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.

Assessing the need for and acceptability of a free-of-charge postpartum HPV vaccination program.

OBJECTIVE: Human papillomavirus (HPV) vaccine uptake rate among young adult US women was only 23% in 2010. One way to improve this low rate is to administer the vaccine postpartum. We examined whether this population requires vaccination and whether they would be agreeable to receiving it free of charge after delivery. STUDY DESIGN: Women 26 years of age or younger seeking prenatal care in publicly funded clinics in southeast Texas were interviewed in 2012 regarding their HPV vaccination status, barriers to vaccination, and whether they would be willing to receive this vaccine postpartum if offered free of charge. Medical charts were reviewed to extract additional information. RESULTS: Overall, 13.0% (65 of 500) stated they had initiated and 7.6% (38 of 500) completed the 3-dose vaccine series. Ethnic differences were noted with 21.0% of non-Hispanic whites, 14.6% of blacks, and 9.3% of Hispanics (P = .002) initiating the vaccine and 13.5%, 7.8%, and 5.2% (P = .006) competing all 3 doses, respectively. Lowest initiation (4.2%) and completion (1.4%) rates were observed among recently immigrated Hispanic women. Those who had not graduated from high school and older women were less likely to have been vaccinated. Almost 83% of those who had not received any HPV doses or completed the series were willing to receive the injection free of charge in the hospital after their delivery. CONCLUSION: HPV vaccine uptake rates are very low among women receiving prenatal care in southeast Texas. Offering this vaccine free of charge to postpartum women could be an effective strategy in this population because 5 of 6 women favored receiving it in this setting.

The Patient Acceptable Symptom State in Female Urinary Incontinence.

OBJECTIVE: The objective of this study is to characterize an acceptable health state, using the patient acceptable symptom state (PASS) question, in adult women with urinary incontinence. METHODS: This is a prospective multicenter cohort study determining PASS thresholds from condition-specific measures using an electronic research platform in English-speaking women seeking nonsurgical treatment of urinary incontinence between March 2019 and May 2020. Exclusions included pregnancy, isolated overactive bladder, and pelvic organ prolapse greater than stage II. The cohort was described and then grouped based on achievement of PASS. The PASS thresholds were determined using the 75th percentile and univariate regression methods. Multivariable regression modeling was used to understand the influence of covariates on PASS achievement. RESULTS: The study was completed by 100 (80%) of the 125 enrolled subjects. Of these, 45% (n = 45) achieved PASS after a median of 7 weeks of treatment (range, 6-13 weeks). The corresponding questionnaire score for PASS was estimated to be 6 for the Incontinence Severity Index, 3 for the Patient Global Impression of Severity and Improvement, 37.5 using the Urinary Distress Inventory 6, and 33.3 using the Incontinence Impact Questionnaire 7. Increasing age was independently associated with achieving PASS after adjusting for treatment adherence and outcomes scores (adjusted odds ratio, 1.05 [95% confidence interval, 1.01-1.10]; P = 0.02). CONCLUSIONS: PASS was achieved in 45% of women after conservative treatment of urinary incontinence. PASS offers a new perspective for analysis and interpretation of outcome measures used in pelvic floor disorders and can serve as a reference for future research and clinical care pathways.

High-definition ultrasound characterization of acute cyclophosphamide-induced cystitis in the mouse.

Purpose: To examine associations if any between changes in voiding function, hematuria, and bladder ultrasonography metrics in murine cyclophosphamide-induced chemical cystitis. Materials and Methods: Cystitis was induced in 6 female mice by an intraperitoneal injection of cyclophosphamide (300 mg/kg). Voiding frequency, void volume, hematuria assessment, and ultrasonographic measurements of the bladder were obtained at baseline, days 1 to 5, and days 9, 11, and 13. Voiding was induced with preferred sweet drinking solution and voiding data collected using an automated data collection system in 135 minute sessions. Bladder wall thickness, lumen volume, and vascular Doppler were acquired using a high definition ultrasound system. Spearman's correlation was used to analyze the association between the voiding changes, hematuria, and ultrasound findings. Results: Hematuria was present 24 hours after cyclophosphamide injection. All animals displayed increased bladder vascularity, bladder wall thickness, and void frequency that was associated with concurrent decreased total and average void volumes. Increased bladder wall vascularity was correlated with the presence of hematuria (r=0.59, p<0.01) and bladder wall thickness (r=0.79, p<0.01). Hematuria correlated with increased void frequency (r=0.34, p<0.01). Average void volume was negatively correlated with hematuria (r=-0.50, p<0.01) and frequency (r=-0.38, p<0.01). Conclusions: High-definition ultrasound imaging permits in vivo monitoring of changes in bladder morphology associated with voiding function in relation to cyclophosphamide-induced cystitis. Ultrasound imaging of the bladder may assist in differential diagnosis of bladder dysfunction.