A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures.

OBJECTIVE: The objective of this study is to identify the incidence of and risk factors for urinary tract infection (UTI) after office cystoscopy and urodynamic studies (UDS) in a female population. METHODS: This was a retrospective cohort study investigating incidence of and risk factors for UTI after office testing. Inclusion criteria included women presenting for either cystoscopy or UDS from September 2019 to February 2020. Modified Poisson regression with robust error variance was used to identify risk factors for UTI after cystoscopy and UDS in a female population. RESULTS: A total of 274 patients met inclusion criteria. One hundred eighty-five patients underwent office cystoscopy. Nine (4.8%) had a postcystoscopy UTI. Significant risk factors for postcystoscopy UTI included recurrent UTI (relative risk, 7.51; 95% confidence interval, 1.66-34.05) and a history of interstitial cystitis (relative risk, 4.56; 95% confidence interval, 1.52-13.73). Of those with recurrent UTI, 13.7% had a postcystoscopy UTI. Among patients with interstitial cystitis, 25% had a postcystoscopy UTI. One hundred ninety-two patients underwent UDS. Ten (5.2%) developed a post-UDS UTI. No risk factors were identified. CONCLUSIONS: Patients with recurrent UTI were 7.51 times more likely to develop a UTI after cystoscopy, whereas those with interstitial cystitis were 4.56 times more likely to develop a UTI after cystoscopy. The incidence of UTI after UDS was low overall. Understanding who is at higher risk of postprocedural UTIs may help identify subpopulations that may benefit from prophylactic strategies.

Vesicovaginal fistula repair at the time of colpocleisis.

INTRODUCTION AND HYPOTHESIS: The objectives of this video are to discuss the presentation, evaluation, and surgical management of a patient with a vesicovaginal fistula at the time of colpocleisis. METHOD: We present the case of an 83-year-old woman with a history of stage IV prolapse who had had a pessary device removed. Urine had been noted to be in the vaginal vault, leading to suspicion of a vesicovaginal fistula. Following evaluation, the patient decided to proceed with surgical management. The patient underwent a vesicovaginal fistula repair with concomitant colpocleisis. A cystoscopy was performed at the conclusion of the case where the bilateral ureteral stents were removed and a strong efflux was noted at both ureteral orifices. RESULTS: At the patient's 1-month follow-up, she had no complaints of prolapse or vaginal leaking. CONCLUSION: Neglect of a vaginal pessary can lead to serious complications, indicating the importance of patient education and careful follow-up. Surgical planning is a key component in effectively managing a vesicovaginal fistula with ureteral presentation in order to preserve ureteral integrity. Concomitant vesicovaginal repair and colpocleisis can be performed safely with effective cure of a vesicovaginal fistula and stage IV prolapse.

Concomitant laparoscopic and vaginal excision of duplicated collecting system.

INTRODUCTION AND HYPOTHESIS: A duplicated collecting system is the most common birth defect related to the urinary tract and is more common in women. Approximately 0.7% of the healthy adult population and 2-4% of patients with urinary tract symptoms have duplicated ureters. This video discusses the presentation, evaluation, and treatment of duplicated urinary collecting systems, and presents a case of duplicated collecting system with ectopic ureteral implantation at the vaginal introitus. METHODS: We present the case of a 56-year-old presenting with a history of incontinence and recurrent urinary tract infections starting in adolescence and her workup for a duplicated collecting system, as well as subsequent surgical management with narrated footage. The patient was counseled that a distal ectopic ureter remnant could serve as a nidus for infection and the patient elected to undergo complete excision of the distal ectopic ureter. CONCLUSION: Duplicated urinary collecting systems are the most common birth defect related to the urinary tract and can be frequently encountered by the pelvic surgeon. Knowledge of the presentation and workup of a suspected duplicated collecting system is important in carrying out appropriate treatment.

Intrapartum risk factors for postpartum urinary retention: a case-control study.

INTRODUCTION: Urinary voiding dysfunction is a common postpartum condition. Increased knowledge of risk factors for postpartum urinary retention could improve early identification of women at risk and lead to enhanced postpartum surveillance. We sought to identify intrapartum factors that contribute to postpartum urinary retention. METHODS: This retrospective case-control study compared subjects who developed postpartum urinary retention requiring indwelling catheterization after vaginal delivery to a control group who did not require catheterization. The control group was randomly selected in a 1:4 ratio. Continuous data were analyzed using a two-sample t-test and Mann-Whitney U test. Categorical data were analyzed using Fisher's exact test and two proportions test. Logistic regression was performed to identify variables independently associated with increased risk for development of postpartum urinary retention. RESULTS: A total of 5802 women who delivered vaginally met eligibility criteria with 38 women (0.65%) experiencing postpartum urinary retention. Logistic regression revealed that nulliparity, ≥ 2nd-degree obstetrical laceration, and intermittent catheterization during labor were independently associated with increased risk for postpartum urinary retention. CONCLUSION: No single factor predicted development of postpartum urinary retention; however, a higher index of suspicion after vaginal delivery is warranted for nulliparous women, ≥ 2nd-degree obstetrical laceration, and if intermittent catheterization during labor was required.

Does spinal anesthesia lead to postoperative urinary retention in same-day urogynecology surgery? A retrospective review.

INTRODUCTION AND HYPOTHESIS: Spinal anesthesia has been reported to be a risk factor for postoperative urinary retention (POUR) in various surgical specialties. We hypothesized that spinal anesthesia was a risk factor for POUR after outpatient vaginal surgery for pelvic organ prolapse (POP). METHODS: This was a retrospective review of an urogynecology database for all outpatient POP vaginal surgeries performed in 2014 to evaluate the risk of POUR after general versus spinal anesthesia. A standardized voiding trial was performed by backfilling the bladder with 300 ml of saline. A successful trial was achieved if the patient voided two-thirds of the total volume instilled, confirmed by bladder ultrasound. Our primary outcome was to compare POUR requiring discharge with a Foley catheter between spinal and general anesthesia. Multivariate logistic regression was performed for variables with significance at p < 0.1 at the bivariate level. RESULTS: A total of 177 procedures were included, 126 with general and 51 with spinal anesthesia. The overall POUR rate was 48.9%. Type of anesthesia was not a risk factor for POUR. Multivariate logistic regression demonstrated that age < 55 years (adjusted odds ratio [OR] 3.73; 95% confidence interval [CI], 1.31-11.7), diabetes (adjusted OR 4.18, 95% CI 1.04-21.67), and having a cystocele ≥ stage 2 (adjusted OR 4.23, 95% CI 1.89-10) were risk factors for developing POUR. CONCLUSIONS: Acute urinary retention after outpatient vaginal pelvic floor surgery can vary by procedure, but overall is 48.9%. Spinal anesthesia does not contribute to POUR, but rates are higher in those women that are younger than 55 years of age, have a cystocele ≥ stage 2 preoperatively, and a history of diabetes.

Infantile Serine Biosynthesis Defect Due to Phosphoglycerate Dehydrogenase Deficiency: Variability in Phenotype and Treatment Response, Novel Mutations, and Diagnostic Challenges.

Serine biosynthesis defects can present in a broad phenotypic spectrum ranging from Neu-Laxova syndrome, a lethal disease with multiple congenital anomalies at the severe end, to an infantile disease with severe psychomotor retardation and seizures as an intermediate phenotype, to a childhood disease with intellectual disability at the mild end. In this report we present 6 individuals from 3 families with infantile phosphoglycerate dehydrogenase (PGDH) deficiency who presented with psychomotor delay, growth failure, microcephaly, and spasticity. The phenotype was variable with absence of seizures in 2 sisters in family 1 and 1 infant in family 2 and seizures with pronounced happy affect in 3 sisters in family 3. The initiation of serine treatment had pronounced effect on seizures and spasticity in the sisters in family 3, but minimal developmental effects on the children in families 1 and 2. With such phenotypic variability, the diagnosis of PGDH deficiency can be challenging.