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2.
J Urol ; 203(1): 185-192, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31347955

RESUMO

PURPOSE: Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. MATERIALS AND METHODS: A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. RESULTS: At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. CONCLUSIONS: The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.


Assuntos
Neuroestimuladores Implantáveis , Incontinência Urinária de Urgência/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fontes de Energia Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Sacro , Incontinência Urinária de Urgência/fisiopatologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-31672589

RESUMO

STUDY OBJECTIVE: To compare the 30-day incidence of deep or organ-space and/or superficial incisional surgical site infections (SSIs) by the subtype of laparoscopic hysterectomy and to report on additional risk factors for SSIs following laparoscopic hysterectomy. DESIGN: Retrospective cohort study. SETTING: American College of Surgeons National Surgical Quality Improvement Program Database. PATIENTS: Women undergoing laparoscopic hysterectomy from 2012 to 2014. INTERVENTIONS: Women were stratified into 3 groups by the type of hysterectomy: total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), and laparoscopic supracervical hysterectomy (LSCH). Demographic and clinical characteristics were compared for the 3 groups using the Kruskal-Wallis test or 1-way analysis of variance, where appropriate, for continuous variables and the chi-square or Fisher's exact test for categoric variables. Post hoc analyses were performed for multiple comparisons. Univariate analyses to examine the association with SSI were performed using the t test or Wilcoxon rank sum test as appropriate for continuous variables and the chi-square test or Fisher's exact test as appropriate for categoric variables. Significant variables on univariate analysis were included in a stepwise, backward multivariable logistic regression to identify the independent risk factors of SSI. MEASUREMENTS AND MAIN RESULTS: In total, 46 755 women underwent laparoscopic hysterectomy. Most were classified as TLH (26 009, 56%), followed by LAVH (13 884, 30%), and LSCH (6862, 14%). The overall rate of 30-day deep or organ-space SSI was 1.8% (n = 445). Thirty-day deep or organ-space SSI was lower in women who underwent LSCH (0.6%) than in women who underwent TLH (1.0%) or LAVH (1.1%; p = .001), but there was no difference in the incidence of superficial incisional SSI (0.8%, 0.8%, and 0.8% for TLH, LAVH, and LSCH, respectively; p = .75). On multivariate regression analysis, LSCH remained independently associated with a decreased risk of deep or organ-space SSI (adjusted odds ratio, 0.60; 95% confidence interval, 0.43-0.84; p = .003). In addition, relative to the women who were discharged on the same day, women admitted for >24 hours had 2-fold increased odds of deep or organ-space SSI. Asian race, smoking, perioperative transfusion, dirty or infected cases, and American Society of Anesthesiologist class 3 were associated with increased odds for deep or organ-space SSI. Length of stay >24 hours and Native Hawaiian/Pacific Islander race were associated with increased odds of superficial incisional SSI. CONCLUSION: LSCH is associated with a decreased risk of deep or organ-space SSI compared with other subtypes of laparoscopic hysterectomy. Same-day discharge after laparoscopic hysterectomy is associated with decreased odds of SSI.

6.
J Urol ; 202(3): 585-591, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31063049

RESUMO

PURPOSE: Some patients continue to have bothersome lower urinary tract symptoms despite treatment. We examined characteristics associated with bother from lower urinary tract symptoms in a prospective cohort. MATERIALS AND METHODS: In this 1-year prospective, observational cohort study we obtained data on patients with lower urinary tract symptoms who were seeking care at a total of 6 tertiary care centers in the United States. Participants answered the AUA-SI (American Urological Association Symptom Index) global urinary bother question at study entry and 12 months later. Multilevel logistic and linear regression was used to identify factors associated with worsening bother and bother at 12 months, respectively. RESULTS: Of the 756 participants 121 (16%) had worsened lower urinary tract symptom bother during the study period. When adjusted for other variables, worsened lower urinary tract symptom bother was more likely among men who were nonwhite (OR 1.79, 95% CI 0.94-3.40) or who had diabetes (OR 1.68, 95% CI 0.86-3.27) and among women with diabetes (OR 1.77, 95% CI 0.85-3.67), prior treatment of lower urinary tract symptoms (OR 2.58, 95% CI 1.22-5.46) or a higher depression level (OR 1.29, 95% CI 1.10-1.52). Baseline factors associated with more severe bother at 12 months in men included more severe bother at baseline, nonwhite race, worse urinary frequency and incontinence, and higher levels of stress (p <0.05). Among women more severe bother at baseline, urinary urgency and frequency, and worse physical function were associated with more severe bother at 12 months. CONCLUSIONS: Urinary symptom severity at baseline, race, depression and psychological stress were associated with the bother of lower urinary tract symptoms in a prospective cohort of men and women treated at tertiary care facilities. These findings may inform the clinical care of patients with bothersome lower urinary tract symptoms and direct providers to better prognosticate for patients with challenging lower urinary tract symptoms cases.


Assuntos
Sintomas do Trato Urinário Inferior/psicologia , Autorrelato/estatística & dados numéricos , Estresse Psicológico/diagnóstico , Adulto , Idoso , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Estresse Psicológico/psicologia
7.
Urology ; 130: 22-28, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31018115

RESUMO

OBJECTIVE: To describe the distribution of post-void residual (PVR) volumes across patients with and without lower urinary tract symptoms (LUTS) and examine relationships between self-reported voiding symptoms, storage symptoms, and PVR. METHODS: PVR and demographic data were obtained from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) observational cohort study. Self-reported symptoms were collected using the American Urological Association Symptom Index and the LUTS Tool. PVR values were obtained from 2 other cohorts: living kidney donors with unknown LUTS from the Renal and Lung Living Donors Evaluation Study (RELIVE), and continent women in the Establishing the Prevalence of Incontinence (EPI) study, a population-based study of racial differences in urinary incontinence prevalence. RESULTS: Across the 3 studies, median PVRs were similar: 26 mL in LURN (n = 880, range 0-932 mL), 20 mL in EPI (n = 166, range 0-400 mL), and 14 mL in RELIVE (n = 191, range 0-352 mL). In LURN, males had 3.6 times higher odds of having PVR > 200 mL (95% CI = 1.72-7.48). In RELIVE, median PVR was significantly higher for males (20 mL vs 0 mL, P= .004). Among women, only the intermittency severity rating was associated with a probability of an elevated PVR. Among men, incomplete emptying and burning severity rating were associated with a higher odds of elevated PVR, but urgency severity ratings were associated with lower odds of elevated PVR. CONCLUSION: Care-seeking patients have PVRs similar to those in people with unknown history of LUTS (RELIVE) and without self-reported LUTS (EPI). Although PVR was correlated with voiding symptoms, the mean differences only explain ∼2% of the variance.


Assuntos
Doenças Assintomáticas , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micção
8.
J Urol ; 202(5): 880-889, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30925127

RESUMO

PURPOSE: Lower urinary tract symptoms are prevalent and burdensome, yet methods to enhance diagnosis and appropriately guide therapies are lacking. We systematically reviewed the literature for human studies of biomarkers associated with lower urinary tract symptoms. MATERIALS AND METHODS: PubMed®, EMBASE® and Web of Science® were searched from inception to February 13, 2018. Articles were included if they were in English, performed in benign urological populations without neurological disorders or interstitial cystitis/bladder pain syndrome, and assessed a biomarker's association with or ability to predict specific lower urinary tract symptoms or urological conditions. Bioinformatic pathway analyses were conducted to determine whether individual biomarkers associated with symptoms are present in unifying pathways. RESULTS: Of 6,150 citations identified 125 met the inclusion criteria. Most studies (93.6%) assessed biomarkers at 1 time point and were cross-sectional in nature. Few studies adjusted for potentially confounding clinical variables or assessed biomarkers in an individual over time. No individual biomarkers are currently validated as diagnostic tools for lower urinary tract symptoms. Compared to controls, pathway analyses identified multiple immune response pathways that were enriched in overactive bladder syndrome and cell migration/cytoskeleton remodeling pathways that were enriched in female stress incontinence. CONCLUSIONS: Major deficiencies in the existing biomarker literature include poor reproducibility of laboratory data, unclear classification of patients with lower urinary tract symptoms and lack of adjustment for clinical covariates. Despite these limitations we identified multiple putative pathways in which panels of biological markers need further research.


Assuntos
Biomarcadores/metabolismo , Sintomas do Trato Urinário Inferior/metabolismo , Micção/fisiologia , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia
9.
Female Pelvic Med Reconstr Surg ; 25(2): 157-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807420

RESUMO

OBJECTIVE: This study aimed to describe symptom prevalence and quality of life impact from lower urinary tract symptoms (LUTS) in women living with female genital mutilation (FGM) in the United States. METHODS: A convenience sample of English-speaking women with FGM were invited to complete an anonymous survey including the Female Lower Urinary Tract Symptoms questionnaire to assess symptom prevalence and bother and the Pelvic Floor Impact Questionnaire-7 to assess quality of life impact from pelvic floor disorders. Data are reported as median (interquartile range). Correlations were calculated using Spearman ρ. RESULTS: Thirty women with an age of 29 (24-40) years were included. Sixty-seven percent self-identified as black/African and 77% were Muslim. Women reported being circumcised between ages 1 week and 16 years (median, 6 years). Forty percent reported type I circumcision, 23% reported type II, 23% reported type III, and 13% were unsure. Fifty percent were vaginally parous. Seventy-three percent of women reported the presence of LUTS. Twenty-seven percent voided at least 9 times per day, and 60% had nocturia at least 2 times. Bothersome voiding symptoms were commonly reported: urinary hesitancy (40%), strained urine flow (30%), and intermittent urine stream (47%). Fifty-three percent reported urgency urinary incontinence and 43% reported stress urinary incontinence. Symptom prevalence and bother were correlated for all 12 items (ρ = 0.51-0.90, P < 0.001). Median Pelvic Floor Impact Questionnaire-7 score was 102 (8-144), with 63% reporting urinary symptoms having "moderate" or "quite a bit of" impact on their activities, relationships, or feelings. CONCLUSION: Lower urinary tract symptoms are common and bothersome in women with FGM. Providers caring for patients with FGM should inquire about LUTS.


Assuntos
Circuncisão Feminina/estatística & dados numéricos , Sintomas do Trato Urinário Inferior/epidemiologia , Transtornos Urinários/epidemiologia , Adulto , Circuncisão Feminina/efeitos adversos , Feminino , Humanos , Noctúria/epidemiologia , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Avaliação de Sintomas , Estados Unidos/epidemiologia , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária de Urgência/epidemiologia , Adulto Jovem
10.
Int Urogynecol J ; 30(1): 101-105, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30003284

RESUMO

INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a Polish language version of the short form of the Pelvic Floor Distress Inventory (PFDI-20) and to validate it in a sample of Polish-speaking women with pelvic floor disorders (PFDs). METHODS: The PFDI-20 was initially translated in a stepwise fashion as guided by the International Urogynecological Association (IUGA) Translation Protocol. After initial forward translation from English to Polish, a community review process consisting of cognitive interviews and confirmation via back translation was performed. The final Polish version of the PFDI-20 was administered to Polish-speaking patients presenting with PFDs at university-based urogynecology clinics in Poland and the United States, along with a Polish version of the King's Health Questionnaire (KHQ). Internal consistency and criterion validity were assessed. Test-retest reliability was assessed in 100 patients after 2 weeks. RESULTS: A total of 254 women with PFDs enrolled in this multicenter study. Complete data from 44 Polish-speaking women in the United States and 200 women in Poland were analyzed. Participants had a mean age of 60.3 ± 11.2 years and mean body mass index (BMI) 27.6 ± 4.7. Internal consistency as measured by Cronbach's alpha was good (0.89). Criterion validity was adequate between responses on the KHQ and PFDI-20 with Pearson correlations in particular domains (0.27-0.50, P < 0.05). Excellent test-retest reliability was demonstrated by intraclass correlation using a two-way mixed-effects model with absolute agreement (0.87). CONCLUSIONS: The Polish version of the PFDI is a reliable tool for evaluating pelvic floor symptoms in Polish-speaking women with PFDs.


Assuntos
Distúrbios do Assoalho Pélvico/psicologia , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/epidemiologia , Polônia/epidemiologia
11.
Female Pelvic Med Reconstr Surg ; 25(5): 369-371, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29509646

RESUMO

OBJECTIVE: The objective of this study was to describe the expected duration of self-catheterization in women discharged home performing intermittent self-catheterization (ISC) after retropubic midurethral sling (RMUS). METHODS: We conducted a retrospective cohort analysis of women who underwent an isolated RMUS by 3 providers between 2009 and 2014 at a single institution. A 300 mL retrograde-fill voiding trial (VT) was performed before discharge. Those who failed their VT (postvoid residual [PVR] >1/3 total bladder volume [TBV]) and could perform ISC are included in this analysis. Subjects were categorized into mild retention (PVR >1/3 and <2/3 the TBV) or severe retention (PVR ≥2/3 the TBV). Patients could discontinue ISC after achieving 2 consecutive PVR volumes of less than 75 mL. Duration of catheterization was determined in days. RESULTS: Two hundred women underwent isolated RMUS. Forty-seven (23.5%) failed their VT of whom 39 (included in this analysis) could perform ISC and had complete data. Subjects had a mean ± SD age of 49 ± 11 years. The median (interquartile range) PVR volume postoperatively was 250 (190-325) mL. Median (interquartile range) days of postoperative ISC for the cohort was 2 (1-4); 37.5% were catheterized for 1 day, 32.5% for 2 days, 2.5% for 3 days, and 27.5% for more than 3 days. Seventeen (39.5%) met the criteria for mild retention and 26 (60.5%) met the criteria for severe retention. There was no difference in the postoperative catheterization days between the mild and severe retention groups (P = 0.16). CONCLUSIONS: Urinary retention will resolve within 2 days in the majority (73%) of women discharged performing ISC after RMUS.

12.
Int Urogynecol J ; 30(1): 65-70, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29536138

RESUMO

INTRODUCTION AND HYPOTHESIS: This study adapted the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) into the Tigrigna language of northern Ethiopia and validated the their reliability and validity through patient interviews. METHODS: Expert translation, cognitive interviewing, and patient interviews using translated questionnaires were conducted. A subset of women was reinterviewed 1 week later. Intraclass correlation coefficients (ICC), Bland-Altman analysis, and Cronbach's alpha values were assessed. Total and subscale scores were compared between women with and without pelvic floor disorders (PFDs) using the Mann-Whitney U test. Spearman's correlation coefficients were used to compare severity of pelvic organ prolapse (POP) stage according to the POP Quantification (POP-Q) system and PFDI-20 and PFIQ-7 and subscale scores. RESULTS: Ten women participated in cognitive interviewing and 118 age 49 ± 10 years, mean ± standard deviation (SD) with and without PFDs were interviewed using the translated questionnaires, both of which presented adequate face validity and test-retest reliability [intraclass correlation coefficient (ICC) 0.765-0.969, p < 0.001]. Construct validity was significant between clinical symptoms and full forms (p <0.001) and their subscales (p <0.001), except for the Pelvic Organ Prolapse Impact Questionnaire (POPIQ). Differences between first and second scores on total PFDI-20 and PFIQ-7 and subscales largely fell within 0 ± 1.96 SD. Cronbach's alpha values were 0.891-0.930 for PFDI-20 and 0.909-0.956 for PFIQ-7 (p < 0.001). Analysis of known groups showed differences PFDI-20 and PFIQ-7 scores between women with and without PFDs (p <0.001 for full forms and subscales, except for anal incontinence (AI) and the Urinary Impact Questionnaire (UIQ)/POPIQ. CONCLUSION: The translated Tigrigna versions of the PFDI-20 and PFIQ-7 questionnaires are reliable, valid, and feasible tools to evaluate symptoms and quality of life (QoL) of Tigrigna-speaking Ethiopian women with PFDs.


Assuntos
Distúrbios do Assoalho Pélvico/psicologia , Prolapso de Órgão Pélvico/psicologia , Inquéritos e Questionários , Adulto , Estudos Transversais , Etiópia , Feminino , Humanos , Pessoa de Meia-Idade , Distúrbios do Assoalho Pélvico/diagnóstico , Prolapso de Órgão Pélvico/diagnóstico , Reprodutibilidade dos Testes
13.
Female Pelvic Med Reconstr Surg ; 25(5): 362-364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29621040

RESUMO

OBJECTIVE: The aims of this study were to determine the rate and describe 30-day postoperative complications of concomitant pelvic organ prolapse and/or urinary incontinence (POPUI) procedures in women undergoing surgery for a gynecologic malignancy. METHODS: Women who underwent surgical intervention for a gynecologic malignancy between 2010 and 2014 were identified using postoperative International Classification of Diseases, Ninth Revision codes 179.0 to 184.9 in the American College of Surgeons National Surgical Quality Improvement Program database. Women who underwent POPUI procedures were identified using Current Procedural Terminology codes between 51840 and 58294. Infectious, pulmonary, cardiac, and venous thromboembolism complication rates were calculated. Patient demographics and postoperative complication rates were analyzed using Student t, χ, and Fisher exact tests and compared between women with a gynecologic malignancy who did and did not undergo concomitant POPUI procedures. RESULTS: We identified 23,501 women with a diagnosis of a gynecologic malignancy. The most common included uterine (63%), ovarian (25%), and cervical cancer (8%). Only a small proportion of the women undergoing gynecologic cancer surgery (n = 556 [2.4%]) had concomitant POPUI procedures. The most commonly performed POPUI procedures included anterior and/or posterior colporrhaphy (n = 205 [32%]), laparoscopic colpopexy (n = 181 [28.2%]), and midurethral sling (n = 70 [10.9%]). There were no differences in 30-day reoperation; infectious, pulmonary, and cardiac complications; or venous thromboembolic events between women who did and did not have concomitant POPUI surgery. CONCLUSIONS: Using a large national surgical database, only 2.4% of women undergoing gynecologic cancer surgery had a concomitant POPUI procedure. Our data suggest that postoperative complications may not increase when concomitant surgery for POPUI is done at the time of gynecologic cancer surgery.

14.
Female Pelvic Med Reconstr Surg ; 25(6): 426-429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30570502

RESUMO

OBJECTIVES: The aims of the study were to determine the relationship between pelvic organ prolapse (POP) and health-related quality of life dimensions and to evaluate the utility of the PROMIS Profile in women undergoing surgical treatment for POP. METHODS: We performed a planned ancillary analysis of 103 women recruited between January 2014 and December 2015 to the Restricted Convalescence Outcomes following Urogynecologic Procedures study. All participants underwent surgery for POP and completed the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Severity Scale, and the 57-item Patient Reported Outcomes Measurement Information System (PROMIS-57) questionnaire, preoperatively and at 3 months postoperatively. Data were analyzed using Pearson and Spearman correlations. RESULTS: Preoperative PFDI-20 and PFIQ-7 scores were significantly correlated with all PROMIS domains including physical function, anxiety, depression, fatigue, sleep disturbance, satisfaction with participation in social roles, pain interference, and higher pain intensity. Worse self-reported condition assessments on the Patient Global Impression of Severity were significantly correlated with worse physical function, more pain interference, and higher pain intensity on the PROMIS Profile at baseline. Postoperatively, PFDI-20, PFIQ-7, and all PROMIS Profile domain scores improved significantly (P ≤ 0.05). Correlations between PDFI-20, PFIQ-7, and PROMIS domains persisted at 3 months. CONCLUSIONS: In a cohort of women undergoing surgery for POP, pelvic floor symptom severity is associated with health-related quality of life domains measured by the PROMIS-57.

15.
Artigo em Inglês | MEDLINE | ID: mdl-29979357

RESUMO

OBJECTIVE: The objective of this study was to determine the incidence of newly diagnosed, clinically meaningful laboratory abnormalities on routine preoperative laboratory testing in women undergoing urogynecologic surgery. METHODS: All urogynecologic cases performed at a single institution over a 3-year period were reviewed. Women undergoing major surgery routinely had a basic metabolic panel, complete blood count (CBC), and type and screen, whereas women undergoing minor surgery had testing at the surgeon's discretion. Demographics, surgical details, preoperative laboratory values, and instances of postoperative transfusion were abstracted. If testing revealed a clinically meaningful abnormality, physician notes were reviewed to determine whether the abnormality was previously known or led to surgical postponement. RESULTS: A total of 836 cases were identified: 411 major (49%) and 425 minor (51%). Patients had a mean ± SD age of 57 ± 13 years and body mass index of 27 ± 6 kg/m. Medical comorbidities were hypertension, 38%; diabetes, 24%; chronic kidney disease, 3%; and congestive heart failure, 4%; 89% had an American Society of Anesthesiologists class of less than or equal to 2. A total of 453 (54%) had preoperative CBC, and 367 (44%) had preoperative basic metabolic panel. Six (1.3%) new abnormalities (hemoglobin between 8.0 and 10.0) were identified on CBC. Thirty-one women had elevated creatinine level (>1.0), and 28 (90%) of these had a history of hypertension. No surgeries were postponed or changed owing to anemia, thrombocytopenia, or renal dysfunction. No clinically significant electrolyte abnormalities were identified. Type and screen were collected on 394 patients; none were transfused intraoperatively. CONCLUSIONS: Routine preoperative laboratory testing does not identify clinically meaningful abnormalities or alter surgical management in women undergoing urogynecologic surgery.

16.
Int Urogynecol J ; 29(11): 1675-1680, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29961109

RESUMO

INTRODUCTION AND HYPOTHESIS: We compared pre- and postoperative sexual function scores in sexually active women undergoing pelvic organ prolapse (POP) surgery. METHODS: Planned secondary analysis of women enrolled in the Restricted Convalescence: Outcomes Following Urogynecologic Procedures study, a randomized trial of postoperative activity after POP surgery. All participants could return to sexual activity at 6 weeks. Participants completed the Pelvic Floor Distress Inventory (PFDI), the Patient-Reported Outcomes Measurement Information System (PROMIS) profile, and the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaires at baseline and 3 months. GRISS is a validated 28-item survey for heterosexual couples that contains seven subscales to assess sexual function. Higher scores represent worse sexual function. RESULTS: Thirty-seven sexually active women were assessed. Mean age ± standard deviation (SD) was 56 ± 11, most of whom (92%) were Caucasian; 78% had undergone minimally invasive sacrocolpopexy, and the remainder had native tissue vaginal repairs. GRISS scores improved 3 months after surgery [4.5 ± 2.6 to 3.6 ± 2.2, p < 0.001; mean decrease of 0.9, 95% confidence interval (CI) 0.36-1.36]. PFDI scores improved from 122 ± 53 at baseline to 28 ± 31 at 3 months (p < 0.001). Higher GRISS scores were correlated with higher PFDI scores (Spearman's rho = 0.35, p = 0.03) at baseline and 3 months (Spearman's rho = 0.31, p = 0.03). Several GRISS subscales improved after surgery: partner avoidance (p = 0.01), vaginismus (p = 0.02), noncommunication (p = 0.01), dissatisfaction (p = 0.03), and anorgasmia (p = 0.001). However, sexual infrequency (p = 0.08) and nonsensuality (p = 0.4) did not change. Fifty-one percent had sexual dysfunction before surgery, which decreased to 32% after surgery (p = 0.04). CONCLUSION: Sexual function and satisfaction are significantly improved 3 months following POP surgery. Improved sexual function is correlated with improved pelvic floor symptoms.


Assuntos
Prolapso de Órgão Pélvico/psicologia , Satisfação Pessoal , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/psicologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Orgasmo , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/cirurgia , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Vagina/cirurgia
17.
Female Pelvic Med Reconstr Surg ; 24(2): 87-89, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29474278

RESUMO

OBJECTIVES: This study aimed to determine if personnel handoffs or number of learners in the operating room (OR) are associated with longer OR times in women having pelvic organ prolapse surgery. METHODS: A retrospective review of women undergoing prolapse surgery in 2016 was conducted. Demographics; procedure; OR, anesthetic, and surgical time; number of handoffs between anesthesia members, circulators, and surgical technologies; and number of learners were abstracted. RESULTS: One hundred forty-eight women underwent pelvic organ prolapse surgery. Mean age was 54 ± 14 years, and most women were healthy and white. Procedures performed were as follows: 31% laparoscopic sacrocolpoexies (LASCs), 28% robotic sacrocolpopexies (RASCs), 19% colpocleises, and 22% native tissue reconstructions. For minimally invasive sacrocolpopexies (LASC + RASC), mean OR time was 270 ± 65 minutes. Median anesthesia, surgical technology, and circulator handoffs for sacrocolpopexies were 2 (interquartile range, 0-4), 1 (0-3), and 2 (2-6). Median number of learners in the OR for sacrocolpopexies was 4 (interquartile range, 1-7). Patient comorbidities and American Society of Anesthesiologists class were not associated with longer OR times (P = 0.9 and P = 0.4). Longer OR times were positively correlated with increasing numbers of anesthesia, surgical technology, and circulator handoffs, but not with the number of learners (Spearman ρ = 0.34, P = 0.001; ρ = 0.34, P < 0.001; ρ = 0.59, P < 0.001, and ρ = 0.16, P = 0.43). For LASC, every technology handoff was associated with 23 additional minutes of OR time (P = 0.004). For RASC, every technology handoff was associated with 31 additional minutes of OR time (P = 0.007), and each circulator handoff was associated with 15 additional minutes (P = 0.05). CONCLUSION: Handoffs between OR personnel are associated with longer OR times, independent of patient factors.


Assuntos
Transferência da Responsabilidade pelo Paciente/normas , Prolapso de Órgão Pélvico/cirurgia , Fatores Etários , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Salas Cirúrgicas/normas , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
18.
Female Pelvic Med Reconstr Surg ; 24(1): 48-50, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28430727

RESUMO

OBJECTIVE: The study aims to identify sources of and changes in referral patterns for pelvic floor disorders. METHODS: All new patient visits to urogynecology at our institution between January 2010 and December 2015 were identified. Patient demographics, referral source, insurance type, and visit diagnoses using ICD-9 codes were abstracted. ICD-9 codes were grouped into 18 urogynecologic diagnoses. Data were analyzed using SPSS (Version 20; Chicago, IL). RESULTS: Five thousand seven hundred ninety-nine new patient visits were included in the analysis. The mean age was 54 ± 17 years and 59% were Caucasian. Forty-four percent were referred by obstetrician/gynecologists (OB/GYNs), 32% by primary care providers (PCPs), 14% by self-referral, and 9% by other specialties. New patient visits increased overall by 280% over 6 years; self- and PCP referrals increased by 480% and 320%, respectively. In comparison, OB/GYN referrals increased by only 229%. Patients diagnosed with prolapse and stress incontinence were more likely to be referred by an OB/GYN (P < 0.001), whereas PCPs were more likely to refer for urinary tract infections (P < 0.005) and urgency urinary incontinence (P < 0.001) than OB/GYNs. CONCLUSIONS: Demand for pelvic floor specialists is growing quickly, with PCP and self-referrals outpacing referrals from obstetrician-gynecologists to tertiary care urogynecology practices.


Assuntos
Ginecologia , Obstetrícia , Distúrbios do Assoalho Pélvico/epidemiologia , Padrões de Prática Médica , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
19.
Female Pelvic Med Reconstr Surg ; 24(3): 252-255, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28248849

RESUMO

OBJECTIVE: The aim of the study is to investigate the relationship between anal penetrative intercourse (API) and pelvic floor symptoms, specifically, anal incontinence (AI). METHODS: This was an institutional review board-approved, cross-sectional, e-mail survey of women enrolled in the Illinois Women's Health Registry. Participants were anonymously queried about their sexual practices and the effects of these on bowel and bladder symptoms. Urinary symptoms were assessed using the urogenital distress inventory-6 and bowel symptoms with the fecal incontinence severity index (FISI). RESULTS: One thousand three women (mean age of 46 ± 15 years) completed the survey. Eighty percent were white, 56% were married, and 99% reported ever being sexually active. Thirty-two percent had API at least once, and 12% considered it "part of their sexual practice." Sixty percent of the cohort reported a bothersome urinary symptom on the urogenital distress inventory-6, 70% reported AI on the FISI, and 15% reported fecal incontinence. Of women who engaged in API, 18% reported it changed their stool consistency, and 10% reported it caused AI. Having engaged in API within the last month was correlated with higher FISI scores (P = 0.05) and with fecal incontinence on the FISI (28.3% vs 14.4%; P = 0.01; odds ratio, 2.48). In addition, API was more commonly practiced among women who reported that vaginal intercourse caused dyspareunia (17% vs 12%, P = 0.05) or changes in bladder symptoms such as urgency or dysuria (44% vs 30%, P < 0.001). CONCLUSIONS: Self-reported AI and FI (as measured by the FISI scores) are higher in women who have had API, and frequency of API may be important in determining the risk of bowel symptoms.


Assuntos
Canal Anal/fisiopatologia , Incontinência Fecal/etiologia , Comportamento Sexual/estatística & dados numéricos , Adulto , Estudos Transversais , Incontinência Fecal/epidemiologia , Feminino , Humanos , Illinois , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Índice de Gravidade de Doença , Inquéritos e Questionários , Transtornos Urinários/epidemiologia , Transtornos Urinários/etiologia
20.
Int Urogynecol J ; 28(11): 1671-1675, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28470415

RESUMO

INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse is common in the elderly population and may be surgically treated with colpocleisis. We aimed to identify and compare surgical characteristics and 30-day perioperative complications in patients who underwent colpocleisis with and without concomitant vaginal hysterectomy (VH) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: Women who underwent vaginal closure procedures from 2006 to 2014 were identified utilizing Current Procedural Terminology (CPT) codes for LeFort colpocleisis (57120) and vaginectomy (57110). Patients undergoing a concomitant VH were identified by CPT codes ranging from 58260 to 58294. Variables including patient demographics, operative time, hospital length of stay, transfusion' and reoperation were evaluated. Specific medical complications, surgical site infection' and urinary tract infection (UTI) rates were calculated. Variables were analyzed using chi-squared, Fisher's exact, student's t tests and logistic regression. RESULTS: We identified 1,027 women in the ACS-NSQIP database who underwent vaginal closure procedures. The majority of patients (893, 87.0%) underwent colpocleisis alone, and the remainder (134, 13.0%) underwent concomitant VH. Operative times were shorter in patients undergoing colpocleisis alone. UTI was the most common postoperative complication affecting 4.3% of the entire cohort. Twelve women (1.2%) had a serious medical complication, seven who underwent colpocleisis alone and five who underwent colpocleisis with concomitant VH. In backward logistic regression' serious medical complications were the only variable independently associated with VH at the time of colpocleisis (p < 0.05). CONCLUSIONS: Colpocleisis is a safe procedure with rare serious adverse events.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia
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