You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20112083 SIZE OF UROGENITAL HIATUS AND LEVATOR CONTRACTION STRENGTH AS RISK FACTOR FOR VOIDING DYSFUNCTION FOLLOWING SURGICAL CORRECTION OF PELVIC ORGAN PROLAPSE Mohamed Ghafar, Cruz Velasco, Thomas Nolan, Ralph Chesson, Ahmet Bedestani, and J. Christian Winters Mohamed GhafarMohamed Ghafar New Orleans, LA More articles by this author , Cruz VelascoCruz Velasco New Orleans, LA More articles by this author , Thomas NolanThomas Nolan New Orleans, LA More articles by this author , Ralph ChessonRalph Chesson New Orleans, LA More articles by this author , Ahmet BedestaniAhmet Bedestani New Orleans, LA More articles by this author , and J. Christian WintersJ. Christian Winters New Orleans, LA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2378AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The objective of our study was to correlate size of urogenital hiatus and levator ani contraction strength with early postoperative voiding dysfunction and to determine whether early postoperative voiding dysfunction can be predicted prior to anti-incontinence procedures and pelvic organ prolapse (POP) repair. METHODS Retrospective chart review of 225 patients after surgery for POP and or stress urinary incontinence was conducted. Prolapse and size of urogenital hiatus (GH) was evaluated by using the Pelvic Organ Prolapse Quantification (POP-Q), Levator contraction strength was recorded using the oxford 0–5 classification scale. Patients were stratified into groups based on levator contraction strength. Voiding dysfunction was defined as residual of > 100 ml that required discharge home with intermittent catheter or further period of catheterization. Potential predictors of voiding dysfunction stratified by pelvic strength (PS) were assessed with Chi-square test. Univariate and multivariate logistic regression analysis to assess association with voiding dysfunction was performed. RESULTS Descriptive statistics on the whole sample and then broken down by categories of pelvic strength(0–1) vs (2–5) showed that mean/ median age, PVR, and GH varies significantly with pelvic strength. (P=0.0001), (P=0.002), and (0.009). Univariate logistic regression analysis showed there is a significant association between GH, pelvic strength and or voiding mechanism (normal vs. abdominal straining) evaluated by urodynamics (P=0.002), (P=0.0001) and (P=0.002) with post-operative voiding dysfunction. Also patients with pelvic strength score of 0–1 compared to those with score of 2–5, were 14 times as likely as likely to have dysfunction (P=<0.0001). Multivariate logistic regression analysis showed that pelvic strength and PVR were a significant predictors of voiding dysfunction (P=0.0001) and (P=0.0028). CONCLUSIONS Wide urogenital hiatus, diminished levator ani contraction strength, mechanism of voiding,and age, correlated with increased early postoperative voiding dysfunction. The most consistent factors associated with early voiding dysfunction were levator contraction strength and PVR. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e833 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Ghafar New Orleans, LA More articles by this author Cruz Velasco New Orleans, LA More articles by this author Thomas Nolan New Orleans, LA More articles by this author Ralph Chesson New Orleans, LA More articles by this author Ahmet Bedestani New Orleans, LA More articles by this author J. Christian Winters New Orleans, LA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Introduction and hypothesis The objective of this study is to define the diagnosis of hypertrophic cervical elongation clinically and to perform histochemical and histological evaluations of patients with and without hypertrophic cervical elongation. Methods This prospective study was conducted at Louisiana State University between December 2005 and May 2008. Fourteen women with cervical elongation and 28 women without prolapse were studied. Results The amounts of elastin, collagen, and smooth muscle did not differ between study and control groups. Estrogen and progesterone receptor content in cervical elongation were elevated compared to the cervix of women without prolapse. Hypertrophic cervical elongation was defined as the difference between point C and point D of the Pelvic Organ Prolapse Quantification system greater than 8 cm. Conclusions Estrogen and progesterone receptor levels are greater in women with hypertrophic cervical elongation compared with a normal cervix.

OBJECTIVE:To estimate the incidence and location of injury to the urinary tract during hysterectomy for benign gynecologic disease.METHODS:This was a prospective clinical study in an academic environment performed at three sites. Diagnostic cystourethroscopy was performed on all patients after hysterectomy for benign disease.RESULTS:Eight hundred thirty-nine patients were enrolled. The incidence of urinary tract injury associated with hysterectomy for benign disease was 4.3% (39 of 839 cases). The rate of bladder injury was 2.9% (24 of 839 cases), and rate of ureteral injury was 1.8% (15 of 839 cases). There were three cases of simultaneous bladder and ureteral injuries, resulting in a cumulative injury rate of 4.3%. The injury detection rate using intraoperative diagnostic cystoscopy was 97.4% (817 of 839 cases). The most common site of injury to the ureter was at the junction of the ureter and the uterine artery in 80% (12 of 15 cases) of ureteral injuries. Transection and kinking injuries were the most frequent type of injury. There were 21 cases of subnormal dye efflux from the ureteral orifices, with no subsequent injury detected on further evaluation.CONCLUSION:Ureteral injury occurred most commonly at the level of the uterine artery, and transection and kinking injuries were most frequent. Diminished dye efflux from ureteral orifices was not associated with injury.LEVEL OF EVIDENCE:III.

This study aimed to document intraoperative and postoperative complications associated with the use of transvaginal polypropylene mesh in the repair of pelvic organ prolapse (POP).

BACKGROUND:After Hurricane Katrina, the 2 primary teaching sites for Louisiana State University Health Sciences Center in New Orleans were destroyed. In this study, we examine the measures the Louisiana State University Department of Obstetrics and Gynecology took to provide uninterrupted education for Obstetrics and Gynecology residents and the outcome of those measures.METHODS:Information was gathered from the program director's office and the Accreditation Council for Graduate Medical Education website. Resident turnover during the disaster and where residents trained before and after Katrina were tabulated. Council on Resident Education in Obstetrics and Gynecology scores, obstetric statistics, and American Board of Obstetrics and Gynecology pass rates before and after Katrina were analyzed for significant differences from year to year.RESULTS:After Katrina, all residents were shifted to other teaching sites in the state, and the program gained 2 additional private teaching sites. The department lost 10 residents in the year following Katrina and replaced them with 5 new residents for the next academic year. There was no significant difference in Council on Resident Education in Obstetrics and Gynecology scores for individual residents from 2004 to 2006, and the median score for the program has not changed significantly for the past 4 years. The only number that has changed is the number of cesarean sections performed by second-year residents, which decreased significantly from 2005-2006 to 2006-2007 but has stabilized over the last year. The classes of 2004-2006 had 100% pass rates on the written American Board of Obstetrics and Gynecology examination, with 1 failure in 2007.CONCLUSIONS:The Obstetrics and Gynecology program at Louisiana State University Health Sciences Center provided uninterrupted training for residents through cooperation with other Louisiana State University facilities and private institutions in the state. We saw a small decrease in the number of cesarean sections performed by our second-year residents 1 year after Katrina; however, the rest of the resident experience has remained stable.

The primary role of the obstetrician/gynecologist in the management of hypertension in the past was obstetrical-related hypertension. The role of the gynecologist in overall health care maintenance and disease prevention is expanding and the recognition and treatment of hypertension should be considered in this role. Hypertension is a primary cause of cardiovascular disease, which remains a significant cause of morbidity and mortality in women. More than 60 million persons in the United States have some degree of hypertension, with an incidence of 65% between the ages of 65 and 74 years. The contribution of hypertension to overall cardiovascular morbidity and mortality in women has been considered less important than in men, but this absence of data may be the result of gender bias. Cardiovascular disease is in many cases the manifestation of multiple risk factors including obesity, hyperlipidemia, hypertriglyceridemia, type 2 diabetes, and hyperinsulinemia. Hypertension continues as the most prevalent associated factor in cardiovascular disease and in many cases coexists with other risk factors. Hypertension awareness has resulted in the lowering of average blood pressure in the United States over the past several decades.

The increasing dependency of patient care activities on data acquired and accessed through computerized information systems assumes a prerequisite that staff responsible for using clinical data systems are skilled and confident in the use of computers. The Institute of Medicine’s (IOM) reports, To Err is Human: Building a Safer Health System, Crossing the Quality Chasm: A New Health System for the 21st Century, and Patient Safety: Achieving a New Standard for Care, have raised national awareness about medical errors and emphasized the dependency of patient safety and quality care delivery on the integration of computerized information systems into the clinical work environment. Healthcare organizations (HCOs) are increasingly budgeting capital and operating dollars to purchase and install information systems to support care and clinical decision making. If patient safety and quality care delivery are to a great extent contingent upon advanced information technology, a critical question is: Has healthcare developed the necessary capacities in its clinical workforce to reliably and efficiently use computerized information systems? A nurse’s work is highly dependent on the acquisition, utilization, and documentation of patient data in paper-based and computerized information systems. Nurses are major consumers of health information such as clinical guidelines, intervention protocols, and continuing education materials. The accessibility of this information relies increasingly on the use of electronic databases and the Internet. Computer literacy is requisite for effective nursing. Hobbs reports the current average age of nurses in clinical work settings is 33 years. The 2000 National Sample Survey of Registered Nurses (RNs) documents an established and continuing trend of an aging RN population, with fewer than one third (31.7%) of RNs in the United States currently under age 40. Only 9.1% of RNs were under age 30 in 2000. The statistics suggest that the

Anxiety and depression are two of the most common disorders women may expect to experience in a lifetime. Up to 2% may suffer from anxiety-related disorders,(35) while 25% may suffer from depression (48) Even though anxiety and depression are seen more often in women, obstetricians-gynecologists traditionally have not been trained in the diagnosis or treatment of these conditions. For example, two major textbooks in obstetrics fail to address these disorders.(13, 19) Pregnancy is a highly stressful time in a woman's life and is often associated with anxiety and depression. Fear of a deformed infant, pain in childbirth, and motherhood are common sources of anxiety that may ultimately lead to depression. Fortunately, most women do well with simple reassurance from their provider and family support. A small subset of symptomatic patients require psychotropic medications prior to conception, during the embryonic period, or initiation during the pregnancy.The purpose of this article is to review diagnostic criteria used in diagnosing anxiety and depressive disorders and to discuss available treatment options. Additionally, how pregnancy may affect these disorders is explored. A concern to all obstetricians is the potential and real risks to the developing fetus from pharmacologic treatments. What is known about the common medications used in treating these disorders is emphasized. From this information, the authors suggest guidelines to answer the following questions:Should psychotropic medications be discontinued prior to conception or as soon as pregnancy is diagnosed?If a potential teratogen was taken during pregnancy, what are the recommendations for screening the fetus for anomalies?What is the necessity of using a drug that is known or suspected to cause fetal anomalies?

Twenty-three young adult rhesus monkeys from China were evaluated for the presence ofHelicobacter pylori. GastricbodyandantralbiopsysamplesweretestedforH.pyloribyPCRanalysis,culture,rapidureasetesting, and histologic evaluation. Serologic testing to detect H. pylori immunoglobulin G (IgG) antibodies was performed by using a commercially available human-based enzyme-linked immunosorbent assay (ELISA) test and an ELISA test which utilized homologous H. pylori antigens and an anti-rhesus IgG conjugate. PCR analysiswithH.pylori-specific26-kDaproteinprimersdetectedH.pyloriin21ofthe23rhesusmonkeys(91%). Culture testing identified the organism in 12 of the 23 animals (52%). Rapid urease tests were positive for all animals. H. pylori was diagnosed by histological examination in 11 of 23 monkeys (48%). Of the 21 monkeys positive for H. pylori by PCR, only 3 (14%) had positive results by the commercial ELISA test, yielding a sensitivity of 14%, a specificity of 100%, and an accuracy of 22%. However, 19 of the 21 PCR-positive animals (90%) had positive results by the ELISA test with homologous rhesus H. pylori antigen and anti-monkey conjugate, with predicted index values greater than or equal to 0.7 considered positive and values between 0.5 and 0.7 considered equivocal. This test had a sensitivity of 90%, a specificity of 100%, and an accuracy of 91%. Therefore, the ELISA test with rhesus monkey origin components was more accurate for detecting infected animals than the human-based ELISA.

Anxiety and depression are common disorders that the obstetrician-gynecologist frequently encounters, and they often require consultation with mental health care professionals. Pregnancy offers an unusual challenge because many of the decisions made about the safety of certain drugs are educated guesses. Common sense dictates that no drug should be used unless a serious threat to the mother exists such as suicide. Preconceptional counseling and early referral to and from colleagues in mental health should help the obstetrician guide mother and fetus to a successful pregnancy outcome.

The purpose of this investigation was to evaluate the influence of full-time occupation on pregnancy outcome in a low-risk group of dependent wives of active-duty servicemen. Two hundred forty-five dependent wives worked full time (>37.5 h/week) and 1,021 dependent wives did not work during the pregnancy. All of the patients were cared for by the same group of physicians and nurse midwives over the 19-month study interval. The main outcomes measured included the route of delivery, 5-min Apgar scores, maternal transport to a tertiary care facility, preterm labor, preeclampsia/eclampsia, hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, intrauterine growth retardation, fetal demise, and abruptio placenta. Significantly more working women underwent operative vaginal delivery [odds ratio = 2.2, 95% confidence interval (CI) 1.2–4.2; P < 0.02], were transferred to a tertiary care facility (odds ratio = 2.9, 95% CI 1.3-6.4; P < 0.008) for preterm labor unresponsive to tocolytic therapy, and deli...