Urogynecology (Hagerstown, Md.)最新文献

{"title":"Vaginal Orthosis After Native Tissue Reconstructive Surgery: Design and Phase 0.","authors":"Max C Cadena, Christopher X Hong, Alexandra Blokker, Derek Sham, Holly E Richter","doi":"10.1097/SPV.0000000000001628","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001628","url":null,"abstract":"<p><strong>Importance: </strong>Pelvic organ prolapse recurrence following native tissue repair occurs with composite failure rates of 9-19% within 12 months, predominantly involving apical/anterior compartments. Objective The objective of this study was to develop a novel vaginal orthosis (NVO) device prototype through an iterative design process based on investigator and user feedback.</p><p><strong>Study design: </strong>The NVO was designed based on pelvic floor biomechanical principles to mitigate unopposed intra-abdominal pressure of the anterior vagina by absorbing and redirecting intra-abdominal forces to the levator ani and tailored to accommodate postoperative vaginal caliber and axis. Prototypes were fabricated by 3D-printing negative molds, cast, and cured with medical-grade biocompatible silicone. Ten healthy volunteers were recruited to provide qualitative feedback for iterative design refinement (phase 0).</p><p><strong>Results: </strong>Through an iterative engineering design process, initial concepts were refined to align with the natural, resting H-shape of the vagina. Key features included a distal self-retaining feature, posterior curvature, proximal taper, and apical/anterior contact areas for support. A more rigid material to withstand intra-abdominal forces without folding was required; therefore, Shore A60 (medium soft) instead of A40 (soft) silicone was used. Based on participant feedback, the NVO retaining feature width range was reduced (47.5-63 mm to 45-50 mm) to decrease pressure on lateral vaginal walls and levator ani distally maintaining self-retaining function. Updates to the fitting and education process also provided increased descriptive instructions for insertion and removal.</p><p><strong>Conclusions: </strong>A novel vaginal orthosis was designed specifically tailored to facilitate wound healing using an orthomedical model, improving the design through iterative feedback.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883773","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":"Residents' Exposure to Obstetric Anal Sphincter Injury: A 16-Year Temporal Trend.","authors":"Courtney K Pfeuti, Lindsay Gugerty, John A Occhino, Suneet P Chauhan","doi":"10.1097/SPV.0000000000001618","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001618","url":null,"abstract":"<p><strong>Importance: </strong>Exposure to the surgical management of obstetric anal sphincter injuries (OASIS) is limited during obstetrics training.</p><p><strong>Objectives: </strong>The objective of this study was to quantify residents' exposure to OASI repair during 4-year obstetrics and gynecology (OBGYN) residency and examine temporal trends over a 16-year period.</p><p><strong>Study design: </strong>This was a retrospective cohort study of residents' exposure to OASIS at a community academic hospital from 2007 to 2022. Individuals with documented OASIS (third- or fourth-degree laceration) by International Classification of Diseases, Ninth and Tenth Revisions, codes during vaginal delivery (VD), spontaneous vaginal delivery (SVD), or operative vaginal delivery (OVD), were included. Delivery rates and OBGYN resident positions were examined. Temporal trends in OASIS were analyzed in 4-year epoch to determine average resident exposure during OBGYN residency.</p><p><strong>Results: </strong>During the 16-year study period, there were 103,234 deliveries (62% VD, 4% OVD, 34% cesarean delivery). Among VDs, there were 2,344 (3.4%) OASIS with 88.5% classified as third-degree and 11.5% as fourth degree. The OASI rate decreased from 4.2% (2007-2010) to 2.9% (2019-2022), whereas OBGYN residents increased by 49% (67 to 99; P < 0.001). Average resident exposure to OASIS decreased from 11 (2007-2010) to 5 (2019-2022; P = 0.55). Subclassification revealed that residents were exposed to 5 third-degree repairs and less than 1 fourth-degree repair, on average, during 2019-2022.</p><p><strong>Conclusions: </strong>During 4 years of training, average resident exposure was to 7 OASIS, 6 third degree, and 1 fourth degree. Limited exposure to OASIS during residency may be detrimental, as surgical treatment is a complicated yet essential obstetric procedure that carries significant risk of patient morbidity and potential long-term sequelae. Therefore, reliance on supplementation with simulation may improve surgeon competence in OASI management.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883798","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":"Reasons for Missed Appointments.","authors":"Rachan Ghandour, Jeannine M Miranne, Julia Shen, Rachel Murphy, Mireya Taboada, Melissa Plummer, Steph Schatzman-Bone, Vatche A Minassian","doi":"10.1097/SPV.0000000000001646","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001646","url":null,"abstract":"<p><strong>Importance: </strong>Little is known about reasons behind missed appointments in subspecialty settings, particularly in urogynecology practices.</p><p><strong>Objective: </strong>The aim of the study was to understand patient-perceived barriers to appointment attendance at an academic urban multisite urogynecology practice.</p><p><strong>Study design: </strong>This was a prospective, qualitative study of patients who missed their appointments at a urogynecology practice from April to September 2023. Patients were invited to participate in semistructured interviews. Nonrandom, purposive sampling ensured a reflective sample. The interview guide addressed attendance barriers, reasons for missed appointments, and clinic accessibility. Inductive coding was applied to interview text fragments and a codebook was developed.</p><p><strong>Results: </strong>Of the 230 eligible patients, 110 (48%) were contacted and 26/110 (24%) consented and completed interviews. Patients identified the following 3 major barriers to appointment attendance: (1) community and environmental barriers, (2) patient-related factors, and (3) clinic-related factors. Community and environmental barriers (n = 20 [77%]) included unforeseen circumstances and transportation issues, with 52% citing transportation difficulties. Patient-related factors (n = 16 [62%]) included family obligations, personal illness, mental health concerns, confusion with appointments, or competing job responsibilities. Clinic-related factors (n = 9 [35%]) included scheduling and timing issues. Participants proposed changes to facilitate attendance, which included clinics offering transportation assistance, providing interpersonal support through support groups, and improving the internet-based portal to make patient communication easier.</p><p><strong>Conclusions: </strong>Identifying the reasons why patients miss appointments is pivotal to providing patient-centered care. Our findings provide a deeper understanding of issues underlying missed urogynecology appointments. Future research to develop an algorithm to identify barriers to attending appointments and provide interventions such as transportation support could result in more accessible, equitable care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883794","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":"Comparative Neuroexcitation Patterns Using fNIRS in Women With Overactive Bladder.","authors":"Linda S Burkett, Mina Ghatas, Helen Query, Peter Daniels, Gabrielle Grob, Ashley Matthew, Devin Rogers, Lynn Stothers, John E Speich, Adam P Klausner","doi":"10.1097/SPV.0000000000001625","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001625","url":null,"abstract":"<p><strong>Importance: </strong>Functional near-infrared spectroscopy (fNIRS) is a noninvasive technique used to quantify prefrontal cortex (PFC) neuroexcitation. The PFC is involved in the decision to void, and dysfunction in the region has been associated with overactive bladder (OAB). This study demonstrates neuroexcitation differences in the brain region associated with the decision to void (prefrontal cortex) using noninvasive fNIRS.</p><p><strong>Objective: </strong>The objective of this study was to compare PFC neuroexcitation during natural filling in female participants with and without OAB.</p><p><strong>Study design: </strong>Female participants with OAB were cross-sectionally compared with controls without urinary urgency. The fNIRS signals were continuously recorded during an oral hydration protocol. Simultaneously, recordings of real-time bladder sensation of fullness were completed. A period of \"high sensation\" was defined as the time from first desire to 100% sensation. Signal analysis included removal of motion artifact, low pass filtering, and interpolated to standardize reporting bladder filling time.</p><p><strong>Results: </strong>A total of 25 female participants were enrolled and had complete analyzable data, including 14 with OAB and 11 controls without OAB. Change in O2Hb during the high sensation period was significantly lower in all PFC regions in the OAB group compared with controls (P < 0.001). The majority of OAB participants had a constant or decreasing neuroexcitation pattern, which differenced in comparison to normal controls who displayed an increasing pattern.</p><p><strong>Conclusions: </strong>This study demonstrates that fNIRS PFC excitation during a period of high sensation is consistently lower in women with OAB as compared with controls. These data support the hypothesis that the PFC plays an inhibitory role in voiding function and that there may be a lack of inhibitory control in women with OAB.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883780","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 Activity Restrictions After Reconstructive Pelvic Surgery.","authors":"Alejandra Cacheiro Bofarull, Chris Elizabeth Philip, Gabriela Francis, Pedro Henrique Costa Matos da Silva, Chloe Koski, Linda Suk-Ling Murphy, Victoria Alzogaray, Olivia H Chang","doi":"10.1097/SPV.0000000000001622","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001622","url":null,"abstract":"<p><strong>Importance: </strong>Restrictive physical activity after pelvic reconstructive surgery is recommended, although the optimal duration and intensity are not standardized.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to evaluate the existing literature comparing clinical outcomes for liberal postoperative physical activity versus standard of care, defined as restricted postoperative physical activity, after pelvic reconstructive surgery.</p><p><strong>Study design: </strong>PubMed, CENTRAL, Scopus, Web of Science, and CINAHL databases were searched for observational and randomized studies comparing liberal postoperative physical activity and standard of care in women undergoing pelvic reconstructive surgery, reporting anatomic and functional outcomes. Statistical analysis was performed using RevMan software, presenting results as mean difference (MD) or odds ratio in a random-effects model, with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Five randomized trials, representing total n = 434, were included, with 2 studies on sling surgical procedures and 3 on prolapse surgical procedures. Data from 3 studies suggest no significant difference between liberal and standard postoperative instructions in surgical outcomes, measured by Point Ba from POP-Q assessment tool, up to 3 months follow-up (MD, -0.04; 95% CI, -0.16 to 0.07; P = 0.49). Disease-specific symptom distress, measured by Pelvic Floor Distress Inventory-20, favored the liberal approach (MD, -10.09; 95% CI, -18.33 to -1.86; P = 0.02). Other domains, including Urinary Distress Inventory-6, also showed significant improvements with liberal postoperative activities (MD, -4.29; 95% CI, -7.84 to -0.74; P = 0.02).</p><p><strong>Conclusions: </strong>Patients with liberal postoperative physical activity recommendations in prolapse repair surgical procedures had similar short-term anatomic outcomes compared with standard restrictions, with more favorable outcomes in disease-specific symptom relief and quality of life.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848641","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":"Effect of Vaginal Prolapse Repair and Midurethral Sling on Urgency Incontinence Symptoms.","authors":"Christina M Mezes, Gregory B Russell, Robert E Gutman, Cheryl Iglesia, Charles Rardin, Kimberly Kenton, Sarah Collins, Catherine A Matthews","doi":"10.1097/SPV.0000000000001620","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001620","url":null,"abstract":"<p><strong>Importance: </strong>Limited evidence exists on the effect of combined native tissue vaginal prolapse repair with midurethral sling on urgency urinary incontinence (UUI) symptoms.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effect of combined native tissue vaginal prolapse repair with midurethral sling on UUI symptoms at 12 months postoperatively and identify risk factors for persistent UUI.</p><p><strong>Study design: </strong>This secondary analysis utilized data from a randomized trial comparing retropubic versus single-incision slings in women undergoing treatment of stress incontinence and vaginal prolapse with native tissue vaginal repair and midurethral sling. Responses to Question 16 of the Pelvic Floor Distress Inventory-20 were grouped into no and mild UUI (0, 1) versus moderate and severe UUI (2, 3, 4), and associations between UUI symptoms and patient and surgical characteristics were explored.</p><p><strong>Results: </strong>At baseline, 196/254 (77%) reported at least moderate UUI bother, whereas 58 (23%) had no bother. At 12 months postoperatively, persistent, resolved and de novo UUI were 41%, 59%, and 11%, respectively. At baseline, higher body mass index (odds ratio [OR], 1.08 95% CI, 1.02-1.14; P = 0.005) and symptomatic SUI (OR, 4.76; 95% CI, 2.53-9.01; P < 0.001) were associated with UUI. At 12 months, age (OR, 1.18, 95% CI, 1.04-1.35; P = 0.012) and Charlson Comorbidity Index (OR, 1.21; 95% CI, 1.00-1.45; P = 0.049) were associated with UUI. Colpocleisis was the only significant protective factor for the presence of UUI at 12 months (OR, 0.35; 95% CI, 0.13-0.97; P = 0.043).</p><p><strong>Conclusion: </strong>At 12 months postoperatively, almost 60% saw resolution of baseline UUI symptoms, especially those undergoing colpocleisis.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848639","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":"A Multicenter Prospective Cohort Study of Antibiotics for OnabotulinumtoxinA.","authors":"Elise Morocco, Lannah Lua-Mailland, Adrienne Werth, Danielle Carr, Sarah Rabice, Sarah Ashmore, Vi Duong, Margaret Wilkes, Wesley Nilsson, Tanaz Ferzandi","doi":"10.1097/SPV.0000000000001621","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001621","url":null,"abstract":"<p><strong>Importance: </strong>Urinary tract infection (UTI) is the most common complication of intradetrusor onabotulinumtoxinA (BTX-A) injection. Despite this, there are no evidence-based guidelines on antibiotic prophylaxis.</p><p><strong>Objectives: </strong>Our primary aim was to determine whether antibiotic prophylaxis decreased symptomatic, culture-proven UTI rates within 6 weeks of intradetrusor BTX-A injection. Our secondary aims were to determine if there are differences between antibiotic regimens and to identify risk factors for developing a UTI.</p><p><strong>Study design: </strong>This was a prospective, observational multicenter cohort study of female patients receiving BTX-A for idiopathic overactive bladder. We compared patients who received antibiotics (nitrofurantoin or trimethoprim-sulfamethoxazole) to those who did not. To detect a 15% difference in UTI rates between groups (80% power, alpha = 0.05), 270 participants were needed.</p><p><strong>Results: </strong>A total of 282 participants ultimately received BTX-A and were included in the analysis. One hundred eighty-one (62.6%) were in the antibiotic cohort and 101 (35.8%) were in the no-antibiotic cohort. The overall rate of symptomatic, culture-proven UTI was 12.1%, and there was no difference between the antibiotic and no-antibiotic cohort (10.6% vs 14.9%, respectively; P = 0.29). On multivariable logistic regression, UTI was associated with older age (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02-1.11), BTX-A dose of 200 units (aOR, 4.24; 95% CI, 1.45-12.35), and self-catheterization (aOR, 26.0; 95% CI, 3.62-186.5). The odds of symptomatic UTI were lower among postmenopausal participants (aOR, 0.13; 95% CI, 0.02-0.68) and participants in the Northeast United States (aOR, 0.23; 95% CI, 0.08-0.72).</p><p><strong>Conclusions: </strong>Our study did not find a lower rate of symptomatic, culture-proven UTI among participants who took antibiotics compared with those who did not.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848638","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":"Missed Opportunities: A Mixed-Methods Assessment of Disparities in Treatment for Fecal Incontinence.","authors":"Vienne Seitz, Jed Calata, Ling Mei, Emily R W Davidson","doi":"10.1097/SPV.0000000000001619","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001619","url":null,"abstract":"<p><strong>Importance: </strong>Previous work identified racial disparities in access to fecal incontinence (FI) treatments. However, less is known about patient perspectives of these barriers.</p><p><strong>Objectives: </strong>This study assessed differences in FI symptom severity and treatment utilization between Black and White patients.</p><p><strong>Study design: </strong>This mixed-methods assessment studied adult non-Hispanic Black and White women treated for FI who either did not respond to medical therapy nor received sacral neuromodulation or did not follow up after medical therapy. Structured interviews queried patients about treatments offered and symptom severity.</p><p><strong>Results: </strong>Of the 118 patients in the retrospective evaluation, 59 (50%, 24 Black and 35 White) were interviewed. Black patients were more likely than White patients to report occasional, weekly, or daily solid and stool incontinence (75.0% vs 48.6%, P = 0.042; 87.5% vs 51.4%, P = 0.004, respectively) and flatal incontinence (83.3% vs 62.9%, P = 0.088).Of those prescribed fiber supplements and antidiarrheal medications, Black patients were less likely to report symptom improvement (25.0% vs 70.0%, P = 0.013; 57.1% vs 87.5%, P = 0.092, respectively, for each medication type) and ongoing regimen adherence (25.0% vs 63.3%, P = 0.013; 28.6% vs 87.5%, P = 0.035, respectively).Black patients were more likely to report impairment in daily functioning secondary to FI (83.3% vs 57.1%, P = 0.034) and were more likely to seek a follow-up visit with a health care professional that performs sacral neuromodulation (79.2% vs 28.6%, P < 0.001).</p><p><strong>Conclusions: </strong>Black patients were more likely to have severe symptoms and poorer treatment outcomes and desire future follow-up, highlighting the importance of addressing racial differences in patient preferences in FI management strategies.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848640","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":"Use of a Vessel Sealer for Hysterectomy at Time of Prolapse Repair: A Randomized Clinical Trial.","authors":"Marlana M Ray, Catrina C Crisp, Rachel N Pauls, Jonathan Hoehn, Kelsey Lewis, Mildrede Bonglack, Jennifer Yeung","doi":"10.1097/SPV.0000000000001617","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001617","url":null,"abstract":"<p><strong>Importance: </strong>Electrosurgical vessel sealing devices for vaginal hysterectomy have demonstrated reduced postoperative pain. This modality, however, has not been evaluated in patients undergoing vaginal hysterectomy with pelvic reconstruction.</p><p><strong>Objective: </strong>The aim of the study was to describe postoperative pain levels utilizing the LigaSure vessel sealing device for vaginal hysterectomy in patients undergoing major reconstructive surgery.</p><p><strong>Study design: </strong>In this single-blinded, randomized controlled trial, participants were randomized to vaginal hysterectomy utilizing the LigaSure vessel sealing device versus standard clamping and suturing techniques. Following hysterectomy, all participants underwent major vaginal reconstruction, including apical suspension via high uterosacral ligament fixation. The primary outcome was postoperative pain on a 100-mm visual analog scale 3-6 hours after surgery. Secondary outcomes included hysterectomy operative time, blood loss, pain scores and narcotic use on days 1, 3, 5, and 2 weeks after surgery.</p><p><strong>Results: </strong>A total of 95 participants were randomized: 48 (50.5%) in the intervention arm and 47 (49.5%) in the control arm. Between 3 and 6 hours postoperatively, there was no difference in overall pain scores (49 vs 50.5). Groups also had similar hysterectomy operative times (40.5 minutes vs 38 minutes) and blood loss (100 mL vs 100 mL). Pain scores and narcotic use on postoperative days 1, 3, 5, and 2 weeks were not different.</p><p><strong>Conclusions: </strong>While vessel sealing devices may reduce pain after vaginal hysterectomy alone, these benefits were not detected following concomitant major pelvic reconstruction. Similar operative times and blood loss between groups may be due to the expertise of the surgical subspecialist and not the device itself.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831170","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":"Assessing Diversity, Equity and Inclusion Statements of Urogynecology Fellowships.","authors":"Nicole Jenkins, Qilin Cao, Gregory Vurture, Scott W Smilen","doi":"10.1097/SPV.0000000000001623","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001623","url":null,"abstract":"<p><strong>Importance: </strong>The Accreditation Council for Graduate Medical Education (ACGME) has aimed to increase diversity among the physician workforce. Prospective applicants utilize websites to identify programs that share a commitment to equity and inclusion. Published statements of Diversity, Equity, and Inclusion (DEI) demonstrate a fellowship program's recognition of the importance of improving diversity in health care and medical education.</p><p><strong>Objective: </strong>The aim of the study was to assess the utilization of DEI statements published on urogynecology and reconstructive pelvic surgery (URPS) fellowship program websites.</p><p><strong>Study design: </strong>All ACGME accredited URPS fellowship websites in July 2023 were reviewed for presence of a DEI statement as a primary outcome. Website content was then compared across geographical regions (Northeast, Mid-Atlantic, Midwest, South, and West).</p><p><strong>Results: </strong>Seventy-two URPS programs had a dedicated website for review. Nine (12.5%) URPS programs had a published diversity statement. There were no statistical differences in the presence of a statement in URPS fellowships based on core-surgical speciality or geographic region.</p><p><strong>Conclusions: </strong>A majority of URPS programs lack a DEI statement (87.5%) demonstrating an area for improvement. With an increasingly diverse patient population, the recruitment of a diverse pool of physician applicants is more crucial than ever. By advocating for transparency, URPS fellowship programs can foster an environment that nurtures a physician workforce better equipped to provide culturally inclusive health care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831168","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}