Urogynecology (Hagerstown, Md.)最新文献

{"title":"Treatment Crossover Following Advanced Therapy for Overactive Bladder Syndrome.","authors":"Preston Edge, Lisa R Yanek, Danielle Patterson, Chi Chiung Grace Chen, Victoria L Handa","doi":"10.1097/SPV.0000000000001639","DOIUrl":"10.1097/SPV.0000000000001639","url":null,"abstract":"<p><strong>Importance: </strong>Patients deciding between advanced therapies for overactive bladder syndrome may be interested to know the likelihood of treatment crossover after sacral neuromodulation, intradetrusor OnabotulinumtoxinA, or percutaneous tibial nerve stimulation. Treatment crossover was defined as a switch from one advanced therapy to another.</p><p><strong>Objectives: </strong>The aim of this study was to estimate the rate of treatment crossover after each advanced therapy for nonneurogenic overactive bladder syndrome. Our secondary objective was to compare medication use after each advanced therapy.</p><p><strong>Study design: </strong>Using claims data from the MarketScan database, privately insured women 18-65 years old with overactive bladder syndrome were identified for this retrospective cohort study. For all patients who received an advanced therapy between 2013 and 2019, we calculated the proportion who subsequently crossed over to a different advanced treatment. For each advanced therapy, we also calculated the proportion who subsequently utilized overactive bladder medication.</p><p><strong>Results: </strong>We identified 7,231 adult women who underwent index advanced therapy for overactive bladder syndrome between 2013 and 2019. Treatment crossover occurred in 309 women (4.3%) and was significantly more likely following percutaneous tibial nerve stimulation (8.0%) compared to sacral neuromodulation (4.2%) or intradetrusor OnabotulinumtoxinA (2.6%, P < 0.01). Treatment crossover was also more likely following sacral neuromodulation compared to intradetrusor OnabotulinumtoxinA (P < 0.01). Medication use after advanced therapy was more common after percutaneous tibial nerve stimulation (29.2%) compared to intradetrusor OnabotulinumtoxinA (20.4%) or sacral neuromodulation (18.8%, P < 0.01).</p><p><strong>Conclusions: </strong>Treatment crossover following advanced therapy for overactive bladder syndrome was uncommon but was significantly more likely after percutaneous tibial nerve stimulation. Medication use following advanced treatment occurred in a substantial minority in all cohorts.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":"31 2","pages":"108-114"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017800","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 Recovery Among Patients With Chronic Pain Undergoing Pelvic Reconstructive Surgery.","authors":"Adrienne J Werth, Victoria Abalyan, Elena Tunitsky-Bitton, David O'Sullivan, Elisabeth Sappenfield","doi":"10.1097/SPV.0000000000001597","DOIUrl":"10.1097/SPV.0000000000001597","url":null,"abstract":"<p><strong>Importance: </strong>Limited data exist on postoperative recovery among patients with chronic pain undergoing pelvic reconstructive surgical procedures.</p><p><strong>Objective: </strong>The objective of this study was to evaluate if patients with versus without self-reported chronic pain experience different recovery after pelvic reconstructive surgery.</p><p><strong>Study design: </strong>From September 2022 to May 2023, this prospective cohort study enrolled patients with and without chronic pain, who were undergoing vaginal or laparoscopic procedures for pelvic organ prolapse. Preoperative pain was assessed using the Brief Pain Inventory (BPI) and Pepper Assessment Tool for Disability (PAT-D). Postoperative recovery was evaluated at 2, 4, and 12 weeks using the Postdischarge Surgical Recovery (PSR) scale, Global Surgical Recovery (GSR) index, and PAT-D questionnaire. The primary outcome was PSR scores at 4 weeks postoperatively.</p><p><strong>Results: </strong>Ninety patients were recruited, with 43 reporting chronic pain and 47 without. Demographics were similar. Patients with chronic pain had higher preoperative BPI and PAT-D scores. Perioperative outcomes and hospital stay were similar. Patients with chronic pain used more postoperative opioids in the hospital (27.0 ± 27.8 vs 24.3 ± 60.3 morphine milligram equivalents [MME]; P = 0.03) and at home (40.1 ± 54.7 vs 19.9 ± 39.0 MME; P = 0.03). The PSR scores at 4 weeks were not significantly different. No differences were observed in PSR or GSR scores at all time points. Patients with chronic pain had a higher PAT-D score at 12 weeks. Fewer chronic pain patients returned to work by 12 weeks and desired more time off work.</p><p><strong>Conclusions: </strong>Patients with and without chronic pain had similar surgical outcomes and recovery. However, chronic pain patients required more postoperative opioid pain medication and preferred more time off work.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"115-122"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607628","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":"Development and Validation of a Laparoscopic Sacrocolpopexy Training Model.","authors":"Heather M Winn, Elena Tunitsky-Bitton, Amanda O'Meara, Erinn M Myers, Brittany L Anderson-Montoya, Megan E Tarr","doi":"10.1097/SPV.0000000000001583","DOIUrl":"10.1097/SPV.0000000000001583","url":null,"abstract":"<p><strong>Importance: </strong>Proper training is necessary to develop the highly specialized skills required to safely perform laparoscopic sacrocolpopexy. Currently, there is no validated training model for laparoscopic sacrocolpopexy that includes dissection of the presacral space, both vaginal and presacral mesh attachments, and peritoneal closure.</p><p><strong>Objectives: </strong>This study aimed to create a procedure specific hierarchical task analysis for laparoscopic sacrocolpopexy and then develop and validate a corresponding laparoscopic sacrocolpopexy pelvic training model for the simulation environment.</p><p><strong>Study design: </strong>This was an observational simulation study that was divided into 5 phases: (1) development of hierarchical task analysis, (2) model construction, (3) participant recruitment and simulation testing, (4) reliability and validity testing, and (5) creation of a standard passing performance measure.</p><p><strong>Results: </strong>Construct, face, and content validity were established for this model. According to the participating experts, the model was able to replicate the steps of presacral dissection, anterior vaginal and sacral mesh attachment, and peritoneal closure. Thirteen trainees and 5 experts completed the simulation, and all \"agreed\" or \"strongly agreed\" that the model seemed useful for improving suturing technique and learning the procedure. Additionally, a passing performance measure was determined through contrasting groups methodology.</p><p><strong>Conclusions: </strong>We developed a novel, reusable, and validated training model that can be utilized as a training resource for the many critical skills necessary to safely and efficiently perform laparoscopic sacrocolpopexy.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"123-130"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482719","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":"Joint Terminology Report: Terminology Standardization for Female Bladder Pain Syndrome.","authors":"","doi":"10.1097/SPV.0000000000001591","DOIUrl":"10.1097/SPV.0000000000001591","url":null,"abstract":"<p><strong>Abstract: </strong>Female bladder pain syndrome (FBPS), previously known as interstitial cystitis/bladder pain syndrome, is a life-altering and morbid condition that occurs primarily in female patients and can be variable in presentation. Given the absence of pathognomonic symptoms and sensitive diagnostic tests, significant symptomatic overlap with numerous other pelvic conditions (such as pelvic floor tension myalgia or endometriosis) occurring in women makes diagnosis of FBPS challenging. The frequent co-occurrence of FBPS with other pain conditions and functional somatic syndromes further complicates diagnosis and management. The challenges have limited the progress made in understanding the pathophysiology of the condition and improving approaches to treatment and prevention. Improvement in standardization of the terminology used to describe this unique condition is needed to improve the accuracy of diagnosis and the clinical care for affected patients. Given the variability in presentation and the differing definitions for the condition world-wide, the American Urogynecologic Society and the International Urogynecologic Association convened a joint writing group to standardize terminology around common signs and symptoms of the condition and to clarify the diagnosis as it pertains to female patients with the condition. After careful consideration of a broad range of available data and clinical experiences, consensus opinion recommended adopting the term \"FBPS\" instead of the misleading \"interstitial cystitis\" to describe a chronic, intermittent condition of at least 3 months' duration affecting women involving symptoms of pain or discomfort localized to the bladder, often with bladder filling, which are not attributed to other pathology. This term will allow clinicians, researchers, and learners alike to standardize their understanding of FBPS.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"74-85"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924283","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":"Individual Factors in Young Female Athletes' Bladder Health (the Y-FAB Study).","authors":"Stacey Bennis, Cara Joyce, Elizabeth R Mueller, Colleen M Fitzgerald","doi":"10.1097/SPV.0000000000001576","DOIUrl":"10.1097/SPV.0000000000001576","url":null,"abstract":"<p><strong>Importance: </strong>Bladder health in high school and collegiate females is not well understood.</p><p><strong>Objective: </strong>The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes.</p><p><strong>Study design: </strong>English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake.</p><p><strong>Results: </strong>One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes ( P < 0.01) versus more stress fractures in athletes ( P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids ( P = 0.03).</p><p><strong>Conclusions: </strong>Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"91-100"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninferiority Randomized Clinical Trial: KIM Sling With Reusable Trocars Versus TVT Exact Sling.","authors":"Samantha L Margulies, Anna E Osment, Adele Bernard, Michelle N Schroeder, Amy L Askew, Ijeoma S Agu, Christina A Kunycky, Elizabeth J Geller, Marcella Willis-Gray, Christine M Chu, Jennifer M Wu","doi":"10.1097/SPV.0000000000001596","DOIUrl":"10.1097/SPV.0000000000001596","url":null,"abstract":"<p><strong>Importance: </strong>The Neomedic Knotless Incontinence Mesh (KIM) sling with sterilizable trocars decreases medical waste versus midurethral slings with disposable trocars. Limited comparative data exist.</p><p><strong>Objective: </strong>The aim of the study was to assess to the success of the retropubic KIM sling compared to the Gynecare TVT Exact sling.</p><p><strong>Study design: </strong>This was a single-center, randomized noninferiority trial comparing outcomes of 2 retropubic slings-KIM sling and TVT Exact sling-in women with stress urinary incontinence from August 2021 to May 2023. Primary outcome was subjective success at 6 weeks defined by a composite outcome of the response to the question #17 on the The Pelvic Floor Distress Inventory-20 questionnaire and no retreatment of stress urinary incontinence. Secondary outcomes included rates of urinary retention, mesh erosion, and reoperation for mesh complications. Sample size estimate based on noninferiority margin of 14%, equal success of 90%, alpha 0.05, and 80% power with a 20% dropout was 72 per group.</p><p><strong>Results: </strong>Among 147 patients, 74 (50.3%) were randomized to KIM sling versus 73 (49.7%) to TVT exact. The rates of 6-week success were 68.5% for the KIM sling and 83.3% for the TVT exact with a risk difference 14.8% (95% confidence interval, 1.1-28.5). The KIM sling is not noninferior to the TVT Exact sling. There were no differences in secondary outcomes.</p><p><strong>Conclusions: </strong>The KIM sling is not noninferior to the TVT Exact sling for success at 6 weeks based on a composite outcome score. This clinical trial is ongoing to assess outcomes at 6 months and 1 year. ( Clinicaltrials.gov NCT04985799).</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"101-107"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607623","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":"Resolution of Overactive Bladder Symptoms After Anterior and Apical Prolapse Repair.","authors":"Megan Abrams, Sarah Sears, Susan Wherley, Stephen Rhodes, Jeffrey Mangel, David Sheyn","doi":"10.1097/SPV.0000000000001502","DOIUrl":"10.1097/SPV.0000000000001502","url":null,"abstract":"<p><strong>Importance: </strong>Patients often present with both overactive bladder (OAB) and pelvic organ prolapse (POP) concerns. It is unknown whether treatment of POP improves OAB.</p><p><strong>Objective: </strong>This study aimed to evaluate whether OAB improves after anterior/apical POP repair for anterior wall prolapse.</p><p><strong>Study design: </strong>This was a prospective study of women with anterior/apical prolapse at or beyond the hymen and concomitant OAB symptoms, undergoing apical repair. Overactive bladder severity was evaluated with the Urogenital Distress Inventory-6 (UDI-6) questionnaire and the Incontinence Impact Questionnaire-7 preoperatively and 2, 6, 12, and 24 weeks postoperatively. The primary outcome was a reduction of ≥11 points or greater on the UDI-6 at 6 months. Those who reported an ≥11-point reduction were termed responders. Multivariable regression analyses were performed to evaluate factors associated with reduction in OAB symptoms after POP surgery.</p><p><strong>Results: </strong>A total of 117 patients met the criteria for analysis, with 79.5% reporting improved OAB symptoms after POP repair at 6 months. There were no preoperative differences between groups. The mean preoperative UDI-6 and Incontinence Impact Questionnaire-7 scores were higher in the responder group (51.1 ± 16.8 vs 26.4 ± 15.1 [ P < 0.001] and 44.6 ± 23.8 vs 22.8 ± 21.4 [ P = 0.001], respectively), and the presence of detrusor overactivity was lower (29.0% vs 54.2%, P = 0.02). After regression, a higher preoperative UDI-6 total was associated with an increased likelihood of symptom improvement at 6 months (adjusted odds ratio, 1.14 per point [1.08-1.19]), whereas detrusor overactivity on preoperative urodynamics was associated with a decreased likelihood of OAB symptom improvement (adjusted odds ratio, 0.10 [0.02-0.44]).</p><p><strong>Conclusion: </strong>Overactive bladder symptoms improve in the majority of patients undergoing apical repair for anterior/apical prolapse beyond the hymen.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"147-153"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289808","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":"Prevalence and Clinical Correlates of Endometriosis in Patients With IC/BPS.","authors":"Mary Namugosa, Amr El Haraki, Rory Ritts, Kaylee Ferrara, Gopal Badlani, Robert Evans, Stephen J Walker","doi":"10.1097/SPV.0000000000001589","DOIUrl":"10.1097/SPV.0000000000001589","url":null,"abstract":"<p><strong>Importance: </strong>Interstitial cystitis/bladder pain syndrome (IC/BPS) presents as a complex heterogeneous disorder that poses a significant clinical challenge both for diagnosis and treatment. The identification of patient subgroups with significant overlap in their nonurological associated symptoms, including endometriosis, may enable a more targeted therapeutic approach.</p><p><strong>Objective: </strong>This study investigated the prevalence, clinical correlates, and clinical sequelae associated with concurrent endometriosis in patients with IC/BPS.</p><p><strong>Study design: </strong>Demographic, clinical, surgical, and questionnaire data from female patients (n = 533) with a diagnosis of IC/BPS were evaluated in this retrospective cohort study. Surgical history was obtained from patient electronic medical records, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Data from participants with and without concurrent endometriosis were compared using univariate analysis, followed by binary logistic regression to identify associated variables.</p><p><strong>Results: </strong>Of 533 participants, 108 (20.3%) reported a history of endometriosis. Those with concurrent endometriosis were younger, had a larger bladder capacity, and had a higher number of nonurological associated symptoms. Patients with concurrent endometriosis were less likely to have a history of cystectomy (the surgical removal of the bladder) and report allergies but more prone to report comorbidities such as chronic pelvic pain, chronic fatigue, fibromyalgia, migraines, and pelvic floor dysfunction. Binary logistic regression identified a positive association between endometriosis and chronic pelvic pain, and a negative association between allergies and low bladder capacity for those with concurrent endometriosis.</p><p><strong>Conclusions: </strong>Endometriosis is common in younger female patients with IC/BPS and is associated with a non-bladder-centric (ie, systemic pain disorder) phenotype.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"131-138"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Mark Cuban Cost Plus Drug Company Effect on Urogynecologic Drugs.","authors":"Raymond Xu, Megan Escott, Amr Sherif El Haraki","doi":"10.1097/SPV.0000000000001653","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001653","url":null,"abstract":"<p><strong>Importance: </strong>The Mark Cuban Cost Plus Drug Company (ie, Cost Plus Drugs) is a service that makes generic drugs affordable. Cortese et al recently published the top 9 most commonly used oral medications in treatment of urologic conditions and showed that Cost Plus Drugs would have provided an estimated $1.29 billion reduction in 2020 costs if they replaced the Medicare prices.</p><p><strong>Objectives: </strong>We sought to investigate the savings for all drugs commonly used in urogynecology.</p><p><strong>Study design: </strong>We reviewed the generic drugs provided by Cost Plus Drugs and selected those commonly used for the treatment of urogynecologic conditions (N = 16). For each of the 16 drugs we identified the Cost Plus Drugs prices for the 30- and 90-count quantities. We then also calculated the 2021 Medicare spending for the 16 drugs. The potential savings were calculated as the difference between Cost Plus Drugs and Medicare 30- and 90-count prices, multiplied by the volume-adjusted number of units dispensed to Medicare beneficiaries in 2021.</p><p><strong>Results: </strong>The total estimated savings when using Cost Plus Drugs compared to Medicare was $462,375,491.53 and $618,833,850.34 for 30- and 90-count pricing, respectively. The price of a 42.5-gram tube of vaginal estrogen cream was $22.48 on Cost Plus Drugs, compared to $293.66 through Medicare Part D.</p><p><strong>Conclusions: </strong>Cost Plus Drugs is a novel program that has tremendous implications on costs savings in the context of prescription drugs and is particularly true for drugs used in the treatment of urogynecologic conditions, specifically vaginal estrogen.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048955","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":"Obstetric Anal Sphincter Injury: Vaginal Birth After Cesarean Versus First Vaginal Delivery.","authors":"Brigid S Mumford, Lara Lemon, John Harris, Lauren E Giugale","doi":"10.1097/SPV.0000000000001647","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001647","url":null,"abstract":"<p><strong>Importance: </strong>Modern data regarding the relationship between vaginal birth after cesarean (VBAC) and obstetric anal sphincter injury (OASI) are minimal with mixed results.</p><p><strong>Objective: </strong>The aim of the study was to determine if VBAC is associated with an increased risk of OASIs.</p><p><strong>Study design: </strong>This was a retrospective cohort study of liveborn deliveries from 2018 to 2022 within a large, multihospital academic health system. The primary outcome was the proportion of OASIs compared between patients who underwent a first vaginal delivery (primiparous vaginal delivery group) versus patients who underwent a first VBAC (VBAC group).</p><p><strong>Results: </strong>A total of 17,044 patients were included. A total of 16,208 had a primiparous vaginal delivery and 836 underwent VBAC. Vaginal birth after cesarean patients were older (29.9 vs 27.0 years, P < 0.01), more likely to self-identify as Black or Asian race (26.1% vs 18.0%, P < 0.01), and had lower maternal weight (182.7 vs 187.2 lbs, P < 0.01). The proportion of OASIs was significantly higher in the VBAC group (6.9% vs 5.1%, P = 0.02). Vacuum-assisted vaginal deliveries were more common in the VBAC group (7.7% vs 5.4%, P < 0.01).On multivariable logistic regression, VBAC was not significantly associated with OASIS (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.75-1.36, P = 0.95). Operative vaginal delivery (OR = 6.44, CI = 5.51-7.52, P < 0.01), older maternal age (OR = 1.05, CI = 1.03-1.07), and Asian race (OR 2.62, CI = 2.10-3.26) demonstrated increased odds of OASIs. Patients who identified as Black demonstrated lower odds of OASIs (OR = 0.68, CI = 0.50-0.93).</p><p><strong>Conclusions: </strong>While there was a greater proportion of OASIs in the VBAC group compared to the primiparous vaginal delivery group, VBAC was not an independent risk factor.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017665","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}