OBJECTIVE:Hysterectomy is the second most common surgery performed among women in the United States. The associations between hysterectomy and the risk of pelvic floor disorders remain unclear. The objective of this study is to systematically review the associations between hysterectomy and the likelihood of pelvic floor disorders. DATA SOURCES:A systematic search of Medline and Embase from inception to October 11, 2024, was performed without language restrictions. The systematic review was registered in The International Prospective Register of Systematic Reviews (CRD42023443210). STUDY ELIGIBILITY CRITERIA:Studies included randomized controlled studies and nonrandomized comparative studies (that reported adjusted analyses) of adult female individuals aged ≥18 years old who underwent a hysterectomy through any route for benign indications. At least 1 year of follow-up after hysterectomy was required. Studies of individuals undergoing concomitant surgery for pelvic floor disorders were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS:Twelve investigators independently screened each abstract and potentially eligible full-text article in duplicate. Data extraction, risk of bias assessment, and strength of evidence grading were conducted using standard instruments. Meta-analyses were performed using random-effects models. Outcomes included pelvic organ prolapse, urinary incontinence (nonspecific, mixed, and stress), overactive bladder, voiding dysfunction, fecal incontinence, and defecatory dysfunction. Results were stratified by time since hysterectomy (≤10 years vs >10 years). RESULTS:We included 60 studies (8 randomized controlled trials, 20 cohort studies, and 32 case-control studies) with 3,567,848 participants. In the first 10 years, hysterectomy was associated with higher likelihood of (nonspecific) urinary incontinence (effect size 1.29, 95% confidence interval 1.11-1.47; 25 studies), stress urinary incontinence (effect size, 1.31; 95% confidence interval, 1.06-1.56; 14 studies), overactive bladder (effect size, 1.41; 95% confidence interval, 1.25-1.58; 16 studies), and mixed urinary incontinence (effect size, 1.62; 95% confidence interval, 1.40-1.85; 3 studies). Beyond 10 years, hysterectomy was associated with higher likelihood of pelvic organ prolapse (effect size, 1.56; 95% confidence interval, 1.35-1.78; 6 studies) and stress urinary incontinence (effect size, 2.40; 95% confidence interval, 2.17-2.63; 5 studies). CONCLUSION:Hysterectomy is associated with a statistically significant higher likelihood of urinary incontinence of all types within 10 years, as well as pelvic organ prolapse and stress urinary incontinence beyond 10 years after hysterectomy. It is important to discuss these risks at the time of counseling for hysterectomy with consideration of medical or nonhysterectomy treatment options if clinically acceptable.

ImportanceUnlike other surgical specialties, obstetrics and gynecology (OB-GYN) has been predominantly female for the last decade. The association of this with gender bias and sexual harassment is not known.ObjectiveTo systematically review the prevalence of sexual harassment, bullying, abuse, and discrimination among OB-GYN clinicians and trainees and interventions aimed at reducing harassment in OB-GYN and other surgical specialties.Evidence ReviewA systematic search of PubMed, Embase, and ClinicalTrials.gov was conducted to identify studies published from inception through June 13, 2023.: For the prevalence of harassment, OB-GYN clinicians and trainees on OB-GYN rotations in all subspecialties in the US or Canada were included. Personal experiences of harassment (sexual harassment, bullying, abuse, and discrimination) by other health care personnel, event reporting, burnout and exit from medicine, fear of retaliation, and related outcomes were included. Interventions across all surgical specialties in any country to decrease incidence of harassment were also evaluated. Abstracts and potentially relevant full-text articles were double screened.: Eligible studies were extracted into standard forms. Risk of bias and certainty of evidence of included research were assessed. A meta-analysis was not performed owing to heterogeneity of outcomes.FindingsA total of 10 eligible studies among 5852 participants addressed prevalence and 12 eligible studies among 2906 participants addressed interventions. The prevalence of sexual harassment (range, 250 of 907 physicians [27.6%] to 181 of 255 female gynecologic oncologists [70.9%]), workplace discrimination (range, 142 of 249 gynecologic oncologists [57.0%] to 354 of 527 gynecologic oncologists [67.2%] among women; 138 of 358 gynecologic oncologists among males [38.5%]), and bullying (131 of 248 female gynecologic oncologists [52.8%]) was frequent among OB-GYN respondents. OB-GYN trainees commonly experienced sexual harassment (253 of 366 respondents [69.1%]), which included gender harassment, unwanted sexual attention, and sexual coercion. The proportion of OB-GYN clinicians who reported their sexual harassment to anyone ranged from 21 of 250 AAGL (formerly, the American Association of Gynecologic Laparoscopists) members (8.4%) to 32 of 256 gynecologic oncologists (12.5%) compared with 32.6% of OB-GYN trainees. Mistreatment during their OB-GYN rotation was indicated by 168 of 668 medical students surveyed (25.1%). Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%). Various interventions were used and studied, which were associated with improved recognition of bias and reporting (eg, implementation of a video- and discussion-based mistreatment program during a surgery clerkship was associated with a decrease in medical student mistreatment reports from 14 reports in previous year to 9 reports in the first year and 4 in the second year after implementation). However, no significant decrease in the frequency of sexual harassment was found with any intervention.Conclusions and RelevanceThis study found high rates of harassment behaviors within OB-GYN. Interventions to limit these behaviors were not adequately studied, were limited mostly to medical students, and typically did not specifically address sexual or other forms of harassment.

Introduction and HypothesisThis manuscript is a part of the International Urogynecology Consultation (IUC) on pelvic organ prolapse (POP) chapter three, committee three, on the impact of lifestyle modifications (i.e., weight loss, treatment of constipation, activity restriction, etc.) on the prevention and treatment of POP.Materials and MethodsAn international group containing ten female pelvic medicine specialists and one university-based medical librarian performed a systematic search of the literature in Medline using the MeSH terms: pelvic organ prolapse (ID: D056887), cystocele (ID: D052858), uterine prolapse (ID: D014596), rectocele (ID: D020047), and women (ID: D014930) to identify studies addressing lifestyle modifications as prevention or treatment for POP on 10/18/21. Relevant studies were included in this review.ResultsA total of 18,483 studies were identified in the initial literature search; 187 full-text articles were deemed pertinent and independently reviewed and double-screened by ten reviewers. After full-text review, information from 86 articles was included in this review.ConclusionWomen may consider various lifestyle modifications to help prevent and treat POP, even if it is challenging to quantify the efficacy of these interventions.

OBJECTIVE:To assess and compile the current level of evidence regarding successful surgical treatment of vesicovaginal fistulae and how these perioperative interventions affect anatomic, patient-centered, and adverse outcomes. DATA SOURCES:PubMed and EMBASE were searched from inception through September 9, 2022. METHODS OF STUDY SELECTION:This review included comparative studies (of any sample size) and single-group studies (1,000 or more participants) of primary or recurrent vesicovaginal fistula (ie, vesicovaginal fistula, urethrovaginal fistula, and bladder neck-vaginal fistula). We evaluated preintervention assessment or management, various techniques for intraoperative management, and postoperative management. Outcomes of interest included anatomic and objective outcomes (such as successful repair, fistula closure, urinary incontinence, recurrent fistula, perioperative complications) and subjective outcomes (such as voiding symptoms and quality of life). Abstracts and full-text articles were screened in duplicate, and study descriptions and findings were extracted into standardized extraction forms. Risk of bias was assessed independently by two investigators and adjudicated by a third. Study quality was summarized with standardized tools. We conducted random-effects model and restricted maximum-likelihood meta-analyses of relative risks when at least three studies compared similar interventions and reported similar outcome measures. TABULATION, INTEGRATION, AND RESULTS:Forty-six studies met the inclusion criteria. Studies were categorized into 11 domains: 1) preoperative assessment, 2) preoperative and postoperative physical therapy, 3) route of surgery, 4) incorporation of a flap, 5) trimming, 6) layered closure, 7) intraoperative antibiotics, 8) fibrin glue, 9) fascial sling, 10) postoperative Foley catheter duration, and 11) quality of life. Although the strength of the data is insufficient, preoperative phenazopyridine, physical therapy, layered closure, and intraoperative antibiotics seemed to improve the rate of successful fistula repair. Route of surgery (vaginal vs abdominal laparotomy) was determined primarily by surgeon preference and showed no difference in successful fistula repair. In addition, use of interpositional flaps, trimming fistula edges, fibrin glue, and fascial sling did not show significant improvement in rates of fistula cure. Overall, quality-of-life scores improved postoperatively regardless of route of repair and use of interpositional flaps. CONCLUSION:Our findings highlight the limited information available to guide evidence-based treatment of vesicovaginal fistula repair. Overall, high-quality evidence is lacking to provide guidelines; therefore, expert opinion remains the primary influence for fistula repair recommendations. SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42021214948.

OBJECTIVE:To assess the amount of opioid medication used by patients and the prevalence of persistent opioid use after discharge for gynecologic surgery for benign indications. DATA SOURCES:We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from inception to October 2020. METHODS OF STUDY SELECTION:Studies with data on gynecologic surgical procedures for benign indications and the amount of outpatient opioids consumed, or the incidence of either persistent opioid use or opioid-use disorder postsurgery were included. Two reviewers independently screened citations and extracted data from eligible studies. TABULATION, INTEGRATION, AND RESULTS:Thirty-six studies (37 articles) met inclusion criteria. Data were extracted from 35 studies; 23 studies included data on opioids consumed after hospital discharge, and 12 studies included data on persistent opioid use after gynecologic surgery. Average morphine milligram equivalents (MME) used in the 14 days after discharge were 54.0 (95% CI 39.9-68.0, seven tablets of 5-mg oxycodone) across all gynecologic surgery types, 35.0 (95% CI 0-75.12, 4.5 tablets of 5-mg oxycodone) after a vaginal hysterectomy, 59.5 (95% CI 44.4-74.6, eight tablets of 5-mg oxycodone) after laparoscopic hysterectomy, and 108.1 (95% CI 80.5-135.8, 14.5 tablets of 5-mg oxycodone) after abdominal hysterectomy. Patients used 22.4 MME (95% CI 12.4-32.3, three tablets of 5-mg oxycodone) within 24 hours of discharge after laparoscopic procedures without hysterectomy and 79.8 MME (95% CI 37.1-122.6, 10.5 tablets of 5-mg oxycodone) from discharge to 7 or 14 days postdischarge after surgery for prolapse. Persistent opioid use occurred in about 4.4% of patients after gynecologic surgery, but this outcome had high heterogeneity due to variation in populations and definitions of the outcome. CONCLUSION:On average, patients use the equivalent of 15 or fewer 5-mg oxycodone tablets (or equivalent) in the 2 weeks after discharge after major gynecologic surgery for benign indications. Persistent opioid use occurred in 4.4% of patients who underwent gynecologic surgery for benign indications. Our findings could help surgeons minimize overprescribing and reduce medication diversion or misuse. SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42020146120.

(Abstracted from Obstet Gynecol 2023;141:681–696) Although opioid analgesics can be an effective pain control method in the acute postoperative period, their use comes with risks such as opioid misuse, persistent use, or opioid use disorders. As most postsurgical patients use less than half of their prescribed opioids (and rarely dispose of unused medication), millions of legitimately prescribed opioid tablets are available for diversion and misuse annually.

OBJECTIVE: To evaluate the effect of simulation training vs traditional hands-on surgical instruction on learner operative skills and patient outcomes in gynecologic surgeries. DATA SOURCES: PubMed, Embase, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from inception to January 12, 2021. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials, prospective comparative studies, and prospective single-group studies with pre- and posttraining assessments that reported surgical simulation-based training before gynecologic surgery were included. METHODS: Reviewers independently identified the studies, obtained data, and assessed the study quality. The results were analyzed according to the type of gynecologic surgery, simulation, comparator, and outcome data, including clinical and patient-related outcomes. The maximum likelihood random effects model meta-analyses of the odds ratios and standardized mean differences were calculated with estimated 95% confidence intervals. RESULTS: Twenty studies, including 13 randomized controlled trials, 1 randomized crossover trial, 5 nonrandomized comparative studies, and 1 prepost study were identified. Most of the included studies (14/21, 67%) were on laparoscopic simulators and had a moderate quality of evidence. Meta-analysis showed that compared with traditional surgical teaching, high- and low-fidelity simulators improved surgical technical skills in the operating room as measured by global rating scales, and high-fidelity simulators decreased the operative time. Moderate quality evidence was found favoring warm-up exercises before laparoscopic surgery. There was insufficient evidence to conduct a meta-analysis for other gynecologic procedures. CONCLUSION: Current evidence supports incorporating simulation-based training for a variety of gynecologic surgeries to increase technical skills in the operating room, but data on patient-related outcomes are lacking.

Background On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico’s pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the “UNM Global Health COVID-19 Intelligence Briefing.” Objective In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. Methods Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. Results An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. Conclusions The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty.

BACKGROUND On March 11, 2020, the New Mexico (NM) Governor declared a Public Health Emergency in response to the coronavirus disease 2019 (COVID-19) pandemic. The NM Medical Advisory Team (MAT) contacted faculty at the University of New Mexico (UNM) to form a team to assist in consolidating available information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 to facilitate NM’s pandemic management. In response, faculty, physicians, staff, graduate students, and medical students created the “UNM Global Health COVID-19 Intelligence Briefing.” OBJECTIVE Based on the growing number of daily scientific publications and news reports and the potential risk of community misinformation, we formed a team of academics to consolidate and disseminate relevant daily briefings with a goal of informing healthcare and public policy decisions for the state of NM. METHODS Microsoft Teams™ was used for manual and automated capture of COVID-19 articles (daily average=456), and composition of briefings. Articles were summarized according to relevant content and statistical findings. Multi-level triaging allowed for the most impactful articles to be reviewed and summarized with priority placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and other topics informing on healthcare and policy response to COVID-19. Team members met virtually to edit the briefing on clarity and grammar, and to prioritize articles based on scientific merit. The finalized briefing was emailed to a LISTSERV® and posted on the UNM Digital Repository. An IRB-approved survey to assess the impact of the briefing was sent to readers. RESULTS The briefings reached approximately 1,000 people by email alone. This number was likely higher with direct subscribers forwarding to colleagues. Tracking showed 5,047 downloads across 116 countries as of July 5, 2020. The survey received 114 respondents consisting of physicians, academic faculty, administrators, government employees, students, and nurses. Respondent feedback showed 95% gained relevant knowledge of the pandemic, 79% believed it decreased misinformation, 24% used the briefing as their primary source of information, and 79% forwarded to colleagues. CONCLUSIONS Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing. The UNM Global Health COVID-19 Intelligence Briefing accomplished the goal of disseminating relevant COVID-19 information to help guide NM government policy and clinical practice. A secondary benefit included advancing medical student education.

Our aim was to determine whether postoperative telephone follow-up was noninferior to in-person clinic visits based on patient satisfaction. Secondary outcomes were safety and clinical outcomes. Women scheduled for pelvic surgery were recruited from a single academic institution and randomized to clinic or telephone follow-up. The clinic group returned for visits 2, 6, and 12 weeks postoperatively and the telephone group received a call from a nurse at the same time intervals. Women completed the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) questionnaire, Pelvic Floor Distress Inventory (PFDI)-20, and pain scales prior to and 3 months postoperatively. Randomized patients who completed the S-CAHPS at 3 months were included for analysis. Sample size calculations, based on a 15% noninferiority limit in the S-CAHPS global assessment surgeon rating, required 100 participants, with power = 80% and alpha = 0.025. From October 2016 to November 2017, 100 participants were consented, underwent surgery, were randomized, and included in the final analysis (clinic group n = 50, telephone group n = 50). Mean age was 58.5 ± 12.2 years. Demographic data and surgery type, dichotomized into outpatient and inpatient, did not differ between groups. The S-CAHPS global assessment surgeon rating from patients in the telephone group was noninferior to the clinic group (92 vs 88%, respectively, rated their surgeons 9 and10, with a noninferiority limit of 36.1; p = 0.006). Adverse events did not differ between groups (n = 26; 57% fclinic vs 43% telephone; p = 0.36). Patients in the telephone group did not require additional emergency room or primary care visits. Clinical outcome measures improved in both groups, with no differences (all p > 0.05). Telephone follow-up after pelvic floor surgery results in noninferior patient satisfaction, without differences in clinical outcomes or adverse events. Telephone follow-up may improve healthcare quality and decrease patient and provider burden for postoperative care. ClinicalTrials.gov , www.clinicaltrials.gov , NCT02891187.

OBJECTIVEThe aim of this study was to identify smartphone Kegel and pelvic floor exercise applications (apps) and identify those with superior functionality, features, and accuracy.METHODSWe identified a complete list of Kegel and pelvic floor exercise applications by searching iTunes and Google Play stores for "pelvic floor," "pelvic floor exercises," "Kegel," and "Kegel exercises." We used a modified APPLICATIONS scoring system to evaluate all identified apps.RESULTSWe identified 120 apps related to Kegel exercises. Apps unrelated to the pelvic floor, unavailable in English, or duplicated on a separate platform were excluded from the analysis, leaving 90 unique apps. After a preliminary review, we excluded an additional 58 apps that were nonfunctional, required a biofeedback device, or intended for pregnant women. The final 32 apps included 15 paid and 17 free apps. Paid apps had higher rates of privacy features than free apps (80% vs 53%), used more images and figures (53% vs 41%), and were more likely to cite primary literature in their descriptions (33% vs 29%). Paid apps were also more likely to have tech support available (73% vs 53%). Overall score, however, was almost identical between the groups, with paid apps averaging 9.93 and free apps 9.41. The highest rated free and paid app both received a score of 12, consisting of Kegel Trainer and Kegel Trainer Pro, respectively.CONCLUSIONThe quality of the apps is markedly variable in both the paid and unpaid applications. Using the APPLICATIONS scoring system, the apps were very similar in overall quality and value.

BACKGROUND: The opioid epidemic in the United States is a public health emergency. Minimally invasive surgical technology has decreased length of hospital stay, improved postoperative recovery, and decreased postoperative pain. Hysterectomy is one of the most commonly performed surgeries in the United States. Increasing trends in minimally invasive gynecologic surgery are expected to reduce patients' postoperative pain. It is unclear whether this assumption has resulted in decreasing postoperative opioid prescriptions or patient need for these prescriptions, as prescribing patterns may be contributing to the current opioid public health emergency. OBJECTIVE: We sought to describe opioid prescribing and patient procurement practices for postoperative pain at time of discharge for benign hysterectomy from 2004 through 2014 using the Truven Health Analytics MarketScan Research Database. The trends of the route of hysterectomy over this time period were concomitantly described to reflect the movement toward more minimally invasive approaches. STUDY DESIGN: The Truven Health Analytics MarketScan Research Database including the Commercial Claims and Encounters Database, and the Medicare Supplemental and Coordination of Benefits Database were utilized. Current Procedural Terminology, 4th Edition, and International Classification of Diseases, Ninth Revision, codes identified all patients who underwent a hysterectomy for benign indications from 2004 through 2014. Hysterectomy routes were categorized into abdominal, laparoscopic, and vaginal. The MarketScan database captures prescriptions filled at a retail or mail-order pharmacy and does not capture prescriptions filled within the inpatient, hospital facility. The days of opioids procured by patients at the time of discharge were identified for each encounter. Descriptive statistics were used to summarize data within the entire study period. Although this article is purely descriptive, further analyses were conducted for exploratory purposes only. analysis of variance and x(2) analyses were used for continuous and categorical variables, respectively. Multiple linear regression models were used to describe associations between variables of interest and postoperative opioid prescriptions. RESULTS: We identified 793,016 patients who underwent a hysterectomy for benign indications from 2004 through 2014. Of these, 96% were identified from the Commercial Claims and Encounters Database. During the study period, the overall route of hysterectomy was categorized into 40.5% abdominal, 42.0% laparoscopic, and 17.5% vaginal hysterectomy. The route of hysterectomy changed from 60.2-25.6% (a decrease of Delta = 34.58; 95% confidence interval, 33.96-35.20) for abdominal, 17.0-61.9% (an increase of Delta = 44.83; 95% confidence interval, 44.21-45.44) for laparoscopic, and 22.8-12.6% (a decrease of Delta = 10.25; 95% confidence interval, 9.77-10.73) for vaginal. At discharge, the percentage of patients who were prescribed opioids and filled them increased from Delta =5.6-82.1% (an increase of LI = 56.50; 95% confidence interval, 55.88-57.13 with P < .001) from 2004 through 2014 for all hysterectomy routes. Additionally, the quantity of opioids prescribed also increased. CONCLUSION: Opioid prescriptions filled for postoperative pain after hysterectomy substantially increased from 2004 through 2014. Opioid prescription procurement has increased despite a concomitant increase in minimally invasive hysterectomy routes. In light of the current opioid epidemic, physicians must recognize that postoperative prescribing practices may contribute to chronic opioid use. Heightened awareness of opioid prescribing practices following surgery is critically important to decrease risk of development of chronic opioid dependence.

To describe opioid prescribing practices for postoperative pain at time of discharge for benign hysterectomy from 2003 to 2014 using the Truven Health Analytics MarketScan® Research Database. Additionally, to describe the route of hysterectomy trends over the same time period to reflect the movement toward more minimally invasive approaches. The Truven Health Analytics MarketScan® Research Database including the Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefits Database were utilized. Current Procedural Terminology (CPT4) and International Classification of Diseases 9th revision (ICD-9) codes identified all patients who underwent a hysterectomy for benign indication between 2003 to 2014. Hysterectomy routes were categorized into abdominal, laparoscopic, vaginal, and other. The opioid type, dose, and days supplied at the time of discharge were identified. Descriptive statistics were used to summarize data within the entire study period. Linear regression models were used to describe trends among hysterectomy route and opioid prescriptions. We identified 796,726 patients who underwent a hysterectomy for benign indications between 2003 and 2014. Of these, 764,683 were identified from the Commercial Claims and Encounters Database and 32,043 from the Medicare Database. During the study period, route of hysterectomy was categorized into 40.3% abdominal, 41.8% laparoscopic, 17.4% vaginal, and 0.5% other hysterectomy. From 2003 to 2014, the route of hysterectomy changed from 60.8% to 25.5% abdominal, 17.5% to 62.4% laparoscopic, 21.2% to 11.8% vaginal, and 0.5% to 0.3% other hysterectomy (Figure 1a). The percentage of patients prescribed opioids at the time of discharge for all hysterectomy routes increased from 17.0% in 2003 to 47.2% in 2014 (Figure 1b). Opioid prescriptions for postoperative pain after hysterectomy substantially increased between 2003 and 2014. Opioid prescriptions have increased despite a concomitant increase in less invasive routes for hysterectomy. In light of the current opioid epidemic, physicians must recognize that postoperative prescribing practices may contribute to chronic opioid use. Improving awareness of opioid prescribing practices at time of surgical discharge is necessary to work towards developing postoperative patient care plans with increased safety and efficacy.

To demonstrate surgical management of eviscerated sigmoid colon epiploica through a vaginal cuff dehiscence in the setting of stage 4 pelvic organ prolapse. This video describes a unique case of a 62-year-old P2 female with new onset vaginal pressure and bulge four years after a vaginal hysterectomy. She denied pain but reported a vaginal mass that she had been unable to manually reduce for the past 5 days. She was transferred from another institution with a computed tomography (CT) scan demonstrating a 6 to 7-cm mass protruding through the vaginal epithelium which was concerning for mesenteric evisceration. The patient was managed through a combined laparoscopic and vaginal approach. Eviscerated epiploica from the sigmoid colon was identified and reduced vaginally. Three segments of non-viable epiploica were then excised laparoscopically and proctoscopy was performed to evaluate possible injury or involvement of the distal sigmoid colon. A Mayo McCall uterosacral culdoplasty was performed to decrease pressure on the repaired vaginal defect by resuspending the vaginal apex and reinforcing the closure, in an attempt to prevent short-term evisceration recurrence. The patient’s total vaginal length at the completion of the case was 7-8 cm. A combined laparoscopic and vaginal repair of a vaginal cuff dehiscence was performed. It is important to perform concomitant intra-abdominal evaluation at the time of evisceration repair to rule out bowel necrosis, with the potential assistance of a general or colorectal surgeon. Performing a concomitant Mayo McCall culdoplasty may theoretically prevent recurrent evisceration in the setting of vaginal prolapse.

To assess the differences in patient-reported, catheter-specific satisfaction and quality of life with either suprapubic or transurethral postoperative bladder drainage following reconstructive pelvic surgery.

Thorough preoperative counseling allows patients and their physicians to develop appropriate, individualized treatment plans for pelvic organ prolapse that consider women's preoperative sexual function and sexual function goals.

BACKGROUND: Physicians and hospital systems often have relationships with biomedical manufacturers to develop new ideas, products, and further education. Because this relationship can influence medical research and practice, reporting disclosures are necessary to reveal any potential bias and inform consumers. The Sunshine Act was created to develop a new reporting system of these financial relationships called the Open Payments database. Currently all disclosures submitted with research to scientific meetings are at the discretion of the physician. We hypothesized that financial relationships between authors and the medical industry are underreported.OBJECTIVES: We aimed to describe concordance between physicians' financial disclosures listed in the abstract book from the 41st annual scientific meeting of the Society of Gynecologic Surgeons to physician payments reported to the Center for Medicaid and Medicare Services Open Payments database for the same year.STUDY DESIGN: Authors and scientific committee members responsible for the content of the 41st annual scientific meeting of the Society of Gynecologic Surgeons were identified from the published abstract book; each abstract listed disclosures for each author. Abstract disclosures were compared with the transactions recorded on the Center for Medicaid and Medicare Services Open Payments database for concordance. Two authors reviewed each nondisclosed Center for Medicaid and Medicare Services listing to determine the relatedness between the company listed on the Center for Medicaid and Medicare Services and abstract content.RESULTS: Abstracts and disclosures of 335 physicians meeting inclusion criteria were reviewed. A total of 209 of 335 physicians (62%) had transactions reported in the Center for Medicaid and Medicare Services, which totaled $ 1.99 million. Twenty-four of 335 physicians (7%) listed companies with their abstracts; 5 of those 24 physicians were concordant with the Center for Medicaid and Medicare Services. The total amount of all nondisclosed transactions was $ 1.3 million. Transactions reported in the Center for Medicaid and Medicare Services associated with a single physician ranged from $ 11.72 to $ 405,903.36. Of the 209 physicians with Center for Medicaid and Medicare Services transactions that were not disclosed, the majority (68%) had at least 1 company listed in the Center for Medicaid and Medicare Services that was determined after review to be related to the subject of their abstract.CONCLUSION: Voluntary disclosure of financial relationships was poor, and the majority of unlisted disclosures in the abstract book were companies related to the scientific content of the abstract. Better transparency is needed by physicians responsible for the content presented at gynecological scientific meetings.