ABSTRACT:The American Urogynecologic Society (AUGS) identified diversity, equity, and inclusion as the cornerstone of excellence in governance and operations. Although efforts to increase diversity of our membership have been ongoing for years, there had not previously been an adequate investment to ensure an inclusive climate that emphasizes equity across our volunteers and programs. In June 2020, the AUGS President, Dr Shawn Menefee, and Board of Directors called for a Presidential Task Force on Diversity, Equity, and Inclusion to study the current state of our society and make recommendations for future directions. The charge was intentionally broad. In review of the literature, there was little to inform the best means to proceed aside from administering climate surveys to gauge the current culture of inclusion and bias. The task force believed that the challenge was not only to describe the problem but also to articulate solutions. We ultimately moved to rewrite the Diversity and Inclusion and Code of Conduct Statements and develop an Action Plan that would accelerate the efforts of AUGS to foster inclusion and improve equity through the existing governance structure. In this document, we describe how the task force was organized and conducted the work to develop strategies that were aligned with the AUGS mission: "As the leader in female pelvic medicine and reconstructive surgery, AUGS drives excellence in care for women through education, research, advocacy, and interdisciplinary collaboration."
Editor-in-Chief, Urogynecology. From the University of California, San Diego. Correspondence: Linda Brubaker, MD. From the University of California, San Diego. E-mail: [email protected]. This article was published online ahead of print on May 28, 2022.
ABSTRACT:In November 2020, the federal government of Ethiopia invaded its northern region of Tigray, in collusion with the Government of Eritrea and ethnic Amhara militias. The invading forces pillaged the schools, destroyed the transportation infrastructure, burned crops and killed livestock, and looted the health care system. Thousands of civilians were killed, often in extrajudicial executions. Thousands of Tigrayan women were raped. Tens of thousands of Tigrayans fled to Sudan as refugees. Hundreds of thousands face famine and millions more have been internally displaced. The region is under a total communications blackout. The banking system has collapsed. The federal government has harassed external aid workers and imposed a de facto blockade on all medicines and famine relief. A man-made humanitarian catastrophe unlike any in recent memory is unfolding. The world medical community must speak up. The madness must stop.
Importance Understanding women's acceptance of telemedicine as a model of care for pelvic floor disorders (PFDs) allows for a more patient-centered approach to widespread implementation in female pelvic medicine and reconstructive surgery. Objectives The pandemic sparked rapid and widespread implementation of telemedicine. Our goal was to assess acceptance, satisfaction, and desire for future use of telemedicine among women seeking care for PFDs. Study Design We performed a structured telephone survey of new patients who underwent video visits, and established patients who underwent video or telephone visits, when nonurgent, in-person visits were suspended. Our survey assessed the following domains: satisfaction, future use of telemedicine, level of comfort, perceived utility, and access and comfort with technology. Results Between April and July 2020, we conducted telemedicine visits with 221 patients, 131 (63% of eligible patients) of whom agreed to participate in our survey (63 (74%) telephone and 68 (56%) video, including 35 established and 33 new patients). Overall, most participants (96.3%) described being "very" or "somewhat satisfied" with telemedicine in addressing their needs and "comfortable" sharing personal information with providers in a telemedicine visit (94.7%). However, video participants (both new and established) were more likely to view telemedicine as valuable (P = 0.02) than telephone participants. Furthermore, established video participants perceived greater quality care of care (P = 0.01) than telephone participants. Conclusions Video telemedicine is a well-accepted adjunct model of care with the potential to expand the reach of quality subspecialty care of value to women with PFDs.
Importance Obesity may be a modifiable risk factor for pelvic floor disorders. Objectives The objective of this study is to determine associations between weight, weight changes, and cumulative exposure to excess body mass index (BMI) from prepregnancy to 1 year postpartum on pelvic floor support and symptoms 1 year after first vaginal birth. Study Design In 645 primiparous women who gave birth vaginally, we assessed anatomic pelvic floor support, pelvic floor symptoms and BMI at the third trimester, 5 - 10 weeks, and 1 year postpartum; we also assessed BMI prepregnancy and predelivery. Using multivariable models, we determined associations between pelvic floor outcomes 1 year postpartum and BMI quartiles at different timepoints, gestational weight gain, and postpartum weight retention. We evaluated associations between stress urinary incontinence (SUI) and moderate/severe urinary incontinence (UI) 1 year postpartum and cumulative excess BMI from prepregnancy to 1-year postpartum (BMI1year). Results Body mass index was not associated with anatomic support, composite symptom burden, overactive bladder, anal incontinence, or constipation at any timepoint. Gestational weight gain and postpartum weight retention were not associated with any 1-year outcome. Body mass index at every timepoint was positively associated with SUI and moderate/severe UI; BMI1year was most predictive. Cumulative excess BMI was positively associated with SUI and moderate/severe UI but only slightly more predictive of these outcomes than BMI1year alone. Conclusions Body mass index over the pregnancy trajectory was not associated with outcomes other than UI. The small advantage of cumulative exposure to excess BMI over BMI1year in predicting SUI and moderate/severe UI suggests that BMI1year adequately captures risk of these 1-year outcomes.
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.
Objective The objective was to perform a cost-effectiveness analysis of posterior repair performed at the time of sacrocolpopexy (SCP). Methods We used TreeAge Pro to construct a decision model comparing laparoscopic hysterectomy with SCP with and without concurrent posterior repair (SCP and SCP + PR). Using a time horizon of 1 year, we modeled prolapse recurrence, prolapse retreatment, and complications, including rectal injury, rectovaginal hematoma requiring surgical take-back, and postoperative dyspareunia. Costs included index surgery, surgical retreatment, and complications. We modeled effectiveness as quality-adjusted life years (QALYs). Cost-effectiveness was defined using the incremental cost-effectiveness ratio and willingness to pay of $100,000/QALY. Sensitivity analyses were performed. Results Sacrocolpopexy was the dominant strategy with a cost of $65,714 and an effectiveness of 0.84. It was cost-effective at willingness to pay threshold less than $100,000/QALY. The SCP + PR costs more ($75,063) with lower effectiveness (0.83). The effectiveness of the 2 strategies was similar, differing only by 0.01 QALY, which is less than the minimally important difference for utilities. Tornado plots showed CEA results were most influenced by the cost of SCP, cost of SCP + PR, and probability of dyspareunia after SCP. In 1-way sensitivity analyses, the model outcome would change only if the cost of SCP was increased by 12.8% or if the cost of SCP + PR decreased by 14.5%. For dyspareunia, our model would only change if the probability of dyspareunia after SCP alone was 75.9% (base case, 18.6%), whereas the probability of dyspareunia after SCP + PR was 26.8%. Conclusion In this cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy.
Importance Currently, apical prolapse is diagnosed via assessing the levels of C and D points in the pelvic organ prolapse quantification (POP-Q) system. However, it is not yet known whether the other components of this system are useful for diagnosing apical prolapse and its symptoms. Objective The aim of the study was to evaluate the association between the perineal body size (PB), total vaginal length (TVL), and apical prolapse and its symptoms. Study Design Two hundred women, 100 women with apical prolapse and 100 women without, were included in this cross-sectional study. The association between the PB, TVL, and apical prolapse and its symptoms were evaluated. The relationship between the other POP-Q measurements and apical prolapse/prolapse symptoms were also evaluated as the secondary outcome of the study. Results The TVL (cutoff value, ≤8 cm; sensitivity, 80%; specificity, 60%) and the genital hiatus size (GH; cutoff value of >4.5 cm; sensitivity, 90%; specificity, 91%) were significantly associated with apical prolapse. The PB cutoff value of 3.4 cm or less had lower sensitivity (49%) and specificity (70%) for the diagnosis of apical prolapse. The GH (cutoff value, >4.8 cm; area under curve [AUC], 0.927), C (cutoff value, >−5.8 cm; AUC, 0.955), and Ba (cutoff value, >−1.1 cm; AUC, 0.891) were significantly associated with apical prolapse symptoms. However, there was no association between the PB or TVL with symptoms. Conclusions The study results showed that the TVL and GH were more strongly associated with apical prolapse than PB. The GH, C, and Ba were also associated with prolapse symptoms, but PB and TVL were not.
Importance There are no publications on national trends in performance of concomitant stress urinary incontinence (SUI) treatment with pelvic organ prolapse surgery over the past decade. Objectives The objective of this study was to describe trends in the performance and type of concomitant SUI treatment from 2011 to 2019. Study Design Surgical procedures for pelvic organ prolapse and coding for prolapse repair were identified from the American College of Surgeons National Surgical Quality Improvement Program database. An autoregressive interrupted time series model estimated temporal trends in concomitant SUI treatment associated with 3 consequential events: U.S. Food and Drug Administration's (FDA) requirement for postmarketing studies from mesh manufacturers (January 2012), publication of the Outcomes following Vaginal Prolapse Repair and Midurethral Sling (OPUS) trial (June 2012), and the FDA's reclassification of vaginal mesh as a high-risk device (January 2016). Results There were 43,370 cases identified. The rate of concomitant SUI treatment decreased from 46.1% to 35.7% across the analysis period. No significant trend before postmarketing studies (−0.2%; 95% confidence interval [CI], −0.8 to 1.1) was observed. After postmarketing studies, there was a downward deflection of −2.0% per quarter (95% CI, −3.6 to −0.4). After OPUS, we observed a flattening of the trend to −0.2% (95% CI, −0.8 to 0.4) that persisted after FDA reclassification. Sling procedures remained predominant (96.2% of SUI procedures) and performance of urethropexy decreased across the analysis period (−0.1%; 95% CI, −0.08 to −0.2). Conclusions After the FDA's order for postmarketing studies, rates of concomitant SUI treatment significantly decreased. Rates stabilized after the OPUS trial at around 35% and did not subsequently change. Rates of nonmesh concomitant SUI treatment decreased during the analysis period.
Objective The objective was to determine whether a difference exists in short-term urinary retention after tension-free vaginal tape (TVT) midurethral sling placement when performed alone compared with when placed during a concomitant prolapse procedure. Methods We conducted a single-center retrospective cohort study that compared TVT procedures performed alone (group 1) to those with a concomitant prolapse procedure (group 2). The primary outcome was the proportion of patients discharged with an indwelling Foley catheter after failing postoperative voiding trial. Results There were 100 women in group 1 and 267 women in group 2. Concomitant prolapse procedures included vaginal approach (n = 47), robotic (n = 218), or both (n = 2). Forty-nine patients (13.4%) failed the initial voiding trial and 21 patients (5.7%) were discharged with an indwelling Foley catheter. The rate of short-term urinary retention requiring an indwelling catheter at discharge was not significantly different between group 1 and group 2 (9 [9.0%] vs 12 [4.5%], P = 0.1). The duration of catheterization after discharge was shorter in group 1 compared with group 2 (2.1 ± 1.1 vs 4.3 ± 2.0 days, P = 0.008). In multivariate analysis, patients discharged with a catheter were more likely to have diabetes with an odds ratio of 3.1 (95th confidence interval, 1.2–8.1). Conclusions The proportion of patients discharged with an indwelling catheter did not significantly differ if TVT was performed alone or at the time of a concomitant prolapse procedure (9.0% vs 4.5%, P = 0.1).
Importance Many health care providers place concomitant midurethral slings during pelvic organ prolapse repair, yet growing evidence supports staged midurethral sling placement. Objectives The aim of this study was to compare urinary function after transvaginal uterovaginal prolapse repair with and without midurethral sling. Study Design Secondary analysis of the Study of Uterine Prolapse Procedures Randomized Trial (hysterectomy with uterosacral ligament suspension vs mesh hysteropexy). Our primary outcome was Urinary Distress Inventory score (UDI-6) through 5 years compared between women with and without a concomitant sling within prolapse repair arms. Sling effect was adjusted for select clinical variables and interaction terms (alpha = .05). Results The sling group included 90 women (43 hysteropexy, 47 hysterectomy), and the no-sling group included 93 women (48 hysteropexy, 45 hysterectomy). At baseline, the sling group reported more bothersome stress (66% vs 36%, P < 0.001) and urgency incontinence (69% vs 48%, P = 0.007). For hysteropexy, there were no significant long-term differences in UDI-6 scores or bothersome urine leakage between sling groups. For hysterectomy, women with sling had better UDI-6 scores across time points (adjusted mean difference, -5.1; 95% confidence interval [CI], -9.9 to -0.2); bothersome stress and urgency leakage were less common in the sling group (stress adjusted odds ratio, 0.1 [95% CI, 0.0-0.4]; urge adjusted odds ratio, 0.5 [95% CI, 0.2-1.0]). Treatment for stress incontinence over 5 years was similar in the sling (7.9%) versus no-sling (7.6%) groups. Conclusions Five-year urinary outcomes of concomitant midurethral sling may vary by type of transvaginal prolapse surgery, with possible benefit of midurethral sling at the time of vaginal hysterectomy with apical suspension but not after mesh hysteropexy.
Importance This study assesses resting genital hiatus (GH) measurements under anesthesia as compared with in-office measurements for intraoperative planning purposes. Objectives The aim of this study was to determine the influence of general anesthesia and apical suspension on GH measurements compared with office measurements. Study Design This was a retrospective cohort of women who underwent minimally invasive sacrocolpopexy within an academic urogynecology practice. Genital hiatus for each patient was measured at 4 time points: (1) preoperative office examination (baseline) at rest (GHrest) and with strain (GHstrain); (2) following anesthesia induction, at rest (GHinduction); (3) immediately after sacrocolpopexy, at rest (GHcolpopexy); and (4) 4- to 6-week postoperative visit, strain (GHpostop). Enlarged baseline GHstrain was defined as ≥4 cm. Paired statistics and analysis of variance were used for comparisons. Results Fifty-one women were included, whose mean age was 61.3 ± 8.2 years; the majority had stage ≥3 prolapse (n = 39 [76.4%]). Concomitant procedures included hysterectomy (n = 33 [64.7%]) and posterior colporrhaphy or perineorrhaphy (n = 8 [15.7%]). The majority had an enlarged baseline GHstrain (n = 39 [76.4%]), and overall cohort mean was 4.7 ± 1.3 cm. Compared with baseline GHrest, mean GHinduction was larger (GHinduction: 4.6 ± 1.4 cm vs GHrest: 3.8 ± 1.2 cm, P < 0.01) but not different from baseline GHstrain (GHinduction: 4.6 ± 1.4 cm vs GHstrain: 4.7 ± 1.3 cm, P = 0.81). GHcolpopexy was decreased from baseline GHstrain with a mean difference of 1.1 ± 1.3 cm (P < 0.01). This difference was driven by women with enlarged baseline GHstrain who experienced a mean decrease of 1.5 ± 1.1 cm (P < 0.01). Conclusions Genital hiatus after induction of anesthesia does not significantly differ from preoperative straining GH. Apical suspension with sacrocolpopexy alone resulted in immediate reduction in GH measures, with greater decreases observed in women with enlarged preoperative GH.
Importance There is a paucity of evidence-based, physician-authored content available on social media. Data are lacking on physicians use of social media, including intended audience and content. Objective The aim of this study was to explore the patterns of Twitter and Instagram use for popular urogynecology hashtags between physicians, patients, and allied health professionals (AHPs). Study Design Twelve hashtags derived from the Urogynecology Tag Ontology project were used as search terms to select Twitter and Instagram posts. Up to 5 top posts per hashtag per author type (physician, patient, or AHP) were included. Posts were analyzed using Dedoose qualitative analytic software by author, hashtag, intended audience, and themes. Results On Twitter, 109 posts met inclusion criteria: 41% written by physicians, 40% patients, and 18.3% AHPs. For Instagram, 72 posts were included: 50% written by patients, 39% AHPs, and 11% physicians. Twitter physician posts were mainly intended for health professionals (64%) with only 18% for patients. Patients posted to the general public (57%) and patients (36%). Instagram physician posts were intended for health professionals (49%), whereas 62% of AHPs posted to patients. Most patient posts were directed to other patients (90%). Physicians posted about academic peer discussions, medical education, and advocacy. Patients posted about personal experiences, treatments, or dissatisfaction. Conclusions Physicians are more likely to post on Twitter than Instagram, with content focused primarily on their peer group, and physicians/patients are unlikely to engage with each other. There is an opportunity to improve social media interactions between physicians and the public while increasing high-quality patient education.
Objectives Our objective was to compare the rate of native tissue repair (NTR) versus sacrocolpopexy (SCP) and reconstructive (RECON) versus obliterative repair (OBR) for the treatment of pelvic organ prolapse (POP), evaluating for health care disparities based on race, socioeconomic, and geographic factors. Methods The National Inpatient Sample database was queried for patients older than 18 years undergoing POP surgery from 2008 to 2018. Baseline demographics, comorbidity index, socioeconomic, and hospital variables were extracted. The weighted t test, Wilcoxon test, and χ2 test were used to compare the rate of (1) NTR versus SCP and (2) RECON vs OBR. Multivariate weighted logistic regression was used to compare while controlling for confounders. Reference groups were White race, Medicare patients, northeast region, small hospital size, and rural location. Results Of 71,262 patients, 67,382 (94.6%) underwent RECON. Patients undergoing OBR were older and had a higher comorbidity score. Multivariate analysis showed the following: (1) Black, Hispanic, and other races; (2) Medicaid patients; (3) patients at urban teaching hospitals are less likely to receive RECON. Patients in the midwest were more likely to receive RECON. Among 68,401 patients, 23,808 (34.8%), and 44,593 (65.19%) underwent SCP and NTR, respectively. Hysterectomy was more common in the NTR group. Multivariate analysis showed the following:(1) Black, Hispanic, and “other” races; (2) uninsured and Medicaid patients; (3) patients in the midwest, south, and west were at higher odds of receiving NTR. Patients in large and urban hospitals were less likely to undergo NTR. Conclusions Racial, socioeconomic, and geographic disparities exist in surgical management for POP warranting further study to seek to eliminate these disparities.
Importance Academic urogynecologists incorporating fellows/residents into operative cases must ensure safety and quality outcomes throughout the learning curve of the academic year. Objectives We evaluated if the month of year relative to fellow/resident promotions in July affects operating time, complications, and prolapse recurrence for minimally invasive sacral colpopexy (MISC) or uterosacral ligament suspension (USLS). Study Design This was a retrospective study comprising MISC and USLS from January 2009 to August 2015. Patient demographics, clinical, and surgical data were compared between months with July as month 1. Linear regression assessed operating time. Logistic regression assessed prolapse recurrence (composite of any POP-Q point beyond the hymen, pessary use, or reoperation) and complications. Results One thousand seven participants had a mean age of 59.9 ± 9.4, body mass index of 27.6 ± 4.2, gravity of 3.0 ± 1.5, and parity of 2.6 ± 1.1. Most had stage III (67.7%) or II prolapse (25.6%). Minimally invasive sacral colpopexy represented 81.0% (58.8% laparoscopic, 41.2% robotic). Uterosacral ligament suspensions were 68.1% vaginal versus laparoscopic/robotic. Median follow-up was 34 weeks (interquartile range, 11–82). Mean operating time was 199.8 ± 66.4 minutes with no impact by month (P = 0.26). Minimally invasive sacral colpopexy (vs USLS, β = 36.4 minutes), conversion to laparotomy (β = 112.9 minutes), and concomitant hysterectomy (β = 33.4 minutes) increased operating time (P < 0.001). Complications ranged 7.9% (January) to 23.8% (March) with mean of 17.1%. Complications were unaffected by month (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.95–1.04), but USLS had more complications than MISC (OR, 1.55; 95% CI, 1.05–2.28). Prolapse recurred in 9.4% with no impact by month (OR, 0.95; 95% CI, 0.88–1.02). Minimally invasive sacral colpopexy had less recurrence than USLS (OR, 0.33; 95% CI, 0.18–0.60). Conclusions Month of year relative to resident/fellow promotion did not affect operating time, complications, or recurrence, debunking the myth of worse outcomes earlier in the academic year.
Supplemental digital content is available in the text. Objectives This study aimed to explore associations between relative and maximal intra-abdominal pressure (IAP) on pelvic floor outcomes in primiparas delivered vaginally. Methods At 5–10 weeks and 1 year postpartum, we measured absolute IAP by vaginal sensor while participants lifted a weighted car seat (IAPLIFT) and performed isometric trunk flexion endurance (IAPTFE) and seated maximal strain (IAPSTRAIN). Primary outcomes, completed 1 year postpartum, included worse pelvic floor support (descent to or beyond the hymen) and positive symptom burden (bothersome symptoms in ≥2 of 6 domains on the Epidemiology of Prolapse and Incontinence Questionnaire). We calculated relative IAP (as absolute IAP/IAPSTRAIN). Results Of 542 participants, 9.7% demonstrated worse support and 54.3% demonstrated symptom burden at 1 year postpartum. In multivariable analyses, absolute IAPLIFT and absolute IAPTFE at 5–10 weeks postpartum were not associated with worse support. As relative IAP at 5–10 weeks increased, the prevalence of worse support decreased (prevalence ratio [PR] of 0.77 [95% confidence intervals (CIs), 0.63–0.94] and PR of 0.79 [95% CI, 0.67–0.93]) per 10% increase for relative IAPLIFT and relative IAPTFE, respectively. This was largely due to IAPSTRAIN, which increased the prevalence of worse support (PR, 1.15 [95% CI, 1.06–1.25]) per 10 cm H2O increase. One year postpartum, only IAPSTRAIN increased the prevalence of worse support (PR, 1.11 [95% CI, 1.02–1.20]) per 10 cm H2O. Of all IAP measures at both time points, only absolute IAPLIFT at 1 year significantly increased the prevalence of symptom burden (PR, 1.11 [95% CI, 1.05–1.18]) per 10 cm H2O. Conclusions This exploratory analysis suggests that postpartum IAPSTRAIN may increase the prevalence of worse support in primiparas delivered vaginally.
Objective The American College of Obstetricians and Gynecologists does not provide a recommendation regarding the preferred vaginal preparation solution. We intended to compare the effectiveness of chlorhexidine versus iodine in decreasing vaginal bacterial counts. Methods In this institutional review board–approved study, participants undergoing total hysterectomy via vaginal or laparoscopic approach were randomized to 4% chlorhexidine or 10% iodine for presurgical vaginal preparation. Swabs were collected from the vaginal mucosa before, then 30, 60, and 90 minutes after preparation. Our primary outcome was the number of positive cultures (≥5,000 bacteria) at 90 minutes. The secondary outcomes included the presence of selected pathogens, postoperative complications, and infections. The sample size of 71 per arm was calculated using ɑP = 0.05, 80% power, and anticipating a 22% difference in positive cultures. Results Between May 2018 and August 2019, 85 participants were randomized. The average age was 59.8 years (SD, 11.4), and the median Charlson Comorbidity Index score was 2 (minimum, 0; maximum, 6). Baseline bacterial counts were similar in both groups. Chlorhexidine demonstrated a lower percentage of positive cultures at 90 minutes (47.6% vs 85.4%; odds ratio, 10.6; P = 0.001). In addition, the median bacterial count in the chlorhexidine group was significantly lower than the iodine group (3,000 vs 24,000 colony-forming units, P < 0.001) at 90 minutes. No surgical site infections were identified in either group during the 30-day postoperative period, and there were no reported adverse reactions to either solution. Conclusions Chlorhexidine resulted in substantially lower bacterial counts after preparation compared with iodine. Gynecologic surgeons may consider switching to 4% chlorhexidine for vaginal preparation before hysterectomy.
Introduction and hypothesis The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. Methods This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. Results A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. Conclusions A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.
Objective The aim of this study was to investigate trends and outcomes of ambulatory minimally invasive sacrocolpopexy (MISC) using data from a contemporary multicenter nationwide cohort. Methods We used the American College of Surgeons National Surgical Quality Improvement Program database to identify women who underwent nonemergent MISC (laparoscopic and robotic) from 2012 to 2018. Exclusion criteria were age <18 or ≥90 years, rectal prolapse, postoperative discharge day ≥3, and concomitant hysterectomy, transvaginal mesh repair, colpocleisis, and/or colorectal surgery. Baseline demographics and 30-day outcomes were compared between patients who underwent same-day discharge (SDD; discharge on postoperative day [POD] 0) and those discharged on POD 1–2 using Kruskal-Wallis, Fisher exact, and Pearson χ2 tests. A 2-sided Cochran-Armitage trend test assessed SDD over time, and person-years methodology was used to assess readmission rates. Multivariable logistic regression and Cox proportional hazards modeling evaluated associations between SDD and postoperative outcomes. We hypothesized that SDD increased over the study time frame and is not associated with adverse outcomes. Results Of 2,928 women, 362 (12.4%) were SDD, and 2,566 (87.6%) were discharged POD 1–2. The proportion of SDD nearly quadrupled over time (5.6% [2012], 20.6% [2018]; P < 0.001). The SDD group was younger (mean age, 61.9 vs 63.6; P = 0.04), with lower proportion of American Society of Anesthesiologists class III or higher (21.8% vs 27.5%; P = 0.02) and hypertension (37.3% vs.46.5%; P < 0.001), shorter total operation time (median, 142 vs 172 minutes; P < 0.001), and fewer concomitant slings (21.5% vs 33.0%; P < 0.001). Outcomes were similar for SDD: 30-day overall complications (3.0% vs 4.4%; P = 0.23), readmissions (1.1% vs 2.0%; P = 0.28), and reoperations (1.1% vs 0.9%; P = 0.55) and persisted with multivariable analysis. Conclusion Ambulatory MISC significantly increased during the study period and appears safe and feasible in select patients.
IMPORTANCE:To study alternative voiding trial (VT) methods after urogynecologic surgery that may potentially decrease catheterization.OBJECTIVE:The aim of the study is to compare voiding assessment based on a minimum spontaneous voided volume of 150 mL with the standard retrograde fill (RF) approach in women after urogynecologic procedures.STUDY DESIGN:Women undergoing urogynecologic surgery were randomized to RF or spontaneous void (SV) groups. Women in the RF group had their bladders backfilled with 300 mL of saline before catheter removal, those in the SV group did not. To pass the VT, patients in the RF group were required to void 150 mL at one time within 60 minutes, and patients in the SV group had to do the same within 6 hours. The primary outcome was the VT failure rate. We also compared the false pass rate, urinary tract infections, satisfaction, and preference of VT method.RESULTS:One hundred nine women were enrolled in the study, 54 had SV and 55 underwent RF. Baseline characteristics were not significantly different other than history of prior hysterectomy. There was no significant difference in procedures between the groups. There was no difference in VT failure rate between the groups-SV (7.4%) and RF (12.7%, P = 0.39). The false pass rate was 0 in each group. Urinary tract infection rates were similar between SV (14.8%) and RF (14.5%) groups ( P = 0.34). Patient satisfaction for VT method was not significantly different.CONCLUSIONS:Spontaneous VT was not superior to retrograde void trial. Therefore, we cannot recommend one method of VT after urogynecologic surgery.CondensationVoiding assessment based on minimum SV of 150 mL is comparable with VT with RF after surgeries for prolapse and urinary incontinence.
