Evaluation and management of defecatory dysfunction in women.

PURPOSE OF REVIEW: To summarize the current recommendations for the evaluation and management of defecatory dysfunction in women and highlight key relationships between defecatory dysfunction and other pelvic floor disorders, including pelvic organ prolapse, fecal incontinence, and voiding dysfunction. RECENT FINDINGS: Conservative measures including lifestyle modifications, pharmacotherapy, and biofeedback continue to be the mainstay of treatment with newer therapies emerging. Physiologic testing and/or radiologic imaging should be considered for those who fail conservative therapy or are clinically complex. Surgical management is appropriate for carefully selected patients with anatomic causes of defecatory dysfunction. Further research is needed on surgical outcomes and patient expectations. SUMMARY: Pelvic floor disorders, including defecatory dysfunction, have a significant societal impact and are highly prevalent among women. Given its potential complexity, a broader focus is needed when evaluating women with defecatory symptoms and effective treatment may require multidisciplinary care.

Management of Overactive Bladder in Older Women.

PURPOSE OF REVIEW: This review will highlight our current understanding of age-related changes in bladder function and propose important clinical considerations in the management of overactive bladder (OAB) specific to older women. RECENT FINDINGS: Frailty, functional and cognitive impairment, multimorbidity, polypharmacy, estrogen deficiency, and remaining life expectancy are important clinical factors to consider and may impact OAB symptom management in older women. Third-line therapies, particularly PTNS, may be preferable over second-line therapy in some cases. Due to the complexity within this population, the standard treatment algorithms may not be applicable, thus a broader, more holistic focus is recommended when managing OAB in older women.

Fungal Lumbosacral Osteomyelitis After Robotic-Assisted Laparoscopic Sacrocolpopexy.

Sacral osteomyelitis is a rare complication after robotic sacrocolpopexy, with previous reports of enteric and skin flora as inciting organisms. We report a patient who presented with severe low back pain and fever 6 weeks after a robotic sacrocolpopexy, who was subsequently diagnosed as having lumbosacral discitis and osteomyelitis with thoracic intervertebral extension. Empiric antibiotic therapy was initially administered. After laparoscopic mesh excision and abdominal wash out, Candida albicans was isolated from the excised mesh. Postoperatively, the patient was treated with a 12-month course of oral fluconazole with significant clinical improvement. To our knowledge, this is the second reported case of fungal osteomyelitis, providing further recommendations for the management of postoperative sacral osteomyelitis using a minimally invasive surgical technique and guidance by a multidisciplinary team.

Obesity and Perioperative Complications in Pelvic Reconstructive Surgery in 2013: Analysis of the National Inpatient Sample.

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.

Validity of the brief inpatient screen for intimate partner violence among adult women.

BACKGROUND: Identifying intimate partner violence in healthcare settings is becoming the standard of care. The Brief Inpatient Screen was designed to assess recent emotional, physical, and sexual abuse in a general inpatient medical-surgical setting and compared to the Composite Abuse Scale. METHODS: Researchers matched "cases" (inpatients screening Brief Inpatient Screen-positive) to up to four "controls" (inpatients screening Brief Inpatient Screen-negative). Forty-six female hospital inpatients ages 18-64 years completed a self-administered survey. The sensitivity and specificity of the Brief Inpatient Screen and its subscales were compared to the Composite Abuse Scale. Researchers examined the performance of the Brief Inpatient Screen when used as a verbal screen versus an anonymous written screen. RESULTS: Twelve of 46 participants (26%) had a positive screen. Compared to the Composite Abuse Scale, the overall sensitivity and specificity of the verbal Brief Inpatient Screen were 52.6% (95% CI 28.9-75.6) and 92.6% (95% CI 75.7-99.1), respectively. The written Brief Inpatient Screen showed improved sensitivity overall (68.4%, 95% CI 43.5-87.4) for the most severe intimate partner violence. Subscale analysis revealed greater sensitivity for emotional and severe combined intimate partner violence. CONCLUSIONS: The verbal Brief Inpatient Screen, when compared to the Composite Abuse Scale, was limited in its ability to identify intimate partner violence. An anonymous written format improved sensitivity. Future research should optimize intimate partner violence screening among inpatients.