OBJECTIVE:To create a standardized counseling tool for return to sexual activity after pelvic reconstructive surgery. METHODS:An expert panel created an initial counseling tool based on the conceptual framework previously developed in a rigorous qualitative analysis of women's experience of their first sexual encounters after pelvic reconstructive surgery. This instrument was then refined through cognitive patient interviews. Women who had previously undergone reconstructive surgery for pelvic organ prolapse or urinary incontinence and returned to sexual activity were recruited from four clinical sites across the United States and Canada for participation in cognitive interviews. Participants reviewed proposed counseling statements and were asked to describe their meaning, suggest any necessary changes, and rate their importance. Summaries of the ongoing cognitive interviews were periodically presented to the working group for discussion, and the instrument was revised accordingly. Interviews were conducted until no new substantive comments were made. RESULTS:Nineteen cognitive patient interviews were conducted, and three rounds of modifications were made to the initial counseling tool. Modifications included merging multiple counseling statements to avoid redundancy and eliminating statements that were not considered important by patients. Patients consistently rated statements about the safety of resuming intercourse and anticipated discomfort with initial sexual encounters as very important. CONCLUSION:We developed a novel, patient-centered counseling tool for the return to sexual activity after pelvic reconstructive surgery using a previously established conceptual framework and cognitive patient interviews. It addresses an important surgical outcome for patients and offers surgeons a concise, high-value counseling tool.

As novel therapies continue to enhance the survival rates of patients with gynecologic cancers, it is increasingly important to prioritize quality of life concerns. Pelvic floor disorders (PFD) are common among women, and research indicates that those with gynecological cancer experience more pelvic floor symptoms. Many patients in gynecologic oncology (GO) do not receive urogynecology evaluations before, during, or after treatment. As well, disruptions to anatomy during surgery and radiation can make it more difficult and less safe to intervene after treatment. This quality improvement study aims to assess the effectiveness and thoroughness of PFD management in GO patients. Should we identify a need, this study will advocate for the establishment of a streamlined urogynecology referral pathway for patients undergoing treatment for gynecologic cancers. A retrospective study was conducted at an academic institution over a two-year period. Women aged 18 and older were included if they presented as new patients in the division of GO between April 1, 2022, and April 1, 2023, and scheduled an appointment with the division of urogynecology and reconstructive pelvic surgery (URPS) between April 1, 2022, and April 1, 2024. The primary outcome of interest was the number of women who met this criterion. Secondary outcomes included the rates, types, and treatment of pelvic floor disorders (PFDs). There were 28 included patients. The mean (SD) age was 62 (17). Types of neoplasms included 5 (17.9%) ovarian, 11 (39.3%) uterine, 0 cervical, 1 (3.6%) vaginal, and 11 (39.3%) other. For cancer treatment, 1 (3.6%) underwent radiation, 2 (7.1%) chemotherapy, 15 (53.6%) surgery, and 13 (46.4%) no treatment. There were 22 (78.6%) patients who had some screening for PFD at their initial GO visit, although the degree of screening varied. Of those screened, 14 (63.6%) patients had no PFD symptoms, 0 reported pelvic organ prolapse (POP), 6 (27.3%) urge urinary incontinence (UUI), 6 (27.3%) stress urinary incontinence (SUI), 0 fecal incontinence, and 1 (4.5%) sexual dysfunction. There were 22 patients examined for PFD at their initial GO visit. Of those, 18 (81.8%) had no documented PFD finding, whereas 4 (18.2%) exhibited POP, 0 incontinence, and 0 vaginismus. The average time from initial GO visit to initial URPS visit was 214.4 days. Notably, 11(39.3%) had a canceled URPS visit. Of those who had an URPS visit, diagnoses included: 0 vaginismus, 0 dyspareunia, 5 (29.4%) recurrent urinary tract infection (UTI), 1 (5.9%) cystocele, 1 (5.9%) rectocele, 1 (5.9%) apical prolapse, 0 procidentia, 8 (47.1%) SUI, 9 (52.9%) UUI, 0 overflow incontinence, 6 (21.4%) mixed urinary incontinence, 0 intrinsic sphincter deficiency, and 5 (29.4%) something not specified. There were 8 (28.6%) patients reporting PFD symptoms began before oncology treatment, 3 (10.7%) reporting symptoms began afterwards, and 17 (60.7%) reporting unknown symptom initiation. This study indicates a need for more thorough PFD screening and examination in GO patients and a more reliable referral pathway with expedited treatment. Next steps involve developing a system to more effectively identify GO patients with PFD and subsequently have them referred for expedited evaluation and treatment. No.

Elective surgery is essential to maintain the financial solvency of most health systems, contributing as much as 60% of hospital revenue. Scheduling of surgical cases to optimally utilize operating room (OR) resources requires thoughtful planning and communication within the complex healthcare team. Under-estimating surgical time, late cancellations, and prolonged delays between cases undermines the effort to care for as many patients as possible and can dramatically affect the financial balance of the hospital.

Cases in which foreign bodies have been inserted into the vagina predominately occur in the pediatric population. This report presents the case of an adult woman with a retained foreign body for 13 years. A duplicated ureter suggestive of a Mullerian anomaly was incidentally identified on intraoperative cystoscopy. Mullerian anomalies may be associated with complex patient presentations and are associated with reproductive implications that should be discussed based on patient-specific characteristics.

Patients highly value surgeon counseling regarding the first sexual encounters after pelvic reconstructive surgery. Current surgeon counseling practices are varied. We aimed to create a standardized counseling tool for return to sexual activity after pelvic reconstructive surgery based on patient experiences and feedback. An expert panel created an initial counseling tool based on the conceptual framework previously developed in a rigorous qualitative analysis of women's experience of their first sexual encounters after pelvic reconstructive surgery. This instrument was then refined through cognitive patient interviews. Women who had previously undergone reconstructive surgery for pelvic organ prolapse (POP) and/or urinary incontinence (UI) and returned to sexual activity were recruited from four clinical sites across the United States and Canada for participation in cognitive interviews. Participants were read counseling statements and asked to describe their meaning, suggest any necessary changes and rate their importance. Summaries of the ongoing cognitive interviews were periodically presented to the working group for discussion and the instrument was revised accordingly. Interviews were conducted until no new substantive comments were made. We anticipated that 20 interviews would be adequate for saturation. A total of 19 cognitive patient interviews were conducted and 3 rounds of modifications were made to the initial counseling tool. The final standardized counseling tool is illustrated in Figure 1. Modifications included merging multiple counseling statements to avoid redundancy and eliminating statements which were not considered important by patients. Patients consistently rated statements regarding the safety of resuming intercourse and anticipated discomfort with initial sexual encounters as "very important". We developed a novel, patient-centered counseling tool regarding the return to sexual activity after pelvic reconstructive surgery based on a previously established conceptual framework and cognitive patient interviews. It addresses an important surgical outcome for patients and offers surgeons a concise, high-value counseling tool. Further study of the impact of this standardized tool utilization on patient satisfaction is needed.

The objective of this pilot study was of this pilot study is to to determine if intraoperative Credé predicts occult stress incontinence similar to preoperative prolapse reduced cough stress test (CST) A retrospective chart review of all surgical cases involving anterior and/or apical prolapse repairs between 1/1/2018 and 8/30/2021. Inclusion criteria for the pilot study included having both preoperative prolapse reduced cough stress test and intraoperative Credé documented within the patient chart and operative report. The intraoperative Credé was performed after completion of the anterior and/or apical prolapse repair with 300mL of normal saline backfilled into the patient's bladder. The data from the cases that met this inclusion criteria underwent data analysis with a chi-square. A total of 403 surgical cases involving anterior and/or apical prolapse repair were completed between 1/1/2018 and 8/31/2021. Of those, 45 cases met the inclusion criteria of having both preoperative prolapse reduced cough stress test and intraoperative Credé documented. Of the 12 patients who demonstrated a positive pre-op prolapse-reduced CST, only 7 also had fluid loss during the Credé. Just under half (14 of 33) of the patients who had a negative pre-operative prolapse reduced CST demonstrated fluid loss during intraoperative Credé. Using pre-operative CST as the gold standard, intraoperative Credé demonstrated a sensitivity of 58% and a specificity of 57% with positive and negative predictive values of 33% and 79% respectively. In this pilot study, the intraoperative Credé demonstrated a low positive predictive value, but a relatively strong negative predictive value. Previous studies have focused on pre-operative CST for predicting post-operative occult SUI. Despite these studies, some surgeons plan on reflex midurethral sling for all patients while other schedule an interval sling for those who develop symptoms. Perhaps intraoperative Credé could provide an additional tool for surgical planning. Additional studies are needed to compare CST and Credé, especially following patients post-operatively.

Pelvic organ prolapse (POP) occurs when organs in the female pelvis herniate into the vaginal canal. Moderate to severe cases of POP can cause sexual, urinary, and defecatory dysfunction and often require surgical intervention. Sacral colpopexy (SCP) is a safe, durable procedure widely used to treat apical POP. It is typically performed in a minimally-invasive manner via laparoscopic or robot-assisted surgery, but can be converted to an open abdominal approach intraoperatively if unforeseen challenges arise. There is ample literature describing patient risk factors for intraoperative conversion, but little to describe patient preference in surgical approach. The purpose of this study was to examine factors that may influence a patient's decision to choose to undergo laparotomy vs. opting for a native-tissue vaginal repair. 128 patients between the ages of 32-82 who underwent SCP to treat apical POP were included in the study. Each patient participated in a pre-operative conversation with the operating surgeon during which the patient indicated their preference of surgical approach if intraoperative conversion was deemed necessary. Each patient chose one of two options: to convert the procedure to an open SCP or to convert the procedure to a different, less durable vaginal repair. The data of interest, including demographic information, medical history, and POP severity were collected pre-operatively and were entered into a secure database. Of the 128 patients who underwent SCP, 74% (n=95) elected to undergo laparotomy if intraoperative conversion were to become necessary and 26% (n=33) opted for a native-tissue vaginal repair. The average age of patients who chose laparotomy was 60 years old, which was significantly younger than patients who chose vaginal repair (m=64y, p=0.03). Patients who chose laparotomy were also significantly more likely to have a higher BMI than their counterparts who chose vaginal repair (p=0.03). There was no statistically significant association between groups regarding race, education, marital status, severity of POP, or symptomatology. When given the opportunity to indicate their preference, most patients chose to undergo a more invasive surgery with higher rates of complication to receive SCP, which likely reflects the prolapse patient's desire for the most durable and effective procedure for treating POP. The group opting for native-tissue vaginal repair was significantly older, which is likely due to a greater risk of complication and longer recovery with open abdominal surgery. Patients with a higher BMI were more likely to choose laparotomy, which could reflect the increased risk of POP recurrence with high BMI, especially after vaginal repair. More research is needed to further examine what influences patient preference of surgical approach in elective surgery.

Objective: Inclusion of minority women in gynecologic research is vital for preventing health care inequities and disparities. This research was conducted to determine how frequently race and ethnicity data were reported in oral presentations at the Society for Gynecologic Surgeons (SGS)'s annual meeting.Materials and Methods: The abstracts and articles associated with SGS oral presentations between 2016 and 2020 were reviewed. Data regarding the numbers of subjects and reported races and ethnicities were extracted from each study. The proportion of studies that reported data about race and ethnicity was calculated. The racial and ethnic distributions of subjects within the studies that reported race and ethnicity were compared to distributions in the U.S. census data.Results: The inclusion criteria were met by 72/92 available abstracts and 28/37 available, articles. Data were reported on participants' race in 10/72 (13.9%) abstracts and 21/28 (75.0%) articles. Ethnicity was reported in 3/72 (4.2%) abstracts and 14/28 (50.0 %) articles. In the abstracts and articles that did report on race, races other than White were underrepresented, compared to the U.S. population.Conclusions: Most research abstracts at SGS annual meetings did not include race or ethnicity data. SGS articles were more likely to report these data but did not represent the the U.S. population diversity accurately. (J GYNECOL SURG 20XX:000)

Due to impact of systemic racism on health disparities, we aimed to determine how frequently race and ethnicity are reported in SGS presentations and how inclusive our studies are. Abstracts of SGS oral presentations (2016-2020) and manuscripts of featured SGS papers (2016 – 2019) were reviewed, extracting data regarding the number of subjects, reported race and ethnicity. Studies of non-human subjects were excluded. Proportion of studies that reported data about race, ethnicity was calculated. Descriptive statistics characterized race and ethnicity of participants. There were 86 abstracts (2016-2020) and 38 manuscripts (2016-2020) were reviewed. Seventy-nine of 86 abstracts and 32 of 38 manuscripts met inclusion criteria. Data were reported on subject race in 11 of 79 (14%) abstracts and 25 of 32 (78.1%) manuscripts; ethnicity was reported in 5 of 79 (6%) abstracts and 17 of 32 (53.1%) manuscripts. Of 1,056,566 participants reported in all SGS oral abstract presentations, there were 95,156 (9%) participants reporting race and 2,943 (0.3%) reporting ethnicity. One abstract of 86,023 women did not report numbers of race/ethnicity but factored it into a logistic regression. When this study is removed, leaving 10 studies with 37,911 participants, 27,257 (72%) were reported as White/Caucasian, 3,553 (9.4%) as Black/African American, 703 (1.9%) as Asian, 0 as Native Hawaiian/ Other Pacific Islander, and 0 as American Indian/Alaska Native. When 2 more large database studies were removed from this count, leaving only research conducted on subjects recruited by SGS researchers, 4 of 8 (50%) studies reported categories other than White. Of these 8 studies with 1,319 participants, 1,148 (87%) were White, 49 (3.7%) Black, and no participants were reported as Asian, Native Hawaiian/Pacific Islander, American Indian or Alaska Native. Of 5 studies that had ethnicity reported (n = 29,606), 10.4% were Hispanic. When 1 database study was removed, there were 4 original studies (n = 1,327) with patients recruited by SGS researchers, of which only 13% were Hispanic. Three of 79 studies reported any other health care disparity, including 1 reporting education level and 3 reporting insurance status. Out of 32 papers with 959,619 participants, 124,787 (13%%) were reported as White, 16,121 (16.8%) as Black, 1,275 (1.3%) Asian, 27 (0.0%) Native Hawaiian/ or Other Pacific Islander, and 0 as American Indian or Alaska Native. The majority of abstracts of research presented at the SGS podium do not include information about race/ethnicity; featured SGS manuscripts published in the American Journal of Obstetrics and Gynecology are more likely to report these data however still do not represent the diversity of the U.S. population. To interrupt the impact of structural racism on health, it is imperative that future research characterize participant race and ethnicity in publications and increase the number of women from diverse race and ethnicity included but also increase minority involvement in study design, recruitment, and implementation.

To describe the association, within a gynecologic surgery population, between a patient's age and their main source of healthcare news during the COVID-19 pandemic as well as compliance with preventative guidelines as recommended by the Centers for Disease Control and Prevention. This is a cross-sectional survey conducted via telephone of gynecologic surgery patients whose scheduled procedures were postponed as a result of the COVID-19 pandemic. Subjects were placed into two groups based on age - those 60 and above and those less than 60. Patients were questioned regarding their demographics, behavioral practices, and their primary news source related to the pandemic. Traditional news sources were defined as TV, radio, or newspaper. Modern news sources included any form of social media. Of the 115 subjects eligible for this study, 49 agreed to participate (42.6%). Of these, 27 (55%) were age 60 and above and 22 were under the age of 60 (45%). In the older group, all subjects reported using traditional media while only eight subjects (30%) also reported obtaining healthcare information from modern news sources. In the younger group, 16 subjects (73%) reported using traditional media while 14 (63%) simultaneously reported using modern media. When comparing the groups, there was no statistically significant difference in utilization of traditional news sources by age, however, the older group was much less likely to receive their information from modern media (P < 0.001). Regarding preventative measures, women over the age of 60 were more likely to quarantine than the younger group (OR = 2.35). Conversely, women under 60 were more likely to wear a mask (OR = 3.6), hand wash (OR = 2.36), and social distance (OR = 1.88). All subjects were likely to use traditional media while only those in the younger group were more likely to also utilize modern media and practice most preventative behaviors.

To understand what proportion of gynecology patients planning to undergo a scheduled procedure perceive their surgery as either being "elective" or "non-elective." Secondarily, to understand patient viewpoints and opinions towards surgery delay and any adverse sequelae related to postponement. This is a cross-sectional survey study of patients whose scheduled benign gynecologic surgery was postponed at our institution due to the COVID-19 pandemic. This study was conducted via telephone interview. Subjects were queried and placed into two groups based on how they viewed their surgery – either "elective" or "non-elective". Subjects were asked their sentiments surrounding surgery postponement such as feelings of "surprise" and if they thought postponement was appropriate. Subjects were also asked to identify any adverse sequelae experienced due to postponement of their surgery, including starting new medications, emergency department visits, and urinary tract infections. Out of the 115 subjects eligible for this study, 49 participated and completed the survey (42.6%). The average age of the participants was 60 (range = 23 – 87). The most common indications for surgery were prolapse (18 subjects), urinary incontinence (11 subjects), and pain/endometriosis (9 subjects). Twenty-three subjects (47%) reported they believed their surgery should be considered "elective" and 26 subjects (53%) reported they believed their surgery was "non-elective." Within the "elective" group, 91% of subjects stated that they believed postponement was the right thing to do and only 13% felt "surprised" with postponement versus 63% and 40% in the "non-elective" group, respectively. Overall, 13 patients reported needing a possibly avoidable additional treatment or evaluation related to surgery delay – six of these were in the "elective" group and seven were in the "non-elective" group. Over half of the patients surveyed identified their surgery as being "non-elective," however, the overwhelming majority still agreed that surgery postponement during the COVID-19 pandemic was the right course of action.

Study Objective Peritoneal perineal hernia is a rare prolapse without an established gold standard treatment. In this video, we present a unique technique in repairing this condition. Design Case report. Setting Patient was positioned in low lithotomy. The DaVinci™ Xi robot was docked on the left side and set up for pelvic surgery. Patients or Participants The patient is a 68-year-old female with surgical history of total vaginal hysterectomy and laparoscopic sigmoidectomy who presented for evaluation of a vaginal bulge. MR Defecography demonstrated tissue distortion concerning for peritoneal perineal hernia with marked small bowel decent. Interventions Robotic assisted synthetic mesh placement to obliterate the space between the rectum and vagina to promote visceral adherence. The peritoneum overlying the vaginal apex was dissected off the vagina into the rectovaginal plane and taken down all the way to the perineal body. Synthetic mesh was attached posteriorly to the vaginal wall with delayed absorbable suture. The rectum was then sutured to the posterior vaginal mesh using absorbable suture. In this way, the mesh was "sandwiched" between the two viscera. Care was taken to avoid full-thickness suture placement long the rectal serosa. Excellent obliteration of the Pouch of Douglas was achieved. The mesh was then attached to the sacral promontory using permanent suture. Complete reperitonealization of the mesh was performed using absorbable suture. Measurements and Main Results At her postoperative visit, she reported resolution of her symptoms of pelvic pressure and vaginal bulge. Postoperative MR Defecography revealed the resolution of small bowel decent into the perineal space. Conclusion Our approach was unique in that we reduced the hernia and obliterated the posterior cul-de-sac by suturing the mesh to both posterior vagina and anterior colon. Robotic approach provided minimally invasive care, excellent intraoperative visualization over laparotomy, and better dexterity over laparoscopy. Peritoneal perineal hernia is a rare prolapse without an established gold standard treatment. In this video, we present a unique technique in repairing this condition. Case report. Patient was positioned in low lithotomy. The DaVinci™ Xi robot was docked on the left side and set up for pelvic surgery. The patient is a 68-year-old female with surgical history of total vaginal hysterectomy and laparoscopic sigmoidectomy who presented for evaluation of a vaginal bulge. MR Defecography demonstrated tissue distortion concerning for peritoneal perineal hernia with marked small bowel decent. Robotic assisted synthetic mesh placement to obliterate the space between the rectum and vagina to promote visceral adherence. The peritoneum overlying the vaginal apex was dissected off the vagina into the rectovaginal plane and taken down all the way to the perineal body. Synthetic mesh was attached posteriorly to the vaginal wall with delayed absorbable suture. The rectum was then sutured to the posterior vaginal mesh using absorbable suture. In this way, the mesh was "sandwiched" between the two viscera. Care was taken to avoid full-thickness suture placement long the rectal serosa. Excellent obliteration of the Pouch of Douglas was achieved. The mesh was then attached to the sacral promontory using permanent suture. Complete reperitonealization of the mesh was performed using absorbable suture. At her postoperative visit, she reported resolution of her symptoms of pelvic pressure and vaginal bulge. Postoperative MR Defecography revealed the resolution of small bowel decent into the perineal space. Our approach was unique in that we reduced the hernia and obliterated the posterior cul-de-sac by suturing the mesh to both posterior vagina and anterior colon. Robotic approach provided minimally invasive care, excellent intraoperative visualization over laparotomy, and better dexterity over laparoscopy.

This video aims to show an approach to sacrocolpopexy with vaginal hysterectomy and vaginal attachment of the polypropylene mesh used in the suspension. We present a patient with stage 2 anterior compartment and uterine prolapse. The vaginal hysterectomy is performed first by the resident physician. The cervix is grasped with two Jacobs tenaculi, infiltrated at the incision line with 0.25% bupivacaine, and incised through full thickness epithelium with a curved Mayo scissor. The posterior cul-de-sac is then entered sharply. Lateral pedicles are taken sequentially including sharp anterior entry until the hysterectomy is completed. The rectovaginal dissection is continued to the perineal body and the vesicovaginal dissection is carried out to the ureterovesical junction. Attention is turned to attachment of the mesh. The anterior mesh arm is sutured to the vaginal cuff in the previously dissected space. We include a one centimeter apical "free triangle" which is not be directly sutured to the vaginal cuff, but provides a buffer to reduce the risk of mesh erosion. The Y-stem of the mesh is placed into the abdominal cavity and the posterior arm of the mesh attached within the rectovaginal space. The vaginal cuff is then closed in two layers; the first layer is subcutaneous after which no mesh is visible or palpable at the cuff and the second layer brings together the skin edges with vertical mattress sutures. The sacrocolpopexy is then performed with robotic assistance. Estimated blood loss in this case was 15 milliliters and the patient went home on the day of surgery. At one year postoperatively, the patient was doing well with no recurrent prolapse or surgical complications. The combination of vaginal hysterectomy with sacrocolpopexy ensures our learners gain this important surgical experience while the vaginal placement of the mesh allows for a secure, tension-free attachment.

Objective Obesity can contribute to urinary symptoms such as urgency, frequency, and incontinence. In addition to classic treatments, weight loss interventions offer a unique clinical opportunity to improve these symptoms. Study Design The American Urogynecologic Society Systematic Review Group conducted a review of articles on the impact of surgical and behavioral weight loss (BWL) interventions on urinary symptoms in overweight and obese women. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation criteria. Results The review group identified 43 publications from 39 studies, including 10 reports that used data from 5 randomized trials. Overall, there is high-certainty evidence that BWL, such as diet and exercise, decreases the prevalence of stress urinary incontinence 15% to 18% and overall urinary incontinence (UI) by 12% to 17% at 1 to 2.9 years. The certainty of evidence on the long-term impact of these interventions was lower. The certainty of the evidence was moderate to low regarding the benefit of BWL on urgency UI and overactive bladder symptoms. No randomized trials evaluated the impact of surgical weight loss on urinary symptoms, and the certainty of evidence of other study types was very low. Conclusions There is high-certainty evidence that BWL results in modest improvements in stress and overall UI in overweight and obese women at 1 to 2.9 years after the intervention. Robust studies with low risk of bias are needed to assess whether these benefits are maintained over the long term and are associated with adverse events and to assess the impact of surgical weight loss interventions on urinary outcomes in overweight and obese women.

The coronavirus disease 2019 pandemic warrants an unprecedented global healthcare response requiring maintenance of existing hospital-based services while simultaneously preparing for high-acuity care for infected and sick individuals. Hospitals must protect patients and the diverse healthcare workforce by conserving personal protective equipment and redeployment of facility resources. While each hospital or health system must evaluate their own capabilities and surge capacity, we present principles of management of surgical services during a health emergency and provide specific guidance to help with decision making. We review the limited evidence from past hospital and community responses to various health emergencies and focus on systematic methods for adjusting surgical services to create capacity, addressing the specific risks of coronavirus disease 2019. Successful strategies for tiered reduction of surgical cases involve multidisciplinary engagement of the entire healthcare system and use of a structured risk-assessment categorization scheme that can be applied across the institution. Our institution developed and operationalized this approach over 3 working days, indicating that immediate implementation is feasible in response to an unforeseen healthcare emergency.

This case presents the work-up and management of a patient with a fibroid uterus and urinary incontinence. Five international experts also provide their evaluation and approach to this case. According to the literature, there is uncertainty surrounding the relationship between fibroids and urinary incontinence. The experts emphasize patient counseling and a staged approach.

INTRODUCTION: Surgical site infections (SSI), are defined as superficial, deep, or organ space infections that occur within 30 days of surgery. SSIs are known to greatly increase health care costs and hospital length of stay. In additional to using standard sterile surgical technique and antibiotic prophylaxis, additional strategies been proposed to reduce risk of SSI which include the use of negative pressure wound therapy devices. METHODS: We identified all post-cesarean delivery and post-hysterectomy SSI cases as per infection control criteria at the University of Florida between January 1 and December 31, 2017. We developed a SSI risk assessment tool based on based on review of these cases using a defect analysis tool, literature review of SSI risk factors and surgical risk calculators. RESULTS: There were 21 OBGYN surgical site infections in 2017. Of these infections, 14 occurred after cesarean delivery and 7 after hysterectomy for a rate of 1.56 and 2.46 respectively. The mean BMI was 41.3 and 39.27 for cesarean delivery and hysterectomy, respectively. Only, 33% of cases were scheduled surgery with the remaining classified as non-scheduled urgent or emergent cases. CONCLUSION: An EPIC “smartphrase” was created in our electronic medical record system to help identify patients at increased risk for SSI. Use of this smartphrase should prompt surgeons to consider additional wound infection prophylaxis such as the use of a negative pressure would therapy device. Future direction would include whether or not the use of such a smartphrase increases the use of additional wound infection protective strategies and reduced SSI risk.

OBJECTIVES:Robotic sacrocolpopexy for pelvic organ prolapse (POP) has increased, along with marketing and media coverage. It is unknown whether this exposure influences patients' opinions on POP repair. This study describes the preference for and knowledge of robotic surgery in women with POP. METHODS:We performed a cross-sectional survey of new patients presenting with POP at 7 academic sites. Subjects had no prior surgical counseling. A self-administered questionnaire was designed to investigate robotic surgery knowledge, preference, and exposure. Subjects expressed their preferred route of POP repair (robotic, vaginal, abdominal, laparoscopic, or no preference). Knowledge was determined by the number of correctly answered questions (range, 0-7). Perception of robotic surgery was compared with other surgical routes. RESULTS:One hundred seventy-six subjects were included. Most had no surgical preference (66.3%), whereas 27.3% preferred nonrobotic and 6.4% preferred robotic routes. The mean knowledge score was 2.3 (SD, 1.7). Women preferring robotic surgery were more likely to view it as faster than laparoscopic surgery (P < 0.001). These same subjects did not perceive any advantages for robotic surgery related to blood loss, pain, and organ injury (P > 0.05). Most reported no prior exposure to robotic surgery information (56.2%) or advertisements (65.2%). Those with prior exposure most frequently obtained information via the Internet and encountered hospital advertisements. CONCLUSIONS:The majority of women with POP reported no preference for robotic approach to POP surgery. Knowledge about robotic surgery was low, even among subjects who expressed preference. Comprehensive counseling may help patients make informed decisions even when surgical preferences exist.