Urogynecology (Hagerstown, Md.)最新文献

{"title":"Sacrococcygeal Joint as a Landmark in Sacral Neuromodulation: A Cadaveric Study.","authors":"Laurel Carbone, Rodger Rothenberger, Ankita Gupta, Sean Francis, Jeremy T Gaskins, Kathryn Seymour, Stacy M Lenger","doi":"10.1097/SPV.0000000000001927","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001927","url":null,"abstract":"<p><strong>Importance: </strong>Understanding sacrococcygeal anatomic variation aids in successful execution of office percutaneous nerve evaluation (PNE) without fluoroscopy and sacral neuromodulation (SNM).</p><p><strong>Objective: </strong>In office PNE, the S3 foramen is approximated using an established average distance from the tip of the coccyx to the S3 foramen (approximately 9 cm). Given potential variations in coccyx length, the purpose of this study was to evaluate the reliability of the distance from the sacrococcygeal joint to the S3 foramen as an additional landmark that improves identification of the S3 foramen when performing SNM.</p><p><strong>Study design: </strong>Ten fresh-frozen female cadavers were available for sacral dissection. Numerous bony measurements were obtained: length/width of the coccyx, tip of the coccyx to bilateral S3/S4 foramina, sacrococcygeal joint to bilateral S3/S4 foramina, and interforaminal distance. Median distances were obtained for all measurements. Relationships between measurements were calculated using Pearson product-moment correlation.</p><p><strong>Results: </strong>Pertinent median cadaveric measurements included coccyx length 34.7 mm, distance from the tip of the coccyx to S3 foramen was 92.2 mm (left) and 94.0 mm (right), distance from sacrococcygeal joint to S3 foramen was 61.8 mm (left, IQR, 59.8 to 67.4 mm) and 63.2 mm (right, IQR, 59.9 to 66.4 mm). A significant correlation was found between change in coccyx length and the tip of the coccyx to the S3 and S4 foramina.</p><p><strong>Conclusion: </strong>Our study demonstrates reliable median distances from the sacrococcygeal joint to the bilateral S3 foramen. A distance of 6 cm superior to the sacrococcygeal joint is an additional landmark useful for locating the S3 foramen in sacral neuromodulation.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083284","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":"Defecation Posture Modification Device Effect on Postoperative Bowel Function: An RCT.","authors":"Meredith H Carrel-Lammert, Mildrede N Bonglack, Gisele C Moran, Catrina C Crisp, Jonathan M Hoehn, Kelsey E Lewis, Jennifer Y Yeung, Rachel N Pauls","doi":"10.1097/SPV.0000000000001929","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001929","url":null,"abstract":"<p><strong>Importance: </strong>Defecatory symptoms are a concern for patients after pelvic reconstructive surgery. Devices that change the anorectal angle improve bowel function; however, this has not been assessed in the pelvic reconstructive surgery population.</p><p><strong>Objective: </strong>The objective of this study was to evaluate if a defecation posture modification device improves straining with the first bowel movement after posterior colporrhaphy.</p><p><strong>Study design: </strong>We conducted a nonblinded, randomized controlled trial of individuals undergoing posterior colporrhaphy. Participants were randomized to receive either a defecation posture modification device or no device. All participants were discharged with our standard pain and bowel regimen. The primary outcome was straining with the first bowel movement on a 10-point visual analog scale (VAS). Secondary outcomes included pain, satisfaction, Bristol Stool Form Scale classification, medication use, and device satisfaction.</p><p><strong>Results: </strong>Among 160 women enrolled, 150 were analyzed. Demographics were similar between groups, with most patients in their 60s, Caucasian, and with stage 2 prolapse. For the primary outcome, there was no difference in strain with the first bowel movement between arms, with the median level of strain noted as 2 out of 10. There was no difference in the level of pain. Most documented stools are a 4 or higher on the Bristol Stool Form Scale. At 2 weeks postoperatively, most patients were satisfied with and still using their device.</p><p><strong>Conclusions: </strong>There was no difference in median strain with the first bowel movement between the arms, defecation posture modification device versus usual care. Most patients found the device easy to use and planned to continue use.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083310","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":"Novel Metrics for Evaluating Skills in Simulation.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1097/SPV.0000000000001926","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001926","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027196","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":"Factors Linked to Sexual Function Assessment in Urinary Incontinence Care.","authors":"Karla Wente, Sumihiro Suzuki, Sheila Dugan","doi":"10.1097/SPV.0000000000001925","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001925","url":null,"abstract":"<p><strong>Importance: </strong>Female sexual dysfunction affects up to half of midlife females and is strongly associated with urinary incontinence. Medical visits for urinary incontinence represent critical opportunities to identify and address sexual health concerns; however, the frequency and determinants of sexual function assessment in this high-risk population remain understudied.</p><p><strong>Objective: </strong>The objective of this study was to identify how often sexual function is documented during initial encounters for midlife females with urinary incontinence and factors associated with assessment.</p><p><strong>Study design: </strong>We performed a retrospective electronic health record review of 1,580 initial outpatient encounters for females aged 40-70 years presenting with complaints of urinary incontinence in urogynecology, gynecology, or urology clinics. Sexual function assessment was coded based on the Female Sexual Function Index domains or general sexual functioning statements. Multivariable logistic regression examined associations between patient and health care professional/visit characteristics and documented assessment. Sensitivity analyses assessed the influence of high-volume health care professionals.</p><p><strong>Results: </strong>Sexual function assessment was documented in 53.1% of encounters. In adjusted analyses, male health care professional sex was associated with significantly lower odds of assessment. Increasing patient age and unmarried status were also independently associated with reduced odds of documentation. Visit location, health care professional specialty, and licensure were significant in the primary model, although specialty and licensure effects were influenced by high-volume health care professionals. Race, ethnicity, and insurance status were not significantly associated with assessment.</p><p><strong>Conclusions: </strong>Approximately half of midlife females presenting with urinary incontinence did not have documented sexual function assessment, despite known associations of female sexual dysfunction in this population. Assessment patterns varied by health care professional and patient characteristics, suggesting potential disparities in sexual function screening. Standardized approaches to sexual function assessment during urinary incontinence visits may increase female sexual dysfunction detection and improve comprehensive, equitable care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013345","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 Vaginal Mesh Hysteropexy Versus Hysterectomy/USLS: SUPeR Trial.","authors":"Heidi S Harvie, Amanda A Honeycutt, Benjamin Carper, Shawn Menefee, Nazema Siddiqui, David Ellington, Charles Rardin, Sarah E Jeney, Stephanie Glass Clark, Donna Mazloomdoost, Sonia Thomas","doi":"10.1097/SPV.0000000000001924","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001924","url":null,"abstract":"<p><strong>Importance: </strong>Pelvic organ prolapse is a common and burdensome condition. Hysterectomies are commonly performed with prolapse surgical repair; however, hysteropexy, a uterine-preserving surgical procedure, lessens operative time and is often preferred by patients.</p><p><strong>Objective: </strong>Cost-effectiveness was assessed for vaginal sacrospinous hysteropexy with a polypropylene graft versus vaginal hysterectomy with bilateral uterosacral ligament suture apical suspension.</p><p><strong>Study design: </strong>A prospective economic evaluation was performed concurrent with the Study of Uterine Prolapse Procedures Randomized Trial, conducted April 2013 through February 2020. Participants included 168 postmenopausal women requesting vaginal surgery for symptomatic uterovaginal prolapse. The analysis was from the U.S. health care sector perspective, with a 5-year time horizon. Costs were in 2020 U.S. dollars, with health care unit costs assigned from the 2020 Medicare Fee Schedule and Hospital Outpatient Prospective Payment System. Effectiveness was measured using quality-adjusted life years (QALYs) calculated from the Short-Form Six-Dimension (SF-6D) and the rate of sustained surgical treatment success at 5 years.</p><p><strong>Results: </strong>Costs and QALYs did not differ between treatment groups: costs were $11,631 (95% CI, $8,257, $15,005) hysteropexy versus $12,622 (95% CI, $10,172, $15,072) hysterectomy (P=0.64); and QALYs totaled 3.77 (95% CI, 3.67, 3.87) hysteropexy versus 3.77 (95% CI, 3.66, 3.87) hysterectomy (P=0.99). The cost-effectiveness point estimate was dominant for hysteropexy over hysterectomy. However, at a willingness-to-pay threshold of $150,000 per QALY, the probability that hysteropexy is cost-effective compared with hysterectomy was only 53%.</p><p><strong>Conclusions: </strong>While hysteropexy had a lower failure rate through 5 years compared with hysterectomy, the surgical treatments provide similar economic value for women with symptomatic uterovaginal prolapse.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992876","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":"Expanded Culture Techniques Identify Uropathogens in \"Contaminated\" Cultures.","authors":"Carson F Woodbury, Mark Khemmani, Aishah Kothawala, Robert B Moreland, Namisha Dhillon, Ann K Lal, Alan J Wolfe, Thythy T Pham","doi":"10.1097/SPV.0000000000001922","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001922","url":null,"abstract":"<p><strong>Importance: </strong>Treating asymptomatic bacteriuria (ASB) during pregnancy is recommended to reduce adverse pregnancy outcomes. Some urine cultures reported as contaminated may represent clinically significant bacteriuria. Enhanced culture techniques detect more microbes than standard urine cultures.</p><p><strong>Objectives: </strong>The objective of this study was to characterize discordance in results from 3 culture approaches in asymptomatic pregnant patients screened for bacteriuria whose samples were flagged as contaminated by the clinical laboratory.</p><p><strong>Study design: </strong>This was a planned secondary analysis of a randomized controlled trial comparing clean-catch urine and Peezy device collection in asymptomatic pregnant patients. Paired urine samples were sent to the clinical laboratory and a translational researcher's laboratory. Clinical laboratory standard urine culture results (clinSUC) deemed \"contaminated\" were compared with those from the research laboratory's standard culture (resSUC; same conditions, all identified microbes reported) and expanded quantitative urine culture (EQUC; more urine, expanded growth conditions, longer incubation). Discordant results included cases where (1) the relative abundance of known uropathogens identified by resSUC or EQUC exceeded 50% or (2) the predominant pathogen differed from clinSUC.</p><p><strong>Results: </strong>Sixty-seven participants had contaminated cultures. For clinSUC versus resSUC, discordance was 14 of 67 (20.9%). For clinSUC versus EQUC, discordance was 11 of 67 (16.4%). There was no significant difference between discordance rates (P= 0.51). Only 3 of 67 participants with contaminated cultures had a second urine specimen collected during pregnancy.</p><p><strong>Conclusion: </strong>In asymptomatic pregnant patients, expanded culture and reporting techniques identified uropathogens in 16-21% of urine specimens for which standard urine culture results were interpreted as contaminated.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922238","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":"Coding for Sling Operation, Revision, and Urethrolysis.","authors":"Joseph Panza, Ashley Hilton","doi":"10.1097/SPV.0000000000001923","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001923","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922216","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":"Role of Perioperative Trauma-Informed Care in Gender-Affirming Surgery.","authors":"Jaya Prakash, Laura A Potter, Youngwu Kim-Ortega, Milena M Weinstein","doi":"10.1097/SPV.0000000000001918","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001918","url":null,"abstract":"<p><p>Despite advances and expansion in the field of gender-affirming surgery (GAS) in recent years, perioperative care quality remains an area for improvement. Transgender and gender-diverse patients experience disproportionately high rates of intimate partner violence and sexual trauma, making them particularly vulnerable to re-traumatization while engaging in perioperative care for GAS. Implementing trauma-informed care (TIC) practices across preoperative, intraoperative, postoperative, and institutional phases can improve safety, trust, and patient outcomes. This narrative review synthesizes literature from 2015 to 2025 to outline a framework for integrating TIC principles across the surgical continuum. Embedding TIC within GAS represents not only a pathway to surgical excellence but also a critical step toward equity, psychological safety, and healing in gender-affirming health care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908209","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":"Long-Term Outcomes After Vaginal, Open or Robotic Surgery for Vault Prolapse.","authors":"Courtney K Pfeuti, Rubin Raju, John B Gebhart, Mallika Anand, Emanuel C Trabuco, John A Occhino, Yan Li, Deondre Jordan, Brian J Linder","doi":"10.1097/SPV.0000000000001915","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001915","url":null,"abstract":"<p><strong>Importance: </strong>Long-term comparative evidence guiding the optimal route and technique for repair of posthysterectomy vaginal vault prolapse is limited.</p><p><strong>Objective: </strong>The objective of this study was to compare symptom relief and prolapse retreatment rates after modified McCall culdoplasty (MMC) with uterosacral ligament suspension, abdominal sacrocolpopexy (ASC), and robotic sacrocolpopexy (RSC) for posthysterectomy apical prolapse.</p><p><strong>Study design: </strong>We performed a retrospective cohort study of women treated surgically for posthysterectomy apical prolapse between 2000 and 2018. Baseline characteristics and retreatment events were abstracted from the electronic health record. Pelvic floor symptoms and retreatment outcomes were evaluated through survey-based follow-up including validated questionnaires. Retreatment-free survival was estimated using Cox proportional hazards models with inverse probability weighting (IPW) to adjust for baseline differences.</p><p><strong>Results: </strong>Among 865 patients, 564 (65.2%) responded to follow-up surveys. Median follow-up was 3.4 years (IQR: 0.48, 6.1) for MMC, 4.6 years (IQR: 0.89, 9.9) for ASC, and 3.6 years (IQR: 0.57, 7.1) for RSC. Forty-eight retreatments occurred (5.5%; 28 surgical, 20 pessary). Ten-year retreatment-free survival was higher after ASC compared with MMC (93% vs 87%; P=0.045), although it did not differ between RSC and ASC (P=0.051) or RSC and MMC (P=0.94). In IPW-adjusted analyses, ASC was associated with a lower 10-year retreatment risk compared with MMC (HR, 0.30; 95% CI, 0.10-0.91; P=0.033). Postoperative symptom and sexual function scores were similar across procedures.</p><p><strong>Conclusions: </strong>All 3 approaches provide high retreatment-free survival with similar symptom relief. Open and robotic sacrocolpopexy demonstrated similar retreatment-free survival. Compared with MMC, ASC was associated with a lower retreatment rate with similar patient-reported outcomes. Shared decision making is important given differences in retreatment and morbidity.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893165","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":"Understanding Category I and III Codes and Their Effect on Your Practice.","authors":"Cindy Basinski, Nemi M Shah","doi":"10.1097/SPV.0000000000001921","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001921","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148893178","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}