Disparities in Sports Medicine Health Care Access in Illinois High Schools: Access to Team Physicians, Athletic Trainers, and Automated External Defibrillators.

ABSTRACT: High school athletes have higher rates of injuries and sudden death than their college counterparts. Medical care for these athletes should include access to team physicians, athletic trainers, and automated external defibrillators. Disparities in medical care access provided by high schools for their athletes may be due to school characteristics or socioeconomic or racial factors. This study investigated relationships between these factors and access to team physicians, athletic trainers, and automated external defibrillators. Medical care access is negatively related to the percentage of low-income students and positively related to the number of sports offered. Relationships between race and access to a team physician became nonsignificant when the percentage of low-income students was considered. Physicians who treat high school athletes should consider the medical care access provided by their schools when they educate these patients about preventing and treating sports injuries.

Occurrence and recurrence of gastric dilatation with or without volvulus after incisional gastropexy.

This study investigated recurrence of gastric dilatation without (GD) or with volvulus (GDV) after incisional gastropexy (IG) in dogs that underwent IG for prevention of GDV. Signalment, concurrent surgical procedures, presence of GD or GDV at the time of IG were obtained from medical records of dogs that underwent IG. Owners were contacted to determine whether the dogs experienced GD or GDV after IG, dates of postoperative GD or GDV episodes, survival status, date of death for deceased dogs. Gastric dilatation and GDV recurrence rates were calculated for 40 dogs that had at least 2 y follow-up from the time when IG was performed and for dogs that experienced GD or GDV during the follow-up period. No dogs experienced GDV after IG and 2 dogs (5.0%) experienced GD after IG. The results suggest that GD and GDV rates after IG may be comparable to recurrence rates after other methods of gastropexy.

Occurrence et récurrence de la dilatation gastrique avec ou sans volvulus après une gastropexie incisionnelle. Cette étude a examiné la récurrence de la dilatation gastrique sans volvulus (DG) ou avec volvulus (DGV) après une gastropexie incisionnelle (GI) chez les chiens qui avaient subi une GI pour la prévention de la DGV. Le signalement, les interventions chirurgicales concomitantes, la présence de la DG ou de la DGV au moment de la GI ont été obtenus dans les dossiers médicaux de chiens qui ont subi une GI. On a contacté les propriétaires pour déterminer si les chiens avaient eu une DG ou une DGV après la GI, les dates des épisodes postopératoires de DG ou de DGV, l'état de la survie et la date de la mort pour les chiens décédés. Les taux de récurrence de la dilatation gastrique et de la DGV ont été calculés pour 40 chiens qui ont eu un suivi d'au moins 2 ans à partir de la réalisation de la GI et pour les chiens qui avaient eu une DG ou une DGV durant la période de suivi. Aucun chien n'a eu une DGV après une GI et 2 chiens (5,0 %) ont connu une DG après la GI. Les résultats suggèrent que les taux de DG et de DGV peuvent être comparables aux taux de récurrence après d'autres méthodes de gastropexie.(Traduit par Isabelle Vallières).

Comparison of topical anesthetics for intravitreal injections : a randomized clinical trial.

PURPOSE: To determine whether there is a difference in anesthetic effect between topical proparacaine drops, 4% lidocaine solution, or 3.5% lidocaine gel, and whether this has an impact on the overall injection experience. METHODS: One hundred and twenty sequential patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group 1), proparacaine + 4% lidocaine-soaked cotton tipped swabs (Group 2), or 3.5% lidocaine gel (Group 3). Discomfort associated with the lid speculum, with the needle, and with burning sensation was graded on a scale of 0 to 10 (0 = no pain, 10 = worst pain ever). The overall injection experience was graded as Excellent, Very Good, Fair, Poor, or Awful. RESULTS: The average lid speculum pain score for Group 1 was 0.85, Group 2 was 0.50, and Group 3 was 0.65 (P = 0.32). The average needle pain score for Group 1 was 1.78, Group 2 was 1.75, and Group 3 was 1.48 (P = 0.38). The average burning pain score for Group 1 was 1.45, Group 2 was 1.58, and Group 3 was 1.13 (P = 0.23). Overall satisfaction was rated as Excellent or Very Good in 95%, 97.5%, and 92.5% of Group 1, 2, and 3 patients, respectively (P = 0.64). CONCLUSION: The use of topical proparacaine drops provides very effective and cost-effective anesthesia during office-based intravitreal injections.

Surgical treatment of medial patellar luxation without femoral trochlear groove deepening procedures in dogs: 91 cases (1998-2009).

OBJECTIVE: To assess signalment, outcomes, and complications for dogs surgically treated for medial patellar luxation (MPL) with a combination of lateral retinacular imbrication and tibial crest transposition procedures without femoral trochlear groove deepening techniques, and to determine whether osteoarthritis progressed in these patients during the 8-week period following surgery. DESIGN: Retrospective case series. Animals-91 dogs. PROCEDURES: Medical records were reviewed for information on signalment, clinical history, unilateral versus bilateral disease, preoperative and postoperative MPL grades, duration of follow-up, and perioperative and postoperative complications. Radiographs obtained preoperatively and during 8-week follow-up examinations were reviewed and assigned degenerative joint disease (DJD) scores (range, 0 to 3). Data were analyzed to determine factors influencing outcomes. Kaplan-Meier curves were constructed for recurrence of MPL. RESULTS: Minor postoperative complications were reported for 31 of 91 (34.1%) dogs. Patellar reluxation occurred in 18 of 91 (19.8%) dogs. Reluxation or complications for which additional surgery was recommended developed in 6 of 91 (6.6%) dogs. At last clinical follow-up, 10 of 91 (11.0%) dogs had at least occasional lameness. No difference was revealed between preoperative and postoperative (8-week follow-up) radiographic DJD scores. CONCLUSIONS AND CLINICAL RELEVANCE: Results of surgical treatment of MPL without femoral trochlear groove deepening procedures were comparable to those in studies of surgical treatment that included groove deepening procedures. Radiographic indices of DJD did not increase during the 8 weeks following surgery. These results suggest that trochlear groove deepening procedures are not always necessary, and patients that undergo these techniques should be carefully selected.

Prevalence of bowel symptoms in women with pelvic floor disorders.

INTRODUCTION AND HYPOTHESIS: To determine the prevalence of a variety of bowel symptoms in women with pelvic floor disorders METHODS: We reviewed charts of consecutive new patients presenting to our urogynecologic clinic between July 2006 and April 2008. Women completed two bowel symptom questionnaires: (1) a nonvalidated questionnaire inquiring about symptoms of fecal/flatal incontinence, painful bowel movements, difficulties in bowel movement, and the need for splinting and (2) the validated, Colorectal-Anal Distress Inventory (CRADI) subscale of the short form of the Pelvic Floor Distress Inventory. Demographic and clinical information were extracted from patients' charts. RESULTS: Four hundred sixty-three women were included. Only 3% of the women presented with defecatory dysfunction or fecal incontinence as their chief complaint. However, 83% answered affirmatively to the presence of at least one CRADI bowel symptom. The most common bowel symptom was incomplete emptying at the end of a bowel movement (56%), followed by straining to have a bowel movement (55%), and flatal incontinence (54%). CONCLUSIONS: Women rarely seek urogynecologic care primarily for bowel symptoms, although they have a high prevalence of bowel symptoms.

Thumb carpometacarpal suspension arthroplasty using interference screw fixation: surgical technique and clinical results.

PURPOSE: Arthritis of the thumb carpometacarpal (CMC) joint is a common condition, for which reconstruction using the flexor carpi radialis (FCR) is a standard treatment. We describe the technique and clinical results for thumb CMC arthroplasty using interference screw fixation of the FCR to the first metacarpal through a single incision. METHODS: Over 12 months, 29 consecutive CMC arthroplasties were performed in 29 patients using FCR transfer tenotomized at the level of the scaphoid with an absorbable biotenodesis screw for fixation. There were 24 women and 5 men, with a mean age of 58 years. Patients were evaluated at a minimum of one year with radiographs, standardized outcome instruments, and measurements of motion and strength. The scaphoid to first metacarpal distance was measured at 2 weeks, 3 months, and greater than 1 year to assess settling. RESULTS: A total of 28 patients were available at a mean of 19 months. No arthroplasties required revision. Postoperative scaphoid to first metacarpal distance was 5.9 mm, which had decreased by a mean of 1.4 mm at final follow-up. There were no side-to-side differences in range of motion or strength in the entire cohort except for lateral key pinch, which was lower on the reconstructed side. The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 15, and the mean visual analog scale score was 1. Correlations were found between age and lateral key pinch strength for the reconstructed and contralateral sides. There were no significant relationships among Disabilities of the Arm, Shoulder, and Hand score, visual analog scale, radiographic settling, side-to-side strength or range of motion versus gender, Eaton stage, or workers' compensation status. CONCLUSIONS: Our series demonstrates excellent clinical outcomes with no revisions at an average of 19 months for this technique. Strength, range of motion, and radiographic settling compare favorably with published results of alternative techniques. Except for lateral key pinch, there was no statistically significant difference in strength compared with the contralateral side. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Observations relating to urinary sensation during detrusor overactivity.

AIMS: To describe the temporal relationship between increases in lower urinary tract (LUT) sensation and changes in detrusor and/or urethral pressures measured in real time. METHODS: We reviewed 33 multichannel urodynamic tracings that included a continuous recording of LUT sensation and that demonstrated detrusor overactivity incontinence (DOI) or detrusor overactivity (DO). Four physicians reviewed each urodynamic tracing and reached agreement about the temporal relationship between LUT sensation and detrusor contraction. RESULTS: Median age was 60 (36-82) years. Fourteen (42%) had urodynamic diagnoses of mixed incontinence, 18 (55%) had DOI, and 1 (3%) had DO without DOI. We reviewed 119 episodes of detrusor overactivity from the 33 recordings. We found no difference in change in sensation level when comparing DO episodes with DOI episodes or between different urodynamic diagnoses (P > 0.5). There was no dominant temporal pattern seen for the whole group (P = 0.84), that is, there was no evidence that the change in sensation level was more likely to occur before, during, or after DO/DOI episodes. When evaluating the changes in the urethral pressure, the most common pattern seen was an increase in sensation level after a fall in urethral pressure, but no dominant pattern was seen. CONCLUSIONS: Our findings suggest that increased LUT sensation during DO/DOI is not reliably caused by measurable alterations in bladder or urethral pressure.

Relationships between osteoprotegerin (OPG), receptor activator of nuclear factor kappaB ligand (RANKL), and growth hormone (GH) secretory status in short children.

GH deficiency places children at risk for decreased bone density and increased fracture rates. The RANKL/RANK/OPG system plays an important role in linking bone formation to bone resorption. Although OPG is thought to be secreted as a compensatory response to states of low bone density, its concentrations have not been found to differ significantly between GH-deficient, acromegalic, and healthy adults. AIM: To evaluate the associations between OPG and RANKL serum levels and GH secretory status in children. CHILDREN: 54 short children were recruited. METHODS: Serum OPG and RANKL, IGF-I, IGFBP-3, stimulated GH levels, bone DEXA results, and growth velocity were assessed. Regression modeling was used to evaluate significant predictors of OPG and RANKL levels. RESULTS: There were no significant differences in OPG and RANKL serum levels or bone DEXA results between GH-deficient and GH-sufficient children. A statistically significant quadratic relationship between OPG and IGFBP-3 concentrations was observed. CONCLUSIONS: IGFBP-3 was found to be the only significant predictor of OPG serum levels, allowing us to speculate that increased OPG levels may represent a compensatory response to the missing anabolic actions of IGF-I and/or GH in children with GH deficiency.

Application of holographic display in radiotherapy treatment planning II: a multi-institutional study.

We hypothesized that use of a true 3D display providing easy visualization of patient anatomy and dose distribution would lead to the production of better quality radiation therapy treatment plans. We report on a randomized prospective multi-institutional study to evaluate a novel 3D display for treatment planning.The Perspecta Spatial 3D System produces 360 degrees holograms by projecting crosssectional images on a diffuser screen rotating at 900 rpm. Specially-developed software allows bi-directional transfer of image and dose data between Perspecta and the Pinnacle planning system.Thirty-three patients previously treated at three institutions were included in this IRB-approved study. Patient data were de-identified, randomized, and assigned to different planners. A physician at each institution reviewed the cases and established planning objectives. Two treatment plans were then produced for each patient, one based on the Pinnacle system alone and another in conjunction with Perspecta. Plan quality was then evaluated by the same physicians who established the planning objectives. All plans were viewable on both Perspecta and Pinnacle for review. Reviewing physicians were blinded to the planning device used. Data from a 13-patient pilot study were also included in the analysis.Perspecta plans were considered better in 28 patients (61%), Pinnacle in 14 patients (30%), and both were equivalent in 4 patients. The use of non-coplanar beams was more common with Perspecta plans (82% vs. 27%). The mean target dose differed by less than 2% between rival plans. Perspecta plans were somewhat more likely to have the hot spot located inside the target (43% vs. 33%). Conversely, 30% of the Pinnacle plans had the hot spot outside the target compared with 18% for Perspecta plans. About 57% of normal organs received less dose from Perspecta plans. No statistically significant association was found between plan preference and planning institution or planner.The study found that use of the holographic display leads to radiotherapy plans preferred in a majority of cases over those developed with 2D displays. These data indicate that continued development of this technology for clinical implementation is warranted.

Revision of the acetabulum with a contemporary cementless component.

We evaluated the performance of a contemporary cementless acetabular component at a minimum of 5 years postoperatively. One hundred eighty-seven consecutive acetabular component revisions were performed using a hemispherical porous-coated component. Patients were followed prospectively with radiographs and Harris hip scores. Twenty patients died, leaving 158 patients (166 hips) available for follow-up at a mean of 91 months. No patients were lost. Eleven acetabular components (7%) required repeated revision, including 4 (2%) for aseptic loosening. Seven of the 145 unrevised acetabular components with radiographic follow-up (5%) were loose. The results of acetabular revision with this contemporary acetabular component were good but inferior to those of earlier-generation implants. This difference is likely multifactorial.

Pelvic floor fitness using lay instructors.

OBJECTIVE: Typically, pelvic muscle training for women with pelvic floor disorders is provided by medical personnel. We sought to evaluate the feasibility and symptom improvement after a nonmedical pelvic muscle training class in a prospective cohort. METHODS: Study participants volunteered to participate in an 11-week pelvic fitness and education class taught by a lay instructor at five fitness classrooms in the Chicago area. Participation was limited to adult women who verbally indicated that their pelvic symptoms included a minimum of some urge urinary symptom. Standardized assessments were completed before class, at the end of class, and 1 year after completion of the classes. These assessments included the 12-item short-form, validated pelvic questionnaires (Urogenital Distress Inventory Short Form, Incontinence Impact Questionnaire Short Form, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire), and self-reported goals selection and achievement. RESULTS: Eighty-seven of 102 participants provided before and after class data, and 76 also provided 1-year data. Participants had a mean age of 58 years and a mean body mass index of 26.3. Most (91%) were white, and 63% had at least completed college. After class improvements in Urogenital Distress Inventory Short Form bothersomeness ratings were noted for all items and maintained at 1 year for all but pain or discomfort. Significant quality-of-life and sexual function improvements were reported after class and at 1 year. The 12-item short-form responses documented improvements in six areas of general health. The most important self-selected goal was achieved in 71% after class and maintained by 67% at 1 year. CONCLUSION: Nonmedical pelvic fitness classes are promising for pelvic symptom improvement in self-selected participants. LEVEL OF EVIDENCE: II.

Early behavioral and histological outcomes following a novel traumatic partial nerve lesion.

A new partial nerve lesion (PNL) model is needed to better simulate traumatic lesions seen clinically that result in both dysfunction and neuropathic pain. We assessed surgical variability and several outcome measures including histology during the acute postoperative period. A surgical lesion was created in the rat tibial nerve by removing a segment, later confirmed by myelinated axon counts. Variability in the model was assessed with four different outcome measures during the first postoperative week (n=24), with additional histological outcomes at 7 days (n=13) and pain testing at 21 days (n=9). At 7 days postoperative, the PNL resulted in a tibial functional index (TFI) of -41.3% distinct from a percent motor deficit (PMD) of -76.3%. However, the respective deficits from 2 to 7 days were similar. Either test could detect outliers, but PMD measurements had a lower coefficient of variation and were easier to perform and analyze. The deleted segment contained 26% of the myelinated axons and resulted in distal degeneration that was either 46% based on axon counts or 54% based on area. Replicated experiments confirmed the PMD, muscle atrophy, and formation of neuropathic pain. In conclusion, our partial lesion histologically progresses twofold during the first postoperative week with profound behavioral deficits involving both motor and sensory loss. These results based on sensitive and correlative outcome measures support the application of this novel model in experimental nerve lesion studies.

Medical record documentation of peripartum urinary incontinence.

OBJECTIVE: To determine the rate of medical record documentation of urinary incontinence (UI) symptoms during the third trimester of pregnancy and postpartum period. STUDY DESIGN: Third-trimester prenatal patients were invited to participate in an institutional board-approved prospective study. Participants completed the 15-item, validated Medical, Epidemiological and Social Aspects of Aging (MESA) questionnaire. The MESA was readministered to participants during a 6-8-week postpartum visit. Outpatient and inpatient medical records were reviewed to determine whether UI symptoms were documented. RESULTS: One hundred sixty women had antenatal MESA and 90 had postpartum MESAs. Of the 160 women with antenatal MESAs, 118 were symptomatic (73%). Five medical records (3.1%) reflected any assessment of UI. Postpartum, 43% of women were incontinent by MESA. Documentation of incontinence assessment was present in 21% of medical records. CONCLUSION: Medical record documentation of UI symptom screening throughout pregnancy and postpartum rarely occurred in this study population.

Short and long term failure of the modular oncology knee prosthesis.

This retrospective study investigated the modes of implant failure in 80 patients with modular oncology knee prostheses. Twenty patients (25%) required revision: 12 (60%) for stem loosening, 6 (30%) for bearing failure, and 2 (10%) for infection. Patients with bone sarcomas survived longer; however, long-term prosthetic survivorship was a problem. A higher failure rate was found in patients with tibial tumors and with adjuvant treatment of chemotherapy. This study demonstrates for improved long-term survivorship of modular oncology knee prostheses, there must be improvement in the methods of stem fixation, prosthetic materials, and bearing mechanics.

Evaluation of endothelial function in women with polycystic ovary syndrome.

OBJECTIVES: Previous studies have suggested that vascular reactivity may be altered in women with polycystic ovary syndrome (PCOS). We sought to evaluate the vascular reactivity specifically the endothelial function (EF) in women with PCOS and to study the effect of metformin on their EF. STUDY DESIGN: Thirty-one women diagnosed with PCOS and 33 healthy controls underwent evaluation of EF using a post-ischemia reactive hyperemia technique (Endo-PAT). EF was quantitatively determined as the ratio between the arterial pulse wave amplitude following a 5min arterial occlusion in the forearm to the pre-occlusion value. Oral metformin 850mg bid was administered to PCOS patients. After 3 months of treatment EF was reassessed using the same technique. RESULTS: The average endothelial function was 1.48+/-0.32 in the PCOS group versus 2.00+/-0.51 in the controls (P<0.001). There were no significant changes in the EF among the 18 patients who were treated with metformin, EF index pre- and post-treatment was 1.42 versus 1.43, respectively. CONCLUSIONS: Endothelial dysfunction is more likely to occur among PCOS patients than in healthy controls. These preliminary results suggest that metformin treatment for 3 months in PCOS patients does not improve endothelial function.

Prediction tool for thrombi associated with peripherally inserted central catheters.

The upper extremity deep vein thrombosis rate is increasing at the same time that the rate for insertions of peripherally inserted central catheters is on the rise. There is little information on whether the established risk factors for lower extremity deep vein thromboses are effective to predict the occurrence of upper extremity deep vein thrombosis. The purpose of this study was to identify patients at highest risk for upper extremity deep vein thrombosis in order to initiate effective prophylaxis. A retrospective review was undertaken of medical records of all patients with peripherally inserted central catheters inserted in a 6-month period at a Midwestern US hospital. Of the 233 charts reviewed, 17 (7.3%) recorded an upper extremity deep vein thrombosis during the patient's hospital stay. Of the multiple factors identified with deep vein thrombosis in the literature, a weighted risk factor measure, the upper extremity deep vein thrombosis prediction tool, was developed. Sensitivity of the instrument for upper extremity deep vein thrombosis is high (88%), as are its specificity (82%) and negative predictive value (99%), whereas the positive predictive value is low (28%). The total percentage of cases correctly classified is 82%. Further testing is indicated on a larger sample to extend the validity of this instrument.

Progression of radiographic evidence of osteoarthritis following tibial plateau leveling osteotomy in dogs with cranial cruciate ligament rupture: 295 cases (2001-2005).

OBJECTIVE: To determine whether radiographic signs of osteoarthritis became progressively worse and tibial slope angle (TSA) changed substantially following tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs. DESIGN: Retrospective case series. ANIMALS: 295 dogs (373 stifle joints). PROCEDURES: Medical records were reviewed. Radiographs obtained before and 8 weeks after surgery were used to determine the degenerative joint disease (DJD) score, calculated as the sum of individual scores (0 through 3) assigned to 30 radiographic factors. Radiographs obtained immediately and 8 weeks after surgery were used to measureTSA. For dogs that underwent bilateral surgery, data for the first joint treated were used in analyses. Data for the second joint treated in dogs that underwent bilateral surgery were analyzed separately. RESULTS: A small, but significant, increase was found in mean DJD score 8 weeks after surgery, compared with mean preoperative score. An inverse relationship was found between preoperative DJD score and the difference between postoperative and preoperative DJD scores. Mean TSA 8 weeks after surgery was significantly higher than mean TSA immediately after surgery. Analysis of data for the second stifle joints in the 78 dogs that underwent bilateral surgery yielded similar results. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that there was a small, but measurable, increase in the severity of radiographic changes attributed to osteoarthritis in the stifle joints of dogs that underwent tibial plateau leveling osteotomy because of cranial cruciate ligament rupture.

Risk factors for ventral luxation in canine total hip replacement.

OBJECTIVE: To identify risk factors associated with ventral luxation (VL) of canine total hip replacement (THR), and outcome. STUDY DESIGN: Retrospective study. ANIMALS: Dogs (n=602) that had THR (563 cemented, 35 cementless, 4 hybrid). METHODS: Dogs (1999-2004) with VL after THR were compared with dogs with uncomplicated THR. Data included signalment, body weight, diagnosis, implant size, acetabular cup orientation, and femoral displacement ratio (FDR). RESULTS: VL was diagnosed in 11 (1.8%) dogs after primary THR. Including 2 other dogs that had VL after the study period, 10 (77%) of 13 dogs had VL within 7 days of surgery. Risk factors for VL included Saint Bernard-type dogs (P=.0001), short neck extension (P=.0005), and high angle of lateral opening in other breeds (P=.018). There were trends toward higher risk of VL with lower FDR in Saint Bernard types (P=.060), and with cementless implants (P=.061). Twelve dogs had revision arthroplasty that was successful in all cementless and 2 cemented VL cases. Five dogs had recurrent VL and a poor outcome. CONCLUSION: VL is generally an early complication of THR, with no single common risk factor identified. CLINICAL RELEVANCE: Saint Bernard types and short neck extensions are associated with increased risk of VL. Poor cup orientation is a determining factor for VL in some dogs, but a protective orientation of the acetabular cup was not found. Revision is successful in most dogs, but recurrent VL merits a guarded prognosis.

Long term disease-free survival resulting from combined modality management of patients presenting with oligometastatic, non-small cell lung carcinoma (NSCLC).

We report outcomes on 23 patients with oligometastastic (1 or 2 sites) NSCLC treated with aggressive local, regional, and systemic treatment. The results suggest that this is a favorable subset of patients who may benefit from such an approach, with a 22% rate of long-term survival. This treatment strategy is a departure from the usual practice of palliative-only therapy for all NSCLC patients presenting with metastatic disease.

Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery.

OBJECTIVE: The purpose of this study was to assess factors that influence patient satisfaction 1 year after pelvic reconstructive surgery. STUDY DESIGN: We previously reported the objective success, goals, and expectations of a cohort of 78 patients 3 months after surgery. A second blinded independent physician investigator contacted the same patients by phone to reassess these items 1 year after surgery. Data were analyzed with the Spearman correlation, the Mann-Whitney test, the chi-squared test of association, and the Friedman test. RESULTS: Seventy patients (89%) of the original cohort completed the second assessment. Although group satisfaction and goal achievement were stable (P < .01), 70% of patients reported a change in their satisfaction ratings between 3 months and 1 year (rho = 0.3). Reduced satisfaction between 3 and 12 months after surgery was strongly associated with decreased goal achievement (rho = 0.47; P = .006). Fifty-six percent of patients reported urge incontinence symptoms after surgery (44% de novo and 12% persistent). Urge incontinence was the most common reason for patient dissatisfaction after surgery (P = .04). CONCLUSION: Symptoms of urge incontinence and reduced achievement of subjective surgical goals are associated with decreased long-term patient satisfaction after reconstructive pelvic surgery.