Female Pelvic Medicine and Reconstructive Surgery最新文献

{"title":"Joint Position Statement on Midurethral Slings for Stress Urinary Incontinence.","authors":"","doi":"10.1097/SPV.0000000000001096","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001096","url":null,"abstract":"T he purpose of this Position Statement by the American Urogynecologic Society (AUGS) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) is to support the use of the midurethral sling (MUS) for the surgical management of stress urinary incontinence (SUI). Developed in the 1990s, the MUS treats SUI in a minimally invasive, outpatient procedure. This technique uses a small mesh strip composed ofmonofilament polypropylene placed through the vagina under the midurethra and exiting from 2 small sites in either the suprapubic or groin area. They are often referred to as full-length slings to differentiate them from smaller single-incision slings or mini slings. This document refers to the full-length MUS. Stress urinary incontinence, defined as the involuntary urine leakage associated with coughing, sneezing, or other types of exertion, is prevalent, with 13.6% of women in the United States having had at least 1 surgical procedure for SUI in their lifetime, resulting in 260,000 continence surgical procedures annually. Stress urinary incontinence is often a bothersome and even debilitating condition that can substantially reduce a woman’s quality of life. Although nonsurgical treatments such as pelvic floor exercises and vaginal inserts (or pessaries) are helpful in alleviating symptoms in some women, many proceed with surgery, which is a more effective, durable treatment. In 2011, the U.S. Food and Drug Administration (FDA) issued a public health notification regarding adverse events associated with transvaginal mesh used to treat pelvic organ prolapse. In 2019, the FDA ordered the manufacturers of surgical mesh products indicated for the transvaginal repair of pelvic organ prolapse to stop selling and distributing their products in the United States. The media attention and litigation surrounding these FDA announcements have resulted in confusion between transvaginal mesh used to treat pelvic organ prolapse and the MUS used to treat SUI. This may have led to a negative perception of the MUS. In 2019, the FDA reaffirmed the findings of its safety panel and literature review stating that the safety and effectiveness of the full-length MUS is well established. The FDA has not recalled or published warnings against the full-length MUS.Most experts who dealwith female SUI are supportive of the use of theMUS and the majority of women who have had one placed are satisfied.","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"707-710"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39646943","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":"Effect of Enhanced Recovery Protocol on Opioid Use in Pelvic Organ Prolapse Surgery.","authors":"Allen A Mehr,&nbsp;Caroline Elmer-Lyon,&nbsp;Erin Maetzold,&nbsp;Catherine S Bradley,&nbsp;Joseph T Kowalski","doi":"10.1097/SPV.0000000000001114","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001114","url":null,"abstract":"<p><strong>Objectives: </strong>Our primary objective was to compare the total opioid use by patients undergoing apical pelvic organ prolapse surgery before and after implementation of an enhanced recovery protocol (ERP).</p><p><strong>Methods: </strong>Participants of this ambispective cohort study included a \"pre-ERP\" retrospective cohort and an \"ERP\" cohort of patients prospectively enrolled after the full implementation of the ERP in January 2019. Demographic and clinical data were collected from the electronic record. Descriptive statistics were used for demographic variables. Total opioid use was calculated for each participant using morphine milligram equivalents (MMEs) and compared between cohorts using the Student t test.</p><p><strong>Results: </strong>Study participants (n = 65) were similar between cohorts and had a mean (SD) age of 62.4 (9.7) years and body mass index of 28.9 (4.8), and had a median parity of 3 (interquartile range, 2-4). Comorbid conditions, assessed with the Charlson Comorbidity Index, were also similar, with a mean (SD) of 2 (2.9). Hysterectomy approach and apical procedures did not differ between groups. After ERP implementation, mean (SD) intraoperative and postoperative MMEs decreased significantly (59.4 [31.6] vs 36.9 [20.5], P < 0.01). Total MMEs prescribed at discharge also decreased (392.3 [88.4] vs 94.6 [61.3], P < 0.01). Total anesthesia time and surgical time were similar, whereas mean total admission time decreased (27.3 [10.8] vs 18 [8.6] hours, P < 0.01). Telephone calls within 30 days increased from mean 1 (1.0) to 2.2 (1.9) (P < 0.01), whereas clinic visits and 30-day readmissions did not differ.</p><p><strong>Conclusions: </strong>Women undergoing apical pelvic organ prolapse surgery at an academic medical center received significantly fewer opioids after implementation of an ERP without a change in postoperative pain scores.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"e705-e709"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8900056/pdf/nihms-1782839.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39646948","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":"Relationship of Pain Catastrophizing With Urinary Biomarkers in Women With Bladder Pain Syndrome.","authors":"Alex Soriano,&nbsp;Antoinette Allen,&nbsp;Anna P Malykhina,&nbsp;Uduak Andy,&nbsp;Heidi Harvie,&nbsp;Lily Arya","doi":"10.1097/SPV.0000000000001041","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001041","url":null,"abstract":"<p><strong>Objectives: </strong>Brain-derived neurotrophic factor (BDNF) has been implicated in central neurological processes. We hypothesize that greater pain catastrophizing is associated with higher urinary BDNF levels in women with bladder pain syndrome.</p><p><strong>Methods: </strong>A secondary analysis of a database of women with urinary urgency was conducted. We identified women who met AUA criteria of bladder pain syndrome. Urinary symptoms, pain catastrophizing, and neuropathic pain were measured using the Female Genitourinary Pain Index, Pain Catastrophizing Scale and painDETECT questionnaires respectively. The relationship of the catastrophizing score with urinary BDNF (primary outcome) and other urinary biomarkers, including nerve growth factor (NGF), vascular endothelial growth factor (VEGF), and osteopontin, was evaluated using univariable and multivariable analyses.</p><p><strong>Results: </strong>In 62 women with bladder pain syndrome, 15 (24%) reported pain catastrophizing symptoms (Pain Catastrophizing Scale score >30). Higher catastrophizing scores were associated with worse urinary symptoms, greater pelvic pain, greater neuropathic pain, and worse quality of life scores (all P < 0.01). On multivariable analysis, after controlling for age, body mass index and urinary symptoms, a higher pain catastrophizing score was associated with lower BDNF (P = 0.04) and lower VEGF levels (P = 0.03). Urinary urgency was associated with a higher NGF level (P = 0.04) while bladder pain was associated with higher levels of NGF (P = 0.03) and VEGF (P = 0.01).</p><p><strong>Conclusions: </strong>Neuroinflammatory mechanisms contribute to the central processing of pain in women with bladder pain syndrome. Worse urinary symptoms are associated with higher NGF and VEGF levels, but worse pain catastrophizing is associated with lower BDNF and VEGF levels. Urinary BDNF levels may be useful in phenotyping women who have central augmentation of pain processing.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"746-752"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8449794/pdf/nihms-1660463.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25533637","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":"Racial and Ethnic Disparities in Obliterative Procedures for the Treatment of Vaginal Prolapse.","authors":"William D Winkelman,&nbsp;Michele R Hacker,&nbsp;Malika Anand,&nbsp;Roger Lefevre,&nbsp;Monica L Richardson","doi":"10.1097/SPV.0000000000001116","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001116","url":null,"abstract":"<p><strong>Objectives: </strong>Although racial disparities are well documented for common gynecologic surgical procedures, few studies have assessed racial disparities in the surgical treatment of vaginal prolapse. This study aimed to compare the use of obliterative procedures for the treatment of vaginal prolapse across racial and ethnic groups.</p><p><strong>Study design: </strong>This is a retrospective cohort study of surgical cases from 2010 to 2018 from the American College of Surgeons National Surgical Quality Improvement Program, a nationally validated database. Cases were identified by Current Procedural Terminology codes. Modified Poisson regression was used to calculate risk ratios and 95% confidence intervals, adjusting for potential confounders selected a priori.</p><p><strong>Results: </strong>We identified 45,865 surgical cases, of which 10% involved an obliterative procedure. In the unadjusted model, non-Hispanic Asian and non-Hispanic Black patients were more likely to undergo an obliterative procedure compared with non-Hispanic White patients (risk ratio [95% confidence interval], 2.4 [2.1-2.7] and 1.2 [1.03-1.3], respectively). These relative risks were largely unchanged when controlling for age, body mass index, diabetes, American Society of Anesthesiologists classification, and concurrent hysterectomy.</p><p><strong>Conclusions: </strong>Although both obliterative and reconstructive procedures have their respective risks and benefits, the proportion of patients undergoing each procedure differs by race and ethnicity. It is unclear whether such disparities may be attributable to differences in preference or inequity in care.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"e710-e715"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812327/pdf/nihms-1745924.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39735785","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":"Reply: Hysterectomy Versus Hysteropexy at the Time of Native-Tissue Pelvic Organ Prolapse Repair: A Cost-Effectiveness Analysis.","authors":"Olivia H Chang,&nbsp;Jonathan P Shepherd,&nbsp;Beri M Ridgeway,&nbsp;Lauren A Cadish","doi":"10.1097/SPV.0000000000001117","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001117","url":null,"abstract":"","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"e716"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39735786","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":"Patient Preparedness for Pelvic Organ Prolapse Surgery: A Randomized Equivalence Trial of Preoperative Counseling.","authors":"Jessica C Sassani,&nbsp;Philip J Grosse,&nbsp;Lauren Kunkle,&nbsp;Lindsey Baranski,&nbsp;Mary F Ackenbom","doi":"10.1097/SPV.0000000000001049","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001049","url":null,"abstract":"<p><strong>Objective: </strong>Preoperative counseling can affect postoperative outcomes and satisfaction. We hypothesized that patient preparedness would be equivalent after preoperative counseling phone calls versus preoperative counseling office visits before prolapse surgery.</p><p><strong>Methods: </strong>This was an equivalence randomized controlled trial of women undergoing pelvic organ prolapse surgery. Participants were randomized to receive standardized counseling via a preoperative phone call or office visit. The primary outcome was patient preparedness measured on a 5-point Likert scale by the Patient Preparedness Questionnaire at the postoperative visit. A predetermined equivalence margin of 20% was used. Two 1-sided tests for equivalence were used for the primary outcome.</p><p><strong>Results: </strong>We randomized 120 women. The study was concluded early because of COVID-19 and subsequent surgery cancellations. There were 85 participants with primary outcome data (43 offices, 42 phones). Mean age was 62.0 years (±1.0) and 64 (75.3%) had stage III or stage IV prolapse. The primary outcome, patient preparedness measured at the postoperative visit, was equivalent between groups (office, n = 43 [97.7%]; phone, n = 42 [97.6%], P < 0.001). Most women reported they would have preferred a phone call (n = 66, 65.5%) with more women in the phone group expressing this preference than the office group (office 40.5% vs phone 90.5%, P < 0.001). Ultimately, nearly all women (96.5%) were satisfied with their method of counseling.</p><p><strong>Conclusions: </strong>Preoperative counseling phone calls were equivalent to office visits for patient preparedness for pelvic organ prolapse surgery. This study demonstrates patient acceptance of phone calls for preoperative counseling. Telehealth modalities should be considered as an option for preoperative patient counseling.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"719-725"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601145/pdf/nihms-1666443.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25533638","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":"Assessment of the Pelvic Floor and Associated Musculoskeletal System: Guide for Medical Practitioners.","authors":"Ingrid Harm-Ernandes,&nbsp;Valerie Boyle,&nbsp;Dee Hartmann,&nbsp;Colleen M Fitzgerald,&nbsp;Jerry L Lowder,&nbsp;Rhonda Kotarinos,&nbsp;Emily Whitcomb","doi":"10.1097/SPV.0000000000001121","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001121","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assist practitioners in performing an accurate assessment of the external and internal pelvic musculoskeletal (MSK) systems to improve appropriate diagnosis and referral of patients with pelvic floor disorders or pelvic pain and to improve understanding of physical therapy (PT) treatment principles, thereby improving communication between practitioners and encouraging a multidisciplinary approach.</p><p><strong>Methods: </strong>A referenced review of the anatomy of the pelvic floor muscles, pelvis, and surrounding structures, followed by a detailed assessment of anatomy, posture, and gait, is presented. A thorough description of PT assessment and treatment is included with clinical relevance.</p><p><strong>Results: </strong>When proper assessments are routinely performed, MSK conditions can be recognized, allowing for prompt and appropriate referrals to PT. Assessment and treatment by qualified physical therapists are integral to pelvic health care. After efficient medical assessment, MSK dysfunction can be addressed expeditiously, thereby avoiding further decline. Left unaddressed, pelvic dysfunction may become chronic.</p><p><strong>Conclusions: </strong>We propose a guide for MSK assessment of the pelvis and associated structures that can be used for both clinical and research purposes. This guide is designed for health care providers caring for women with pelvic floor disorders, including physicians, advanced practice providers, and nurses. This guide serves to improve communication among multidisciplinary practitioners to refine MSK assessment and treatment approaches and thereby advance clinical care and research.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 12","pages":"711-718"},"PeriodicalIF":1.6,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39646946","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":"Vaginal Electrical Stimulation for Postpartum Neuromuscular Recovery: A Randomized Clinical Trial.","authors":"Oluwateniola Brown,&nbsp;Bhumy Davé Heliker,&nbsp;Julia Geynisman-Tan,&nbsp;Meera Tavathia,&nbsp;Margaret G Mueller,&nbsp;Sarah Collins,&nbsp;Kimberly Kenton,&nbsp;Christina Lewicky-Gaupp","doi":"10.1097/SPV.0000000000001037","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001037","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare 3-month postpartum anal incontinence symptoms in women who sustain obstetric anal sphincter injuries and begin immediate vaginal electrical stimulation versus sham therapy.</p><p><strong>Methods: </strong>In this double-blind randomized controlled trial, women who sustained obstetric anal sphincter injuries were randomized to receive self-administered vaginal electrical stimulation using a commercial device or sham therapy with an identical device. Anal incontinence symptom severity was assessed at 1 week (baseline) and again at 13 weeks postpartum using the Fecal Incontinence Severity Index. The primary outcome was anal incontinence symptom severity measured by the total Fecal Incontinence Severity Index score at 13 weeks postpartum.</p><p><strong>Results: </strong>Between February 2016 and September 2018, 48 women completed a 13-week follow-up. At 13 weeks postpartum, median Fecal Incontinence Severity Index scores were higher (more severe) in the vaginal electrical stimulation group (12; interquartile range, 0-23) than in the sham group (4; interquartile range, 0-10) (P = 0.04). Unlike the vaginal electrical stimulation group, the improvement in Fecal Incontinence Severity Index scores in the sham group (vaginal electrical stimulation: 12 [interquartile range, 8-22] to 12 [interquartile range, 0-23] [P = 0.12] vs sham: 12 [interquartile range, 6-18] to 4.0 [interquartile range, 0-11] [P < 0.001]) met the threshold for clinical significance based on the minimum important difference of the Fecal Incontinence Severity Index.</p><p><strong>Conclusion: </strong>At 13 weeks postpartum, women who underwent postpartum vaginal electrical stimulation reported more anal incontinence symptoms compared with those receiving sham therapy. Vaginal electrical stimulation after obstetric anal sphincter injury was not beneficial in reducing anal incontinence symptoms and may impede recovery.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 11","pages":"659-666"},"PeriodicalIF":1.6,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39488202","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":"Validation of the Croatian Version of the 8-Item Overactive Bladder Questionnaire (OAB-V8).","authors":"Mislav Mikuš,&nbsp;Martina Ostroški,&nbsp;Petrana Beljan,&nbsp;Magdalena Karadža,&nbsp;Stipe Dumančić,&nbsp;Marina Šprem Goldštajn,&nbsp;Mario Ćorić,&nbsp;Držislav Kalafatić,&nbsp;Slavko Orešković","doi":"10.1097/SPV.0000000000001098","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001098","url":null,"abstract":"<p><strong>Objectives: </strong>The present study was conducted with the aim to translate, adapt, and validate the 8-item Overactive Bladder Questionnaire (OAB-V8) in Croatia.</p><p><strong>Methods: </strong>This study included a total of 58 female patients with OAB and 66 healthy women. The translation to Croatian followed standardized procedure. All eligible participants completed OAB-V8 at inclusion and 2 weeks after to assess test-retest reliability. Cronbach α coefficient was calculated to assess internal consistency.</p><p><strong>Results: </strong>Our study demonstrated high internal consistency for all items at both visits (Cronbach α between 0.799 and 0.847), with stable internal consistency reliability across items during the 2-week period. However, the exception is the item \"waking up at night to urinate,\" which significantly changed during the 2-week period. Intraclass correlation for OAB-V8 items ranged from 0.810 to 1.0, with Spearman correlations greater than 0.9 for all items (P < 0.01). There were strong significant correlations between frequency of urination during daytime and uncomfortable and sudden urge to urinate, and between nocturia and waking up at night. Discriminative validity showed statistically significant score differences between patients and the control group.</p><p><strong>Conclusions: </strong>The Croatian version of the OAB-V8 was successfully translated, adapted, and validated so the questionnaire is now ready for use as a reliable tool for initial screening and assessing patients with OAB in everyday Croatian clinical practice.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 11","pages":"e687-e690"},"PeriodicalIF":1.6,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39425347","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":"Postoperative Opioid Prescribing After Female Pelvic Medicine and Reconstructive Surgery.","authors":"Krista M L Reagan,&nbsp;Sarah H Boyles,&nbsp;Taylor J Brueseke,&nbsp;Brian J Linder,&nbsp;Marcella G Willis-Gray,&nbsp;Sara B Cichowski,&nbsp;Jaime B Long","doi":"10.1097/SPV.0000000000001113","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001113","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide female pelvic medicine and reconstructive surgery (FPMRS) providers with evidence-based guidance on opioid prescribing following surgery.</p><p><strong>Methods: </strong>A literature search of English language publications between January 1, 2000, and March 31, 2021, was conducted. Search terms identified reports on opioid prescribing, perioperative opioid use, and postoperative pain after FPMRS procedures. Publications were screened, those meeting inclusion criteria were reviewed, and data were abstracted. Data regarding the primary objective included the oral morphine milligram equivalents of opioid prescribed and used after discharge. Information meeting criteria for the secondary objectives was collected, and qualitative data synthesis was performed to generate evidence-based practice guidelines for prescription of opioids after FPMRS procedures.</p><p><strong>Results: </strong>A total of 6,028 unique abstracts were identified, 452 were screened, and 198 full-text articles were assessed for eligibility. Fifteen articles informed the primary outcome, and 32 informed secondary outcomes.</p><p><strong>Conclusions: </strong>For opioid-naive patients undergoing pelvic reconstructive surgery, we strongly recommend surgeons to provide no more than 15 tablets of opioids (roughly 112.5 morphine milligram equivalents) on hospital discharge. In cases where patients use no or little opioids in the hospital, patients may be safely discharged without postoperative opioids. Second, patient and surgical factors that may have an impact on opioid use should be assessed before surgery. Third, enhanced recovery pathways should be used to improve perioperative care, optimize pain control, and minimize opioid use. Fourth, systemic issues that lead to opioid overprescribing should be addressed. Female pelvic medicine and reconstructive surgery surgeons must aim to balance adequate postoperative pain control with individual and societal risks associated with excess opioid prescribing.</p>","PeriodicalId":48831,"journal":{"name":"Female Pelvic Medicine and Reconstructive Surgery","volume":"27 11","pages":"643-653"},"PeriodicalIF":1.6,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39533880","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}