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To compare mesh complications and failure rates after 1 year in laparoscopic minimally invasive sacrocolpopexy (MISC) with ultralightweight mesh attached vaginally during total vaginal hysterectomy (TVH), laparoscopically if posthysterectomy (PH), or laparoscopically during supracervical hysterectomy.Single-center retrospective cohort study.Tertiary referral center.Women with symptomatic pelvic organ prolapse who elected for MISC.Laparoscopic MISC with ultralightweight mesh attached vaginally during TVH, laparoscopically if PH, or laparoscopically during supracervical hysterectomy. Composite failure was defined as recurrent prolapse symptoms, prolapse past the hymen, or retreatment for prolapse.Between 2010 and 2017, 650 patients met the inclusion criteria with 278 PH, 82 supracervical hysterectomy, and 290 vaginal hysterectomy patients. Median follow-up was similar for all groups (382 days vs 379 vs 345; p = .31). The majority in all groups were white (66.6%), nonsmokers (74.8%), postmenopausal (82.5%), and did not use estrogen (70.3%). Mesh complications did not differ among groups (1.6% PH, 2.5% supracervical hysterectomy, 2.2% vaginal hysterectomy; p.99). There was no difference in anatomic failure (5% PH, 1.2% supracervical hysterectomy, 2.1% vaginal hysterectomy; p = .07), reoperation for prolapse (1.4% vs 1.2% vs 0.7%; p = .57), or composite failure (9.0% vs 3.7% vs 4.8%; p = .07).TVH with vaginal mesh attachment of ultralightweight mesh had similar adverse events, mesh exposure rates, and failure rates to those of laparoscopic PH sacrocolpopexy or supracervical hysterectomy with laparoscopic mesh attachment.

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.

The Veterans Health Administration Home Based Primary Care (VHA-HBPC) program serves Veterans with complex, chronic conditions. Emergency management is a concern for VHA-HBPC programs. Geographic information system (GIS) mapping has been implemented for local program operations in 30 locations. An evaluation assessed GIS mapping as a tool in emergency management, including frontline nurses' and nurse leaders' experiences. Nurses' roles included making and using maps for preparedness and response. Maps provided valuable information, including locations of vulnerable patients (eg, ventilator dependent), community emergency resources, and environmental threats (eg, hurricane). Nurses' willingness to embrace this new technology and skill set was notable.

Gynecologic surgery carries a known risk of injury to the urinary tract, especially in the presence of risk factors. Injury to the bladder, particularly a mechanical injury, is more common than injury to the ureter. Urinary tract injuries occur in 0.3% to 0.8% of all gynecologic procedures, and injuries to the bladder occur in 0.05% to 0.66% of such surgeries. The risk of bladder injury increases in hysterectomy procedures. Most research studies have cited occurrence of bladder injuries to be 1.0% to 1.8% in laparoscopically assisted vaginal hysterectomies and vaginal hysterectomies. Despite its frequency, there is limited research on best practices for bladder injury repair. The authors performed a literature search through the PubMed database using the terms "bladder anatomy," "bladder injury," "bladder repair," "cystotomy," "routine cystoscopy," and "vesicovaginal fistula." This review uses gynecologic and trauma literature and discusses prevention, recognition, types of iatrogenic bladder injuries, their clinical significance, current guidelines on bladder injury repair, and the expected follow-up care, and concludes by identifying areas for further research.