Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Obstetrics and Gynecology Expert Panel consists of radiologists specializing in obstetrics and gynecology, obstetrics and gynecology physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 12 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 46 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 68 recommendation statements across the 12 scenarios related to the evaluation of obstetrics and gynecology clinical and diagnostic scenarios. This guideline presents the methods of development and the imaging recommendations for a variety of obstetrical and gynecological conditions including pregnancy assessment, recurrent first trimester pregnancy loss, post-partum indications, disorders of menstruation, localization of intra-uterine contraceptive device, infertility assessment, assessment of adnexal mass, pelvic pain of presumed gynecological origin, and pelvic floor evaluation.

Technical update nº 433: eHealth solutions for urinary incontinence among women

The purpose of this technical update is to establish the state of the science regarding emerging and novel electronic health (eHealth) and mobile health (mHealth) solutions for urinary incontinence among women. Target population Women over 18 years with urinary incontinence. Websites and mobile health applications are useful in the conservative care of urinary incontinence. Relevant care providers should be familiar with such tools, particularly those that use motivational principles for behaviour change, which can be used as adjunct tools for urinary incontinence care. Telemedicine is an effect mode to provide services for the conservative care of urinary incontinence. Use of eHealth and mHealth solutions has potentially significant health outcomes for patients, providers, and global health systems. Broader use of telemedicine, in and of itself, could improve care access and reduce costs incurred by patients and the health care system. Evidence for the efficacy of eHealth and mHealth technologies and applications for urinary incontinence ranges from weak to strong. However, the research landscape for many of these novel solutions is developing rapidly. Furthermore, these options have minimal or no harm and confer an established cost benefit and care access benefit. The Cochrane Library, Medline, EMBASE, CENTRAL databases (from January 2014 to April 2019) were searched to find articles related to conservative care of urinary incontinence in women (over 18 years) and studies on eHealth and mHealth interventions for urinary incontinence. Articles were appraised, and the collective evidence was graded. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). Relevant primary care providers and medical specialists, including physicians, nurses, midwives, and pelvic health physiotherapists.

The "virtual OR:" creation of a surgical video-based gynaecologic surgery teaching session to improve medical student orientation and supplement surgical learning during COVID-19.

The COVID-19 pandemic resulted in changes to clinical clerkship delivery including decreased surgical exposure. The Department of Obstetrics and Gynaecology at Dalhousie University developed a novel, resident-led learning experience using a curated presentation of operative footage. This session aimed to improve medical students' orientation to the operative environment and supplement teaching on pelvic anatomy and gynaecologic surgery in response to decreased exposure during the COVID-19 pandemic. Medical students perceived this session as valuable and felt it improved their preparedness for the operating room. This initiative has the potential to improve medical student orientation to the operative environment.

La pandémie de la COVID-19 a entraîné des changements dans le déroulement des stages d'externat, notamment une diminution l'exposition clinique en chirurgie. Le département d'obstétrique et de gynécologie de l'Université Dalhousie a mis au point une activité d'apprentissage novatrice, dirigée par des résidents, au moyen d'une présentation de vidéos opératoires. La séance visait à faciliter l'accueil des étudiants en médecine dans l'environnement opératoire, ainsi qu'à compléter l'enseignement de l'anatomie pelvienne et de la chirurgie gynécologique compte tenu de l'exposition clinique réduite pendant la pandémie de la COVID-19. Les étudiants ont jugé cette séance utile et ils s'estiment, grâce à elle, mieux préparés pour la salle d'opération. Cette initiative a le potentiel d'améliorer l'accueil des étudiants en médecine dans l'environnement opératoire.

International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain.

INTRODUCTION AND HYPOTHESIS: This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP. METHODS: An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category. RESULTS: The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37-100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies. CONCLUSIONS: The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.

Current Practices in the Surgical Management of Female Stress Urinary Incontinence: A Survey of Canadian Urologists and Gynecologists.

INTRODUCTION: We assessed the practices of urologists and gynecologists who manage stress urinary incontinence surgically to examine the impact of the FDA (U.S. Food and Drug Administration) and/or Health Canada statements on pelvic floor mesh. We also determined how urologists and gynecologists manage recurrent stress urinary incontinence and complications of mesh mid urethral slings. METHODS: We conducted an online survey of urologists and gynecologists who were members of the Canadian Urological Association or Society of Obstetricians and Gynaecologists of Canada. RESULTS: Mid urethral sling was the most common surgery for stress urinary incontinence performed by urologists and gynecologists (100% vs 84%, p=0.0002). The majority of respondents (87%, 119 of 137) were aware of the FDA and/or Health Canada statements and 66% of physicians altered the way they counseled patients before mid urethral sling surgery. An equal proportion of urologists and gynecologists altered their surgical management of stress urinary incontinence due to patient concerns (31% vs 36%) and due to FDA and/or Health Canada statements (16% vs 13%). Repeat mid urethral sling was the most common method of treating recurrent stress urinary incontinence and urologists were more likely than gynecologists to manage complications of mid urethral sling (58% vs 41%, p=0.0286). Chronic pain (33%) and vaginal mesh erosion (26%) were the most common concerns overall. CONCLUSIONS: Mid urethral sling was reported as the most commonly performed surgery for stress urinary incontinence by urologists and gynecologists after the FDA and Health Canada statements. Both groups altered their surgical practices most commonly due to patient concerns, indicating that negative media attention is impacting the way in which urologists and gynecologists practice when surgically managing stress urinary incontinence in Canada. Variation exists between urologists and gynecologists when it comes to managing complications related to mid urethral sling.

The Long-Term Pelvic Floor Health Outcomes of Women After Childbirth: The Influence of Labour in the First Pregnancy.

OBJECTIVE: To estimate the influence of labour and pregnancy factors on long-term pelvic floor health outcomes. METHODS: This population-based cohort study was conducted using linkage between the Nova Scotia Atlee Perinatal Database, the Medical Services Insurance Database, and the Canadian Institute for Health Information's Discharge Abstract Database from 1988 to 2006; this allowed for the evaluation of patient utilization of care providers for pelvic floor disorders and captured conservative and surgical interventions. We compared rates of urinary and anal incontinence, pelvic organ prolapse, and fistula disorders in women undergoing Caesarean section (CS) without labour and women undergoing labour with any method of delivery. Multivariate logistic regression and survival (time-to-event) analyses were performed. RESULTS: Absolute risks for the selected pelvic floor health outcomes were low, regardless of whether labour was experienced in the first pregnancy. Women with one or more deliveries who had a CS without labour in their first pregnancy had reduced risks for all pelvic floor health outcomes, except fistula formation, and they were also less likely to develop these outcomes during the study period. CONCLUSION: Women undergoing obstetrically indicated CS without labour in their first delivery may have reduced risks of pelvic floor health disorders, even after multiple deliveries. These findings contribute important information for health care providers when counselling women and their families who are weighing the risk of long-term pelvic floor disorders against the benefits of spontaneous vaginal delivery.

RETIRED: SOGC Committee opinion on urodynamics testing.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Effectiveness of a new self-positioning pessary for the management of urinary incontinence in women.

OBJECTIVE: The objective of the study was to evaluate the effectiveness of a new self-positioning women's incontinence pessary. STUDY DESIGN: Thirty-two women were enrolled and followed up for 12 months. Evaluation included baseline questionnaires, physical examination including pelvic organ prolapse quantification (POP-Q) scores, cotton swab testing, and assessment of Kegel strength. A pad test and 7 day urolog were also performed before and after pessary fitting. RESULTS: Incontinence questionnaire scores were all significantly reduced as percent of baseline: stress incontinence, 7 of 15 (47%) (P = .000); urge incontinence, 5 of 14 (36%) (P = .002); the urogenital distress inventory (short form); 2 of 6 (33%) (P = .002); and incontinence impact questionnaire (short form), 4 of 8 (50%) (P = .002). Leaking episodes decreased by 4 (7 day urolog) (P = .028) and pad weights by 11 g (P = .006). Among women successfully fitted at 2 weeks, 16 of 21 or 76% continued using their pessary at 1 year. There were no complications with pessary use. CONCLUSION: The Uresta incontinence pessary significantly reduces urinary incontinence and is easy for women to use.