Does the setting for intradetrusor onabotulinumtoxinA injection for management of overactive bladder matter?

Introduction: Intradetrusor onabotulinumtoxinA (Botox) injections, to treat idiopathic overactive bladder (OAB), can be performed in the office setting under local analgesia alone or in the operating room (OR) under local and/or sedation. The objective of this study was to compare the symptomatic improvement in patients with OAB who underwent treatment with intradetrusor onabotulinumtoxinA injections in an in-office versus the OR setting. Methods: We performed a multicenter retrospective cohort study of women with the diagnosis of refractory non-neurogenic OAB who elected to undergo treatment with intradetrusor onabotulinumtoxinA injections between January 2015 and December 2020. The electronic medical records were queried for all the demographic and peri-procedural data, including the report of subjective improvement post procedure. Patients were categorized as either "in-office" versus "OR" based on the setting in which they underwent their procedure. Results: Five hundred and thirty-nine patients met the inclusion criteria: 297 (55%) in the in-office group and 242 (45%) in the OR group. A total of 30 (5.6%) patients reported retention after their procedure and it was more common in the in-office group (8.1%) versus the OR group (2.5%), (P = 0.003). The rate of urinary tract infection within 6 months of the procedure was higher in the OR group (26.0% vs. 16.8%, P = 0.009). The overall subjective improvement rate was 77% (95% confidence interval: 73%-80%). Patients in the OR group had a higher reported improvement as compared to the in-office group (81.4% vs. 73.3%, P = 0.03). Conclusions: In this cohort study of patients with OAB undergoing intradetrusor onabotulinumtoxinA injections, post procedural subjective improvement was high regardless of the setting in which the procedure was performed.

Resolution of Overactive Bladder Symptoms After Anterior and Apical Prolapse Repair.

IMPORTANCE: Patients often present with both overactive bladder (OAB) and pelvic organ prolapse (POP) concerns. It is unknown whether treatment of POP improves OAB. OBJECTIVE: This study aimed to evaluate whether OAB improves after anterior/apical POP repair for anterior wall prolapse. STUDY DESIGN: This was a prospective study of women with anterior/apical prolapse at or beyond the hymen and concomitant OAB symptoms, undergoing apical repair. Overactive bladder severity was evaluated with the Urogenital Distress Inventory-6 (UDI-6) questionnaire and the Incontinence Impact Questionnaire-7 preoperatively and 2, 6, 12, and 24 weeks postoperatively. The primary outcome was a reduction of ≥11 points or greater on the UDI-6 at 6 months. Those who reported an ≥11-point reduction were termed responders. Multivariable regression analyses were performed to evaluate factors associated with reduction in OAB symptoms after POP surgery. RESULTS: A total of 117 patients met the criteria for analysis, with 79.5% reporting improved OAB symptoms after POP repair at 6 months. There were no preoperative differences between groups. The mean preoperative UDI-6 and Incontinence Impact Questionnaire-7 scores were higher in the responder group (51.1 ± 16.8 vs 26.4 ± 15.1 [P < 0.001] and 44.6 ± 23.8 vs 22.8 ± 21.4 [P = 0.001], respectively), and the presence of detrusor overactivity was lower (29.0% vs 54.2%, P = 0.02). After regression, a higher preoperative UDI-6 total was associated with an increased likelihood of symptom improvement at 6 months (adjusted odds ratio, 1.14 per point [1.08-1.19]), whereas detrusor overactivity on preoperative urodynamics was associated with a decreased likelihood of OAB symptom improvement (adjusted odds ratio, 0.10 [0.02-0.44]). CONCLUSION: Overactive bladder symptoms improve in the majority of patients undergoing apical repair for anterior/apical prolapse beyond the hymen.

Plastic pollution transcends marine protected area boundaries in the eastern tropical and south-eastern Pacific.

The Eastern Tropical and South-Eastern Pacific region is of global biodiversity importance. At COP26, the governments of Costa Rica, Panama, Colombia, and Ecuador committed to the expansion of existing MPAs to create a new Mega MPA, safeguarding the Eastern Tropical Pacific Marine Corridor. It offers a profound step forward in conservation efforts but is not specifically designed to protect against the more diffuse anthropogenic threats, such as plastic pollution. We combine published data with our own unpublished records to assess the abundance and distribution of plastic pollution in the region. Macro- and microplastic concentrations varied markedly and were not significantly different when comparing areas inside and outside existing MPA boundaries. These findings highlight the diffuse and complex nature of plastic pollution and its ubiquitous presence across MPA boundaries. Understanding the sources and drivers of plastic pollution in the region is key to developing effective solutions.

The Response of the Urinary Microbiome to Botox.

INTRODUCTION AND HYPOTHESIS: Our objective was to evaluate if botox alters the urinary microbiome of patients with overactive bladder and whether this alteration is predictive of treatment response. METHODS: This multicenter prospective cohort study included 18-89-year-old patients undergoing treatment for overactive bladder with 100 units of botox. Urine samples were collected by straight catheterization on the day of the procedure (S1) and again 4 weeks later (S2). Participants completed the Patient Global Impression of Improvement form at their second visit for dichotomization into responders and nonresponders. The microbiome was sequenced using 16s rRNA sequencing. Wilcoxon signed rank and Wilcoxon rank sum were used to compare the microbiome, whereas chi-square, Wilcoxon rank sum, and the independent t-test were utilized for clinical data. RESULTS: Sixty-eight participants were included in the analysis. The mean relative abundance and prevalence of Beauveria bassiana, Xerocomus chrysenteron, Crinipellis zonata, and Micrococcus luteus were all found to increase between S1 and S2 in responders; whereas in nonresponders the mean relative abundance and prevalence of Pseudomonas fragi were found to decrease. The MRA and prevalence of Weissella cibaria, Acinetobacter johnsonii, and Acinetobacter schindleri were found to be greater in responders than nonresponders at the time of S1. Significant UM differences in the S1 of patients who did (n = 5) and did not go on to develop a post-treatment UTI were noted. CONCLUSIONS: Longitudinal urobiome differences may exist between patients who do and do not respond to botox.

At-sea solid waste production by a small-scale fishery in Peru.

Marine litter is a growing environmental problem for which fisheries-sourced waste remains poorly understood. In Peru, there is an ongoing challenge of waste management from the small-scale fisheries fleet given the lack of facilities to receive the variety of debris produced by fishers, which includes hazardous wastes such as batteries. In this study, onboard solid waste production was monitored daily by land-based observers upon landing at the port of Salaverry, Peru, from March to September 2017. The analysed small-scale gillnet and longline fishing fleets produced annually an estimated 11,260 kg of solid waste. Of particular concern is the production of single use plastics (3427 kg) and batteries (861 kg) due to their potential long-lasting impacts on the environment and challenges related to their proper disposal. A management plan for solid waste has been developed for Salaverry; therefore, a subsequent assessment was conducted in 2021-2022 of the behaviours and perceptions of fishers regarding the implementation of this plan. Most fishers (96%) reported disposing of their waste on land, except organic waste which is disposed of at sea. While fishers in Salaverry have become more conscious of the issues surrounding at-sea waste disposal and have an interest in better segregating and managing their waste, there remains a need for improved waste management and recycling protocols and procedures at the port to make this possible.

Pudendal Nerve Block Analgesia at the Time of Vaginal Surgery: A Randomized, Double-Blinded, Sham-Controlled Trial.

IMPORTANCE: Effective opioid-sparing postoperative analgesia requires a multimodal approach. Regional nerve blocks augment pain control in many surgical fields and may be applied to pelvic floor reconstruction. OBJECTIVE: This study aimed to evaluate the impact of pudendal nerve block on postoperative pain control and opioid consumption after vaginal surgery. STUDY DESIGN: In this randomized, double-blind, sham-controlled trial, we enrolled women undergoing pelvic reconstruction, excluding patients with chronic pelvic pain or contraindications to nonnarcotic analgesia. Patients were randomized to transvaginal pudendal nerve block (9 mL 0.25% bupivacaine and 1 mL 40 mg/mL triamcinolone) or sham injection (10 mL normal saline). Primary outcomes were pain scores and opioid requirements. Sixty patients were required to show a 20-mm difference on a 100-mm visual analog scale (VAS). RESULTS: We randomized 71 patients: 36 pudendal block and 35 sham. Groups were well matched in baseline characteristics and surgery type. Prolapse repairs were most common (n = 63 [87.5%]), and there was no difference in anesthetic dose or operative time. Pain scores were equivalent in the postanesthesia care unit (mean VAS, 53.1 [block] vs 56.4 [sham]; P = 0.517) and on postoperative day 4 (mean VAS, 26.7 [block] vs 35.5 [sham]; P = 0.131). On postoperative day 1, the intervention group reported less pain, but this did not meet our 20 mm goal for clinical significance (mean VAS, 29.2 vs 42.5; P = 0.047). A pudendal block was associated with lower opioid consumption at all time points, but this was not statistically significant. CONCLUSIONS: Surgeon-administered pudendal nerve block at the time of vaginal surgery may not significantly improve postoperative pain control or decrease opioid use.

A novel anchoring system for pelvic organ prolapse repair: an observational study.

INTRODUCTION AND HYPOTHESIS: Sacrospinous ligament (SSL) fixation is an effective and widely used vaginal procedure for correcting apical prolapse. The Saffron Fixation System (Coloplast Corp., Minneapolis, MN, USA) is a new anchoring device aimed at facilitating a durable, easy, and short procedure for SSL fixation with the goal of minimizing operative complications. The objective was to demonstrate the efficacy and safety of anchor deployment and suture fixation for pelvic organ prolapse repair using the Saffron Fixation System. METHODS: An observational human cadaver study was conducted to measure the distance between anchor location and anatomical landmarks in the pelvis, and the holding force of the fixated anchors. Anchors were placed in four human cadavers by different implanters. The pull-out force of these anchors was measured to assess efficacy (three cadavers by three implanters) and the distance between anchors and primal vessels and nerves was measured to assess safety (one cadaver by one implanter). RESULTS: Nineteen out of 20 anchors (95%) were correctly placed as judged by independent assessment performed by non-implanting surgeons. Distance between anchors and surrounding nerves and vessels exceeded 10 mm. Mean (SD) pull out-force was 17.9 (5.6) N. CONCLUSION: The innovative anchoring device that was developed appeared to enable precise and solid anchor placement in the SSL. Future clinical studies are needed to explore if the theoretical advantages of this device translate to improved clinical outcomes in comparison with available suturing and anchoring devices.

Opioid use following pelvic reconstructive surgery: a predictive calculator.

INTRODUCTION AND HYPOTHESIS: Our objective was to evaluate the amount of opioids used by patients undergoing surgery for pelvic floor disorders and identify risk factors for opioid consumption greater than the median. METHODS: This was a prospective cohort study of 18- to 89-year-old women undergoing major urogynecological surgery between 1 November2020 and 15 October 2021. Subjects completed one preoperative questionnaire ("questionnaire 1") that surveyed factors expected to influence postoperative pain and opioid use. At approximately 1 and 2 weeks following surgery, patients completed two additional questionnaires ("questionnaire 2" and "questionnaire 3") about their pain scores and opioid use. Risk factors for opioid use greater than the median were assessed. Finally, a calculator was created to predict the amount of opioid used at 1 week following surgery. RESULTS: One hundred and ninety patients were included. The median amount of milligram morphine equivalents prescribed was 100 (IQR 100-120), whereas the median amount used by questionnaire 2 was 15 (IQR 0-50) and by questionnaire 3 was 20 (IQR 0-75). On multivariate logistic regression, longer operative time (aOR 1.64 per hour of operative time, 95% CI 1.07-2.58) was associated with using greater than the median opioid consumption at the time of questionnaire 2; whereas for questionnaire 3, a diagnosis of fibromyalgia (aOR=16.9, 95% CI 2.24-362.9) was associated. A preliminary calculator was created using the information collected through questionnaires and chart review. CONCLUSIONS: Patients undergoing surgery for pelvic floor disorders use far fewer opioids than they are prescribed.

Solid waste assessment in a coastal fishing community in Peru.

Peru has a large small-scale fishing fleet upon which many coastal communities depend for their food and livelihoods. Nonetheless, no thorough assessments have been conducted of solid waste production and management of small-scale fisheries (SSF) and associated communities. We aimed to assess gillnet SSF and household solid waste generation in San Jose, north Peru. A solid waste generation assessment was conducted by monitoring solid waste production during 22 fishing trips and interviewing 70 families. Daily waste generation and recycling per capita, were calculated applying separate Generalized Linear Mixed-Effect Models. Organic waste is the most frequently produced during fishing activities (38%) and at home (83%), followed by plastic and metal. Glass, paper/cardboard, and fishing nets were solely produced during fishing trips. Daily waste per capita was estimated on 0.14 kg∗(day)-1 onboard, and 0.33 kg∗(day)-1 at home. Additionally, perception interviews showed that the population of San Jose perceived solid waste as a threat to public health and marine ecosystems. This study provides a first attempt to assess solid waste production in a Peruvian fishing community, showing the need for an integrated management plan embracing vessel and land-based solid waste generation.

Review of threats to the Pacific seahorse Hippocampus ingens (Girard 1858) in Peru.

Illegal wildlife trade has been identified as a major source of global commerce of seahorses. The Convention on International Trade in Endangered Species of Wild Fauna and Flora listed the genus Hippocampus in Appendix II in 2004, when several countries that commercialized these species also banned transactions through domestic legislation, Peru being one of them. Nevertheless, since the 2004 ban was decreed in Peru, transactions have continued, including international commerce, as well confiscations of illegal seahorse Hippocampus ingens (Girard 1858) products. The authors reviewed three official government sources for information on seahorse trade in Peru, identifying differences in the reporting of the two agencies that monitor exports and imports of seahorses, likely due to non-standardized use of product categorization codes (Partidas Arancelarias). Confiscations reported by one of the agencies confirmed that illegal trade continued despite the ban and in similar amounts of what was exported by Peru before the ban (1053 kg confiscated in 2019 vs. 1460 kg exported in 2004, an estimated 437,888 and 607,067 seahorses, respectively). This review highlights gaps in seahorse conservation in Peru, which include research gaps (e.g., taxonomy, biology and use of habitats) as well as the identification of fisheries impact and improvements in by-catch reporting. This review also highlights areas for possible improvement in international trade (e.g., standardized descriptions of Partidas) that ultimately would allow the country to follow the Convention for Illegal Trade of Endangered Species regulations for seahorses.

Lessons from 12 years of marine fauna stranding data in the south of Peru.

In Peru, while several mass mortality events have been reported in the last two decades, there has been minimal systematic stranding monitoring. In this study, we report on repeated stranding monitoring that took place between October 2003 and October 2015, at Ite beach, Tacna (17° 54' 47" S 70° 58' 21" W). The objectives of the study were to assess the proportion of strandings by taxon and whether there were seasonal effects on abundance of stranded marine fauna. The study location was assessed opportunistically by trained observers who recorded and identified every stranded marine animal to the highest taxonomic degree possible. Stranded specimens of seabirds and marine mammals were grouped into overarching taxa of coastal and oceanic seabirds, and cetaceans and carnivorans. A principal component analysis (PCA) to visualize the association among stranded taxa registered along the study period and sea surface temperature anomalies using the Oceanic El Niño Index (ONI 3.4) and El Niño Coastal Index (ICEN) indexes and a Kruskal-Wallis test were conducted to evaluate abundance differences among taxonomic groups, taxa strandings and seasons. A total of 17,827 carcasses were encountered, 92.4% was seabirds and 7.6% marine mammals. Differences in abundances were significant among coastal and oceanic seabirds and marine mammals. Significant differences among seasons for cormorants and boobies were also identified. Coastal seabirds and pinnipeds dominated the stranding counts. A massive mortality of cormorants and boobies was registered between June and July 2014 possibly due to a moderate El Niño event. These strandings provide valuable information that could help lay the groundwork for implementation of a stranding network and science-based management projects in southern Peru.

Assessing information-sharing networks within small-scale fisheries and the implications for conservation interventions.

The effectiveness of behavioural interventions in conservation often depends on local resource users' underlying social interactions. However, it remains unclear to what extent differences in related topics of information shared between resource users can alter network structure-holding implications for information flows and the spread of behaviours. Here, we explore the differences in nine subtopics of fishing information related to the planned expansion of a community co-management scheme aiming to reduce sea turtle bycatch at a small-scale fishery in Peru. We show that the general network structure detailing information sharing about sea turtle bycatch is dissimilar from other fishing information sharing. Specifically, no significant degree assortativity (degree homophily) was identified, and the variance in node eccentricity was lower than expected under our null models. We also demonstrate that patterns of information sharing between fishers related to sea turtle bycatch are more similar to information sharing about fishing regulations, and vessel technology and maintenance, than to information sharing about weather, fishing activity, finances and crew management. Our findings highlight the importance of assessing information-sharing networks in contexts directly relevant to the desired intervention and demonstrate the identification of social contexts that might be more or less appropriate for information sharing related to planned conservation actions.

Pelvic Organ Prolapse Surgery in the Elderly and Frail: Safety of a Reconstructive Versus Obliterative Approach.

OBJECTIVES: The aim of this study was to compare the risk of complications associated with obliterative surgery versus reconstructive surgery in elderly and frail patients undergoing surgery for pelvic organ prolapse. METHODS: We performed a retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program Database from 2010 to 2017. We compared characteristics and perioperative complications in patients aged 80 years or older who underwent obliterative surgery versus reconstructive surgery. Multivariate logistic regression and propensity score matching were used to control for confounding. A subanalysis was performed that included patients who were considered frail as defined by the National Surgical Quality Improvement Program Modified Frailty Index 5. RESULTS: Of 1,654 total patients, reconstructive surgery was performed in 56.9% of patients, and obliterative surgery was performed in 43.1%. The respective composite complication rates were 9.2% and 9.8% (P = 0.69), whereas severe complications were experienced by 1.9% in the reconstructive group versus 0.8% in the obliterative group (P = 0.07). On multivariate logistic regression, reconstructive surgery was not significantly associated with the composite complication rate (adjusted odds ratio, 1.0; 95% confidence interval, 0.7-1.4; P = 0.80). After propensity score matching, composite complications did not differ between groups, but the rate of severe complications was significantly higher in patients who underwent reconstructive surgery compared with obliterative surgery (2.1% vs 0.8%; odds ratio, 2.53; 95% confidence interval, 1.01-6.36; P = 0.05). In frail patients only, complication rates did not differ between groups. CONCLUSIONS: In patients aged 80 years or older, the overall rate of complications did not differ between those who underwent reconstructive surgery versus obliterative surgery. However, propensity score matching identified an increased risk of the most severe complications in patients who underwent reconstructive surgery.

Green, yellow or black? Genetic differentiation and adaptation signatures in a highly migratory marine turtle.

Marine species may exhibit genetic structure accompanied by phenotypic differentiation related to adaptation despite their high mobility. Two shape-based morphotypes have been identified for the green turtle (Chelonia mydas) in the Pacific Ocean: the south-central/western or yellow turtle and north-central/eastern or black turtle. The genetic differentiation between these morphotypes and the adaptation of the black turtle to environmentally contrasting conditions of the eastern Pacific region has remained a mystery for decades. Here we addressed both questions using a reduced-representation genome approach (Dartseq; 9473 neutral SNPs) and identifying candidate outlier loci (67 outlier SNPs) of biological relevance between shape-based morphotypes from eight Pacific foraging grounds (n = 158). Our results support genetic divergence between morphotypes, probably arising from strong natal homing behaviour. Genes and enriched biological functions linked to thermoregulation, hypoxia, melanism, morphogenesis, osmoregulation, diet and reproduction were found to be outliers for differentiation, providing evidence for adaptation of C. mydas to the eastern Pacific region and suggesting independent evolutionary trajectories of the shape-based morphotypes. Our findings support the evolutionary distinctness of the enigmatic black turtle and contribute to the adaptive research and conservation genomics of a long-lived and highly mobile vertebrate.

Stable isotope and fatty acid analyses reveal significant differences in trophic niches of smooth hammerhead Sphyrna zygaena (Carcharhiniformes) among three nursery areas in northern Humboldt Current System.

Fishery pressure on nursery areas of smooth hammerhead in northern Peruvian coast have become a serious threat to sustainability of this resource. Even though, some management actions focused on conservation of the smooth hammerhead populations were proposed in recent years, their scientific foundations are often limited, and biomass of smooth hammerhead in Peruvian waters continues to decrease. To inform management and conservation, this study aims to evaluate the trophic niche of smooth hammerhead juveniles from three nursery areas in the northern Peruvian coast using stable isotope and fatty acid analyses. First, we compared the environmental characteristics of each nursery area (i.e., sea surface temperature and chlorophyll-a concentration) and concluded that nursery areas differed significantly and consistently in sea surface temperature. Subsequently, we evaluated isotopic composition of carbon and nitrogen and fatty acid profiles of muscle and liver tissues collected from juvenile smooth hammerhead from each nursery area. We found that juvenile smooth hammerhead captured in San José were enriched in heavier 13C and 15N isotopes compared to those captured in Máncora and Salaverry. Furthermore, the broadest isotopic niches were observed in juveniles from Máncora, whereas isotopic niches of juveniles from Salaverry and San José were narrower. This difference is primarily driven by the Humboldt Current System and associated upwelling of cold and nutrient rich water that drives increased primary production in San José and, to a less extent, in Salaverry. Compared to smooth hammerhead juveniles from Máncora, those from San José and Salaverry were characterised by higher essential fatty acid concentrations related to pelagic and migratory prey. We conclude that smooth hammerhead juveniles from three nursery areas in the northern Peruvian coast differ significantly in their trophic niches. Thus, management and conservation efforts should consider each nursery area as a unique juvenile stock associated with a unique ecosystem and recognize the dependence of smooth hammerhead recruitment in San José and Salaverry on the productivity driven by the Humboldt Current System.

Tamsulosin vs placebo to prevent postoperative urinary retention following female pelvic reconstructive surgery: a multicenter randomized controlled trial.

BACKGROUND: Postoperative urinary retention is common after female pelvic reconstructive surgery. Alpha receptor antagonists can improve dysfunctional voiding by relaxing the bladder outlet and may be effective in reducing the risk of postoperative urinary retention. OBJECTIVE: This study aimed to determine whether tamsulosin is effective in preventing postoperative urinary retention in women undergoing surgery for pelvic organ prolapse. STUDY DESIGN: This was a multicenter, double-blind, randomized controlled trial between August 2018 and June 2020, including women undergoing surgery for pelvic organ prolapse. Patients were excluded from recruitment if they had elevated preoperative postvoid residual volume, history of postoperative urinary retention, or a contraindication to tamsulosin. Those who experienced cystotomy were excluded from analysis. Participants were randomized to a 10-day perioperative course of tamsulosin 0.4 mg vs placebo, beginning 3 days before surgery. A standardized voiding trial was performed on postoperative day 1. The primary outcome was the development of postoperative urinary retention, as defined by the failure of the voiding trial or subsequent need for catheterization to empty the bladder. Secondary outcomes included the rate of urinary tract infection and the impact on lower urinary tract symptoms as measured by the American Urological Association Symptom Index. RESULTS: Of 119 patients, 57 received tamsulosin and 62 received placebo. Groups were similar in regard to demographics, preoperative prolapse and voiding characteristics, and surgical details. Tamsulosin was associated with a lower rate of postoperative urinary retention than placebo (5 patients [8.8%] vs 16 patients [25.8%]; odds ratio, 0.28; 95% confidence interval, 0.09-81; P=.02). The number needed to treat to prevent 1 case of postoperative urinary retention was 5.9 patients. The rate of urinary tract infection did not differ between groups. American Urological Association Symptom Index scores significantly improved after surgery in both groups (median total score, 14 vs 7; P<.01). Scores related to urinary stream improved more in the tamsulosin group than in placebo (P=.03). CONCLUSION: In this placebo-controlled trial, tamsulosin use was associated with a reduced risk of postoperative urinary retention in women undergoing surgery for pelvic organ prolapse.

Adverse Cardiovascular Events Associated With Female Pelvic Reconstructive Surgery.

OBJECTIVE: To evaluate national trends in major adverse cardiovascular and cerebrovascular events (MACCE) in female pelvic reconstructive surgery (FPRS). METHODS: Data from the National Inpatient Sample was used to identify women undergoing FPRS between 2012 and 2016. Demographic, procedural, and comorbidity data were collected. Patients were stratified into those with and without MACCE (defined as all-cause mortality, cardiac arrest, myocardial infarction (MI) and acute ischemic stroke). Descriptive statistics are expressed as medians and interquartile ranges. Pairwise analysis was performed using Wilcoxon rank-sum or Fisher exact test as appropriate. Multivariable logistic regression was used to identify independent risk factors for MACCE. RESULTS: During the study period, 53,540 patients underwent FPRS. The rate of MACCE was 4.8 per 1000 surgeries; MI, 3.7; acute ischemic stroke, 0.6; cardiac arrest, 0.4; and all-cause mortality, 0.3. Patients experiencing MACCE were more likely to have major preexisting cardiovascular comorbidities, coagulopathy, neurologic disease (ND), and diabetes and were more likely to undergo robotic colpopexy (20.7% vs 9.6%, P < 0.001), vaginal colpopexy (32.0% vs 28.5%, P = 0.04), and to receive a blood transfusion (8.2% vs 2.5%, P < 0.001).On logistic regression, preexisting coagulopathy was the strongest predictor of MACCE (adjusted odds ratio [aOR], 5.53; 95% confidence interval [CI], 2.39-12.78), followed by blood transfusion (aOR, 4.84; 95% CI, 1.89-12.45), congestive heart failure (aOR, 3.61; 95% CI, 1.56-8.37), ND (aOR, 3.14; 95% CI, 1.23-8.06), and electrolyte abnormalities (aOR, 1.99; 95% CI, 1.05-3.99). CONCLUSION: Major adverse cardiovascular and cerebrovascular events after FPRS is a rare event, with MI being the most common manifestation. Preexisting ND, congestive heart failure, coagulopathy, electrolyte disturbances, and perioperative transfusions are strongly associated with MACCE.

Two-year outcomes of the ARTISAN-SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system.

AIMS: Sacral neuromodulation (SNM) is a guideline-recommended treatment with proven therapeutic benefit for urinary urgency incontinence (UUI) patients. The Axonics® System is the first Food and Drug Administration-approved rechargeable SNM system and is designed to deliver therapy for a minimum of 15 years. The ARTISAN-SNM study was designed to evaluate UUI participants treated with the Axonics System. Two-year follow-up results are presented. METHODS: One hundred and twenty-nine UUI participants underwent implantation with the Axonics System. Therapeutic response rate, participant quality of life (QoL), and satisfaction were determined using 3-day voiding diaries, ICIQ-OABqol, and satisfaction questionnaires. Participants were considered responders if they had a 50% or greater reduction in UUI episodes post-treatment. As-treated and Completers analyses are presented. RESULTS: At 2 years, 93% of the participants (n = 121 Completers at 2 years) were therapy responders, of which 82% achieved ≥ 75% reduction in UUI episodes and 37% were dry (100% reduction). Daily UUI episodes reduced from 5.6 ± 0.3 at baseline to 1.0 ± 0.2 at 2 years. Statistically significant improvements in ICIQ-OABqol were reported. All participants were able to recharge their device and 94% of participants reported that the recharging frequency and duration were acceptable. Participant demographics nor condition severity were correlated with clinical outcomes or recharging experience. No unanticipated or serious device-related adverse events occurred. CONCLUSIONS: At 2 years, participants treated with the Axonics System demonstrated sustained safety and efficacy, high levels of satisfaction with therapy and recharging. Participant-related factors were not associated with efficacy or recharging outcomes, indicating the reported results are applicable to a diverse population.

Diet, trophic interactions and possible ecological role of commercial sharks and batoids in northern Peruvian waters.

The Peruvian sea represents one of the most productive ocean ecosystems and possesses one of the largest elasmobranch fisheries in the Pacific Ocean. Ecosystem-based management of these fisheries will require information on the trophic ecology of elasmobranchs. This study aimed to understand the diet, trophic interactions and the role of nine commercial elasmobranch species in northern Peru through the analysis of stomach contents. A total of 865 non-empty stomachs were analysed. Off northern Peru, elasmobranchs function as upper-trophic-level species consuming 78 prey items, predominantly teleosts and cephalopods. Two distinctive trophic assemblages were identified: (a) sharks (smooth hammerhead shark Sphyrna zygaena, thresher shark Alopias spp. and blue shark Prionace glauca) that feed mainly on cephalopods in the pelagic ecosystem; and (b) sharks and batoids (Chilean eagle ray Myliobatis chilensis, humpback smooth-hound Mustelus whitneyi, spotted houndshark Triakis maculata, Pacific guitarfish Pseudobatos planiceps, copper shark Carcharhinus brachyurus and school shark Galeorhinus galeus) that feed mainly on teleosts and invertebrates in the benthonic and pelagic coastal ecosystem. This study reveals for the first time the diet of T. maculata and the importance of elasmobranchs as predators of abundant and commercial species (i.e., jumbo squid Dosidicus gigas and Peruvian anchovy Engraulis ringens). The results of this study can assist in the design of an ecosystem-based management for the northern Peruvian sea and the conservation of these highly exploited, threatened or poorly understood group of predators in one of the most productive marine ecosystems.

Cystoscopy with antibiotic irrigation during pelvic reconstruction and minimally invasive gynecologic surgery: A double-blind randomized controlled trial.

AIMS: After pelvic reconstructive surgery, the risk of postoperative urinary tract infection (UTI) is significant; intraoperative cystoscopy may contribute to this risk. Intravesical antibiotics are used in the ambulatory setting and may be applied to the surgical arena. Our objective was to evaluate the efficacy of antibiotic irrigation during intraoperative cystoscopy to prevent postoperative UTI. METHODS: This double-blind randomized controlled trial enrolled 216 women undergoing cystoscopy with elective surgery for pelvic organ prolapse, stress urinary incontinence, or laparoscopic gynecologic surgery at an academic medical center 2016-2019. Participants were randomized to cystoscopic irrigation fluid type: normal saline (control) or 200,000 U polymyxin B + 40 mg neomycin solution in normal saline (antibiotic). Patients and providers who treated UTIs were blinded. The primary outcome was treatment of UTI within 6 weeks postoperatively, defined as positive culture or treatment for a symptomatic UTI. χ2 and multivariable logistic regression analyses were performed. RESULTS: We enrolled 216 women: 111 control (51.4%) and 105 antibiotic (48.6%). Mean age was 51.6 years. Groups were well matched in medical comorbidities and surgery type. Primary vaginal surgery was most common (n = 127, 58.8%). Overall, 10.7% of patients developed a postoperative UTI with no difference in incidence between groups: 9.9% of control (n = 11, 95% confidence interval [CI]: 4.0%-16.0%) versus 11.4% of antibiotic subjects (n = 12, 95% CI: 5.0%-18.0%), on χ2 (p = .718) and logistic regression analysis (adjusted odds ratio, 1.3; CI: 0.53-3.16; p = .569). CONCLUSION: When cystoscopy is performed during elective pelvic surgery, use of antibiotic irrigation does not impact the rate of postoperative UTI.