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Importance: Coronavirus disease 2019 (COVID-19) has changed practice patterns resulting in same-day discharge after most urogynecologic surgical procedures., Objective: We aimed to determine if COVID-19 practice patterns changed patients' voiding trial (VT) results after surgery., Study Design: This is a retrospective cohort study of women undergoing urogynecologic surgery at an academic tertiary care center. We compared patients who had surgery between January 1, 2019, and February 28, 2020, (pre-COVID, discharged on postoperative day [POD] 1) with those who underwent surgery between January 1, 2021, and February 28, 2022, (during COVID, discharged on POD 0 or POD 1). Demographics, surgical characteristics, and VT results were compared using nonparametric tests. A logistic regression was performed to adjust for confounders. P value <0.05 was considered statistically significant., Results: A total of 237 patients were included. Patients were mostly White, older than 65 years (interquartile range, 56-73 years), and had a median parity of 2 (interquartile range, 2-3). Approximately 31% of patients in the pre-COVID group failed their VT, whereas 38% in the during-COVID group failed ( P = 0.275). Moreover, 40.5% of women discharged the day of surgery failed their VT ( P = 0.172). Compared with the pre-COVID group, more patients in the during-COVID group and those discharged on POD 0 contacted their surgeons with questions postoperatively (20.5% vs 35.0% and 35.4%, P = 0.014 and 0.022, respectively). Rates of urinary tract infection were similar by period and discharge day ( P > 0.05). There was no statistical association between day of discharge or the COVID-19 pandemic and VT results., Conclusions: Neither day of discharge nor the presence of the COVID-19 pandemic had a significant effect on postoperative outcomes, including urinary retention, after urogynecologic surgery. Same-day discharge is appropriate for most patients., Competing Interests: J.M.M. is an advisor for Attn: Grace. The rest of authors have declared they have no conflicts of interest., (Copyright © 2023 American Urogynecologic Society. All rights reserved.)

Objective: The aim of the study was to evaluate patient responses on a survey of knowledge, perceptions, concerns, and fears about complications related to pelvic reconstructive surgery (PRS). This is the first step to create a simplified, patient-centered Pelvic Floor Complication Scale that evaluates complications from both the patient and surgeon perspective., Methods: Subjects for this prospective study included women older than 18 years planning surgery within 12 weeks or who had undergone PRS more than 6 months ago. Patients were asked open-ended questions about postoperative complications as well as to rank the severity of potential PRS complications (as mild, moderate, severe). Using thematic analysis, responses were coded and analyzed using Dedoose (Version 8.0.35)., Results: Thirty-three women (16 preop, 17 postop) participated in telephone interviews (n = 26) and focus groups (n = 7). There were no differences in age, race, education, marital status, and previous surgery. Specific complications such as a single urinary tract infection, short-term constipation (<2 weeks), persistent constipation (present preop), bladder injury not requiring repair or catheterization, vascular injury without sequelae, and extra office visits were considered minor. New recurrent urinary tract infections, new persistent constipation, worsening postop constipation (present preop), blood transfusion, readmission, and reoperation were considered severe complications.The most common themes included the following: fears of surgical failure, anesthesia, mesh erosion, discharge with a catheter, and pain. Patients were overall very trusting of their female pelvic medicine and reconstructive surgery surgeons and potential risks did not impact surgical decisions., Conclusions: Our research findings provide significant insight into patient perceptions of complications related to PRS that will aid in future development of a patient-centered Pelvic Floor Complication Scale.

Objective: Our objective was to estimate the prevalence of abdominal wall striae among women with and without pelvic organ prolapse (POP) in a population with pelvic floor disorders., Methods: This cross-sectional study included nonpregnant women with urinary incontinence and POP presenting to a tertiary urogynecology practice between December 2012 and August 2013. Participants completed a nonvalidated questionnaire about striae, and the degree of abdominal wall striae was quantified on physical examination. Baseline demographics, clinical characteristics, and Pelvic Organ Prolapse Quantification (POP-Q) measurements were recorded., Results: One hundred thirty-two women were approached for participation, of which 110 (83%) completed study questionnaires. Of these 110, 59 had POP defined at POP-Q stages 2-4, whereas 51 had normal pelvic support, POP-Q stages 0-1. The mean (SD) age was 55.5 (12) years, and most (78/110) were sexually active. Women with POP were more parous than women without POP (median 2 vs 1, respectively; P = 0.03). However, there was no difference in medical comorbidities, smoking status, or steroid use between groups (P > 0.05). More women with POP reported striae (42/59 [71%] vs 23/51 [45%], P = 0.006) and had quantifiable abdominal wall striae compared with women with normal support (39/59 [66%] vs 22/51 [44%], P = 0.02). On multivariate logistic regression, women with POP were 2.5 times more likely to have striae compared with women without POP after adjusting for skin type and smoking status (odds ratio, 2.5; 95% confidence interval, 1.03-6.06; P = 0.04)., Conclusion: Women with POP are more likely to have striae compared with women without POP.

Objective: To determine whether use of a new personalized risk calculator increases patient satisfaction with the decision whether or not to have a prophylactic midurethral sling (MUS) during pelvic organ prolapse (POP) surgery., Methods: We performed a randomized controlled trial involving English-speaking women without symptoms of stress urinary incontinence (SUI) with ≥ stage 2 POP who planned to undergo POP surgery with 1 of 4 fellowship-trained urogynecologists at a single academic center. Women with a history of prior POP or incontinence surgery, or who were pregnant, or unable to complete study forms were excluded. Participants were randomly assigned to standard preoperative counseling or preoperative counseling with the use of a validated, online risk calculator for de novo SUI after POP surgery. The primary outcome was patient satisfaction with the decision for prophylactic MUS placement during POP surgery at 3 months postoperative assessed using the Satisfaction with Decision Scale for Pelvic Floor Disorders., Results: Sixty-three women were approached for participation. Forty-two agreed to participate, 41 underwent randomization, and 33 had POP surgery and completed 3-month follow-up. Of these 33, 17 were randomized to the risk calculator and 16 to standard counseling. The mean age was 61.2 ± 9.1 years, and 41% (14/33) had a prophylactic MUS. At 3 months postoperative, there was no difference in Satisfaction with Decision Scale for Pelvic Floor Disorders scores between groups (4.67 ± 0.46 [intervention] vs 4.78 ± 0.34 [control]; P = 0.61)., Conclusions: Use of the de novo SUI risk calculator did not increase patient satisfaction with the decision regarding MUS placement during POP surgery.

Objective: To estimate the prevalence of auditory vaginal air passage among women with and without pelvic organ prolapse (POP) in a population with pelvic floor disorders., Methods: This prospective cohort study included women with urinary incontinence and POP who sought consultation at a single center from January 2012 to August 2013. Women with rectovaginal fistula, prior surgery for POP or incontinence, and current pregnancy were excluded. Participants completed a nonvalidated questionnaire about auditory vaginal air passage, also known as vaginal wind. The subset who had pelvic reconstructive surgery completed the same questionnaire 6 months postoperatively. Baseline demographic and clinical characteristics and preoperative and postoperative POP quantification data were collected., Results: One hundred thirty-two women were approached for participation, of whom 110 (83%) completed baseline study questionnaires. Of these 110, 59 had POP and 51 had normal pelvic support. The mean age was 55±12 years. Sixty-nine percent (76/110, 95% confidence interval [CI] 60-78%) experienced vaginal wind an average of 2.1±8.7 times weekly. There was no difference in the prevalence of vaginal wind between women with and without POP. Women with vaginal wind were younger than those without vaginal wind (mean age 52±12 years compared with 62±11 years, P<.001). The majority with vaginal wind experienced symptoms during intercourse (65/75 [87%], 95% CI 77-93%) and were at least somewhat bothered by it (49/76 [64%], 95% CI 53-75%), but only 22% (17/76, 95% CI 14-33%) reported a negative effect on quality of life., Conclusion: Vaginal wind is common among women with pelvic floor disorders but is not associated with POP., Level of Evidence: II.

Introduction and Hypothesis: This study evaluates the effect of baseline pelvic organ prolapse (POP) severity on improvement in overactive bladder (OAB) symptoms after pelvic reconstructive surgery., Methods: We performed a retrospective cohort study of women with POP and OAB who underwent surgical correction of symptomatic apical and/or anterior POP. OAB was defined as an affirmative response to item #15 (urinary frequency) and/or item #16 (urge incontinence) of the Pelvic Floor Distress Inventory (PFDI). POP severity was dichotomized as Pelvic Organ Prolapse Quantification (POP-Q) stage 1-2 versus stage 3-4. Our primary outcome was complete resolution or improvement of urinary frequency or urge incontinence on the PFDI 12 months postoperatively., Results: At 12 months postoperative, 41 (89%) women with stage 1-2 POP versus 47 (85 %) with stage 3-4 POP reported improvement in urinary frequency (p = 0.58). Thirty five (90 %) with stage 1-2 and 34 (85 %) with stage 3-4 POP reported improvement in urge incontinence (p = 0.74). On multiple logistic regression, women with stage 3-4 POP had a decreased odds of improvement in frequency or urge incontinence compared with women with stage 1-2 POP (adjusted odds ration [AOR] = 0.06 [95 % CI 0.01-0.67]), after adjusting for confounders., Conclusions: Women with coexisting POP and OAB who undergo surgical correction of POP experience improvement in OAB symptoms after surgery, although women with more severe POP may be at a higher risk of persistent frequency or urge incontinence.