Urogynecology (Hagerstown, Md.)最新文献

{"title":"Social Determinants and Time to Surgery for Pelvic Floor Disorders.","authors":"Shihyun Kim, Michael Pezzillo, Alexis Malecki, Kathy Lu, Ma Xuan, Mira Kheil, Ali Luck","doi":"10.1097/SPV.0000000000001850","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001850","url":null,"abstract":"<p><strong>Importance: </strong>Patients with social determinants of health (SDoH)-related barriers have reduced access to care for pelvic floor disorders (PFDs), but whether SDoH influence time to surgical decision making is unknown.</p><p><strong>Objectives: </strong>We aimed to assess the association of various SDoH with time to surgical decision making in patients who had surgery for a PFD.</p><p><strong>Study design: </strong>We conducted a retrospective cross-sectional study of patients who underwent surgery for overactive bladder, stress urinary incontinence, or pelvic organ prolapse between January 2013 and December 2023 at a large metropolitan health care system in Michigan. Patients were stratified by residence. Associations of demographic, clinical, and SDoH variables with time to surgical decision were tested with nonparametric tests and multivariable linear regression. Pandemic period comparisons were assessed with nonparametric and categorical tests.</p><p><strong>Results: </strong>Among 115 patients included in the analysis, the mean age was 68.4±10.9 years; 17 patients (14.8%) identified as Arab, 20 patients (17.4%) identified as Asian, 36 patients (31.3%) identified as Black, and 42 (36.5%) as White. Most patients had public insurance (66.9%), and almost half lived in Wayne County (48.7%). Having public insurance (exp[β]=2.9; 95% CI, 1.08-7.75; P=0.03), residing in Wayne County (P=0.01), and being treated during the COVID-19 pandemic (exp[β]=2.9; 95% CI, 1.12-7.44; P=0.03) were associated with a longer time to surgical decision.</p><p><strong>Conclusions: </strong>Our findings suggest that certain SDoH, such as public insurance and county of residence, may influence PFD surgical decision times.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679281","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":"Self-care Pessary Management and Factors Associated With Long-Term Pessary Use.","authors":"Lucy Olson, Heather Winn, Irene Morcuende, Rene R Genadry, Joseph T Kowalski, Catherine S Bradley","doi":"10.1097/SPV.0000000000001839","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001839","url":null,"abstract":"<p><strong>Importance: </strong>There is limited evidence on predictors and complications of long-term pessary use and how outcomes vary by management strategy.</p><p><strong>Objectives: </strong>The objectives of this study were to compare outcomes of pessary self-care (SC) versus office-based care (OC) and identify factors associated with long-term pessary use in patients with pelvic organ prolapse (POP).</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of patients fitted with a pessary for POP and with >3 months of use between 2008 and 2017. Patients were classified by pessary management strategy (SC vs. OC) and duration of use. Patient characteristics, complications, and reasons for discontinuation were compared between groups using bivariable and multivariable analyses.</p><p><strong>Results: </strong>The study included 275 patients who used a pessary for a median of 17.1 (range: 3-110) months. Of 268 with follow-up, 89 (33%), 107 (40%), and 72 (27%) used the pessary for <1 year, 1-<3 years, and ≥3 years, respectively. Most (77%) performed SC. SC users were healthier, younger, more sexually active, and had less advanced POP than OC users (all P≤0.01). SC users had fewer space-occupying pessaries (61 (28.6%) vs 40 (64.5%), P<0.001), though many self-managed Gellhorn (n=50), cube (n=10) and donut (n=1) pessaries. SC users had a similar duration of use to OC users but fewer vaginal erosions and office visits (both P<0.001). Duration of use was not associated with management. In multivariable models, increasing age predicted longer use, and pulmonary disease predicted shorter use.</p><p><strong>Conclusions: </strong>In this cohort, the majority of patients were able to self-manage a pessary. Duration of use was associated with patient characteristics but not with management type.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679278","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":"What Every Urogynecologist Should Know About Getting Paid in 2026.","authors":"Jocelyn J Fitzgerald, Allison Willett, Tanaz R Ferzandi, Cheryl B Iglesia","doi":"10.1097/SPV.0000000000001847","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001847","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596785","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":"Removing the Boxed Warning for Vaginal Estrogen: A Win for Our Patients.","authors":"Sarina N Hanfling, Rachel Rubin, Christine Vaccaro","doi":"10.1097/SPV.0000000000001846","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001846","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596769","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":"Minimally Invasive Sacrocolpopexy-Which Patients Are Likely to Stay Overnight?","authors":"Shane Skibba, Jessica Savoni, Courtney Poston, Alina Hassan, Eric Hurtado","doi":"10.1097/SPV.0000000000001836","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001836","url":null,"abstract":"<p><strong>Importance: </strong>Minimally invasive sacrocolpopexy (MISC) is a highly successful surgical procedure for pelvic organ prolapse. In today's health care setting, cost is an important issue with savings from same-day discharge (SDD) versus observation/admission (O/A).</p><p><strong>Objective: </strong>The purpose of this study was to determine risk factors for O/A versus SDD in patients undergoing MISC.</p><p><strong>Study design: </strong>A retrospective cohort study was performed from 2018 to 2023 on patients undergoing MISC within the Cleveland Clinic system. The primary outcome was to determine risk factors for O/A with a secondary analysis for postoperative differences. Univariate analysis assessed the association between the patients' characteristics and discharge time. The χ2 or Fisher exact test was used for categorical factors, and the Wilcoxon rank-sum test was applied for continuous factors. Multivariate logistic regression with backward elimination was conducted to determine the independent factors for discharge. A P value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Out of 798 patients, 537 had SDD and 261 had O/A after MISC. Multivariable logistic regression revealed the following as independent factors for O/A: race as \"other,\" late surgical start time, increased operative time, higher first and last pain score, and higher American Society of Anesthesiologists classification. Postoperatively, O/A was associated with higher rates of unplanned office and emergency department visits, more office messages, and fewer catheters at discharge.</p><p><strong>Conclusions: </strong>In this study, several factors were associated with O/A versus SDD with MISC. Awareness of these factors may help with counseling patients, setting expectations, and arranging surgical schedules to maximize SDD and decrease costs. Further studies are needed to quantify costs and patient satisfaction.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596730","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":"Are Nocturia and Falls Associated? A Secondary Analysis.","authors":"Jasmine E Arrington, Aya Bashi, Cindy L Amundsen, J Eric Jelovsek, Annika Sinha","doi":"10.1097/SPV.0000000000001806","DOIUrl":"10.1097/SPV.0000000000001806","url":null,"abstract":"<p><strong>Importance: </strong>Nocturia is believed to increase falls in older patients, a leading cause of injury-related death; however, the impact of other risk factors in patients with nocturia is limited.</p><p><strong>Objectives: </strong>To evaluate the association between nocturia and falls and injury.</p><p><strong>Study design: </strong>This was a secondary analysis of male and female participants from one site of the Lower Urinary Tract Dysfunction Network study. Participants with prior falls were excluded. Bayesian logistic and ordinal regression models were used to estimate associations between nocturia episodes and fall outcomes, adjusting for arthritis, gait instability, and obstructive sleep apnea (OSA). Probability of an association was obtained from the posterior distribution of each model, and any association was defined as the median adjusted odds ratios (aOR) >1.</p><p><strong>Results: </strong>Among 121 participants, 21.5% experienced at least one fall. The probability of any association between nocturia episodes and the presence of falls was 0.16 (aOR: 0.9, 95% credible interval (CI), 0.8, 1.1). Arthritis (aOR: 2.0, 95% CI: 1.3, 3.0), gait instability (aOR: 5.5, 95% CI: 3.3, 9.2), and OSA (aOR: 2.4, 95% CI: 1.4, 3.9) demonstrated a high probability of association with falls, with probabilities of 0.99 and 1.0, respectively. The probability of any association between nocturia episodes and injury (aOR: 0.8, 95% CI: 0.7, 1.0) and injury severity (aOR: 0.9, 95% CI: 0.7, 1.1) was 0.05 and 0.10, respectively.</p><p><strong>Conclusions: </strong>Nocturia episodes have low probabilities of association with falls, injury, and injury severity after controlling for additional covariates. Fall reduction efforts should focus on additional risk factors in patients with nocturia.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":"32 4","pages":"364-370"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488897","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":"Cost-Effectiveness of Sacrohysteropexy Versus Hysterectomy With Sacrocolpopexy.","authors":"Lauren H Griswold, Katherine L Dengler, Eva K Welch, Jill Brown","doi":"10.1097/SPV.0000000000001842","DOIUrl":"10.1097/SPV.0000000000001842","url":null,"abstract":"<p><strong>Importance: </strong>Limited evidence is available comparing the cost-effectiveness of mesh augmented repairs with and without uterine preservation. Our model suggests that minimally invasive supracervical hysterectomy with sacrocolpopexy (SCH-SCP) is cost-effective compared with minimally invasive sacrohysteropexy (MISH) as it decreases the number of subsequent major surgical procedures, endometrial cancer diagnoses, and endometrial cancer deaths. This information is useful for decision making at the health system level and should be considered in the surgical counseling discussion.</p><p><strong>Objective: </strong>The objective of this study was to compare the cost-effectiveness of SCH-SCP versus MISH.</p><p><strong>Study design: </strong>A decision tree model using TreeAge® software was developed to evaluate the cost-effectiveness of SCH-SCP compared with uterine-sparing MISH. Effectiveness was expressed in quality-adjusted life years (QALYs), and the willingness-to-pay (WTP) threshold was set to $100,000 per QALY. The literature review provided probabilities, utilities, and cost data. We estimated the incremental cost-effectiveness ratio (ICER) between the 2 strategies, completed a probabilistic sensitivity analysis (PSA), and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000.</p><p><strong>Results: </strong>SCH-SCP was a cost-effective strategy, with an ICER of $59,820/QALY compared with MISH. For a cohort of 10,000, MISH is associated with an additional 648 major surgical procedures, 5 endometrial cancer cases, and 2 endometrial cancer deaths. PSA revealed the chance of SCH-SCP being cost-effective was 55.4% at a WTP of $100,000 and 57.9% at a WTP of $200,000.</p><p><strong>Conclusion: </strong>Our model suggests that SCH-SCP may be cost-effective compared with MISH. SCH-SCP decreases the number of additional major surgical procedures, endometrial cancer diagnoses, and endometrial cancer deaths in our analysis.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":"32 4","pages":"454-463"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488904","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":"Relaxing Environment Lowers Anxiety During Chemodenervation: a Randomized Trial.","authors":"Erin Franks, Joseph Rigdon, Michael Kennelly, Erinn Myers, Kelley Kaczmarski, Zahra Bahrani-Mostafavi, Megan Tarr","doi":"10.1097/SPV.0000000000001809","DOIUrl":"10.1097/SPV.0000000000001809","url":null,"abstract":"<p><strong>Importance: </strong>Intradetrusor chemodenervation with onabotulinumtoxinA (BOTOX) injections, a common office-based procedure for overactive bladder (OAB), is associated with patient anxiety and discomfort. Aromatherapy and music have been shown to decrease procedure-related anxiety and pain with improved satisfaction.</p><p><strong>Objectives: </strong>The objectives of this study were to determine whether a relaxing environment consisting of lavender aromatherapy, calming music, and dim lighting compared with a typical office environment decreases patients' anxiety level before undergoing intradetrusor chemodenervation. We hypothesized that a relaxing environment would decrease patients' anxiety level before the procedure as measured by the Visual Analog Scale (VAS). Secondary outcomes included the VAS for pain, satisfaction, and staff energy level.</p><p><strong>Study design: </strong>This was a single-center randomized trial of women receiving office intradetrusor chemodenervation for overactive bladder. Participants were randomized to receive their procedures in a relaxing versus typical office environment. Eighty patients were needed to detect a clinically significant 12 mm difference on the anxiety VAS. Staff completed a preclinic and postclinic Burnout Battery VAS to measure change in their energy level during the day.</p><p><strong>Results: </strong>Patients in the relaxing environment reported a clinically significant reduction in anxiety (-13.8 ± 18.1 vs -4.7 ± 14.7, P = 0.015). Pain was lower for the relaxing environment group, although it did not reach statistical significance (21.9 vs 28.9, P = 0.261). Satisfaction scores were high in both groups (91.4 vs 89.3, P = 0.599) and not significantly different. The procedure room environment did not affect staff energy levels.</p><p><strong>Conclusions: </strong>A relaxing environment of lavender aromatherapy, calming music, and dim lighting is a noninvasive, easily implemented technique to decrease patients' anxiety before office intradetrusor chemodenervation.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":"32 4","pages":"349-357"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488802","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 Procedure Setting on Urinary Retention After Bulkamid Injection.","authors":"Anna Stock, Catherine Adaniya, Madelyn Gaines, Avery Dawes, Emma Wittman, Kevin Moss, Douglass Hale, Jennifer Hamner, Ramzy Burns","doi":"10.1097/SPV.0000000000001828","DOIUrl":"10.1097/SPV.0000000000001828","url":null,"abstract":"<p><strong>Importance: </strong>Urethral Bulkamid is a U.S. Food and Drug Administration-approved nonsurgical treatment for stress urinary incontinence and stress-predominant mixed urinary incontinence due to intrinsic sphincter deficiency. This procedure is commonly performed in the operating room (OR). An office Bulkamid procedure offers an alternative with benefits, including reduced cost, increased accessibility, and avoidance of anesthesia. Urinary retention is a known complication of Bulkamid. Data comparing retention rates between OR and office settings remains limited.</p><p><strong>Objectives: </strong>This study aimed to compare rates of postprocedure urinary retention following Bulkamid procedures performed in an OR versus an office setting.</p><p><strong>Study design: </strong>A retrospective review of 155 medical charts from Bulkamid procedures performed between 2020 and 2024 was conducted. Data included demographics, medical history, and information on postoperative urinary retention. Statistics were performed to assess for differences in postoperative outcomes based on location.</p><p><strong>Results: </strong>Patients who underwent Bulkamid procedures in the office experienced higher rates of immediate postoperative urinary retention (21.1%) compared with those treated in an OR (7.7%) (P=0.02); however, this result was not significant when adjusted for age, body mass index (BMI), and parity. A greater proportion of office patients performed intermittent self-catheterization after the procedure (15.8%) versus none in the OR (0.0%) (P=0.0001). Patients who experienced immediate urinary retention had a higher mean age (67.5 y vs 60.2 y; P=0.05) and lower BMI (27.9 vs 32.2; P=0.05), regardless of setting. Surgical history did not affect retention rates.</p><p><strong>Conclusions: </strong>While an office Bulkamid procedure offers many advantages, it is associated with higher observed rates of immediate postoperative urinary retention.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":"32 4","pages":"406-412"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488952","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":"Urinary Retention After Midurethral Sling: RCT of Retropubic Lidocaine Versus Saline.","authors":"Jessica C Sassani, Charlie Miller, Lindsay Turner","doi":"10.1097/SPV.0000000000001808","DOIUrl":"10.1097/SPV.0000000000001808","url":null,"abstract":"<p><strong>Importance: </strong>Postoperative urinary retention (POUR) is common following midurethral sling (MUS) placement, and can be distressing for patients.</p><p><strong>Objective: </strong>The objective of this study was to compare the effect of retropubic lidocaine versus saline placebo on POUR following MUS placement.</p><p><strong>Study design: </strong>This double-blind, placebo-controlled trial randomized women undergoing MUS placement with or without anterior repair to 20 mL of retropubic 0.5% lidocaine+epinephrine (lidocaine) versus normal saline+epinephrine (saline). Primary outcome was a failed postoperative retrograde voiding trial. Visual Analog Scales (VAS) were administered 2 and 6 hours postoperatively, and 7-day diaries assessed pain and analgesic use. We required 150 participants to detect a 20% reduction in POUR with 80% power, two-sided alpha of 0.05, and 5% loss to follow-up.</p><p><strong>Results: </strong>Between 2020 and 2024, 150 participants were randomized, 75 in each arm. Demographic and surgical characteristics were similar with mean age 51.5 years (44-63) and body mass index 29.0 (25.7-33.6). Participants were predominantly White (94.0%), postmenopausal (54.0%), and multiparous (95.3%). POUR was similar between groups (lidocaine 20.0% vs saline 18.7%, P = 0.84). Saline participants had significantly higher VAS scores at 2 and 6 hours postoperatively (2 h 21 [10-42] vs 11 [0-28], P = 0.008; 6 h 25 [13-50] vs 18 [9-33], P = 0.03), used more nonsteroidal anti-inflammatory drugs (NSAIDS) on POD 1 (76.2% vs 52.3%, P = 0.005) and reported higher levels of \"worst pain in the first 24 hours\" (6 [3.5-7.5] vs 4 [3-6], P = 0.013). At 6 weeks postoperatively, more lidocaine participants were satisfied or very satisfied with the outcome of their surgery (90.7% vs 77.3%, P = 0.03).</p><p><strong>Conclusions: </strong>Compared with saline, retropubic lidocaine at the time of midurethral sling placement does not result in significantly higher rates of POUR, but significantly improves acute postoperative pain, NSAID use, and satisfaction with surgical outcomes.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"340-348"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109106","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}