Urogynecology (Hagerstown, Md.)最新文献

{"title":"Investigating Racial, Ethnic, and Socioeconomic Disparities in Pelvic Organ Prolapse Surgery.","authors":"Samantha DeAndrade, Krystal DePorto, Kaitlin Crawford, Lucas Saporito, AnMarie Nguyen, Tajnoos Yazdany, Christopher Tenggardjaja","doi":"10.1097/SPV.0000000000001633","DOIUrl":"10.1097/SPV.0000000000001633","url":null,"abstract":"<p><strong>Importance: </strong>Racial/ethnic and socioeconomic disparities have been observed in the mode of pelvic organ prolapse surgery. Some of the disparities may be attributed to differences in access to care and advanced surgical technology across the United States, although this is difficult to study.</p><p><strong>Objective: </strong>We aimed to investigate whether racial/ethnic or socioeconomic disparities in a mode of prolapse surgery exist in a managed care setting, where differences in access are minimized.</p><p><strong>Study design: </strong>This was a retrospective cohort study of patients who underwent apical pelvic organ prolapse surgery within Kaiser Permanente Southern California facilities between 2014 and 2017. We conducted bivariate tests to examine the associations between patient characteristics and multivariate logistic regression to predict the odds of having obliterative and native tissue repair surgical procedures by race and income.</p><p><strong>Results: </strong>The analytic sample consisted of 2,798 patients who underwent prolapse surgery. Hispanic/Latina, Non-Hispanic White, Non-Hispanic Black, Asian, and \"other\" race represented 51.1%, 37.0%, 5.7%, 5.3%, and 0.8% of the sample, respectively. Median household income varied by racial groups. After adjusting for patient characteristics and regional factors, we did not find significant differences in apical prolapse surgery mode by race/ethnicity or income level.</p><p><strong>Conclusions: </strong>Within this managed care setting, no disparities in mode of apical prolapse surgery were observed by race/ethnicity or income level when regional and patient-level confounders were controlled for, such as prolapse stage and comorbidities. This may suggest that a significant driver of racial/ethnic disparities observed in prolapse surgery may be attributed to structural level factors.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933850","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":"Smoking's Impact on 30-Day Complications in Mesh and Nonmesh Prolapse Surgery.","authors":"Tara D Marczak, Mallika Anand, Yi Hsieh, Ayodele Ajayi, Michele R Hacker, William D Winkelman","doi":"10.1097/SPV.0000000000001658","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001658","url":null,"abstract":"<p><strong>Importance: </strong>Tobacco smoking is linked to poor surgical outcomes, leading many physicians to avoid synthetic implants like mesh in smokers due to concerns about impaired healing. While long-term outcomes for smokers have been studied, the effect of smoking on 30-day postoperative complications, especially related to surgical mesh, is less understood.</p><p><strong>Objectives: </strong>This study aimed to quantify the association between tobacco smoking and risk of postoperative infection, readmission, and reoperation within 30 days of minimally invasive apical prolapse repair. We also examined whether these associations differed based on whether mesh was used.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database for patients who underwent minimally invasive apical pelvic organ prolapse repair from 2012 to 2022. Smoking in the last year was the exposure. Outcomes included postoperative infection, unplanned readmission, and reoperation within 30 days. We calculated adjusted risk ratios for complications and stratified results based on mesh use.</p><p><strong>Results: </strong>Of 67,235 cases, 5,518 (8.2%) patients smoked in the past year. Smokers had a significantly higher likelihood of infection and unplanned readmission. Smoking did not increase the risk of unplanned reoperation. The association between smoking and 30-day complications did not differ based on mesh use (all P for interaction ≥0.24).</p><p><strong>Conclusions: </strong>Tobacco use was associated with an increase in postoperative complications within 30 days, though the absolute risk was low. There was no evidence of effect modification by mesh use; suggesting that mesh-augmented repairs could be considered in smokers who receive appropriate counseling.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061722","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":"Enhancing Obstructive Sleep Apnea Screening and Nocturia Treatment: A Quality Improvement Study.","authors":"K Marie Douglass, Katharina Laus, Samantha DeAndrade, Taylor Whitaker, Lauren Bernal, Tajnoos Yazdany, Christina Truong","doi":"10.1097/SPV.0000000000001648","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001648","url":null,"abstract":"<p><strong>Importance: </strong>Obstructive sleep apnea (OSA) is common but likely underdiagnosed in urogynecology patients with nocturia, and OSA treatment has the potential to improve nocturia symptoms.</p><p><strong>Objective: </strong>The aim of the study was to assess the effect of implementing a universal screening protocol for OSA in a urogynecology clinic on screening rates, OSA prevalence among patients with nocturia, and symptom improvement following treatment.</p><p><strong>Study design: </strong>This was an observational quality improvement study at a urogynecology clinic at a safety-net hospital. Health care providers were asked to screen all new patients with nocturia using the STOP-BANG questionnaire. We assessed screening rates over an 18-month period and followed patients referred for sleep study to determine the percentage who completed evaluation, were identified as having OSA and, if necessary, prescribed treatment, as well as improvement in nocturia symptoms after treatment.</p><p><strong>Results: </strong>Seventy-eight percent of eligible patients were screened, and screening rates increased substantially over the course of the study. Overall, 20.2% of patients screened positive and were referred for sleep study, and 80.6% of those were ultimately diagnosed with OSA. There were low levels of adherence to the recommended OSA treatment, but patients with OSA who were using the treatment reported better improvement in their symptoms.</p><p><strong>Conclusions: </strong>Initiation of OSA screening in a urogynecology clinic is a significant and feasible way to address nocturia and has the potential to improve symptoms. Improving rates of OSA testing and adherence to OSA treatment will require a multidisciplinary approach, while systems-level changes are needed to address inequities and other barriers to accessing treatment.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048953","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":"Rising Rates of Urethral Bulking: A Retrospective Study of a National Database.","authors":"Taylor Whitaker, Samantha DeAndrade, K Marie Douglass, Tajnoos Yazdany","doi":"10.1097/SPV.0000000000001655","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001655","url":null,"abstract":"<p><strong>Importance: </strong>Stress urinary incontinence (SUI) affects approximately 50% of women. There are limited data regarding trends in management as treatment options have changed.</p><p><strong>Objective: </strong>This study aimed to analyze trends in the surgical management of SUI, including slings and urethral bulking, from 2012 to 2022.</p><p><strong>Study design: </strong>Patients from the American College of Surgeons National Surgical Quality Improvement Program database who had undergone a sling or urethral bulking procedure were identified by Current Procedural Terminology code. Descriptive statistics and independent paired t tests were performed.</p><p><strong>Results: </strong>A total of 81,657 patients received either slings or urethral bulking from 2012 to 2022. The number of slings performed peaked in 2017, decreased in 2020, and has subsequently increased. The rate of urethral bulking increased from 2019 to 2022. The average age patients who received urethral bulking was 64 years versus 56 years for sling patients (P < 0.05). These patients were more likely to be American Society of Anesthesiology class III compared to those receiving slings (39% vs 25%, respectively, P < 0.05). Readmission and reoperation rates were not statistically different. Less invasive procedures were more likely to be performed concurrently with bulking.</p><p><strong>Conclusions: </strong>Sling placement is the most common surgical procedure for SUI but it decreased in 2020, likely due to COVID-19-related delays, and has not yet returned to prepandemic levels. Urethral bulking has become more common, possibly due to new agents available in U.S. markets. Patients who received urethral bulking were more likely to be older, have severe systemic disease, and underwent a less invasive concurrent procedure. Further research is needed to understand these trends.</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":"143048954","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":"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":"Purported Bladder Irritant Intake in Women With Urgency Urinary Incontinence.","authors":"Barbara Ha, Lisa R Yanek, Bryna J Harrington, Joan L Blomquist, Chi Chiung Grace Chen, Danielle Patterson, Victoria L Handa","doi":"10.1097/SPV.0000000000001652","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001652","url":null,"abstract":"<p><strong>Importance: </strong>Patients with urgency urinary incontinence are often recommended to avoid bladder irritants, but there is a lack of evidence for this.</p><p><strong>Objective: </strong>The aim of the study was to compare consumption of purported bladder irritants between women with and without urgency urinary incontinence.</p><p><strong>Study design: </strong>We performed a case-control study of nonpregnant females aged ≥20 years using the National Health and Nutrition Examination Survey, 2007-2020. Cases were defined as participants with moderate, severe, or very severe urgency urinary incontinence without stress urinary incontinence, measured with the Sandvik Incontinence Severity Index. Controls were defined as those without urgency urinary incontinence. The exposures of interest were 6 bladder irritants listed by the National Institute of Diabetes and Digestive and Kidney Diseases: (1) alcohol; (2) spicy foods; (3) chocolate; (4) artificial sweeteners; (5) caffeinated, carbonated, and citrus beverages; and (6) high-acid foods. Weighted multivariable logistic regression analysis was used to determine independent associations between each irritant and urgency urinary incontinence.</p><p><strong>Results: </strong>Overall, this study included 651 cases with urgency urinary incontinence (6.8%) and 8,890 controls (93.2%). More cases reported consuming caffeinated, carbonated, and citrus beverages (53.8% vs 47.1%, P = 0.01) and high-acid foods (50.3% vs 44.3%, P = 0.02). In multivariable analysis, the odds of urgency urinary incontinence were increased significantly with intake of caffeinated, carbonated, and citrus beverages (odds ratio 1.37, 95% confidence interval 1.09-1.73) and high-acid foods (odds ratio 1.29, 95% confidence interval 1.03-1.62).</p><p><strong>Conclusions: </strong>In this case-control study of community-dwelling adult females, urgency urinary incontinence was associated with consumption of caffeinated, carbonated, and citrus beverages and high-acid foods. Adequately powered prospective trials are needed to further investigate the effects of these foods and beverages on urgency urinary incontinence to guide clinical practice.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017822","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}

{"title":"Use of ChatGPT to Generate Informed Consent for Surgery in Urogynecology.","authors":"Emily S Johnson, Eva K Welch, Jacqueline Kikuchi, Heather Barbier, Christine M Vaccaro, Felicia Balzano, Katherine L Dengler","doi":"10.1097/SPV.0000000000001638","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001638","url":null,"abstract":"<p><strong>Importance: </strong>Use of the publicly available Large Language Model, Chat Generative Pre-trained Transformer (ChatGPT 3.5; OpenAI, 2022), is growing in health care despite varying accuracies.</p><p><strong>Objective: </strong>The aim of this study was to assess the accuracy and readability of ChatGPT's responses to questions encompassing surgical informed consent in urogynecology.</p><p><strong>Study design: </strong>Five fellowship-trained urogynecology attending physicians and 1 reconstructive female urologist evaluated ChatGPT's responses to questions about 4 surgical procedures: (1) retropubic midurethral sling, (2) total vaginal hysterectomy, (3) uterosacral ligament suspension, and (4) sacrocolpopexy. Questions involved procedure descriptions, risks/benefits/alternatives, and additional resources. Responses were rated using the DISCERN tool, a 4-point accuracy scale, and the Flesch-Kinkaid Grade Level score.</p><p><strong>Results: </strong>The median DISCERN tool overall rating was 3 (interquartile range [IQR], 3-4), indicating a moderate rating (\"potentially important but not serious shortcomings\"). Retropubic midurethral sling received the highest overall score (median, 4; IQR, 3-4), and uterosacral ligament suspension received the lowest (median, 3; IQR, 3-3). Using the 4-point accuracy scale, 44.0% of responses received a score of 4 (\"correct and adequate\"), 22.6% received a score of 3 (\"correct but insufficient\"), 29.8% received a score of 2 (\"accurate and misleading information together\"), and 3.6% received a score of 1 (\"wrong or irrelevant answer\"). ChatGPT performance was poor for discussion of benefits and alternatives for all surgical procedures, with some responses being inaccurate. The mean Flesch-Kinkaid Grade Level score for all responses was 17.5 (SD, 2.1), corresponding to a postgraduate reading level.</p><p><strong>Conclusions: </strong>Overall, ChatGPT generated accurate responses to questions about surgical informed consent. However, it produced clearly false portions of responses, highlighting the need for a careful review of responses by qualified health care professionals.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017827","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":"Operating on the Oldest-Old: Vaginal Prolapse Surgery Outcomes in Women Over 90.","authors":"Stephanie W Zuo, Kristina Warner, Halina Zyczynski, Mary F Ackenbom","doi":"10.1097/SPV.0000000000001636","DOIUrl":"10.1097/SPV.0000000000001636","url":null,"abstract":"<p><strong>Importance: </strong>Women aged 90 years and older (\"oldest-old\") represent a small but growing population who may experience bothersome pelvic organ prolapse and opt for surgical repair.</p><p><strong>Objective: </strong>This study aimed to compare perioperative adverse events (AEs) within 8 weeks of prolapse surgery between women ≥90 years and younger patients.</p><p><strong>Study design: </strong>We performed a secondary analysis of a dual-center retrospective cohort study of women ≥61 years old undergoing major prolapse surgery from January 2016 to May 2023. We identified all women ≥90 years and matched them to women <90 years in a 1:4 fashion based on Charlson Comorbidity Index score and surgery type. Matching was performed without replacement. The primary outcome was a composite AE outcome, defined as all intraoperative and postoperative complications within 8 weeks of surgery.</p><p><strong>Results: </strong>There were 24 oldest-old undergoing prolapse surgery who were matched to 96 women with mean ± standard deviation age of 77.2 ± 5.7 years. Women ≥90 years were more likely to have a lower body mass index ( P < 0.01), greater preoperative prolapse stage ( P = 0.049), and were less likely to have general anesthesia ( P < 0.01). Patients did not differ in medical comorbidities, frailty status, concomitant hysterectomy or incontinence procedure, or length of postoperative stay. The oldest-old did not experience any intraoperative complications and had low rates of readmission (8.3%) and discharge to skilled nursing facilities (4.2%). Age ≥90 was not associated with composite AEs on multivariable analysis (adjusted odds ratio 1.60, 95% confidence interval [0.39-6.55]).</p><p><strong>Conclusions: </strong>Age ≥90 years does not appear to increase the risk of perioperative AEs in women with similar comorbidities.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980900","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":"Pessary Placement for Voiding Dysfunction Due to Prolapse Among Neurologically Intact Women.","authors":"Sarah Ashmore, Margaret G Mueller, Kimberly Kenton, C Emi Bretschneider","doi":"10.1097/SPV.0000000000001629","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001629","url":null,"abstract":"<p><strong>Importance: </strong>Literature surrounding conservative management of voiding dysfunction (VD) due to pelvic organ prolapse (POP) is limited.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the effect of pessaries on VD in women with symptomatic POP.</p><p><strong>Study design: </strong>This was a retrospective case series of adult women who underwent a pessary fitting for POP and VD between January 2010 to December 2022 at 2 tertiary care centers. Voiding dysfunction was defined as a composite outcome of participant report of obstructive voiding symptoms and postvoid residual volume (PVR) ≥150 mL prior to pessary fitting. Obstructive voiding symptoms were determined by positive response on the Pelvic Floor Distress Inventory-20 to items 5, 6, 19, and/or 20.</p><p><strong>Results: </strong>Sixty-one participants with POP and VD underwent successful pessary fitting at 2 large academic institutions. Median (range) age was 75 years (35-89) and body mass index of 26.5 (18.0-46.3). Participant reports of \"difficult bladder emptying\" and \"sensation of incomplete bladder emptying\" were the most reported symptoms of obstructive voiding. Advanced staged prolapse (prolapse ≥ stage 3) was documented for 84% of participants. Median point C, Ba, and genital hiatus were -2 cm, +3 cm, and 4 cm, respectively, on examination. Median PVR prior to pessary fitting was 263 mL (150-810). Voiding dysfunction resolved in 60 out of 61 participants (98%). Median repeat PVR after pessary placement was 50 mL (0-250).</p><p><strong>Conclusion: </strong>Pessary placement resolved VD due to POP in 98% of participants. Clinicians can offer pessary placement as nonsurgical management for participants with VD due to POP.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017815","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}