To evaluate the efficacy of a digital conversational agent (CeCe) for the treatment of overactive bladder syndrome (OAB) This was a prospective observational trial utilizing a digital conversational agent developed by Renalis. Patients presenting to FPMRS between 10/2021 & 4/2022 & aged 30 years or older were recruited to participate if they had a chief complaint with OAB, defined a urinary urgency, with or without urgency incontinence (UUI), frequency & nocturia for > 6 months & have never been treated with third-line therapy were invited to participate. Patients with recurrent UTI, pelvic pain, symptomatic prolapse, hematuria, neurogenic bladder, a PVR>100 mL, & cognitive impairment preventing use of CeCe were excluded. The primary outcome was a decrease in the ICIQ-OAB-QoL score. Patients were asked to complete the ICIQ-OAB-QoL, SF-36 & GAD-7. Patients were then given access to CeCe which engaged with the patient about their symptoms. On day 3 patients began a 3-day voiding diary including: volume of intake, caffeine intake, daytime & nighttime frequency, & number of incontinence episodes. Then patients would engage with CeCe to via interactive learning modules about bladder health as well as guided urge suppression & bladder training techniques & pelvic floor exercise training. At 4 weeks a 1-day voiding diary was completed. At 8-weeks, the ICIQ-OAB-QoL, PGI-I, SF-36, GAD-7 & a 1-week diary were completed; additional patients completed the System Usability Scale (SUS). A power analysis determined that a total of 30 patients would be needed to demonstrate a significant difference in symptom scores after use of CeCe with 80% power & an alpha-error of 5%. A total of 57 patients were approached & 31 patients were enrolled, with 29 completing the all data collection. The median age was 62 years (IQR: 53-67), all patients were white, 62.1% were post-menopausal, 20.1% had a prior hysterectomy, & 3.0% had either a sling or prolapse repair in the past. Pre & post-treatment ICIQ-OAB-QoL scores were significantly different, (62 (IQR: 49-75) vs 32 (IQR: 24-43), p<0.001), as were GAD-7 scores (3 (IQR: 1-6) vs 0 (IQR:0-3), p=0.02), patients reported an increase in the general health domain of the SF-36, (75 (IQR: 60-85) vs 80 (IQR: 70-90), p=0.03). Patients also reported a decrease in frequency pre- & post-treatment, (7 (IQR:6-10) vs 5 (IQR:4-7), p=-.04), nocturia (2 (IQR:1-3) vs 1 (IQR:1-2), p=0.03), & UUI (2 (IQR: 1-5) vs 0 (IQR: 0-3), p=0.04). There was no difference in rates caffeine intake, fluid intake, or urine output between pre- & post-treatment evaluations. The median system usability score was 92.5 (IQR: 82.5-97.5), indicating excellent usability. The use of a digital conversational agent incorporating patient education, behavioral modifications, & bladder training effectively reduces symptoms severity & improves quality of life in patients with OAB.

To determine cost differences between laparoscopic and robotic sacrocolpopexy. Using the Premier healthcare database, we identified encounters for patients undergoing sacrocolpopexy (SCP) via CPT codes between 2010 and 2020. Patients were stratified into abdominal (A), laparoscopic (L), or robotic assisted (RA) approach. Patients were excluded if undergoing a concomitant procedure for cancer or non-gynecologic conditions. The primary outcome was the difference in cost to the hospital between groups. Patient costs included total cost for the hospital admission, and cost was also broken down into surgery specific codes. Costs were adjusted for inflation to 2020 dollar amounts using World Bank data. Secondary outcomes included differences in rates of short-term complications and risk factors for increased cost and complications. Comorbidities were identified by ICD-9 and 10 codes up to 12 months prior to the index procedure. Complications were identified using CPT, ICD-9, and ICD-10 codes up to 3 months following the procedure. Complications were grouped based on the Clavien-Dindo classification of surgical complications. Generalized additive mixed effects models (GAMMs) were used to analyze costs and complication rates. All models included a random hospital effect to account for between-hospital variability. 1,800 patients were identified in the A-SCP group, 13,596 in the L-SCP group, and 29,038 in the RA-SCP group. Demographics varied significantly between groups for age, race/ethnicity, Charlson Comorbidity Index, insurance type, hospital location, hospital size, and provider volume. Total charges were highest in the RA-SCP group compared to L-SCP and A-SCP (median $52,388.8 (IQR 38,071.7-72,178.6) vs $42,272.6 (IQR 29,057.9-59,800.9) vs $32,657.0 (IQR 22,515.2-48,678.1), p<0.001), as were surgery specific charges (median $48,341.8 (IQR 33,968.6-67,214.4) vs $38,283.6 (IQR 26,398.3-55,098.7) vs $26,248.3 (IQR 16,963.3-42,078.0), p <0.001). Factors that significantly increased total cost of SCP included: laparoscopic and robotic approach (coefficient 0.055, 95%CI 0.046-0.064 and 0.114, 95%CI 0.105-0.122, respectively), obesity (coefficient 0.013, 95%CI 0.009-0.017), and Charlson Comorbidity Index of 1-2 (coefficient 0.007, 95%CI 0.004-0.010). Risk of class 2 complications was lower for both L-SCP and RA-SCP compared to A-SCP (OR 0.56, 95%CI 0.40-0.79 and OR 0.45, 95%CI 0.32-0.62, respectively). Risk of class 3 complications was lower in the L-SCP compared to A-SCP but not the RA-SCP (OR 0.78, 95%CI 0.61-0.99 and 0.84, 95%CI 0.67-1.06, respectively). Risk of class 1 complications did not differ among groups. Both L-SCP and RA-SCP are associated with higher costs compared to A-SCP, RA-SCP more so than L-SCP. More severe short-term complications are more likely with A-SCP.

To examine predictors for health-care seeking behavior for postpartum sexual dysfunction (PPSD) within three years after delivery. Using the Qualtrics platform we administered electronic surveys to 540 women in Ohio, Pennsylvania, and Michigan evaluating the primary domains of female sexual function before and after birth; additional information collected included demographic characteristics, as well as pregnancy and post-partum related variables such as duration of peripartum complications and duration of breastfeeding. Respondents were stratified into controls, those who did not report sexual dysfunction, those with dysfunction seeking care, and those with dysfunction not seeking care. Chi-squared and multivariate logistic regression analyses were used to evaluate variables associated with seeking care for sexual dysfunction. 540 women responded to the survey in completion, with 449 (83.1%) reporting some form of PPSD. The most common reported symptom was decreased desire, 64.3%, followed by decreased arousal 56.3%, pelvic pain, 34.1%, and decreased orgasm, 25.5%. Out of these, 56.5% resumed sex within 3 months of birth, 33.9% resumed sex between 4-12 months, and 5.3% resumed sex between 12-24%. The remainder did not resume sex at the time of the survey. Only 72 (16.0%), sought care for sexual dysfunction. Multivariable regression variables associated with care seeking for PPSD were difficulty with perineal healing (aOR=4.53, 95%CI: 1.54-13.38), transfusion after delivery (aOR=3.71, 95%CI: 1.44-9.56), reporting decreased desire (aOR=8.52, 95%CI: 2.72-26.76), bothered by decreased desire (aOR=7.13, 95%CI: 2.65-19.12), current dyspareunia (aOR=3.41, 95%CI: 1.31-8.87), reporting medication or substance abuse as cause of decreased desire (aOR=7.95, 95%CI: 3.63-17.42). Factors associated with decreased probability of seeking care were number of kids under 18 years in the home (aOR=0.61, 95%CI: 0.43-0.88 per child), number of cesarean deliveries (aOR=0.46, 95%CI: 0.29-0.74, per delivery), lower decreased sexual desire index score (aOR=0.57, 95%CI: 0.42-0.78, per 1.0 unit increase). Predictors for health care seeking behaviors for sexual dysfunction after childbirth include not only degree of sexual dysfunction, but perceived bother of dysfunction. Identifiable variables were a difficult or complicated birthing experience. Though a majority of women experience new or worsening sexual dysfunction postpartum, few seek care. This study highlights the need for a more comprehensive and longer term approach to providing postpartum care that addresses sexual dysfunction beyond the traditional six week visit.

You have accessJournal of UrologyCME1 May 2022PD44-06 PUDENDAL BLOCK ANALGESIA WITH VAGINAL SURGERY: A RANDOMIZED, DOUBLE-BLIND, PLACEBO CONTROLLED TRIAL Emily Slopnick, Graham Chapman, David D. Sheyn, Sarah Sears, Megan Abrams, Kasey M. Roberts, Robert Pollard, and Jeffrey Mangel Emily SlopnickEmily Slopnick More articles by this author , Graham ChapmanGraham Chapman More articles by this author , David D. SheynDavid D. Sheyn More articles by this author , Sarah SearsSarah Sears More articles by this author , Megan AbramsMegan Abrams More articles by this author , Kasey M. RobertsKasey M. Roberts More articles by this author , Robert PollardRobert Pollard More articles by this author , and Jeffrey MangelJeffrey Mangel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002605.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Effective opioid-sparing postoperative analgesia often requires a multimodal approach, which may include regional nerve blocks. The objective of this randomized controlled trial is to determine whether a pudendal nerve block is associated with improved postoperative pain control and decreased opioid consumption compared to a sham injection at the time of vaginal pelvic reconstructive surgery (PRS). METHODS: In this randomized, double-blind, placebo controlled trial, we enrolled women undergoing benign vaginal PRS at a single academic institution. Exclusion criteria included patients with a diagnosis of chronic pelvic pain, inability to receive non-narcotic analgesia, or any concurrent abdominal procedure. Patients were randomized to receive a transvaginal pudendal nerve block (9mL 0.25% bupivacaine + 1mL 40mg/mL triamcinolone) or a sham injection (10mL normal saline) at the conclusion of surgery. The injection syringe was wrapped by pharmacy to blind the surgeon. Postoperatively, all patients received routine care. Primary endpoints were visual analog pain scores (VAS) and postoperative opioid requirement, measured in the post-anesthesia recovery unit (PACU) and on post-operative days (POD) 1 and 4. A power calculation determined 60 patients were required to show a mean difference of 20mm on a 100mm VAS. Opioid administration was standardized as morphine milligram equivalents (MME), and VAS scores were compared with Wilcoxon-Mann-Whitney analysis. RESULTS: We randomized 71 patients: 36 pudendal block and 35 sham injection. The study groups were well matched with no differences in baseline characteristics or type of surgery performed. Pelvic organ prolapse repairs were the most common procedures (n=63, 87.5%). There was no difference in anesthetic dose or operative time between groups. Pain scores were equivalent between groups in the PACU (mean VAS 53.1 block vs 56.4 sham, p=0.517) and on POD 4 (mean VAS 26.7 block vs 35.5 sham, p=0.131). On POD 1, the intervention group did report less pain than the sham group (mean VAS 29.2 vs 42.5, p=0.047). Patients who received a pudendal block took fewer opioid medications than those in the sham group at all time points, but this difference did not meet statistical significance (PACU 5 vs 7.8 MME, POD1 7.5 vs 11.25 MME, POD4 7.5 vs 21.25 MME, all p>0.05). CONCLUSIONS: Pudendal nerve block resulted in decreased pain reported in the immediate postoperative period and less opioid use, though not statistically significant. Pudendal block may be an additional tool for non-narcotic perioperative analgesia with vaginal PRS. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e710 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily Slopnick More articles by this author Graham Chapman More articles by this author David D. Sheyn More articles by this author Sarah Sears More articles by this author Megan Abrams More articles by this author Kasey M. Roberts More articles by this author Robert Pollard More articles by this author Jeffrey Mangel More articles by this author Expand All Advertisement PDF DownloadLoading ...