Importance Acute urinary tract infections (UTIs) are common after prolapse and anti-incontinence surgery, with incidence rates varying from 14% to 64%. Objective The objective was to decrease rates of symptomatic urinary tract infections in patients undergoing pelvic organ prolapse repair and/or anti-incontinence surgery using an intraoperative bundle. Study Design This change in practice was implemented on January 19, 2024, for all patients undergoing prolapse and/or anti-incontinence surgery within our division, with data collected until July 18, 2024. A similar cohort from 1 year before the implementation was used as a comparison. The regimen consisted of re-prepping the urethral meatus with 4% chlorhexidine swab before any instrumentation, including placement of the transurethral catheter or cystoscope. Any time the urethral catheter was temporarily removed, it was placed in a solution of 80 mg gentamicin/500 mL normal saline in the operative field. The number of times urethral instrumentation occurred was recorded. No changes were made to our standard of care for prophylactic intraoperative antibiotics. Patients discharged with a Foley catheter received methenamine hippurate and cranberry tablets per our standard practice. The primary outcome, incidence of symptomatic UTIs within 30 days postoperatively, was determined for pre-bundle and post-bundle implementation participants. Secondary analyses included the association between UTI rates and urethral instrumentation, specific surgeon, and procedure type. We also sought to determine if these interventions were associated with increasing resistance in bacterial isolates from urine cultures. Results The total of 461 patients in pre-bundle and post-bundle groups were similar in age, body mass index, and race distribution, with similar rates of baseline comorbidities of interest: diabetes, recurrent UTIs, and current smoking status. For the primary outcome of symptomatic UTI within 30 days of index surgery, there was a significant decrease from 18.1% to 10.9% ( P =0.034). When analyzing the number of urethral instrumentations per case, the median number was 3, with no difference between those who developed UTI and those who did not. There was no difference in rates of failed voiding trial and no increase in resistant bacterial strains after the bundle implementation. An almost 50% decrease in secondary postoperative urinary retention was demonstrated in the post-bundle group, postulated to be related to the lower rate of UTIs. Conclusions An intraoperative bundle that includes urethral re-prepping before all intraoperative instrumentation and keeping the Foley catheter in a gentamicin/saline solution when not in use demonstrated a 40% decrease in symptomatic UTIs within 30 days of surgery. Given the low cost and ease of implementation of these interventions, surgeons should consider incorporating these measures to help minimize postoperative UTIs after prolapse and anti-incontinence surgery.

IMPORTANCE:Narcotic use after retropubic suburethral sling surgery is not unusual. Surgeons may consider using topical analgesics to minimize narcotic use. OBJECTIVES:The aim of the study was to determine if using bupivacaine-meloxicam (Zynrelef) reduces narcotic use in the first 3 days after surgery, measured as morphine milligram equivalents (MME). Secondary aims were to compare, postoperatively, average and worst pain, satisfaction with pain control and quality of recovery between groups. STUDY DESIGN:This was a single-center prospective single-blinded randomized controlled trial for women undergoing retropubic sling surgery. The intervention arm received Zynrelef at the suprapubic incisions, no placebo was used in controls. Participants tracked pain levels, medication use, satisfaction with pain control and Quality of Recovery surveys in the first 3 postoperative days. Appropriate statistical analyses were applied. RESULTS:A total of 119 women were randomized. For primary outcome, totalmedian MME from postoperative days 0-3, the control group used 37.5 MME compared to 30 MME in the Zynrelef group (interquartile range [IQR] 5.63-71.25; P  = 0.61). Pain scores were low in both groups, participants were satisfied or very satisfied with pain control. Quality of recovery scores were similar between groups, with improvement by postoperative day 3 to near baseline scores. Patients with anxiety/depression used more oxycodone; 10 mg (IQR 0-30) vs 0 mg (IQR 0-15), P  = 0.0027. CONCLUSIONS:Use of Zynrelef during retropubic sling surgery does not reduce narcotic use in the first 3 days postoperatively. Patients can be reassured that pain and narcotic use after surgery are low and recovery is quick.

IMPORTANCE:This study is important as it challenges the effectiveness of silver-coated catheters in reducing urinary tract infections (UTIs) after pelvic floor surgery (PFS). OBJECTIVE:The aim of this study was to investigate the incidence of UTIs in patients using silver-coated silicone transurethral indwelling catheters (TICs) compared with standard silicone TICs among women with postoperative urinary retention following PFS. STUDY DESIGN:This was a double-blind, randomized controlled trial of women undergoing PFS between June 2022 and February 2024 with postoperative urinary retention. Participants were randomized to a silver-coated silicone TIC or a standard silicone TIC. The primary outcome was the incidence of symptomatic, culture-proven UTI within 30 days of surgery. Secondary outcomes included the categorization of uropathogens as well as adverse symptoms potentially related to the catheter. A sample size of 155 participants per arm was calculated to find a relative decrease of 47%, from 30% to 16%. RESULTS:Of 310 participants randomized, 303 were included in the analysis: 154 controls and 149 silver catheter. Demographics were similar for both groups. For our primary outcome, 56 patients in the control group and 52 patients in the silver catheter group were diagnosed with a UTI (36.4% vs 34.9%; P = 0.81). No adverse reactions to the silver catheter were noted. Analysis of the urinary microbiomes demonstrated Escherichia coli was the most represented uropathogen, found in 43% of the urine cultures overall. CONCLUSION:There was no difference in incidence of symptomatic, culture-confirmed UTIs in patients who received silver-coated silicone TICs compared with standard silicone TICs in women undergoing PFS.

IMPORTANCE:Electrosurgical vessel sealing devices for vaginal hysterectomy have demonstrated reduced postoperative pain. This modality, however, has not been evaluated in patients undergoing vaginal hysterectomy with pelvic reconstruction. OBJECTIVE:The aim of the study was to describe postoperative pain levels utilizing the LigaSure vessel sealing device for vaginal hysterectomy in patients undergoing major reconstructive surgery. STUDY DESIGN:In this single-blinded, randomized controlled trial, participants were randomized to vaginal hysterectomy utilizing the LigaSure vessel sealing device versus standard clamping and suturing techniques. Following hysterectomy, all participants underwent major vaginal reconstruction, including apical suspension via high uterosacral ligament fixation. The primary outcome was postoperative pain on a 100-mm visual analog scale 3-6 hours after surgery. Secondary outcomes included hysterectomy operative time, blood loss, pain scores and narcotic use on days 1, 3, 5, and 2 weeks after surgery. RESULTS:A total of 95 participants were randomized: 48 (50.5%) in the intervention arm and 47 (49.5%) in the control arm. Between 3 and 6 hours postoperatively, there was no difference in overall pain scores (49 vs 50.5). Groups also had similar hysterectomy operative times (40.5 minutes vs 38 minutes) and blood loss (100 mL vs 100 mL). Pain scores and narcotic use on postoperative days 1, 3, 5, and 2 weeks were not different. CONCLUSIONS:While vessel sealing devices may reduce pain after vaginal hysterectomy alone, these benefits were not detected following concomitant major pelvic reconstruction. Similar operative times and blood loss between groups may be due to the expertise of the surgical subspecialist and not the device itself.

Objectives: The impact of the Dobbs v. Jackson Women's Health Organization (Dobbs) Supreme Court decision on training of United States Obstetrics and Gynecology (OBGYN) residents and fellows needs qualitative exploration. We aimed to describe how OBGYN residents and fellows feel their training may be affected. Methods: We disseminated a REDCap survey from September 19, 2022, to December 1, 2022, among OBGYN residents and fellows with open-ended questions querying trainees' opinions around how the Dobbs decision may affect their training and the field of OBGYN. Results: The survey received 469 responses, of which 70% contributed data for qualitative analyses. The qualitative data indicated four themes: uncertainty about the future, concerns about patient care, concerns and discrepancies in OBGYN training, and suggestions and hopes for the future. Trainees, even if currently well trained in their view, are concerned about other trainees, patient safety in OBGYN clinical situations, and uncertainty about their own careers and the future of OBGYN. They are concerned that restrictions on family planning and pregnancy management in certain states will restrict care access, limit patient safety, and affect the OBGYN workforce in those locations. Conclusions: This survey of OBGYN trainees indicates significant uncertainty about equity for training and patient care in clinical situations potentially affected by the Dobbs decision and a wider concern about how this will affect the field of OBGYN and the safety of women in the United States.

To determine the prevalence and impact of pelvic floor disorders among patients with a diagnosis of Ehlers Danlos syndrome compared to controls within the same healthcare system. Cases were women ages 18 and older with a diagnosis of Ehlers Danlos syndrome receiving care within a single healthcare system over a 5-year period. Controls met the same inclusion criteria with no diagnosis of Ehlers Danlos syndrome. All subjects were contacted via MyChart to complete the PFDI-20, PFIQ-7, and a demographics survey. Appropriate statistical analyses were applied. Complete survey response rates were 23

Objective To describe the ultrasonographic appearance of the post‐ablative endometrium to improve knowledge of its sonographic findings. Methods This was an Institutional Review Board approved prospective study of patients who underwent second‐generation endometrial ablation from 2016 to 2019 at a single health system. Patients had postoperative transvaginal ultrasounds at 2, 6, and 12 months. Ultrasound reports were analyzed for endometrial thickness, description of the endometrium and myometrium, presence of uterine fibroids, and uterine size. Statistical tests for repeated measures were utilized. Results There were 68 patients with the average age of 42 (SD 6) years and a BMI of 33 (SD 8). Preoperatively the average endometrial thickness was 10 mm, uterine length was 9.7 cm, and 38.2% had leiomyoma. The average endometrial thickness decreased at each ultrasound: 8.4 mm (SD 3.4), 7.2 mm (SD 3.0), and 5.8 mm (SD 2.5) at 2, 6, and 12 months, respectively. When comparing endometrial thickness postoperatively there was a significant difference at 2 and 12 months ( P = .041), and 6 and 12 months ( P = .031). There was no change during the postoperative period in the presence of leiomyoma, hyperechoic endometrium, hypoechoic endometrium, heterogeneous endometrium, and cystic endometrium on the ultrasounds. Conclusion After ablation with a second‐generation device, the endometrial thickness on ultrasound decreases with time following surgery. Additional studies correlating these findings to clinical outcomes would be useful.

Purpose:Studies involving minimally invasive hysterectomy and robotic sacrocolpopexy have demonstrated safety and feasibility of same-day discharge. There are limited data, however, on same-day discharge outcomes for vaginal hysterectomy and pelvic reconstruction. This study aimed to compare 30 and 90-day surgical outcomes between same-day discharge versus overnight stay following vaginal hysterectomy and apical suspension.Patients and Methods:This retrospective study evaluated surgeries performed over two time periods. Overnight stay was standard between December 2018 and February 2020. Same-day discharge was standard from December 2020 to February 2022. All patients who underwent vaginal hysterectomy with apical suspension were included. The primary outcome was to determine if there was an increase in 30-day readmission rates. Secondary outcomes included emergency department visits and reoperations within 30 days, the previous variables at 90 days, and the rate for successful same-day discharge.Results:A total of 324 patients were analyzed over the 30 months: 149 (46%) in the overnight stay group and 175 (54%) in the same-day discharge group. At 30 days, no difference was found between groups for readmissions (2.7% vs 4.0%, p = 0.56), emergency department visits (14.8% vs 14.9%, p = 1.0), or reoperations (2.0% vs.1.7%, p = 1.0). At 90 days, outcomes were also similar. Same-day discharge as standard practice was successful in 80% of patients.Conclusion:In this retrospective two cohort study, the safety of same-day discharge following vaginal hysterectomy with apical suspension was demonstrated with no increased risk of 30 or 90-day readmissions, emergency visits, or reoperation rates. The majority (80%) of patients were discharged on the day of surgery, suggesting feasibility of this model.

Introduction: Ambulatory surgery centers (ASCs) have noted increasing surgical volume. Studies evaluating safety and efficacy have determined ASCs are comparable to hospital-based operating rooms (HBORs). Safety outcomes for suburethral slings in this setting have not been explored. Hypothesis: Safety of suburethral slings is comparable between HBORs and ASCs. Methods: This retrospective study evaluated outcomes of suburethral slings at ASCs compared with HBORs from November 2016 to January 2022. A total of 259 patients, 18 years or older, undergoing suburethral sling surgery were included. The primary outcome was number of emergency department visits within 90 days after surgery. Secondary outcomes were length of stay, estimated blood loss, rates of postoperative urinary retention (POUR), and rates of readmission within 90 days. Statistical analysis was performed with Mann-Whitney U Test for continuous variables and Fisher's exact test for categorical. Results: A total of 259 subjects were analyzed: 140 (54%) at a hospital-based setting and 119 (46%) at an ambulatory surgery setting. There were no differences in subject demographics. The primary outcome was comparable between groups as were secondary outcomes, with the exception of length of stay and POUR. Median length of stay at ambulatory centers was 48 minutes less than at a hospital-based setting (p < 0.001); however, rates of retention were increased (30.3% vs. 12.1%, p < 0.001). Conclusion: Suburethral slings performed at ASCs are comparable in safety to those performed at HBORs.

Historically, planning an overnight stay following total vaginal hysterectomy (TVH) with vaginal reconstruction has been standard practice. Recent research involving minimally invasive hysterectomy and robotic sacrocolpopexy has demonstrated safety and feasibility utilizing same day discharge (SDD). There is limited data, however, on same day discharge outcomes for TVH with vaginal reconstruction. This retrospective study evaluated surgeries performed by the Urogynecology Division at a community-based academic institution over two time periods. Overnight stay (OS) was the standard practice between December 2018 and February 2020, while same day discharge (SDD) was the standard practice from December 2020 to February 2022. All subjects who underwent TVH with vaginal reconstruction in these time periods were included. Primary outcomes were 30-day readmission rates, ED visits, and re-operations. Secondary outcomes analyzed the same variables at 90 days and determined the rate for successful same day discharge. Statistical analysis was performed with Mann-Whitney U Test for continuous variables and Fisher's Exact Test for categorical variables. A total of 340 subjects were analyzed: 155 (46%) in the overnight stay period and 185 (54%) in the same day discharge period. There were no differences in demographic data including age, race, ethnicity, and BMI. When evaluating 30-day readmission rates, there was no difference between overnight stay as standard practice verses same day discharge as standard practice (2.6% vs 3.8% respectively; p=0.76). ED visits within 30 days after surgery were evaluated and no difference between groups was found (OS 14.2% vs SDD 14.1%, p=1.0). Similarly, reoperations were analyzed with no difference found (OS 1.9% vs SDD 1.6%, p=1.0). At 90 days, readmissions (OS 3.9% vs SDD 4.3%, p=1.0), ED visits (OS 16.1% vs SDD 15.1%, p=0.88), and re-operations (OS 1.9% vs SDD 1.6%, p=1.0) were also not significantly different. Rates of postoperative urinary retention (OS 72.3% vs SDD 74.1%, p=0.71) and high-volume blood loss (EBL >200ml) (OS 26.5% vs SDD 26.5%, p=1.0) were similar. For the period of same day discharge as standard practice, 80% of the subjects were successfully discharged the same day. In this retrospective two cohort study, patients undergoing TVH with vaginal reconstructive surgery had similar outcomes with SDD as compared to an overnight stay. With no increased risk of 30 or 90-day readmissions, ED visits, or re-operation rates, safety of same day discharge was demonstrated. Furthermore, the vast majority (80%) of subjects were able to be discharged on the day of surgery, suggesting that patients are willing to accept this model. We believe that surgeons may feel reassured about planning for SDD following major pelvic reconstructive surgery.

Introduction and hypothesis Previous research has not evaluated patient experiences following vaginal reconstructive surgery using a same-day discharge model. The objective of this study was to describe patient experiences following major vaginal reconstructive surgery and same-day discharge. Methods In this descriptive study, patients undergoing vaginal hysterectomy with pelvic reconstruction were preoperatively enrolled. Questionnaires detailing experience with same-day discharge, surgical recovery, and advice for prospective patients were completed. Our primary outcome was question 7 of the Surgical Satisfaction Questionnaire: Looking back, if you “had to do it all over again” would you have the surgery again? Descriptive statistics were performed, and correlations were performed with Spearman’s rank test. Results Sixty patients were enrolled; 54 underwent surgery. Eighty-seven percent of patients completed the 12-week questionnaire. At 12 weeks, 96% of patients ( n = 45) would have the surgery again, and 91% ( n = 42) were satisfied with the results of surgery. Twelve weeks postoperatively, the most common patient-reported complications were urinary tract infection ( n = 8, 17%), catheter concerns ( n = 5, 11%), and constipation ( n = 5, 11%). When asked to list the best parts of their surgical experience, half of patients felt that this was the office staff or physician themselves ( n = 24, 51%). When asked what advice they would provide to future patients, the most common responses included having a support person at home and taking time for recovery. Conclusions In this sample of women receiving same-day discharge following vaginal hysterectomy with pelvic reconstruction, we present a unique insight into the most common patient concerns postoperatively. Rates of satisfaction and comfort were high.

Objectives: We aimed to describe obstetrics and gynecology (OBGYN) trainees' anticipation of how the Dobbs v. Jackson Women's Health Organization (Dobbs) U.S. Supreme Court decision may affect their training. Methods: A REDCap survey of OBGYN residents and fellows in the United States from September 19, 2022, to December 1, 2022, queried trainees' anticipated achievement of relevant Accreditation Council for Graduate Medical Education (ACGME) training milestones, their concerns about the ability to provide care and concern about legal repercussions during training, and the importance of OBGYN competence in managing certain clinical situations for residency graduates. The primary outcome was an ACGME program trainee feeling uncertain or unable to obtain the highest level queried for a relevant ACGME milestone, including experiencing 20 abortion procedures in residency. Results: We received 469 eligible responses; the primary outcome was endorsed by 157 respondents (33.5%). After correction for confounders, significant predictors of the primary outcome were state environment (aOR = 3.94 for pending abortion restrictions; aOR = 2.71 for current abortion restrictions), trainee type (aOR = 0.21 for fellow vs. resident), and a present or past Ryan Training Program in residency (aOR = 0.55). Although the vast majority of trainees believed managing relevant clinical situations are key to OBGYN competence, 10%-30% of trainees believed they would have to stop providing the standard of care in clinical situations during training. Conclusions: This survey of OBGYN trainees indicates higher uncertainty about achieving ACGME milestones and procedural competency in clinical situations potentially affected by the Dobbs decision in states with legal restrictions on abortion.

Acute situational anxiety (ASA) surrounding surgery can have detrimental effects on a patient's response to anesthesia, postoperative recovery, pain, and satisfaction with surgery. There is limited data evaluating ASA in the urogynecology patient population. We, therefore, sought to evaluate ASA in patients undergoing pelvic reconstructive surgery (PRS). This pilot study performed at an independent academic institution evaluated presurgical anxiety levels in patients undergoing PRS. The 17-item Surgical Anxiety Questionnaire (SAQ) was utilized. The SAQ is a validated surgery-specific survey that was designed to incorporate both the theoretical and practical components of preoperative anxiety, with a focus on concerns about general health status, the surgical recovery process, and concerns about limited control and surgical procedures. The instructions on the SAQ ask patients to rate how worried or concerned they are about each item, with a five-point response scale labeled 'not at all', 'a little bit', 'moderately', 'very' and 'extremely'. Responses to each item were scored 0–4, respectively. The highest possible score on the survey is 68. Subjects who underwent surgery for vaginal prolapse were eligible. We estimated 20 patients would provide an adequate sample. The survey was administered on the day of surgery in the preoperative holding area after routine counseling. A Kruskal-Wallis Test was conducted to examine the association between use of anxiety medication and total anxiety score. Twenty patients completed the survey. The median age was 66.5 (IQR 19). Eleven patients underwent a hysterectomy at the time of PRS (55%), and 4 patients underwent a concomitant sling procedure (20%). Our median patient anxiety score was 16 (IQR 15) and our highest individual patient score was 41. The highest scoring matters of concern were "experiencing pain or discomfort after my surgery" (average score of 2.15 out of 4) and "how long will it take to return to my normal daily activities or hobbies" (average score of 2.3 out of 4). The lowest scoring topic of concern was "having an injection or receiving an IV", (average score of 0.3 out of 4). An additional question was added to the original SAQ to identify patients currently taking medication for an anxiety condition. Eight patients (40%) reported "yes". There was no association between anxiety medications and anxiety score. Although patients undergoing pelvic reconstructive surgery do experience worry or concern over postoperative pain and return to daily activities, their anxiety levels are overall low. Further studies would help establish risk factors for higher anxiety, and how to improve anxiety for future patients.

To describe patient perceptions regarding same day discharge (SDD) following major vaginal reconstructive surgery. In this prospective, single-cohort descriptive study, patients undergoing vaginal hysterectomy with pelvic reconstructive surgery were preoperatively enrolled. At both 2 weeks and 12 weeks postoperatively, surveys detailing experience with SDD, surgical recovery, and advice for prospective patients were completed. The Surgical Satisfaction Questionnaire (SSQ-8) and visual analog scale for pain were included. Demographic and surgical data were collected. Our primary outcome was question 7 of the SSQ-8 on the 12-week questionnaire: Looking back, if you "had to do it all over again" would you have the surgery again? Descriptive statistics were performed. Sixty patients were enrolled; 54 underwent surgery. The median age was 65.5 years (IQR 11.75), majority were white (n=52, 96%), and median BMI was 25.3 (IQR 6.65). Although 54 patients completed surgery, 47 were discharged the same day (87%). Forty-two patients having SDD completed the 12-week questionnaire (89%). At 12 weeks, 98% of patients (n=41) would have the surgery again, and 90% (n=38) were satisfied with the results of surgery. Forty patients (95%) had felt prepared to deal with their pain, and 86% of patients (n=36) felt comfortable with SDD. At 12 weeks postoperatively, the most common patient-reported complications were urinary tract infection (UTI; n=8, 19%), catheter concerns (n=4, 10%), and constipation (n=3, 7%). Eleven patients (26%) reported that the worst part of the surgical experience was being discharged with a catheter. When asked to list the best parts of their surgical experience, almost half of patients felt this was the office staff or physician themselves (n=14, 33%). Sixty percent of patients reported the result of surgery as one of the best parts of the surgical experience (n=25). When asked what advice they would provide to future patients undergoing this surgery, the most common responses described having a support person at home, taking time for recovery, and following the postoperative instructions. In this sample of women receiving SDD following vaginal hysterectomy with pelvic reconstruction, we present unique insight into the most common patient concerns postoperatively. Rates of satisfaction and comfort with SDD were high. Patients felt the relationship with the office staff and their surgeon were the best parts of their surgical experience.

BACKGROUND:Patients undergoing vaginal hysterectomy with native tissue pelvic reconstruction typically have low pain levels overall in the postoperative period. Notwithstanding, pain control immediately after surgery may be more challenging and a barrier to same-day discharge. Intrarectal diazepam has been used for acute and chronic pelvic pain and has a pharmacokinetic profile ideal for intermittent use. However, its use has not been investigated after the surgical intervention.OBJECTIVE:This study aimed to evaluate the effect of diazepam rectal suppositories on early postoperative pain after hysterectomy and vaginal reconstruction for pelvic organ prolapse.STUDY DESIGN:This was a double-blind, randomized, placebo-controlled trial comparing postoperative pain scores after vaginal hysterectomy with native tissue prolapse repairs. Patients were randomized to receive either an intrarectal 10-mg diazepam suppository or an identical placebo. Moreover, the participants completed the questionnaires at baseline, the morning of postoperative day 1, and 2 weeks after the operation. Surveys included visual analog scales for pain, a validated Surgical Satisfaction Questionnaire, and queries regarding medication side effects and postoperative recovery. The primary outcome was pain scores based on a visual analog scale approximately 3 hours after surgery. The secondary outcomes included total morphine equivalents after surgery, patient satisfaction with pain control, same-day discharge outcome, and overall satisfaction. The chi-square, Fisher exact, and Mann-Whitney tests were used. Based on a 10-mm difference in postoperative vaginal pain using the visual analog scale, sample size was calculated to be 55 patients in each arm to achieve 80% power with an alpha of.05.RESULTS:From February 2020 to August 2021, 130 participants were randomized. Of those participants, 7 withdrew, and 123 were analyzed: 60 in the diazepam group and 63 in the placebo group. The median age was 65 years (interquartile range, 27-80), the median body mass index was 27.9 kg/m2 (interquartile range, 18.70-45.90), and 119 of 123 participants (96.7%) were White. There was no difference in the baseline characteristics, prolapse stage, or types of procedures performed between groups. Most participants had concurrent uterosacral ligament suspension with anterior and posterior repairs. Of note, 50 of 123 participants (41%) had midurethral slings. Moreover, 61 of 123 participants (50%) were discharged on the day of surgery. There was no difference in the primary outcome of vaginal pain 3.5 to 6.0 hours postoperatively (25 vs 21 mm; P=.285). In addition, the amount of rescue narcotics used in the immediate postoperative period (19.0 vs 17.0 MME; P=.202) did not differ between groups. At 2-weeks postoperatively, patients in the placebo group reported higher satisfaction with pain control in the hospital (31 vs 43 mm; P=.006) and pain control at home (31 vs 42 mm; P=.022). No difference was noted between same-day discharges and those who were admitted overnight.CONCLUSION:The placement of a 10-mg diazepam rectal suppository immediately after pelvic reconstructive surgery did not improve pain or narcotic usage in the early postoperative period. Although the placebo group reported slightly higher satisfaction with pain control 2 weeks after surgery, overall pain levels were low. Therefore, we do not believe that the addition of diazepam to the postoperative regimen is warranted.

Importance There is little consensus on an effective nonantibiotic agent for the prevention of urinary tract infection (UTI) after pelvic reconstructive surgery. Objective The aim of the study was to investigate the impact of methenamine hippurate with cranberry capsules on rates of UTI after pelvic reconstructive surgery, among patients requiring short-term catheterization. Study Design In this randomized, double-blinded placebo-controlled trial, patients discharged with a catheter after pelvic reconstructive surgery were approached to participate. Participants were randomized to receive cranberry with methenamine or cranberry with placebo. Primary outcome was number of UTIs treated within 1 week after surgery. Secondary outcomes included incidence of UTIs treated within 6 weeks postoperatively, bacterial species on culture, urinary pH, catheter duration, patient adherence, and satisfaction. A sample size of 88 participants per arm was planned. Results From June 2019 to July 2021, 185 patients were randomized and 182 analyzed; 89 received placebo and 93 received methenamine. Both groups were similar. Incidence of UTI at 1 week was significantly higher in the placebo group (79.8%) compared with the methenamine group (66.7%; odds ratio, 1.97; 95% confidence interval, 1.01-3.87; P = 0.048). This difference increased by 6 weeks postoperatively (89.9% vs 72.0%; odds ratio, 3.45; 95% confidence interval, 1.51-7.87; P = 0.003). There were fewer pseudomonal UTIs in the methenamine group (P = 0.041). Duration of catheterization and urinary pH were similar. Overall adherence and level of satisfaction was high. Conclusions In this high-risk population, methenamine was well tolerated and significantly reduced UTI rates. Methenamine with cranberry should be considered as an effective prophylactic therapy to reduce this common complication after pelvic surgery.