Female pelvic medicine & reconstructive surgery最新文献

{"title":"Risk Factors for Bladder Perforation at the Time of Retropubic Midurethral Sling Placement.","authors":"Viviana Casas-Puig,&nbsp;C Emi Bretschneider,&nbsp;Mark D Walters,&nbsp;Cecile A Ferrando","doi":"10.1097/SPV.0000000000001192","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001192","url":null,"abstract":"<p><strong>Importance: </strong>There is conflicting evidence regarding predictive factors for bladder perforation during retropubic midurethral sling (R-MUS) placement and lack of evidence to support adoption of techniques to minimize such injury.</p><p><strong>Objectives: </strong>The aims of the study were to describe the incidence of and factors associated with bladder perforation during R-MUS placement and to explore whether retropubic hydrodissection decreases the likelihood of perforation.</p><p><strong>Study design: </strong>This is a case-control study of women undergoing R-MUS placement from 2007 to 2017. Cases were identified by review of the operative reports for evidence of bladder perforation. Patients without bladder perforation were defined as controls and were matched to cases in a 3:1 ratio by surgeon, sling type, and surgery date.</p><p><strong>Results: </strong>A total of 1,187 patients underwent R-MUS placement. The incidence of bladder perforation was 8% (n = 92 patients); 276 controls were matched accordingly (N = 368). Patients with bladder perforations were more likely to have a body mass index (BMI) less than 30 (P = 0.004) and to have a diagnosis of endometriosis (P = 0.02). They were also more likely to have had previous hysterectomy (P = 0.03) and urethral bulking (P = 0.01). On logistic regression, bladder perforation remained associated with a BMI less than 30 (adjusted odds ratio, 2.22 [95% confidence interval, 1.30-3.80]) and endometriosis (adjusted odds ratio 2.90 [95% confidence interval, 1.15-7.01]). Retropubic hydrodissection was performed in 62% of the patients and was not associated with a lower risk of perforation (P = 0.86).</p><p><strong>Conclusions: </strong>The incidence of bladder perforation was 8%. The risk of this complication is higher in patients with a BMI less than 30 and/or endometriosis. Retropubic hydrodissection may not decrease the likelihood of this event.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"444-451"},"PeriodicalIF":1.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40407090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Midurethral Sling Revision or Removal by Its Timing With Prolapse Surgery.","authors":"Sarah Samuel Boyd,&nbsp;Jaime B Long,&nbsp;Edeanya Agbese,&nbsp;Douglas Leslie","doi":"10.1097/SPV.0000000000001138","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001138","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to evaluate incidence of midurethral sling removal/revision based on timing with surgery for pelvic organ prolapse.</p><p><strong>Methods: </strong>This was a retrospective cohort study of women who underwent midurethral sling placement in a claims-based database of women 65 years or older. Three groups were identified using the Current Procedural Terminology codes: (1) isolated sling, (2) concomitant sling, and (3) prolapse surgery and staged sling after prolapse surgery. In the staged group, placement of sling was identified within 18 months after index prolapse surgery. Fascial grafts were excluded. Sling removal/revision was identified across 3 years after sling surgery using Current Procedural Terminology code 57287. Rates of sling removal/revision were calculated by group. Comparisons were made using the χ2 test and analysis of variance. Cumulative incidence of removal/revision was evaluated using the Kaplan-Meier curves. Cox proportional hazards was performed to evaluate factors influencing removal/revision.</p><p><strong>Results: </strong>We identified 39,381 isolated MUSs, 25,389 concomitant, and 886 staged. The rate of sling removal/revision was 3.52%. Rates of removal/revision differed between groups (7% staged vs 3.94% concomitant vs 3.17% isolated sling, P < 0.001). Compared with the staged group, the rate of removal/revision was lower in the isolated sling group (relative risk, 0.4550; 95% confidence interval [CI], 0.358-0.568) and the concomitant group (relative risk, 0.5666; 95% CI, 0.4450-0.7287). After adjusting for patient characteristics, sling revision or removal remained significantly less in the isolated MUS (hazard ratio, 0.50; 95% CI, 0.39-0.65) and concomitant (odds ratio, 0.55; 95% CI, 0.43-0.71) groups.</p><p><strong>Conclusions: </strong>Sling removal/revision is higher when it is staged after prolapse surgery compared with isolated and concomitant placement. Future studies are needed to confirm these findings in a controlled population.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"379-384"},"PeriodicalIF":1.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39884247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Urinary Incontinence in Diabetic Patients Undergoing Pelvic Reconstructive Surgery.","authors":"Moiuri Siddique,&nbsp;Nancy E Ringel,&nbsp;K Lauren de Winter,&nbsp;Tara Marczak,&nbsp;Cassandra Kisby,&nbsp;Emily Rutledge,&nbsp;Alex Soriano,&nbsp;Parisa Samimi,&nbsp;Michelle Schroeder,&nbsp;Stephanie Handler,&nbsp;Jiling Chou,&nbsp;Robert E Gutman","doi":"10.1097/SPV.0000000000001137","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001137","url":null,"abstract":"<p><strong>Importance: </strong>Diabetes is an independent risk factor for urinary incontinence, and its impact on rates of postoperative incontinence after pelvic reconstructive surgery remains unexplored.</p><p><strong>Objective: </strong>The aim of the study was to compare the incidence of postoperative stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence in patients with diabetes mellitus undergoing surgery for pelvic organ prolapse (POP) with or without SUI surgery.</p><p><strong>Study design: </strong>This is a secondary analysis of a multicenter retrospective cohort study involving 10 diverse medical centers that identified a cohort of women with diabetes who had prolapse and/or anti-incontinence surgery. We compared rates of postoperative urinary incontinence among patients who had surgery for prolapse and incontinence versus surgery for prolapse only.</p><p><strong>Results: </strong>Three hundred five patients had surgery for prolapse and incontinence, 330 had surgery for prolapse only, and 189 had anti-incontinence surgery only. De novo UUI was higher among those who underwent surgery for POP and SUI compared with surgery for POP alone (26.4% vs 14.1%, P < 0.01). Rates of persistent SUI (21% vs 4.9%, P < 0.01) and mixed urinary incontinence (15.9% vs 2.7%, P < 0.01) were higher for those who underwent prolapse surgery alone versus prolapse and an incontinence procedure. No differences were seen in hemoglobin A1C levels between those who did and did not report postoperative UI.</p><p><strong>Conclusions: </strong>We found that postoperative de novo UUI rates were high among patients with diabetes after pelvic reconstructive surgery, with the incidence being significantly higher for those who had surgery for prolapse and incontinence compared with surgery for prolapse only.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"372-378"},"PeriodicalIF":1.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39883839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Performance of Apical Suspension at the Time of Surgery for Prolapse: Assessment of the Influence of the American Urogynecologic Society and American College of Obstetricians and Gynecologists Practice Bulletin.","authors":"Douglas Luchristt,&nbsp;Gregory Zemtsov,&nbsp;J Eric Jelovsek","doi":"10.1097/SPV.0000000000001136","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001136","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the association of publication of the American Urogynecologic Society (AUGS)/American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on pelvic organ prolapse and performance of an apical suspension at the time of surgery for pelvic organ prolapse.</p><p><strong>Methods: </strong>Surgical procedures performed with a primary diagnosis of uterovaginal or female genital prolapse, cystocele, or enterocele were isolated from the 2011 to 2019 American College of Surgeons National Surgical Quality Improvement Program Database. An autoregressive interrupted time series regression estimated the overall temporal trend in performance of an apical suspension and assessed for a change in trend associated with publication of the AUGS/ACOG Practice Bulletin in April 2017. A stratified analysis was also performed depending on performance of a concomitant hysterectomy, and sensitivity analysis was performed using only diagnoses of uterovaginal or vaginal vault prolapse.</p><p><strong>Results: </strong>There were 72,194 individuals identified; 83.4% had a diagnosis of uterovaginal or female genital prolapse, 15.2% cystocele and 1.4% enterocele. Only 36.6% of cases had an apical suspension. Prior to the practice bulletin publication, performance of an apical suspension grew at 0.19% per quarter (95% confidence interval [CI], 0.07-0.31), with a trend toward increased utilization (+0.12%; 95% CI, -0.06 to 0.30) after publication. The increase was greater among cases with a concomitant hysterectomy (+0.35%; 95% CI, 0.08-0.62). Sensitivity analyses found similar changes in trend.</p><p><strong>Conclusions: </strong>Performance of apical suspensions during surgery for prolapse remains low and is increasing at less than 1% per year. The AUGS/ACOG practice guidelines were associated with minimal changes in this pattern. Incentives or other strategies may be needed to further encourage standard of care management of prolapse.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"367-371"},"PeriodicalIF":1.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39883837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic Organ Prolapse Takes Up Space in the Bedroom: A Mixed Method Exploration of the Circular Sexual Response Cycle in Women With Pelvic Organ Prolapse.","authors":"Fatima I Shah,&nbsp;Kaylee Ramage,&nbsp;Natalie V Scime,&nbsp;Erin A Brennand,&nbsp;Lauren M Walker","doi":"10.1097/SPV.0000000000001123","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001123","url":null,"abstract":"<p><strong>Objective: </strong>Pelvic organ prolapse (POP) is a multidimensional reproductive health issue, which negatively affects women's sexual well-being. Using the circular sexual response cycle as a framework, we sought to evaluate women's sexual experiences living with POP.</p><p><strong>Methods: </strong>Measures of genital self-image, sexual distress, sexual satisfaction, and sexual function were administered before conducting semistructured interviews. Participants were 16 heterosexual partnered women seeking surgical and nonsurgical treatment for symptomatic POP.</p><p><strong>Results: </strong>Standardized questionnaires indicated normal genital self-image, sexual satisfaction, and sexual function; however, sexual distress scores exceeded normal cutoffs. Eight themes emerged, including reasons for having sex, willingness to initiate and sexual receptivity, contextual factors, sexual stimuli, sexual arousal, responsive desire, outcomes, and spontaneous sexual desire. In contrast to quantitative findings, themes demonstrated sexual difficulty. Women with POP mainly engage in sex out of obligation and report reduced sexual initiation and receptiveness, as well as a negative impact on genital self-image. Pelvic organ prolapse was perceived to adversely affect subjective arousal, responsive desire, and spontaneous desire, despite intact physiological arousal. Difficulty experiencing subjective arousal was profound and seemed to be limited by preoccupation with POP. Sexual satisfaction and rewards were diminished after POP, including orgasmic capacity. Rewarding motivators to engage in sex were seldom discussed and often overshadowed by experiencing guilt and obligation related to sex.</p><p><strong>Conclusions: </strong>The circular sexual response cycle largely fit participants' experiences; however, POP inhibits subjective arousal, which prevents responsive desire for many. Patients may need better support to cope with preoccupation with POP, indicating that addressing the psychosocial symptoms of POP should be prioritized.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"315-320"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39723662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Patient Recall of Planned Intervention After Surgical Counseling: The IRIS Randomized Controlled Trial.","authors":"Sofiya Chernyak,&nbsp;Ricardo Caraballo,&nbsp;Stephanie Chiu,&nbsp;Charbel Salamon","doi":"10.1097/SPV.0000000000001102","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001102","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to determine whether an easy-to-read patient education card given at the preoperative visit can increase patient recall of the planned surgery.</p><p><strong>Methods: </strong>This was a randomized controlled trial. Patients scheduled to undergo pelvic reconstructive surgery were recruited during their preoperative visits. All participants received standard surgical counseling, whereas the intervention group also received a 4 × 6 inch card highlighting the anticipated procedure. The primary outcome was correct recall of the planned surgery as measured by a preoperative questionnaire. Secondary outcomes were correct recall of the surgery postoperatively and patient satisfaction with the information provided.</p><p><strong>Results: </strong>One hundred twenty-eight patients were enrolled with 64 participants in each arm. One hundred twenty-seven participants were analyzed because 1 patient was lost to follow-up. No difference was found between patient demographics, including types of surgical procedures performed. There was a statistically significant improvement in preoperative recall: 30 of 63 participants (47.6%) in the intervention group answered all questions correctly versus 18 of 64 patients (28.6%) patients in the standard counseling group (P = 0.021). There was no difference in the postoperative scores between the 2 groups: 48.3% (28 of 58) and 52.5% (32 of 61) of the participants answered all questions correctly in the intervention and standard counseling only groups, respectively (P = 0.648). There was no difference in satisfaction scores, with a median score of 20 out of 20 for either group (interquartile range = 19-20).</p><p><strong>Conclusions: </strong>A concise and easy-to-use education card enhanced patient preoperative recall of the proposed surgery. This difference was not sustained postoperatively. High satisfaction with the information provided was reported regardless of counseling method.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"280-286"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39425874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of Cellular Senescence in Rat Vaginal Fibroblasts and Treatment With Senolytics: An in Vitro Model for the Study of Pelvic Organ Prolapse.","authors":"Maria E Florian-Rodriguez,&nbsp;Adam M Hare,&nbsp;Neha G Gaddam,&nbsp;Haolin Shi,&nbsp;Patrick Keller,&nbsp;Ruth Ann Word","doi":"10.1097/SPV.0000000000001131","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001131","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to develop an in vitro model of cellular senescence using rat vaginal fibroblasts and determine the effects of treatment with senolytics.</p><p><strong>Methods: </strong>Rat vaginal tissue biopsies were collected. Primary vaginal fibroblasts were isolated and characterized by immunofluorescence. To induce cellular senescence, fibroblasts were treated with etoposide at 3, 10, and 20 mM for 24 hours, followed by treatment with the senolytics dasatinib (1 mM) and/or quercetin (20 mM). After treatment, RNA was extracted and the expression of selected genes was quantified. Immunostaining of senescence markers was also performed.</p><p><strong>Results: </strong>Fibroblasts were confirmed by positive immunostaining for α-smooth muscle actin and vimentin, and negative immunostaining for pan-cytokeratin. Treatment with etoposide resulted in a dose-dependent increase in expression of the senescence-associated secretory phenotype markers MMP-7, MMP-9, and IL-b1 (P < 0.05) compared with controls. Immunostaining showed increased expression of γ-H2A and p21 after treatment with etoposide. Cells treated with dasatinib and quercetin after etoposide treatment had decreased expression of p21, MMP-7, MMP-9, and IL-1b compared with cells treated only with etoposide (P < 0.05).</p><p><strong>Conclusions: </strong>Upregulation of senescence-associated factors provided evidence that senescence can be induced in vaginal fibroblasts in vitro. Furthermore, treatment with the senolytics dasatinib and quercetin abrogated the senescence phenotype induced by etoposide in rat vaginal fibroblasts. Our findings provide a novel model for the study and development of new therapies targeting the disordered extracellular matrix associated with pelvic organ prolapse.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"341-345"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39820901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Complications and Hospital Costs in Robot-Assisted Versus Conventional Laparoscopic Hysterectomy With Concurrent Sacrocolpopexy: Analysis of the Nationwide Readmissions Database.","authors":"Sarah E Andiman,&nbsp;Anthony H Bui,&nbsp;Charles Ascher-Walsh,&nbsp;Jason D Wright,&nbsp;Xiao Xu","doi":"10.1097/SPV.0000000000001133","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001133","url":null,"abstract":"<p><strong>Objectives: </strong>Despite increasing use of robotic technology for minimally invasive hysterectomy with sacrocolpopexy, evidence supporting the benefits of these costly procedures remains inconclusive. This study aimed to compare differences in perioperative complications, 30-day readmissions, and costs between robot-assisted and conventional laparoscopic hysterectomy with concurrent sacrocolpopexy using a large national database.</p><p><strong>Methods: </strong>Using the 2009-2015 Nationwide Readmissions Database and procedure codes, we identified patients who underwent a robot-assisted or conventional laparoscopic hysterectomy with sacrocolpopexy. We measured in-hospital perioperative complications using diagnosis and procedure codes and measured 30-day readmissions based on patient linkages across hospitalizations. Hospital costs were estimated using charges and cost-to-charge ratios. These outcomes were compared between robot-assisted and conventional laparoscopic procedures using bivariate and multivariable regression analysis.</p><p><strong>Results: </strong>Our weighted sample included a total of 7,675 patients. Major perioperative complications occurred in 6.7% of robot-assisted and 11.2% of conventional laparoscopic procedures (unadjusted P < 0.001; adjusted odds ratio, 0.69; 95% confidence interval, 0.51-0.93; P = 0.02). Hospital costs were higher in robot-assisted than in conventional laparoscopic procedures (respective median costs, $16,367 vs $13,898; P < 0.001), with an adjusted cost ratio of 1.24 (95% confidence interval, 1.17-1.31; P < 0.001). The risk of 30-day readmission was similar between robot-assisted and conventional laparoscopic procedures.</p><p><strong>Conclusions: </strong>Nationally representative data suggest that, in laparoscopic hysterectomy with sacrocolpopexy, the robot-assisted approach is associated with a lower risk of perioperative complications, despite higher costs, compared with the conventional one. The risk of 30-day readmission was similar between the robot-assisted and conventional laparoscopic approaches.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"e142-e148"},"PeriodicalIF":1.6,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39883838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Focused Websites Related to Postpartum Pelvic Floor Health: A DISCERN Quality Analysis.","authors":"Deepali Maheshwari,&nbsp;Christina Kunycky,&nbsp;Xibei Jia,&nbsp;Abhilasha Tangada,&nbsp;Katherine Leung,&nbsp;Ellen R Solomon","doi":"10.1097/SPV.0000000000001101","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001101","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to evaluate the quality of patient-focused websites addressing postpartum pelvic floor health.</p><p><strong>Methods: </strong>The Google search engine was used to perform a search of the following 3 terms: (1) \"postpartum pelvic floor (PPF),\" (2) \"postpartum leaking urine (PLU),\" and (3) \"postpartum leaking stool (PLS).\" The top 20 results from each search term were evaluated using the DISCERN quality appraisal tool and Journal of the American Medical Association (JAMA) benchmark criteria by 2 independent researchers. Websites were also categorized by type. Cohen κ was performed to determine interrater reliability between reviewers. The Kruskal-Wallis test was used to evaluate the differences in DISCERN and JAMA criteria scores.</p><p><strong>Results: </strong>The weighted mean κ between the investigators for each search term was κ = 0.47 (range = 0.163 [PPF] to 0.759 [PLU]), suggesting moderate agreement between reviewers. There was a significant difference in mean DISCERN scores between the terms, with \"postpartum leaking urine\" yielding the highest mean score. When comparing DISCERN scores by category, society- and government-sponsored websites (mean = 55 ± 13) scored significantly higher than other categories. Using JAMA criteria, mean scores ranged between 1.83 and 2.83/4, but there were no significant differences between websites.</p><p><strong>Conclusions: </strong>The overall quality of health information available on the internet regarding postpartum pelvic health is low. Higher-quality search results are found within society- and government-sponsored websites as well as under the search term \"postpartum leaking urine.\" It is important for health care providers to guide their patients to websites with reliable information about postpartum pelvic floor recovery.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"240-243"},"PeriodicalIF":1.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39501271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Uroflowmetry Curve Patterns and Nomogram Construct in Healthy Nulliparous Female Adults.","authors":"Danielle Lynn Taylor,&nbsp;Omar F Dueñas-Garcia,&nbsp;Deepali Maheshwari,&nbsp;Tania Sierra,&nbsp;Katherine Leung,&nbsp;Cynthia Hall,&nbsp;Michael Flynn","doi":"10.1097/SPV.0000000000001091","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001091","url":null,"abstract":"<p><strong>Objective: </strong>The aims of the study were to construct uroflowmetry nomograms, evaluate uroflowmetry flow rate patterns, and graphically illustrate overlaid uroflowmetry curves in nulliparous female adult volunteers.</p><p><strong>Methods: </strong>We performed a prospective cross-sectional study evaluating uroflowmetry curve and flow rate patterns on a cohort of nulliparous female adult volunteers. Primary outcome was construction of uroflowmetry maximum and average flow rate nomograms. Secondary outcomes included evaluation of uroflowmetry flow rate patterns and graphical illustrations of overlaid uroflowmetry curves. Uroflowmetry printouts were overlaid and used to create a model of uroflow patterns, and nomogram curves were analyzed in 5 groups based on voided volumes.</p><p><strong>Results: </strong>We enrolled 164 participants and 158 had voided volumes between 50 mL and 800 mL. Participants' mean age and body mass index were 25 years and 23, respectively. Maximum and average flow rate nomograms were created, and analysis of uroflow parameters was performed. Median voided volume was 241 mL (149-431 mL), the median maximum flow was 29 mL/s (20-38 mL/s), and the median average flow was 15 mL/s (10-19 mL/s). Participants were divided into 5 groups based on voided volumes. The nomogram patterns for each voided volume group were visually different from typical nomogram patterns.</p><p><strong>Conclusions: </strong>Uroflowmetry curves and flow rates vary significantly according to voided volume. Our study suggests that in normal healthy nulliparous female adults there is likely a broader range of normal flow rates and uroflowmetry curves than what has been previously reported. Further research is needed to investigate the accuracy of these finding.</p>","PeriodicalId":520625,"journal":{"name":"Female pelvic medicine & reconstructive surgery","volume":" ","pages":"220-224"},"PeriodicalIF":1.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39485291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}