Female Pelvic Medicine and Reconstructive Surgery最新文献

{"title":"Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database","authors":"Jocelyn Stairs, V. Minassian, A. Clancy","doi":"10.1097/SPV.0000000000001146","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001146","url":null,"abstract":"Supplemental digital content is available in the text. Importance Overweight and obese women represent a growing share of pelvic floor reconstruction surgeons’ practices. Determining perioperative risk specific to this population is essential to inform decision making regarding operative approach in this population. Objective The aim of the study was to compare surgical complications among overweight and obese women undergoing apical compartment prolapse surgery by either minimally invasive abdominal or vaginal approach. Study Design The American College of Surgeons National Surgical Quality Improvement Database was used to identify overweight and obese patients (body mass index ≥ 25) undergoing either minimally invasive sacrocolpopexy (MISC) or vaginal vault suspension (VVS) in the form of a sacrospinous vault fixation or uterosacral ligament fixation for pelvic organ prolapse from 2012 to 2019. Odds ratios for surgical complications, readmission, and reoperation were estimated using multivariable logistic regression. Results Of 8,990 eligible patients, 5,851 underwent a VVS and 3,139 patients underwent MISC. There was a greater odds of any complication in the first 30 days following VVS (n = 608 [10.4%]) compared with MISC (n = 247 [7.9%]; odds ratio, 1.27; 95% confidence interval, 1.08–1.48) on multivariable analysis. Urinary tract infections (UTIs) were the most common complication and were more likely following VVS (112 (3.6%) versus 350 (6.0%), P < 0.001). When UTIs were excluded, there was no difference in complications between approaches (1.00; 95% CI, 0.82–1.22). There were no statistically significant odds of readmission, reoperation, or serious complications between approaches. Conclusions Vaginal vault suspension may be associated with a higher odds of any complication compared with MISC in overweight and obese women, but the rate of serious complications, readmission, and reoperation are low, and approaches were comparable when considering complications other than UTI.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"391 - 396"},"PeriodicalIF":1.6,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44924236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative and Maximal Intra-abdominal Pressure and Postpartum Pelvic Floor Outcomes in Primiparas Delivered Vaginally.","authors":"Janet M Shaw,&nbsp;Jing Zhou,&nbsp;Robert Hitchcock,&nbsp;Ingrid E Nygaard,&nbsp;Stefan Niederauer,&nbsp;Xiaoming Sheng","doi":"10.1097/SPV.0000000000001088","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001088","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore associations between relative and maximal intra-abdominal pressure (IAP) on pelvic floor outcomes in primiparas delivered vaginally.</p><p><strong>Methods: </strong>At 5-10 weeks and 1 year postpartum, we measured absolute IAP by vaginal sensor while participants lifted a weighted car seat (IAPLIFT) and performed isometric trunk flexion endurance (IAPTFE) and seated maximal strain (IAPSTRAIN). Primary outcomes, completed 1 year postpartum, included worse pelvic floor support (descent to or beyond the hymen) and positive symptom burden (bothersome symptoms in ≥2 of 6 domains on the Epidemiology of Prolapse and Incontinence Questionnaire). We calculated relative IAP (as absolute IAP/IAPSTRAIN).</p><p><strong>Results: </strong>Of 542 participants, 9.7% demonstrated worse support and 54.3% demonstrated symptom burden at 1 year postpartum. In multivariable analyses, absolute IAPLIFT and absolute IAPTFE at 5-10 weeks postpartum were not associated with worse support. As relative IAP at 5-10 weeks increased, the prevalence of worse support decreased (prevalence ratio [PR] of 0.77 [95% confidence intervals (CIs), 0.63-0.94] and PR of 0.79 [95% CI, 0.67-0.93]) per 10% increase for relative IAPLIFT and relative IAPTFE, respectively. This was largely due to IAPSTRAIN, which increased the prevalence of worse support (PR, 1.15 [95% CI, 1.06-1.25]) per 10 cm H2O increase. One year postpartum, only IAPSTRAIN increased the prevalence of worse support (PR, 1.11 [95% CI, 1.02-1.20]) per 10 cm H2O. Of all IAP measures at both time points, only absolute IAPLIFT at 1 year significantly increased the prevalence of symptom burden (PR, 1.11 [95% CI, 1.05-1.18]) per 10 cm H2O.</p><p><strong>Conclusions: </strong>This exploratory analysis suggests that postpartum IAPSTRAIN may increase the prevalence of worse support in primiparas delivered vaginally.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 2","pages":"96-103"},"PeriodicalIF":1.6,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9009595/pdf/nihms-1744705.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10596846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Pelvic Floor Physical Therapy Attendance Based on Referring Provider Specialty.","authors":"Morgan E Fullerton,&nbsp;Patricia J Mwesigwa,&nbsp;Megha D Tandel,&nbsp;Lorna Kwan,&nbsp;Tamara Grisales,&nbsp;Christopher M Tarnay","doi":"10.1097/SPV.0000000000001061","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001061","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine whether pelvic floor physical therapy (PFPT) attendance differs based on referring provider specialty and identify factors related to PFPT initiation and completion.</p><p><strong>Methods: </strong>This was an institutional review board-approved retrospective cohort study examining referrals from female pelvic medicine and reconstructive surgery (FPMRS) and non-FPMRS providers at a single academic medical center to affiliated PFPT clinics over a 12-month period. Demographics, referring specialty and diagnoses, prior treatment, and details regarding PFPT attendance were collected. Characteristics between FPMRS and non-FPMRS referrals were compared and multivariate logistic regression analyses were performed to identify factors associated with PFPT initiation and completion.</p><p><strong>Results: </strong>A total of 497 referrals were placed for PFPT. Compared with non-FPMRS referrals, FPMRS referrals were for patients who were older (54.7 years vs 35.6 years), and had higher parity; more were postmenopausal (56% vs 18%) and had Medicare insurance (22% vs 10%) (all P < 0.001). Most FPMRS referrals were for patients with urinary incontinence (69% vs 31%), whereas non-FPMRS referrals were for patients with pelvic pain (70% vs 27%) (both P < 0.0001). Pelvic floor physical therapy attendance was similar in both groups when comparing rates of initiation (47% vs 45%) and completion (13% vs 16%). In multivariate analysis, factors associated with initiation were age 65 years or older, additional therapy provided at referring visit, private insurance, Asian race, pregnant or postpartum at time of referral, and more than 1 referring diagnosis (all P < 0.05). No factors were associated with completion.</p><p><strong>Conclusions: </strong>Less than half of the patients referred to PFPT initiate therapy, and only 15% complete PFPT. The populations referred by FPMRS and non-FPMRS providers are different, but ultimately PFPT utilization is similar.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"28 1","pages":"57-63"},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169548/pdf/nihms-1673278.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10461213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design of a Randomized Controlled Trial of Percutaneous Posterior Tibial Nerve Stimulation for the Treatment of Refractory Fecal Incontinence in Women: The NeurOmodulaTion for Accidental Bowel Leakage Study.","authors":"Halina M Zyczynski,&nbsp;Lily A Arya,&nbsp;Emily S Lukacz,&nbsp;Holly E Richter,&nbsp;David D Rahn,&nbsp;Vivian W Sung,&nbsp;Anthony G Visco,&nbsp;Amanda Shaffer,&nbsp;J Eric Jelovsek,&nbsp;Rebecca Rogers,&nbsp;Donna Mazloomdoost,&nbsp;Marie G Gantz","doi":"10.1097/SPV.0000000000001050","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001050","url":null,"abstract":"<p><strong>Objectives: </strong>High-level evidence for second-line noninvasive treatments for fecal incontinence in women is limited. We present the rationale for and design of the NeuromOdulaTion for Accidental Bowel Leakage trial, a randomized controlled trial of percutaneous tibial nerve stimulation (PTNS) and validated sham stimulation in women with refractory accidental bowel leakage.</p><p><strong>Methods: </strong>The rationale and goals for a 2-part study with a run-in phase, use of a generic pulse generator for PTNS and sham stimulation, masking, participant inclusion, primary and secondary outcome measures, and adverse event collection are described. A superiority design will be used to compare change from baseline in St. Mark's score after 12 weekly stimulation sessions between PTNS and sham. Responders to initial treatment (PTNS or sham) will be assigned to scheduled or \"as needed\" intervention for up to 1 year. Secondary outcome measures include incontinence episodes and other bowel events recorded in a 14-day electronic bowel diary, general and condition-specific quality of life instruments, adaptive behavior, global impression of improvement, symptom control, and sexual function.</p><p><strong>Results: </strong>Sample size calculations determined that 165 participants (110 PTNS and 55 sham) would provide 90% power to detect greater than or equal to 4-point difference between PTNS and sham in change from baseline in St. Mark's score at 12 weeks.</p><p><strong>Conclusions: </strong>The methods for the NeuromOdulaTion for Accidental Bowel Leakage trial will provide high-level evidence of the effectiveness and optimal maintenance therapy schedule of a low-cost PTNS protocol in community-dwelling women seeking second-line intervention for refractory accidental bowel leakage.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"726-734"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567096/pdf/nihms-1701690.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38883680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery and Same-Day Discharge After Minimally Invasive Sacrocolpopexy.","authors":"Sarah Evans,&nbsp;Maggie McCarter,&nbsp;Obafunbi Abimbola,&nbsp;Erinn M Myers","doi":"10.1097/SPV.0000000000001043","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001043","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate whether an enhanced recovery after surgery (ERAS) protocol was associated with a higher rate of same-day discharge after robot-assisted or laparoscopic sacrocolpopexy and to describe the safety and feasibility of same-day discharge after these procedures.</p><p><strong>Methods: </strong>A historical control, retrospective cohort study of women undergoing minimally invasive sacrocolpopexy comparing rates of same-day discharge before and after implementation of an ERAS protocol was conducted. Secondary outcomes were obtained by comparing women discharged the same day with those discharged postoperative day ≥1, including postoperative complications and unplanned postoperative patient encounters within 30 days of surgery. Logistic regression was performed to control for potential confounders.</p><p><strong>Results: </strong>Of the 166 women identified (83 before ERAS implementation; 83 after ERAS implementation), 43 underwent same-day discharge versus 123 admitted overnight. The rate of same-day discharge increased 28 percentage points after ERAS implementation (12% vs 40%, P < 0.01). Compared with women admitted overnight, same-day discharge women had shorter procedures (154 vs 173 minutes, P = 0.01), spent longer time in the postanesthesia care unit (130 vs 106 minutes, P = 0.01), and were more likely to be discharged with a Foley catheter (58% vs 28%, P < 0.01). After multivariable logistic regression analysis, ERAS was associated with increased odds of same-day discharge (odds ratio, 4.91; 95% confidence interval, 2.17-11.09). There were no differences in unplanned postoperative patient contacts or postoperative complications within 30 days between same-day discharge and overnight admission groups.</p><p><strong>Conclusions: </strong>Implementation of an ERAS protocol for minimally invasive sacrocolpopexy was associated with a 3-fold increase in same-day discharge.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"740-745"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39184300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Effect of Fesoterodine on Physical Function Relevant to Fall Risk in Older Women With Overactive Bladder.","authors":"Christine M Chu,&nbsp;Heidi Harvie,&nbsp;Lily A Arya,&nbsp;Uduak U Andy","doi":"10.1097/SPV.0000000000001046","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001046","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to measure the effect of treatment with fesoterodine on physical function relevant to fall risk in older women with overactive bladder.</p><p><strong>Materials and methods: </strong>This was a prospective cohort study of women aged 65 years or older with overactive bladder. Urinary symptoms and physical function were measured at baseline and 8 weeks after treatment with fesoterodine. Physical activity and sedentary behavior were measured subjectively using questionnaires and objectively using an accelerometer. Physical function was measured using the Short Physical Performance Battery test.</p><p><strong>Results: </strong>We enrolled 75 women with a median age of 76 years. At baseline, bothersome urgency urinary incontinence and nocturia were reported by 55% and 81%, respectively. At baseline, participants were highly sedentary with a median of 2,118 steps daily. After treatment, urinary symptom severity and health-related quality of life subscale scores of the Overactive Bladder Questionnaire improved significantly (-22.3±24 and 17.5±19.7, respectively; P < 0.0001). The proportion of participants who self-reported a moderate-to-high level of physical activity increased from 27% to 35% after treatment (P = 0.86). However, daily steps decreased significantly (-420.2±949, P < 0.001), whereas daily sedentary time increased by 36.6±88 minutes (P < 0.001). There was no significant change in the Short Physical Performance Battery score (-0.3±2.3, P = 0.6).</p><p><strong>Conclusions: </strong>In older women with overactive bladder, short-term treatment with fesoterodine decreased objectively measured physical activity with no significant change in physical function. Treatment with anticholinergics may need to be supplemented with other therapies to address fall risk in older women with overactive bladder.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"759-765"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39646947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing Outpatient Pelvic Reconstructive Surgery in the Era of the COVID-19 Pandemic.","authors":"Alexander A Berger,&nbsp;Jasmine Tan-Kim,&nbsp;Shawn A Menefee","doi":"10.1097/SPV.0000000000001044","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001044","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic has created a significant strain on the medical system, creating resource scarcity. We sought to demonstrate the reduction in hospital room utilization after implementation of outpatient pelvic reconstructive surgery.</p><p><strong>Methods: </strong>We included all minimally invasive reconstructive surgical procedures in this retrospective cohort study within a large managed care organization of 4.5 million members (2008-2018). We queried the system-wide medical record for Current Procedural Terminology (CPT), International Classification of Diseases, Ninth Revision (ICD-9), and International Classification of Diseases, Tenth Revision (ICD-10) codes for all included procedures and patient perioperative data. Categorical variables were compared using χ2 test for categorical variables and the Kruskal-Wallis test for continuous variables.</p><p><strong>Results: </strong>Of the 13,445 patients undergoing pelvic reconstructive surgery, 5,506 were discharged the same day, whereas 7,939 were discharged the next day. Over the 10-year period, patients without hysterectomy had outpatient surgery rates increase from 31.2% to 76.4% (+45.2%), whereas those with hysterectomy increased from 3% to 56.4% (+53.4%). Hospital room utilization decreased by 45,200 room days/100,000 reconstructive procedures without hysterectomy and 53,400 room days/100,000 reconstructive procedures with hysterectomy. When compared to 2008, in 2018 after more widespread adoption of outpatient elective surgery, for the 738 patients undergoing surgery without hysterectomy, 334 less room days were used, whereas 335 less room days were used among the 640 patients who had a surgical procedure with hysterectomy.</p><p><strong>Conclusions: </strong>The implementation of outpatient pelvic reconstructive procedures leads to a significant reduction in hospital room utilization. Same-day discharge decreases hospital resource utilization, therefore improving hospital access, which may be essential for the delivery of routine care during times of resource scarcity such as the COVID-19 pandemic.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"735-739"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25422062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hematometra After Mesh Laparoscopic Sacrohysteropexy, a Rare Complication?","authors":"Kianoush Zarrindej,&nbsp;Matthew Izett-Kay,&nbsp;Simon Jackson,&nbsp;Natalia Price","doi":"10.1097/SPV.0000000000001107","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001107","url":null,"abstract":"L aparoscopic mesh sacrohysteropexy (LSH) is an increasingly popular surgical option for the management of uterine prolapse. For women in whom first-line conservative measures fail, it has evolved as an alternative to the vaginal hysterectomy with apical suspension, to date the preferred surgical approach. However, vaginal hysterectomy is known to be associated with a high risk of recurrent prolapse with reoperation rates as high as 30%, laparoscopic sacrohysteropexy offerswomen the additional option of uterine preservation. A mesh prosthesis is generally used for abdominal hysteropexy, following on from U.S. Food and Drug Administration approval in 2002 of mesh devices for prolapse. Such abdominal mesh-augmented approaches were adopted to try and address the issue of high rates of reoperation with native tissue repair. Although approaches to LSH continue to evolve as the field advances, the Oxford technique involves cervical encerclage. This theoretically reduces the risk of mesh avulsion from the cervix, but more importantly avoids the placement of mesh in direct contact with the vagina, in an attempt to avoid vaginal mesh extrusion. The role of mesh-augmented prolapse surgery has been subject to scrutiny and attention given the risk of mesh-associated complications, which are particularly high after transvaginal placement of mesh. The recent large multicenter randomized controlled trial, the Prolapse Surgery: Pragmatic Evaluation and Randomised Controlled Trials (PROSPECT) study, compared synthetic and biological graft-augmented prolapse repair against native tissue techniques. The study found no improvement in outcomes with regard to effectiveness or quality of life with the use of transvaginal mesh, however, 1 in 10 women had some form of mesh complication. This corroborates concerns raised by various independent governmental reports in the United Kingdom and elsewhere. Reports have highlighted complications, including mesh exposure or extrusion, vaginal bleeding or discharge, pain, dyspareunia, and bladder and bowel symptoms. There are also reports of neuromuscular sequelae, vaginal scarring, and shrinkage of the mesh implant. These findings highlight the need to critically appraise the risk of mesh-associated complications after all forms of mesh-augmented prolapse surgery. To date, there are limited publications detailing the complications that can occur after LSH. Our recent multicenter crosssectional study of 1,121 women who underwent LSH found an","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"e701-e704"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39417699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levator-Urethra Gap: Normative Data in a Nonpregnant Nulliparous Population.","authors":"W Thomas Gregory,&nbsp;Meagan Cramer,&nbsp;Amanda Holland,&nbsp;Emily Boniface","doi":"10.1097/SPV.0000000000001115","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001115","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to establish a normative range of the levator-urethra gap (LUG) measurement in nonpregnant, nulliparous women to be used as a standard against which assessments of injury or avulsion of the levator ani could be made.</p><p><strong>Methods: </strong>Nulliparous women in the Pacific Northwest who were planning pregnancy within the ensuing 12 months underwent high-resolution magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasonography. In the plane of minimal hiatal dimensions, the LUG was measured on both the right and left sides for 3 contiguous image slices.</p><p><strong>Results: </strong>One hundred thirty-five participants underwent examinations, of which 134 had evaluable MRIs and 70 had evaluable ultrasounds. Mean (SD) age was 30.8 (4.0) years, and mean (SD) body mass index was 25.9 (6.4). The majority of the participants self-identified as White (80%) and non-Hispanic (89%). The 99th percentile was no greater than 2.39 cm on any slice for either MRI or US-based measurements. In the MRI set, the lowest LUG values at which all 3 measurements on a side were found to have exceeded a putative threshold value (for injury) were 2.1 cm for the right side and 2.05 cm for the left side. The corresponding LUG values in the ultrasound set were 2.2 cm on the right and 2.25 cm on the left.</p><p><strong>Conclusions: </strong>The LUG threshold in 3 successive slices in the minimal hiatal dimension suggestive of levator ani injury could be as low as 2.1 cm when using MRI and 2.25 cm when using ultrasound in a similar population.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"e696-e700"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608732/pdf/nihms-1745923.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39425346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of a Multidisciplinary Female Chronic Pelvic Pain Program.","authors":"Lauren C Westbay,&nbsp;William Adams,&nbsp;Margaret Kistner,&nbsp;Cynthia Brincat,&nbsp;Larissa Bresler,&nbsp;Linda C Yang,&nbsp;Colleen M Fitzgerald","doi":"10.1097/SPV.0000000000001045","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001045","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to describe patient-reported longitudinal outcomes in a multidisciplinary female chronic pelvic pain (CPP) program.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study for women cared for in a tertiary, multidisciplinary, female (CPP) program between 2012 and 2017. Patient demographics were collected from electronic medical records. Patients completed the numerical rating scale for pain, Pain Disability Index (PDI), and Patient Global Impression of Improvement scale at each visit. Mixed-effects models were used to assess change in patient responses over time.</p><p><strong>Results: </strong>Patients (N = 317) with a mean age of 44.3 years (SD, 14.6) and median duration of symptoms of 3 years (interquartile range, 1.0-7.0) were assessed in this analysis. The primary diagnosis was pelvic floor myofascial pain (67%). On multivariable analysis, numerical rating scale scores decreased by -0.11 point [95% confidence interval (CI), -0.20 to -0.01] every 3 months (P = 0.03). On multivariable analysis, total PDI score decreased by -0.88 point (95% CI, -1.43 to -0.33) (P = 0.003), and PDI sexual subscores decreased by -0.29 point (95% CI, -0.44 to -0.14) (P < 0.001) every 3 months. A higher (worse) Patient Global Impression of Improvement score was associated with a higher (worse) PDI score at follow-up (odds ratio, 1.04; 95% CI, 1.01-1.07; P = 0.01).</p><p><strong>Conclusions: </strong>Patients in a multidisciplinary CPP program demonstrated improvement over time in pain disability that was associated with an overall global impression of improvement.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"753-758"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39010404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}