Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study.

BACKGROUND: Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling. METHODS: Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling. DISCUSSION: The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population. TRIAL REGISTRATION: NCT05880862. Registered on 30 May 2023.

PEGylated Polymeric Nanoparticles Loaded with 2-Methoxyestradiol for the Treatment of Uterine Leiomyoma in a Patient-Derived Xenograft Mouse Model.

Leiomyomas, the most common benign neoplasms of the female reproductive tract, currently have limited medical treatment options. Drugs targeting estrogen/progesterone signaling are used, but side effects and limited efficacy in many cases are major limitation of their clinical use. Previous studies from our laboratory and others demonstrated that 2-methoxyestradiol (2-ME) is promising treatment for uterine fibroids. However, its poor bioavailability and rapid degradation hinder its development for clinical use. The objective of this study is to evaluate the in vivo effect of biodegradable and biocompatible 2-ME-loaded polymeric nanoparticles in a patient-derived leiomyoma xenograft mouse model. PEGylated poly(lactide-co-glycolide) (PEG-PLGA) nanoparticles loaded with 2-ME were prepared by nanoprecipitation. Female 6-week age immunodeficient NOG (NOD/Shi-scid/IL-2Rγnull) mice were used. Estrogen-progesterone pellets were implanted subcutaneously. Five days later, patient-derived human fibroid tumors were xenografted bilaterally subcutaneously. Engrafted mice were treated with 2-ME-loaded or blank (control) PEGylated nanoparticles. Nanoparticles were injected intraperitoneally and after 28 days of treatment, tumor volume was measured by caliper following hair removal, and tumors were removed and weighed. Up to 99.1% encapsulation efficiency was achieved, and the in vitro release profile showed minimal burst release, thus confirming the high encapsulation efficiency. In vivo administration of the 2-ME-loaded nanoparticles led to 51% growth inhibition of xenografted tumors compared to controls (P < 0.01). Thus, 2-ME-loaded nanoparticles may represent a novel approach for the treatment of uterine fibroids.

Tailoring optimal translocation conditions towards proximity of borotellurite glasses to the red spectrum through CeO2 for practical applications.

We report the critical optical properties such as Average Visible Transmittance (AVT), colour, Color Rendering Index (CRI), and Correlated Color Temperature (CCT) of a multicomponent glass system with a nominal composition of 50TeO2-30B2O3-(20-x)Li2O-xCeO2 (x = 0,0.5,1,2,3,4,5,10,15,20 mol%). Various advanced theoretical approaches as well as calculations are utilized in terms of determining the optical properties of studied glasses. The maximum transmittance and AVT values of the glass system exceeded 80% and 79.59%, respectively. The colour coordinates are found extremely near to D65 and the achromatic point without CeO2 contribution. According to our results, the current system has a promising ability to be utilized for coloured window applications in terms of both AVT and colour with 2% CeO2 doping. Our results showed that, the CeO2 additive is able to move the glass colour straight into the red spectrum by shifting the transmittance spectrum to the long-wavelength portion of the visible spectrum. With 10% CeO2 doping, opacity in the visible area and permeability in the NIR region are obtained, and the CCT value changes from 5002 K to 2560 K. It can be concluded that a filter system with modifiable NIR or red optical characteristics may be produced through the CeO2 alterations in borotellurite glass systems.

Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions.

IMPORTANCE: Overactive bladder (OAB) syndrome and urinary incontinence, age, and comorbid burden are strong risk factors for falls in women. Less is known about their cumulative effects on fall risk in a urogynecologic population. OBJECTIVE: The purpose of this study was to investigate the effects of coexisting OAB, older age, and comorbidities on risk of falling among treatment seeking women with pelvic floor disorders. STUDY DESIGN: We conducted a retrospective medical records review of 348 consecutive women presenting to a urogynecology clinic over 6 months. Fall risk was determined by the Centers for Disease Control and Prevention's, Stopping Elderly Accidents, Deaths, and Injuries screening tool. Clinical and sociodemographic measures were abstracted from the electronic medical record. Odds of screening positive for high fall risk based on different patient profiles were calculated. We then used a classification and regression tree analysis to determine the relative importance of the different variables on fall risk within the homogeneous subgroups. RESULTS: Of the 348 women (mean age, 58.7 ± 15.8 years) who completed the fall risk screen, 124 (36%) screened positive for increased fall risk. Overactive bladder symptoms increased the likelihood of a positive fall risk screen across all combinations of age and comorbid burden. The patient profile of ≥3 OAB symptoms, ≥4 comorbid conditions, and age 65 years or older increased the odds of screening positive for high fall risk more than 6-fold (odds ratio, 6.4; 95% confidence interval, 3.1-12.9). In the following order of importance, the combination of high comorbid burden, OAB, and older age identified approximately 3 in 4 patients (73.3%) at high risk of falling. CONCLUSION: The presence of 3 easily identifiable patient characteristics is strongly associated with a risk of falls in women seeking care for pelvic floor disorders.

Exploring the Radioprotective Indium (III) Oxide Screens for Mammography Scans Using a Three-Layer Heterogeneous Breast Phantom and MCNPX: A Comparative Study Using Clinical Findings.

Background: During mammography, a lead-acrylic protective screen is recommended to reduce radiation exposure to the unexposed breast. Objectives: This research study aimed to construct an Indium-(III)-oxide-rich tellurite-glass screen (TZI8) and compare its performance to that of lead acrylic. Materials and Methods: A three-layer heterogeneous-breast phantom was developed, using the MCNPX (version 2.7.0) Monte Carlo code. An MCNPX-simulation geometry was designed and implemented, using the lead-acrylic and TZI8 shielding screens between the right and left breast. Next, the reliability of the phantom and the variations in absorption between the lead-acrylic and TZI8 glass were investigated. Results: The findings show that the TZI8-protective-glass screen offers significantly greater radioprotection than the lead-acrylic material. The quantity of total dose absorbed in the unexposed breast was much lower for TZI8 than for lead-based acrylic. The TZI8-glass screen gives about 60% more radioprotection than the lead-acrylic screen. Conclusion: Considering the toxic lead in the structure that may be hazardous to the human tissues, the TZI8-glass screen may be used in mammography examination to provide greater radioprotection than the lead-acrylic screen, in order to greatly reduce the dose to the unexposed breast.

A closer look at the efficiency calibration of LaBr3(Ce) and NaI(Tl) scintillation detectors using MCNPX for various types of nuclear investigations.

The nuclear spectroscopy method has long been used for advanced studies on nuclear physics. In order to decrease costs and increase the efficiency of nuclear radiation investigations, quick and efficient solutions are required. The purpose of this research was to calculate the whole energy peak efficiency values for a range of gamma-ray energies, from 30.973 keV to 1408 keV, at various source-detector distances using the MCNPX Monte Carlo code, which is extensively used in nuclear medicine, industry, and scientific research. As a result, the modeled detectors' full-energy peak efficiencies were calculated and compared to both experimental data and Monte Carlo simulations. Experiment results and prior studies using Monte Carlo simulations were found to be very consistent with these results. The counting efficiency against source-detector distance is then calculated using the modeled detectors. The data we have show that LaBr3(Ce) has outstanding detection properties. This study's findings might be used to improve the design of detectors for use in wide range of high-tech gamma spectroscopy and nuclear research applications.

Significance of CD47 expression in endometrial carcinoma.

Objectives: CD47 is a membrane protein that belongs to the immunoglobulin superfamily and regulates macrophage phagocytosis negatively. As CD47 expression at the cancer cell membrane would inhibit the phagocytic activity of immune cells, it is connected to an unfavorable prognosis in leukemia and malignancies of various solid organs. Materials and. Methods: In this study, retrospectively evaluated 72 patients who had been diagnosed with endometrial carcinoma at Pathology Department and had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO) and/or lymphadenectomy. CD47 expression was evaluated in tumorous and nontumor areas in all patients considering cytoplasmic and membranous brown staining in cells. The proportion of expression was evaluated as well as the intensity and an "h score" was obtained. This score was compared with known prognostic parameters. Results: CD47 expressions showed a statistically significant correlation with tumor grade (P < 0.05); however, no significant relationship was observed with myometrial invasion depth and lymph vascular invasion status (P = 0.923 and P = 0.754, respectively). Conclusions: As with other tumors, anti-CD47 antibody may be an alternative treatment option in patients with high-grade endometrial carcinoma.

Simvastatin-loaded liposome nanoparticles treatment for uterine leiomyoma in a patient-derived xenograft mouse model: a pilot study.

Uterine leiomyomas are complex tumours with limited medical treatment options. Simvastatin is used to treat hypercholesterolaemia and has shown promising effects as a treatment option for leiomyomas. Previously, our group demonstrated a promising effect of simvastatin treatment in a patient-derived xenograft mouse model. Here, we tested the efficacy of simvastatin liposomal nanoparticles (NPs). After bilateral leiomyoma xenograft implantation, mice (N = 12) were divided into three treatment arms: control, simvastatin and simvastatin-loaded liposome NPs (simvastatin-NPs). Treatment with simvastatin significantly reduced tumour volume and inhibited the Ki67 expression when compared to the control group. There was a trend of reduced tumour volume and Ki67 expression after treatment with simvastatin-NP; however, the results were not significant. Due to low bioavailability and short half-life of simvastatin, liposomal NPs have the potential to enhance drug delivery, however, in this study NP did not provide improvement over simvastatin, but did demonstrate their potential for the delivery of simvastatin.Impact statementWhat is already known on this subject? Simvastatin treatment in a patient-derived xenograft mouse model reduced tumour growth and decreased proliferation.What do the results of this study add? Treatment with simvastatin significantly reduced tumour volume and inhibited the Ki67 expression when compared to the control group. There was a trend of reduced tumour volume and Ki67 expression after treatment with simvastatin-NP, however, it did not improve the efficacy of simvastatin at reducing tumour growth and proliferation.What are the implications of these findings for clinical practice and/or further research? More studies are needed to optimise the formulation of NPs to further enhance the sustainable delivery of simvastatin.

Predictors of same-day discharge after minimally invasive hysterectomy for benign indications.

OBJECTIVE: To identify predictors of same-day discharge after benign minimally invasive hysterectomy. METHODS: In this retrospective cohort study, we identified women (n = 1084) undergoing benign minimally invasive hysterectomy from 2009 to 2016. Multivariate logistic regression was used to examine demographic, operative, and surgeon factors associated with discharge on postoperative day 0. RESULTS: In our study population, 238 women (22%) were discharged on the same day. Robotic hysterectomy (risk ratio [RR] 2.24; 95% confidence interval [CI] 1.13-4.44), shorter operative time (lowest quartile; RR 5.28; 95% CI 2.66-10.46), and minimal blood loss (lowest quartile; RR 3.01; 95% CI 1.68-6.23) were associated with higher same-day discharge likelihood whereas later procedure start time (2-5 pm; RR 0.38; 95% CI 0.17-0.85) and postoperative complications (RR 0.19; 95% CI 0.06-0.55) significantly decreased its likelihood. The strongest predictor was surgeon's number of years in practice, with recently graduated surgeons more likely to discharge their patients on the same day (RR 3.15; 95% CI 2.09-4.77). CONCLUSION: Same-day discharge after minimally invasive hysterectomy is determined by several patient, operative, and surgeon factors that can be incorporated into an implementation plan to promote earlier discharge. Most especially, scheduling patients based on perceived case complexity and targeted surgeon education can qualify a larger cohort for same-day discharge.

Prevalence and Predictors of Increased Fall Risk Among Women Presenting to an Outpatient Urogynecology and Pelvic Health Center.

OBJECTIVES: The objective of this study was to determine the prevalence of increased fall risk among women presenting to a large pelvic health center using a screening method compatible with the busy clinic environment and to identify factors associated with increased risk. METHODS: A retrospective medical records review was conducted on consecutive treatment-seeking women presenting to a Urogynecology & Pelvic Health Center over 6 months. The Centers for Disease Control and Prevention, Stopping Elderly Accidents, Deaths, and Injuries fall risk screening tool was included among the intake questionnaires all patients completed before their scheduled appointments. Relevant sociodemographic and clinical measures were abstracted from the electronic medical record. RESULTS: Three hundred and forty-eight women completed the fall screen. One hundred and twenty-four (36%) screened positive for increased fall risk. Mean age was 58.7 ± 15.8 years. An age threshold of 68 years best discriminated between those who were and were not identified as at risk. There was a gradient of association between number of urinary symptoms and prevalence of increased fall risk. Patients with 3 or more urinary symptoms were most likely to screen positive (1: odds ratio [OR], 1.51 [0.86-2.66]; 2: OR, 1.62 [0.99-2.64]; 3 or more: OR, 1.84 [1.07-3.17]) after adjusting for other know fall risk factors. CONCLUSIONS: The prevalence of increased fall risk in this patient population is high and highest in women with multiple urinary symptoms. The Stopping Elderly Accidents, Deaths, and Injuries screening tool was a feasible and nonintrusive screening method for identifying increased fall risk during routine patient care. Fall risk and concern about falling should be taken into consideration when deciding management strategies for urinary problems.

Gamma-Ray Protection Properties of Bismuth-Silicate Glasses against Some Diagnostic Nuclear Medicine Radioisotopes: A Comprehensive Study.

This study aimed to perform an investigation for the potential implementation of bismuth silicate glasses as novel shield equipment instead of ordinary shields in nuclear medicine facilities. Accordingly, a group of Bi2O3 reinforced silicate glass system were investigated and compared with ordinary shields in terms of their gamma-ray attenuation properties in diagnostic nuclear medicine radioisotope energies emitted from 99mTc, 111In, 67Ga, 123I, 131I, 81mKr, 201Tl, 133Xe. Mass attenuation coefficient (µm) results for glass samples were calculated comparatively with the XCOM program and MCNPX code. The gamma-ray attenuation parameters such as half value layer (HVL), tenth value layer (TVL), mean free path (MFP), effective atomic number (Zeff) were obtained in the diagnostic gamma ray energy range from 75 to 336 keV. To confirm the attenuation performance of superior sample, obtained results were extensively compared with ordinary shielding materials. According to the results obtained, BISI6 glass sample with the highest Bi2O3 additive has an excellent gamma-ray protection.

Trivalent Ions and Their Impacts on Effective Conductivity at 300 K and Radio-Protective Behaviors of Bismo-Borate Glasses: A Comparative Investigation for Al, Y, Nd, Sm, Eu.

We aimed to determine the contribution of various trivalent ions like Al and rare-earths (Y, Nd, Sm, Eu) on resistance behaviors of different types of bismo-borate glasses. Accordingly, eight different bismuth borate glasses from the system: 40Bi2O3-59B2O3-1Tv2O3 (where Tv = Al, Y, Nd, Sm, and Eu) and three glasses of (40Bi2O3-60B2O3; 37.5Bi2O3-62.5B2O3; and 38Bi2O3-60B2O3-2Al2O3) compositions were extensively investigated in terms of their nuclear attenuation shielding properties, along with effective conductivity and buildup factors. The Py-MLBUF online platform was also utilized for determination of some essential parameters. Next, attenuation coefficients, along with half and tenth value layers, have been determined in the 0.015 MeV-15 MeV photon energy range. Moreover, effective atomic numbers and effective atomic weight, along with exposure and energy absorption buildup factors, were determined in the same energy range. The result showed that the type of trivalent ion has a direct effect on behaviors of bismo-borate glasses against ionizing gamma-rays. As incident photon energy increases, the effective thermal conductivity decreases rapidly, especially in the low energy range, where photoelectric effects dominate the photon-matter interaction. Sample 8 had the minimum heat conductivity at low photon energies; our findings showed that Eu-reinforced bismo-borate glass composition, namely 40Bi2O3-59B2O3-1Eu2O3, with a glass density of 6.328 g/cm3 had superior gamma-ray attenuation properties. These outcomes would be useful for the scientific community to observe the most suitable additive rareearth type and related glass composition for providing the aforementioned shielding properties, in terms of needs and utilization requirements.

A Closer Look on Nuclear Radiation Shielding Properties of Eu3+ Doped Heavy Metal Oxide Glasses: Impact of Al2O3/PbO Substitution.

In this study, a group of heavy metal oxide glasses with a nominal composition of 55B2O3 + 19.5TeO2 + 10K2O + (15-x) PbO + xAl2O3 + 0.5Eu2O3 (where x = 0, 2.5, 5, 7.5, 10, 12.5, and 15 in wt.%) were investigated in terms of their nuclear radiation shielding properties. These glasses containing lanthanide-doped heavy metal oxide were envisioned to yield valuable results in respect to radiation shielding, and thus a detailed investigation was carried out; the obtained results were compared with traditional and new generation shields. Advanced simulation and theoretical methods have been utilized in a wide range of energy regions. Our results showed that the AL0.0 sample with the highest PbO contribution had superior shielding properties in the entire energy range. The effective removal of cross-sections for fast neutrons (ΣR) was also examined. The results indicated that AL5.0 had the greatest value. While increasing the concentration of Al2O3 in samples had a negative effect on the radiation shielding characteristics, it can be concluded that using PbO in the Eu3+ doped heavy metal oxide glasses could be a useful tool to keep gamma-ray shielding properties at a maximum level.

Novel HMO-Glasses with Sb2O3 and TeO2 for Nuclear Radiation Shielding Purposes: A Comparative Analysis with Traditional and Novel Shields.

The radiation shielding characteristics of samples from two TeO2 and Sb2O3-based basic glass groups were investigated in this research. TeO2 and Sb2O3-based glasses were determined in the research as six samples with a composition of 10WO3-(x)MoO3-(90 - x)(TeO2/Sb2O3) (x = 10, 20, 30). A general purpose MCNPX Monte Carlo code and Phy-X/PSD platform were used to estimate the radiation shielding characteristics. Accordingly, the linear and mass attenuation coefficients, half value layer, mean free path, variation of the effective atomic number with photon energy, exposure and built-up energy factors, and effective removal cross-section values were determined. It was determined that the results that were produced using the two different techniques were consistent. Based on the collected data, the most remarkable findings were found to be associated with the sample classified as T80 (10WO3 + 10MoO3 + 80TeO2). The current study showed that material density was as equally important as composition in modifying radiation shielding characteristics. With the T80 sample with the greatest density (5.61 g/cm3) achieving the best results. Additionally, the acquired findings were compared to the radiation shielding characteristics of various glass and concrete materials. Increasing the quantity of MoO3 additive, a known heavy metal oxide, in these TeO2 and Sb2O3-based glasses may have a detrimental impact on the change in radiation shielding characteristics.

Newly Developed Vanadium-Based Glasses and Their Potential for Nuclear Radiation Shielding Aims: A Monte Carlo Study on Gamma Ray Attenuation Parameters.

This study aimed to investigate different types of glasses based on the 46V2O5-46P2O5-(8-x) B2O3-xCuO system in terms of their nuclear radiation shielding properties. Accordingly, five different CuO-doped vanadate glasses were investigated extensively to determine the necessary gamma shielding parameters along with effective conductivity at 300,000 and buildup factors. Phy-x PSD software was used for determination of these vital parameters. Furthermore, these parameters, such as half value layer, tenth value layer, and mean free path were investigated in a broad energy range between 0.015 and 15 MeV. The results revealed that the amount of CuO reinforced in each sample plays an essential role in determination of the shielding abilities of the samples. The sample with the highest CuO content had the highest linear attenuation coefficient and mass attenuation coefficient values. Additionally, the lowest mean free path, half value layer, and tenth value layer values were recorded for glass sample VPCu8. There was an inverse relation between the effective conductivity and effective atomic number and photon energy; that is, as energy increases, the effective conductivity and effective atomic number decreased rapidly, especially in the regions of low energy. Glass sample VPCu8 reported the highest values for both parameters. Moreover, glass sample VPCu8 had the lowest exposure buildup factor and energy absorption buildup factor values. Our findings showed that CuO-reinforced vanadate glass composition, namely 46V2O5-46P2O5-8CuO, with a glass density of 2.9235 g/cm3, was reported to have superior gamma ray attenuation properties. These results would be helpful for scientists in determining the most appropriate additive rare earth type, as well as the most appropriate glass composition, to offer shielding characteristics similar to those described above, taking into consideration the criteria for usage and the needs of the community. The results of this research will be useful to the scientific community in evaluating the prospective characteristics of CuO-doped glass systems and related glass compositions. CuO-doped glass systems and associated glass compositions have a wide range of properties.

Clinical and ethical perspectives of medical professionals towards female genital cosmetic procedures

Objective: To evaluate the attitudes of medical students and professionals towards female genital cosmetic procedures (FGCPs) in terms of medical justification, applicability in practical life, ethical concerns, patient autonomy, and the clinical/social/psychological benefits-harms of these procedures. Materials and Methods: A semi-structured questionnaire providing information about the attitudes of medical students and specialists (n=623) towards FGCPs including G-spot amplification, clitoral hood reduction, vaginoplasty, labia majora augmentation/reduction, labia minora augmentation/reduction, hymenoplasty, laser procedures, vulvar/perianal bleaching, and liposculpture, was completed by a target population and evaluated statistically. Results: Participants stated that FGCPs could be performed only upon patient request and there could rarely be a medical indication for their performance (p<0.05). Nearly half (44.5%) of the participants regarded hymenoplasty as controversial in terms of ethical issues, and 44.6% of participants do so for G-spot amplification. Over half (54.5%) of the participants agreed on the positive effect of FGCPs on improving the quality of life, 55.4% on improving self-esteem, and 54.1% on improving sexual functions of women. About half (49.3%) of respondents thought that the advertising and encouragement of FGCPs should be forbidden and 47% were indecisive about whether FGCPs constituted genital mutilation. Conclusion: The majority of the participants declared that FGCPs could be performed only upon patient request and improve self-esteem, quality of life, and sexual functions. The most controversial procedures in terms of ethics were hymenoplasty and G-spot amplification. Detailed guidelines for the protection of both patients and physicians are needed because the recommendations on FGCPs are insufficient to define the boundaries of medical justification, genital mutilation, advertising, and ethical concerns.

In-Silico Monte Carlo Simulation Trials for Investigation of V2O5 Reinforcement Effect on Ternary Zinc Borate Glasses: Nuclear Radiation Shielding Dynamics.

In the current study, promising glass composites based on vanadium pentoxide (V2O5)-doped zinc borate (ZnB) were investigated in terms of their nuclear-radiation-shielding dynamics. The mass and linear attenuation coefficient, half-value layer, mean free path, tenth-value layer, effective atomic number, exposure-buildup factor, and energy-absorption-buildup factor were deeply simulated by using MCNPX code, Phy-X PSD code, and WinXcom to study the validation of ZBV1, ZBV2, ZBV3, and ZBV4 based on (100-x)(0.6ZnO-0.4B2O3)(x)(V2O5) (x = 1, 2, 3, 4 mol%) samples against ionizing radiation. The results showed that attenuation competencies of the studied glasses slightly changed while increasing the V2O5 content from 1 mol% to 4 mol%. The domination of ZnO concentration in the composition compared to B2O3 makes ZnO substitution with V2O5 more dominant, leading to a decrease in density. Since density has a significant role in the attenuation of gamma rays, a negative effect was observed. It can be concluded that the aforementioned substitution can negatively affect the shielding competencies of studied glasses.

Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial.

We compared wound dressing removal at 24 hours versus 48 hours following low-risk caesarean deliveries. This multicentre, randomised, controlled study included patients 18-44 years of age with low-risk term, singleton pregnancies. The randomisation was done weekly. Scheduled caesarean deliveries without labour were included. For comparison, the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of deep tissues, Isolation of bacteria, Stay in hospital > 14 days (ASEPSIS) score for wound healing assessment was modified. The absolute scores were obtained based on a one-day reading rather than the five-day reading used in ASEPSIS. Zero ("0") was assigned as a complete healing. Higher scores were associated with more severe disruption of healing. The patients were enrolled between March 2015 and February 2017. The demographics were not statistically different. The wound scoring was similar in the groups at discharge and first-week evaluation. At the six weeks post-surgery, the wound scoring was significantly less in the 48-hour (3.9%) versus the 24-hour group (9%; p = .002). Dressing removal at 48 hours had a lower scoring in the low-risk population with scheduled caesarean deliveries.IMPACT STATEMENTWhat is already known on this subject? Surgical dressings are used to provide suitable conditions to heal caesarean incisions. There has been a limited number of studies on the evaluation of ideal timing on wound dressing removal after a caesarean delivery. These studies concluded there are no increased wound complications with removal at six hours versus 24 hours or within or beyond 48 hours after surgery.What do the results of this study add? The postoperative removal of the wound dressing at 48 hours had a lower wound score at six weeks than the removal at 24 hours for women with uncomplicated scheduled caesarean deliveries.What are the implications of these findings for clinical practice and/or further research? Early discharge after caesarean delivery is becoming more common. Dressing removal at 24 hours versus 48 hours becomes more crucial and needs to be clarified. Besides, high-risk populations, different skin closure techniques, and patients in labour should be addressed separately.

Perioperative, postoperative and anatomical outcomes of robotic sacrocolpopexy.

The study aimed to analyse the anatomical, perioperative and postoperative outcomes of the robotic-assisted sacrocolpopexy (RSCP). After obtaining Institutional Review Board (IRB #19-0167) approval, our retrospective case series included 144 consecutive patients that underwent an RSCP for symptomatic stage II pelvic organ prolapse (POP) or symptomatic/asymptomatic stage III/IV POP. Patient information included operative parameters, perioperative and postoperative complications, readmissions and reoperation. Demographics and baseline characteristics were summarised by frequencies and percentages for categorical variables, and by mean/median, standard deviation, and ranges for continuous variables. In our study, concomitant surgeries with sacrocolpopexy consisted of hysterectomy, Burch colposuspension and midurethral sling. The anatomical success rate was 87.5% and the reoperation rate was 10.4%. The mean follow-up time was 12.5 (±8.7) months. Intraoperative complications 13 (9%) were bowel serosal abrasion, bladder wall injuries, trochar site bleeds, subcutaneous emphysema and a retroperitoneal haematoma. Our results suggest that RSCP is a feasible and safe approach for the treatment of POP with a low complication rate and favourable medium-term outcomes regarding anatomical and symptomatic results.Impact statementWhat is already known on this subject? Pelvic organ prolapse affects more than 25% of women in the United States. Apical and anterior compartment defects are challenging cases and sacrocolpopexy is considered the gold standard treatment option for apical and anterior compartment defects. As technology has advanced, minimally invasive approaches have been popular with their pros.What the results of this study add? We present the highest volume case series in the literature from our tertiary care centre for robotic-assisted sacrocolpopexy (RSCP). Our results suggest that RSCP is a feasible and safe approach for the treatment of POP with a low complication rate and favourable 1-year outcomes regarding anatomical and subjective results.What the implications are of these findings for clinical practice and/or further research? Robotic-assisted sacrocolpopexy has the potential to gain more popularity in the near future based on accumulating data on its feasibility and safety results.

Safety and efficacy of robotic-assisted Burch for pure stress urinary incontinence: a large case series.

Burch urethropexy is one of the earliest and most effective surgeries for stress urinary incontinence. Minimally invasive robotic surgery is becoming more popular in the field of urogynecology. Herein, we present the safety and efficacy of a large case series of robotic-assisted Burch urethropexy. A retrospective chart review was performed on robotic-assisted Burch urethropexy cases performed between 2013 and 2019. Patient characteristics, perioperative data and follow-up outcomes were collected at a single teaching institution. A total of 76 women underwent robotic-assisted Burch urethropexy for pure stress urinary incontinence. Fifty of them had concomitant robotic procedures at the time of the Burch. We performed the robotic-assisted Burch urethropexy alone on 26 patients. The mean age was 55 years old. The overall treatment success rate was 85% with a mean follow-up time of 134 (±157.8) days. Complications included cystotomy (3%), urinary tract infection (16%) and postoperative voiding dysfunction (10%). Our study reveals that robotic-assisted Burch urethropexy is a feasible option in the treatment of stress urinary incontinence in terms of operative outcomes and short-term efficacy.Impact statementWhat is already known on this subject? Minimally invasive robotic surgery is becoming more popular in the field of urogynecology. Surgical repairs for stress urinary incontinence will likely increase in the coming years secondary to an aging population. Burch urethropexy is one of the earliest and most effective surgeries for stress urinary incontinence and can be performed abdominally, laparoscopically and now, using robotic assistance.What do the results of this study add? This study reveals that robotic-assisted Burch urethropexy is a feasible option in the treatment of stress urinary incontinence in terms of intraoperative outcomes with good short-term efficacy.What are the implications of these findings for clinical practice and/or further research? Lately, interest in colposuspension procedures has been rekindled as physicians seek alternative stress urinary incontinence treatment options. Robotic-assisted Burch urethropexy will continue to gain popularity with its efficacy and safety.