. Multivariable regression models adjusting for demographic and clinical variables were developed to determine the independent relationship between race and POP symptoms. RESULTS: In our cohort, 174 (75%) were white and 58 (25%) were black. Compared with white women, black women had higher parity, body mass index, Charlson Comorbidity Index score, and anterior POP stage. White women had higher total PFDI-20 scores corresponding to higher scores on all symptom subscales. After controlling for potential confounders, white race and prior anti-incontinence surgery remained associated with higher total PFDI scores. Higher Urogenital Distress Inventory 6 scores were significantly associated with white race, prior anti-incontinence procedures, and increasing body mass index, whereas higher CRADI-8 scores were associated with prior anti-incontinence surgery and higher POP stages. CONCLUSIONS: White women appeared to have more overall symptom bother from prolapse, as well as urinary symptoms, as compared with black women, when assessed by validated questionnaire tools in a cohort of patients who underwent prolapse surgery. Further research is required to determine if racial differences in symptoms translate to differences in outcomes.
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Negro o Afroamericano , Prolapso de Órgano Pélvico/complicaciones , Prolapso de Órgano Pélvico/etnología , Población Blanca , Anciano , Índice de Masa Corporal , Comorbilidad , Femenino , Humanos , Persona de Mediana Edad , Paridad , Prolapso de Órgano Pélvico/cirugía , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Evaluación de Síntomas , Incontinencia Urinaria/cirugíaRESUMEN
OBJECTIVES: The primary aim was to compare the incidence of transient voiding dysfunction (TVD) between vaginal uterosacral ligament suspension, sacrospinous ligament fixation, and robotic sacrocolpopexy. Secondarily, we identified risk factors for TVD and associated postoperative complications. METHODS: This was a retrospective cohort study of women who underwent apical repair at 1 institution. Data were collected from electronic medical records and were presented as means (SD) or numbers (percent) as appropriate. Univariate and multivariate analyses were performed to identify risk factors for TVD and its associated postoperative complications. RESULTS: Three hundred sixty women were included in analysis. Two hundred nineteen (60.8%) passed their voiding trial and 141 (39.2%) experienced TVD. The TVD group demonstrated a higher age, age-adjusted Charlson Comorbidity Index score, and preoperative postvoid residual (all P < 0.05). Univariate analysis demonstrated higher rates of TVD in the vaginal uterosacral ligament suspension and sacrospinous ligament fixation groups compared with the robotic sacrocolpopexy group (P = 0.012). Transient voiding dysfunction occurred more frequently with a concomitant anti-incontinence procedure, anterior repair, and/or posterior repair (all P < 0.05). In multivariate analysis, only an anti-incontinence procedure and concomitant anterior repair were independently associated with a risk of TVD (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.37-3.62, and OR, 2.20; CI, 1.14-4.27, respectively). Transient voiding dysfunction was associated with a culture-proven urinary tract infection within 6 weeks (OR, 3.2; CI, 1.3-8.55). CONCLUSIONS: There was no difference in TVD between types of apical repair. Concomitant anti-incontinence procedure and anterior repair were associated with TVD. Women with TVD have an increased risk of postoperative urinary tract infections.
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Prolapso de Órgano Pélvico/cirugía , Complicaciones Posoperatorias/etiología , Trastornos Urinarios/etiología , Procedimientos Quirúrgicos Urogenitales/efectos adversos , Anciano , Femenino , Humanos , Ligamentos/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Procedimientos Quirúrgicos Robotizados/efectos adversos , Sacro/cirugía , Incontinencia Urinaria/cirugíaRESUMEN
OBJECTIVES: Obstetric anal sphincter injury (OASIS) is a potentially serious complication of vaginal delivery and can lead to both short-term and long-term sequelae. This study sought to identify health care seeking patterns of women who developed pelvic floor symptoms including pelvic pain after OASIS. It also identified demographic and clinical factors associated with seeking subspecialty care from a pelvic floor specialist and demographic and clinical factors associated with seeking care for pelvic pain after OASIS. METHODS: This study is a retrospective cohort study of 69 women who developed pelvic floor disorders after OASIS. RESULTS: For women diagnosed with a pelvic floor symptom, the mean time to follow-up was 2.4 years, the mean number of visits until diagnosis was 2.2 visits, and 2.9 visits were needed for treatment. The most common diagnoses were pelvic pain, lower urinary tract symptoms including incontinence, and defecatory dysfunction. Twenty-five percent of the cohort received treatment from a pelvic floor specialist. These women were more likely to be older and have urinary incontinence. Women with pain were more likely to be seen by a primary care provider and have longer time to diagnosis. CONCLUSIONS: The study showed that multiple visits were needed to both diagnose and treat pelvic floor disorders (PFD) after OASIS. Pelvic pain was the most common primary PFD after OASIS. There should be a high level of suspicion for pelvic floor disorders, especially pain disorders, in women who have sustained a third- or fourth-degree laceration.
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Canal Anal/lesiones , Parto Obstétrico/efectos adversos , Laceraciones/complicaciones , Aceptación de la Atención de Salud , Trastornos del Suelo Pélvico/etiología , Adulto , Estudios de Cohortes , Femenino , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND: Tension-free vaginal tape (TVT) is a popular operative treatment for stress urinary incontinence (SUI). It has a low risk of adverse events, and injuries, particularly to the bowel, are rare. Case reports that have previously discussed these injuries and subsequent removal of TVT have not provided additional insight into management of SUI after these injuries occur. CASE: A postmenopausal woman with persistent SUI presented more than 1 year after TVT placement with bowel perforation incidentally discovered on routine screening colonoscopy. She underwent removal of the TVT and subsequent placement of a fascial sling with postoperative resolution of SUI. CONCLUSION: This case provides additional evidence for bowel injury as a postoperative TVT complication and describes an approach to complicated TVT and persistent SUI.
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Ciego/lesiones , Colonoscopía , Perforación Intestinal/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Cabestrillo Suburetral/efectos adversos , Incontinencia Urinaria de Esfuerzo/cirugía , Ciego/diagnóstico por imagen , Diagnóstico Tardío , Femenino , Humanos , Hallazgos Incidentales , Perforación Intestinal/etiología , Persona de Mediana EdadRESUMEN
OBJECTIVES: The primary aim of this study was to determine the impact of obesity on national rates of perioperative complications in women undergoing pelvic reconstructive surgery in 2013 in the United States. METHODS: Women who underwent pelvic reconstructive surgery were identified in the 2013 National Inpatient Sample using International Classification of Diseases, Ninth Revision procedure codes. Demographic data and comorbidities including obesity (body mass index ≥30 kg/m) were abstracted. Perioperative complications and mortalities that occurred during the same admission were abstracted from the data set using International Classification of Diseases, Ninth Revision diagnosis codes. The complication rates were compared between obese and nonobese subjects. Univariate analysis was performed to determine factors associated with the primary outcome. Significant factors were included in the regression model to determine the adjusted odds ratio for perioperative complications in obese women. RESULTS: A total of 16,639 women underwent pelvic reconstructive surgery in the 2013 National Inpatient Sample data set and were included in the analysis. Approximately 10% of the study cohort was obese. The overall perioperative complication rate during the surgical admission was 25%. On multivariate analysis, obesity was found to increase the odds of perioperative complications by approximately 40% after controlling for age, race, income, concomitant hysterectomy, and medical comorbidities (adjusted odds ratio, 1.40; 95% confidence interval, 1.24-1.58; P < 0.0001). CONCLUSIONS: Obesity is an independent risk factor for perioperative complications in women who undergo pelvic reconstructive surgery. This information can be used for preoperative counseling and risk stratification.
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Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Obesidad/epidemiología , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Índice de Masa Corporal , Estudios de Casos y Controles , Comorbilidad , Femenino , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Humanos , Histerectomía/efectos adversos , Histerectomía/estadística & datos numéricos , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
AIMS: The aim of this study was to compare the expression of urinary nerve growth factor (NGF), brain derived neurotrophic factor (BDNF), substance P (SP), and calcitonin-gene related peptide (CGRP) in women with and without overactive bladder (OAB). We sought to determine factors associated with higher expression of these neuropeptides. METHODS: Participants with OAB and age-matched controls were enrolled. Symptom severity was assessed with validated questionnaires. Urinary neurotrophin levels, symptom scores, and clinical data were compared between the groups. Multivariate analysis determined independent factors associated with urinary neurotrophin levels. RESULTS: Sixty-seven women (38 OAB, 29 controls) were included. Women with OAB and controls were similar in age, race, body mass index, parity, and smoking status. Women with OAB were more likely to report a history of pelvic pain and pelvic surgery. Neurotrophic factor levels normalized to urinary creatinine did not differ between the groups. Increasing age was associated with greater urinary levels of BDNF and NGF (ß = 0.23, 95%CI 0.11-0.34 and 0.75, 95%CI 0.17-1.33, respectively, P < 0.02). Higher urinary NGF was associated with increasing BMI (ß = 0.81, 95%CI 0.05-1.57, P = 0.04) while pain was associated with elevated urinary SP (ß = 0.21, 95%CI 0.09-0.33, P = 0.001). CONCLUSIONS: Our data does not support a relationship between urinary neurotrophin levels and OAB in age-matched postmenopausal women. Further research is necessary to elucidate the role of urinary neurotrophins in the diagnosis and management of OAB. Neurourol. Urodynam. 36:740-744, 2017. © 2016 Wiley Periodicals, Inc.
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Factor Neurotrófico Derivado del Encéfalo/orina , Péptido Relacionado con Gen de Calcitonina/orina , Factor de Crecimiento Nervioso/orina , Sustancia P/orina , Vejiga Urinaria Hiperactiva/orina , Anciano , Biomarcadores/orina , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia/orina , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Vejiga Urinaria Hiperactiva/diagnósticoRESUMEN
OBJECTIVE: To evaluate trends in annual rates of vaginal birth, cesarean delivery, and obstetric anal sphincter injury at a single institution before and after the designation of obstetric anal sphincter injury as a measure of obstetric quality and safety. METHODS: This was a retrospective cohort study of women undergoing a singleton vaginal delivery and diagnosed with obstetric anal sphincter injury over a 16-year period. International Classification of Diseases, 9th Revision codes for perineal lacerations were used as identifiers. Trends in annual cesarean delivery, perineal laceration, and obstetric anal sphincter injury rates were assessed in a linear regression model. The data were divided into two time periods (1998-2005 and 2006-2013) based on the year (2006) in which obstetric anal sphincter injury was designated as a quality marker and compared. RESULTS: A total of 1,366 women had obstetric anal sphincter injury, and 1,360 were included for analysis. There was a 12.1% decline in annual vaginal delivery rates (from 77.1% to 67.8%) and a 40.6% increase in annual cesarean delivery rate (from 22.9% to 32.2%; P<.001). The rate of first-degree and second-degree laceration increased significantly (P=.009), and obstetric anal sphincter injury decreased significantly (P<.001). Operative vaginal birth and episiotomy were associated with obstetric anal sphincter injury in 2006-2013 compared with 1998-2005 (P<.001 and P=.018, respectively). CONCLUSION: After the designation of obstetric anal sphincter injury as an institutional quality measure, rates of obstetric anal sphincter injury decreased.
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Canal Anal/lesiones , Parto Obstétrico/efectos adversos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Femenino , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
INTRODUCTION AND HYPOTHESIS: The objective was to report patterns of sling and transvaginal mesh-related complications using the IUGA/ICS classification of prosthesis-related complications. METHODS: This was a retrospective chart review of all patients who underwent surgical removal of sling, transvaginal mesh, and sacrocolpopexy for mesh-related complications from 2011 to 2013 at three tertiary referral centers. The International Urogynecological Association (IUGA)/International Continence Society (ICS) classification system was utilized. RESULTS: We identified 445 patients with mesh complications, 506 pieces of synthetic mesh were removed, and 587 prostheses-related complications were classified. 3.7 % of patients had viscus organ penetration or vaginal exposure as their presenting chief complaint and 59.7 % were classified as not having any vaginal epithelial separation or category 1. The most common category was spontaneous pain (1Be: 32.5 %) followed by dyspareunia (1Bc: 14.7 %). The sling group was 20 % more likely to have pain compared with the pelvic organ prolapse (POP) mesh group (OR 1.2, 95 % CI 0.8-1.6). The most commonly affected site (S2) was away from the suture line (49 %). Compared with the sling group, the POP group had a higher rate of mesh exposure, which mostly occurred at the suture line area. The majority of patients presented with mesh-related complications more than 1 year post-insertion (T4; average 3.68 ± 2.47 years). CONCLUSION: Surgeons should be aware that patients with vaginal mesh complications routinely exhibit complications more than 1 year after the implantation with pain as the most common presenting symptom.