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One risk of removal of a tined sacral neuromodulation lead is breakage, resulting in a retained lead fragment. We report lead breakage rates, risk factors and outcomes of retained fragments.We report on 464 tined lead removals from 2002 to 2018. Clinical and surgical factors were reviewed and appropriate statistical analysis performed. Retained fragments were reviewed for fragment description and long-term complications.A total of 464 tined lead removals were included, with 35 lead breaks identified, for a rate of 7.5% (35). Factors associated with breakage included male gender (OR 6.58, 95% CI 2.54-17.01, p=0.001) and diabetes (OR 2.42, 95% CI 1.05-5.58, p=0.019). A shorter time since implantation was protective (OR 0.86, 95% CI 0.76-0.98, p=0.002). There was no difference in breakage rate based on age, weight, history of prior revision, bilateral leads, reason for lead removal, surgical technique or surgeon. Of the 35 breaks 27 had imaging available. Of these 66% (18) broke in the tined region and 81% (22) were ghost leads. Most patients (80%, 28 of 35) with retained lead fragments received another implant. Only 1 patient had a related complication of additional surgery for pain related to the fragment.There is a low rate of tined lead breakage during lead removal. However, it is higher than the manufacturer estimate. Protective factors include a shorter time between implant and lead revision. The most common location for lead breakage is in the region of the tines, most are ghost fragments and long-term complications are uncommon.

The sudden loss of smell is among the earliest and most prevalent symptoms of Covid-19 when measured with a clinical psychophysical test. Research has shown the potential impact of frequent screening for olfactory dysfunction, but existing tests are expensive and time-consuming. We developed a low-cost ($0.50/test) rapid psychophysical olfactory test (KOR) for frequent testing and a model-based COVID-19 screening framework using a Bayes Network symptoms model. We trained and validated the model on two samples: suspected COVID-19 cases in five healthcare centers (n=926; 33% prevalence, 309 RT-PCR confirmed) and healthy miners (n=1,365; 1.1% prevalence, 15 RT-PCR confirmed). The model predicted COVID-19 status with 76% and 96% accuracy in the healthcare and miners samples, respectively (healthcare: AUC=0.79, [0.75-0.82], sensitivity: 59%, specificity: 87%; miners: AUC=0.71, [0.63-0.79], sensitivity: 40%, specificity: 97%, at 0.50 infection probability threshold). Our results highlight the potential for low-cost, frequent, accessible, routine COVID-19 testing to support society’s reopening., Graphical Abstract

RESUMEN Introducción y objetivos: La incontinencia de orina de esfuerzo (IOE) es una patología muy frecuente. El tratamiento estándar corresponde al uso de cintas medio uretrales. Dentro de las técnicas quirúrgicas clásicas se encuentra la colposuspensión de Burch (CSB), poco frecuente en la actualidad. El objetivo de este estudio es describir las características de las pacientes con antecedentes de una CSB que consultan en la unidad de Uroginecología. Métodos: Revisión tipo transversal de los datos ingresados a la unidad de Uroginecología del Hospital Dr. Sótero Del Río desde 2007 al 2019. Análisis descriptivo de los antecedentes de las pacientes con antecedente de CSB. RESULTADOS: Durante el periodo analizado, 63 pacientes presentaban antecedentes de CSB. La edad promedio fue 68 años, 88% eran post menopáusicas, 60% fueron sometidas a histerectomía y 24% a cirugías por prolapso (POP). La paridad promedio fue 3 hijos, 15% tuvieron al menos un parto por fórceps. Un 51% consultó por IOE, 54% por vejiga hiperactiva (VH) y 56% por sensación de bulto o peso. El 38% consultó por incontinencia de orina mixta, 37% por IOE + POP y 41% por VH + POP. 22% fueron reoperadas, 16% por medio de TVT y 6% por TOT. Conclusiones: El antecedente de CSB es infrecuente en nuestra población. Similar a lo descrito en la literatura, más de un 50% de las pacientes consultó por síntomas de recurrencia y por complicaciones como POP y VH. Próximos estudios deberían evaluar si el antecedente de CSB es un factor de riesgo de complicaciones quirúrgicas o recurrencia.

The infectiousness and presymptomatic transmission of SARS-CoV-2 hinder pandemic control efforts worldwide. Therefore, the frequency of testing, accessibility, and immediate results are critical for reopening societies until an effective vaccine becomes available for a substantial proportion of the population. The loss of sense of smell is among the earliest, most discriminant, and prevalent symptoms of COVID-19, with 75-98% prevalence when clinical olfactory tests are used. Frequent screening for olfactory dysfunction could substantially reduce viral spread. However, olfactory dysfunction is generally self-reported, which is problematic as partial olfactory impairment is broadly unrecognized. To address this limitation, we developed a rapid psychophysical olfactory test (KOR) deployed on a web platform for automated reporting and traceability based on a low-cost (about USD 0.50/test), six-odor olfactory identification kit. Based on test results, we defined an anosmia score –a classifier for olfactory impairment–, and a Bayesian Network (BN) model that incorporates other symptoms for detecting COVID-19. We trained and validated the BN model on two samples: suspected COVID-19 cases in five healthcare centers (n = 926; 32% COVID-19 prevalence) and healthy (asymptomatic) mining workers (n = 1, 365; 1.1% COVID-19 prevalence). All participants had COVID-19 assessment by RT-PCR assay. Using the BN model, we predicted COVID-19 status with 76% accuracy (AUC=0.79 [0.75 − 0.82]) in the healthcare sample and 84% accuracy (AUC=0.71 [0.63 − 0.79]) among miners. The KOR test and BN model enabled the detection of COVID-19 cases that otherwise appeared asymptomatic. Our results confirmed that olfactory dysfunction is the most discriminant symptom to predict COVID-19 status when based on olfactory function measurements. Overall, this work highlights the potential for low-cost, frequent, accessible, routine testing for COVID-19 surveillance to aid society’s reopening.

Objective To determine if using one 250 mL bottle of intravesical contrast followed by sterile saline alters interpretation of fluoroscopic images during fluoro-urodynamics. Materials and Methods Subjects were randomized to receive 250 mL of intravesical contrast followed by sterile saline until maximal cystometric capacity vs non-dilute intravesical contrast alone during fluoro-urodynamics. Interpreters, blinded to study group, graded images on an ordinal rank scale rating confidence in image interpretation. Primary endpoint was differences in image interpretation between the two groups using visual grading characteristics curves and contrast-to-noise ratios (CNR). Secondary endpoints were obtaining anthropometric data such as body mass index and waist circumference to determine predictors of CNR in a multivariate multiple regression analysis. Results 26 subjects were randomized to receive dilute intravesical contrast and 22 non-dilute contrast; two subjects were unable to complete the study. There was no difference in baseline characteristics between the two groups. Visual grading characteristics demonstrated no difference in readability of the fluoroscopic images between groups and CNR was not statistically different between the two groups. No correlation was identified between CNR and waist circumference or body mass index. Conclusion Interpretation of fluoro-urodynamic images and image quality was not altered with using of 250 mL of contrast followed by saline. Expert reviewers did not perceive a difference in their confidence to distinguish between the two groups. Fluoro-urodynamics can be reliably performed using only 250 mL of contrast without compromising the ability to read the fluoroscopic images.

We sought to determine the usefulness of motor responses during sacral neuromodulation lead placement by testing the hypothesis that a greater number of motor responses during intraoperative electrode testing would be associated with more durable therapy.We retrospectively reviewed all sacral neuromodulation lead placements at a large academic center from 2010 to 2015. Included in study were all unilateral sacral lead placements for which the presence or absence of a motor response was documented discretely for each electrode. Motor responses were quantified into separate subscores, including bellows and toe response subscores (each range 0 to 4) for a possible maximum total score of 8 when combined. Revision surgery was the primary outcome. Univariate and multivariate analyses were performed for factors associated with lead revision.A total of 176 lead placements qualified for analysis. Mean ± SD cohort age was 58.4 ± 15.9 years, 86.4% of the patients were female and 93.2% had undergone implantation for overactive bladder. Median followup was 10.5 months (range 2 to 36). Overall 34 patients (19%) required lead revision. Revision was negatively associated with the total electrode response score (p = 0.027) and the toe subscore (p = 0.033) but not with the bellows subscore (p = 0.183). Predictors of revision on logistic regression included age less than 59 years at implantation (OR 5.5, 95% CI 2-14) and a total electrode response score less than 4 (OR 4.2, 95% CI 1.4-12.8).Fewer total electrode responses and specifically fewer toe responses were associated with sacral neuromodulation lead revision. These data suggest that placing a lead with more toe responses during testing may result in more durable sacral neuromodulation therapy.

Introduction Sacral neuromodulation (SNM) devices (Medtronic, Minneapolis, MN, USA) are not approved to undergo magnetic resonance imaging (MRI) of sites other than the head. When MRIs are required, devices are often removed prior to imaging. We reviewed the prevalence of device removal for MRI at a large academic institution and the subsequent clinical course of these patients. Methods A retrospective review of all SNM explants from 2009–2015 was performed. Cases explanted for MRI were analyzed to collect demographics, clinical characteristics, and postremoval management. Descriptive statistics were calculated. Results Ninety patients underwent SNM device removal, with 21 (23%) occurring for MRI. At explant, 20 patients (95%) were female and median age was 66 years. Suboptimal symptom control from SNM was noted in seven (33%) of these patients preoperatively. Of those explanted, six (29%) required MRI for neurologic and 10 (48%) for orthopedic concerns. The remaining MRI indications included abdominal masses (10%), genitourinary disease (5%), surveillance for prior malignancy (5%), and cardiac disease (5%). Only 16 (76%) patients explanted ultimately underwent MRI. MRI results impacted clinical management in 9/16 (56%) of the imaged patients. Only two (10%) of explanted patients underwent device replacement. Conclusions In patients receiving SNM therapy, device removal for MRI is most commonly due to orthopedic and neurologic pathologies. About half of the MRIs performed impacted non-GU clinical management. It is of paramount importance to confirm the necessity of MRI before removing a functional SNM device. Since SNM replacement was rare in this cohort, research is needed on the safety of various MRI types with SNM devices in vivo.

We investigated the influence of patient age on sacral nerve stimulation trial outcomes, device implantation and treatment durability.We analyzed a database of all sacral nerve stimulation procedures performed between 2012 and 2014 at a high volume institution for associations of patient age with sacral nerve stimulation indication, trial stimulation success, device revision and device explantation.In a cohort of 356 patients those with nonobstructive urinary retention and urgency-frequency were younger than patients with urgency urinary incontinence. Trial stimulation success did not differ by age in stage 1 and percutaneous nerve evaluation trials (p = 0.51 and 0.84, respectively). Logistic regression identified greater odds of trial success in females compared to males (OR 2.97, 95% CI 1.32-6.04, p = 0.009) and for urgency urinary incontinence compared to urgency-frequency (OR 3.02, 95% CI 1.39-6.50, p = 0.006). In analyzed patients there were 119 surgical revisions, including battery replacement, and 53 explantations. Age was associated with a decreased risk of revision with 3% lower odds per each additional year of age (OR 0.97, 95% CI 0.95-0.98, p 0.0001). While age did not influence explantation, for each body mass index unit there was a 5% decrease in the odds of explantation (OR 0.95, 95% CI 0.91-0.98).In contrast to previous studies, older patients experienced no difference in the sacral nerve stimulation response in stimulation trials and no difference in the implantation rate. Furthermore, age was modestly protective against device revision. This suggests that age alone should not negatively predict sacral nerve stimulation responses.

INTRODUCTION AND OBJECTIVES:The tined lead for use with InterStim sacral neuromodulation (SNM) was introduced in 2002. However, little data on lead breakage has been published. In 2010 the manufact...

Background There is no consensus on the relationship between depressive symptoms (DS) and pelvic organ prolapse (POP) symptoms and quality of life (QoL). Our hypothesis was that women with DS and POP have worse symptoms and QoL than those without DS and POP. Aim Our aim was to compare two groups of POP patients, those with depressive symptoms and those without, and evaluate the association of symptoms and QoL. Materials and methods This planned report is part of a prospective study evaluating the impact of pessary use among symptomatic POP patients. Patients were evaluated by POP quantification (POP-Q), pelvic ultrasound (US), voiding diaries, stress test, pad test, Pelvic Floor Distress Inventory (PFDI-20), Prolapse QoL (P-QoL) and the Goldberg Health Questionnaire (GHQ-12) (psychological health screening for DS when score ≥5). A sample size of 78 patients was required to demonstrate a 50-point difference in the global PFDI-20 score with 80% power and 95% probability. Results Ninety-one women with POP were included. GHQ-12 was positive in 47 (51.6%) patients. No differences were found in POP-Q, pad and stress test between those with a positive GHQ-12 and those without. However, GHQ-12 was associated with higher PFDI-20 scores and higher scores in seven of nine P-QoL domains. GHQ-12 persisted as an independent risk factor for worse P-QoL scores after multivariable analysis. Conclusion A ‘positive’ screening for DS was associated with worse PFDI-20 and P-QoL scores despite no difference in objective measurements. It may be that depressed patients interpret their symptoms differently.

Pelvic organ prolapse is a common disease in elderly patients. The most important symptom is vaginal bulge (bulge sensation or the sensation of something coming down through the vaginal introitus). This symptom is not different than in the general population. Diagnosis can be confirmed using just vaginal examinations to identify the presence of protrusion beyond the hymen, and is not different than in the general population. Different treatment options are available, including observation, nonsurgical, and surgical techniques. Pessaries and colpocleisis are the treatment options used more often in elderly patients than in the general population.

We sought to determine the safety of sacral neuromodulation in patients during lumbosacral 1.5 Tesla magnetic resonance imaging.We prospectively recruited patients with a sacral neuromodulation implant who required lumbosacral 1.5 Tesla magnetic resonance imaging. Before imaging the patients completed validated urinary symptom questionnaires and a survey regarding the usual sacral neuromodulation sensation. The implantable pulse generator was interrogated, and impedances, battery life and stimulus amplitude sensory thresholds were assessed before and after magnetic resonance imaging. Devices were switched off before the patient entered the scanner. Patients were monitored during the study and magnetic resonance imaging related adverse events questionnaires were completed after imaging. Validated questionnaires were repeated 1 month after magnetic resonance imaging to assess for changes in sacral neuromodulation therapeutic efficacy.A total of 11 patients were enrolled in the study. Lower back pain, which was noted by 6 of the 11 patients (55%), was the most common indication for imaging. Immediately after magnetic resonance imaging only 1 patient reported mild discomfort during imaging at the site of the implantable pulse generator. This discomfort was present only during the scan and not afterward. Two patients reported warmth at the implantable pulse generator site during the scan, which was also present only during scanning. Patients did not report any other adverse events. There were no major changes in impedance or battery life after magnetic resonance imaging. Stimulus amplitude sensory thresholds and stimulation localization were unchanged. Validated questionnaires 1 month after imaging did not show worsening scores compared to scores before imaging.No significant adverse events occurred in patients implanted with a Medtronic InterStim™ II device who underwent a 1.5 Tesla lumbosacral magnetic resonance imaging scan. Therapeutic efficacy of sacral neuromodulation was unchanged 1 month after imaging.

Urethral perforations after synthetic midurethral sling (MUS) placement are uncommon. Transvaginal removal is an option. The objective of this English and Spanish video is to demonstrate removal of an MUS that had perforated the urethra and the concomitant urethral reconstruction.A 66-year-old woman with a history of an anterior and posterior colporrhaphy and a retropubic MUS 12 years earlier presented with difficulty voiding, recurrent urinary tract infections, and mild stress incontinence (SUI). Physical examination revealed tenderness on the anterior vaginal wall (AVW) without mesh extrusion. Cystourethroscopy showed urethral perforation, distal to the bladder neck and urodynamics demonstrated an obstructive pattern. The patient wished to undergo transvaginal sling removal and reconstruction.The mesh was deep in the AVW perforating the urethra and the vaginal portion was completely removed. The video demonstrates several tips on how to remove a perforating MUS and subsequent urethral reconstruction. Ten months postoperatively the force of stream returned to normal, with no further UTIs, no evidence of fistula, and rare SUI.Urethral perforation with an MUS can be successfully treated with removal of any mesh in proximity to the urethra and urethral reconstruction via a completely transvaginal approach.

The aim of this video is to make vaginal hysterectomy (TVH), vaginal salpingoophorectomy and uterosacral ligament (USL) colpopexy approachable by showing the key procedural steps from both the vaginal and abdominal perspectives.This production shows TVH with salpingoophorectomy and USL colpopexy that was performed on a cadaver and filmed simultaneously from the vaginal and abdominal views. The video begins with an anatomy overview from the open abdomen and proceeds with the TVH. The anterior and posterior peritoneal entries, a technique to safely and easily access the adnexa, as well as the placement of USL suspension sutures are highlighted. The proximity of the ureter and its distance from the three locations most vulnerable to injury during this procedure (the uterine artery pedicle, the infundibulopelvic ligament and the USL) are illustrated. The location of the USL suspension sutures in relation to the ischial spine, the rectum and the sacrum are demonstrated. For all of these crucial steps, a series of picture-in-picture views simultaneously showing the abdominal and vaginal perspectives are presented so that the viewer may better understand the spatial anatomy.This video provides the viewer with a unique anatomic perspective and helps more confidently perform TVH, vaginal salpingooophorectomy and USL colpopexy.

We performed functional magnetic resonance imaging to identify changes in brain activity during sacral neuromodulation in women with overactive bladder who were responsive to therapy.Women recruited into the study had nonneurogenic refractory overactive bladder, responded to sacral neuromodulation and had had a stable program for at least 3 months with no subsequent overactive bladder treatment. Enrolled patients completed validated symptom and quality of life instruments before functional magnetic resonance imaging. Stimulus settings were recorded, devices were switched off for a 5-day washout and instruments were repeated. Three functional magnetic resonance imaging scans with simultaneous sacral neuromodulation stimulation were performed below, at and above stimulus sensory threshold using a block design. This yielded brain activity maps represented by changes in blood oxygenation level dependence. A total of 5 stimulator off and 4 stimulator on cycles of 42 seconds each were imaged. Group analysis was done using a single voxel p value of 0.05 with a false-positive error of 0.05 on cluster analysis.Six of the 13 patients enrolled completed functional magnetic resonance imaging. Median age was 52 years (range 36 to 64). Urinary symptoms and voiding diary data worsened with washout. Overall brain activation generally progressed with increasing stimulation amplitude. However, activation of the right inferior frontal gyrus remained stable while deactivation of the pons and the periacqueductal gray matter only occurred with subsensory stimulation. Sensory stimulation activated the insula but deactivated the medial and superior parietal lobes. Suprasensory stimulation activated multiple structures and the expected S3 somatosensory region. All devices had normal impedance after functional magnetic resonance imaging.Functional magnetic resonance imaging confirmed that sacral neuromodulation influences brain activity in women with overactive bladder who responded to therapy. These changes varied with stimulus intensity.

At our institution many symptomatic patients must wait months or years for surgery. Our aim was to determine the rates of clinically significant pelvic organ prolapse (POP) progression and identify risk factors associated with POP progression. Data from a prospectively maintained database of POP patients evaluated between 2008 and 2013 were analyzed. Women with symptomatic POP and two or more POP-Q examinations prior to surgery were included. POP progression was defined as having any of the POP-Q points Aa, Ba, C, D, Ap or Bp above the hymen at the baseline examination and at or below the hymen at the follow-up examination. Multivariable logistic analysis was preformed and the results are presented as odds ratios (OR) with 95% confidence intervals (CI). Of consecutive patients evaluated between July 2008 and June 2013, 388 met the inclusion criteria and were included. The median time between the POP-Q examinations was 9.9 months (IQR 7.8 to 13.8 months). The POP progression rate was 29.1% (95% CI 24.6–33.6%). Predictors of progression included age (OR 1.7, 95% CI 1.01–2.87) and the baseline status of points Ba, C, Bp and gH (OR 1.91, 95% CI 1.01–3.62; OR 0.53, 95% CI 0.3–0.94; OR 0.54, 95% CI 0.32–0.93; OR 2.15, 95% CI 1.13–4.1; respectively). POP-Q point correlations showed that anterior and posterior compartment points evolve with apical compartment points and gH evolves with both the anterior compartment and the apex. Up to 29.1% of symptomatic patients with POP showed clinically significant progression over a median follow-up of 9.9 months. The likelihood of progression was not significantly associated with time. Those ≥60 years of age as well as those with point Ba ≥4 cm or gH ≥5 cm at baseline were at increased risk of POP progression.

Device infection is one of the most common complications of sacral nerve stimulator placement and occurs in approximately 3-10% of cases. Infection is a serious complication, as it often requires complete explantation of the device. Not much is known regarding risk factors for and methods of preventing infection in sacral nerve stimulation. Multiple risk factors have been linked to device infection including prolonged percutaneous testing and choice of preoperative antibiotic. Methods of infection prevention have also been studied recently, including antibiotic-impregnated collage and type of skin preparation. This review will discuss the recent literature identifying risk factors and means of preventing infection in sacral nerve stimulation. Finally, we will outline a protocol we have enacted at our institution which has resulted in an incidence of infection of 1.6%.

Proper recognition and management of apical prolapse is imperative in maximizing surgical outcomes in women with multi-compartment pelvic organ prolapse. Sacrospinous ligament fixation is a safe and effective, transvaginal and extraperitoneal procedure for apical prolapse. However, the sacrospinous ligament is an anatomically vulnerable location, which lends technical complexity to the procedure along with risk of rare but important complications. This chapter will serve as a guide for the recognition and management of complications of sacrospinous ligament fixation.

Little is known regarding the use of various techniques for sling tensioning. Our objective was to determine which techniques are most commonly used by surgeons and surgeons' views on sling tensioning.An Internet-based survey designed to assess the use of various tensioning evaluation methods, different sling tensioning techniques, and views and beliefs regarding the importance of tensioning was sent to members of major sub-specialty professional organizations. The responses were analyzed using descriptive statistics, and univariate and multivariate logistic analyses were performed to assess the effect of various surgeon characteristics on operative techniques.A total of 596 surgeons (63% gynecologists, 37% urologists) from 56 different countries were included in the analysis. Over 30% of respondents reported performing50 sling operations/year. Use of objective intraoperative tension evaluation methods was 15.6, 7.8, and 1.9% for intraoperative stress tests, cystoscopic evaluation of urethral coaptation, or Q-tip tests respectively. Sixty-three percent indicated that they tension retropubic transvaginal tape (RP) and transobturator tape (TOT) slings similarly, whereas 26.2% place more tension on TOT than RP slings and 10.4% place more tension on RP than TOT slings. Those with fellowship training were 66% more likely to utilize leak point pressure results to inform the degree of tensioning (OR 1.66, CI 1.04-2.66).Our results indicate that there is a wide degree of variation in technique among surgeons. Prospective studies assessing the utility of various techniques could provide more evidence-based approaches to midurethral sling surgery and potentially improve quality and patient outcomes.

Vaginal stenosis is an unfortunate complication that can occur after pelvic radiation therapy for gynecologic or colorectal malignancies. Treatment is challenging and can require significant reconstructive surgery. The objective of this video is to present a case of vaginal stenosis after radiation and describe vaginal reconstruction with a fasciocutaneous Singapore flap.We describe the case of a 42-year-old woman with a history of stage 3 colorectal cancer who underwent partial colectomy, chemotherapy, and pelvic radiation. She subsequently developed a rectovaginal fistula requiring repair with a right-sided gracilis flap. When her stenosis recurred, she underwent vaginal reconstruction with a medial thigh flap.The Singapore flap is a pudendal thigh flap centered on the labial crural fold with a base at the perineal body. As the cutaneous innervation is spared, this flap is sensate. This technique is one option for patients with complex vaginal stenosis who have failed conservative management. However, it is imperative the patient perform vaginal dilation postoperatively and maintain close follow-up with her surgeon, as vaginal stenosis can recur.Postradiation vaginal stenosis is a complex condition to treat; however, vaginal reconstruction with a thigh flap can provide excellent cosmetic and functional results.

INTRODUCTION AND OBJECTIVES: Although early Sacral Neuromodulation (SNM) trials excluded patients with neurologic lower urinary tract dysfunction (NLUTD), an increasing number of small studies show outcomes in these patients are similar to those without NLUTD. The use of SNM in NLUTD remains off label. The aim of this study was to compare SNM in patients with NLUTD to those without NLUTD and determine clinical factors associated with successful utilization of SNM. METHODS: A retrospective review of patients who underwent SNM between 2011 and 2015 was completed. Patients with a neurologic diagnosis in the electronic chart were identified and placed in the NLUTD cohort. Demographic and clinical characteristics of the NLUTD and non-NLUTD cohort were identified. Rates of progression to stage 2, revision and explant were analyzed. The data were examined using Pearson’s chi-square and Fisher exact tests as appropriate. RESULTS: Out of 412 patients, 80 (19.4%) had NLUTD at time of SNM with a mean age was 54 17 years. 75% of the NLUTD group was female (N1⁄460). The neurogenic diagnoses were: spinal cord injury 28.8% (N1⁄423), multiple sclerosis 23.8% (N1⁄419), Stroke 15% (N1⁄412), cerebral palsy12.5% (N1⁄410), peripheral nervous system disorders 12.5% (N1⁄410) and Parkinson’s disease 7.5% (N1⁄46). The primary indication for SNM was urgency incontinence in 62.5% of the NLUTD group (N1⁄450) and 59.5% in the non-NLUTD group (N1⁄4197). Progression to stage 2 SNM was similar in both groups, 90% in NLUTD versus 87% in non-NLUTD. Revision rates were higher in the NLUTD cohort compared to non-NLTUD, 46% versus 35%, but this trend did not reach statistical significance (p1⁄40.09). There was a statistically significant higher explant rate in the NLUTD group, 33% vs 20% (p1⁄40.0194) and the most common reason for explant in both groups was loss of efficacy. Progression to stage 2, revision rates, and explant rates for each type of neurologic diagnosis did not have any statistically significant difference. CONCLUSIONS: The primary indication for SNM in both NLUTD and non-NLUTD was urgency incontinence. The specific neurologic diagnosis is not predictive of SNM success, revision, or explants rates. However, patients with NLUTD appear more likely to need the device explanted when compared to patients with nonNLUTD.

INTRODUCTION AND OBJECTIVES: Sacral neuromodulation is a highly effective therapy; however, up to 30% of patients who undergo sacral nerve stimulator (SNS) implantation will require lead revision within 5 years. Lead breakage can occur during revision, but the rate of breakage and the risk factors associated with it are not well described in the literature. The aim of this study is to describe the rate of lead breakage in our institution and identify potential risk factors for breakage. METHODS: A retrospective review of all SNS lead revisions or explantations performed in the urology department at a tertiary care center between 2010 and 2015 was performed. The clinical, demographic characteristics and lead breakage rate were analyzed. Descriptive statistics are presented as percentages, mean SD or median (interquartile range). T-test, Mann-Whitney U, Chi-Square or Fisher exact tests were used as appropriate. A logistic regression analysis was performed for incomplete lead removal as the dependent variable that included variables with p values < 0.1 in the univariate analysis as well as other clinically relevant variables. p

Introducción: El prolapso genital impacta negativamente la calidad de vida y autoimagen de la mujer. Rutinariamente indicamos la colpoperineocleisis de Labhardt a pacientes de edad avanzada y sin actividad sexual. Objetivo: Evaluar los resultados con esta técnica e identificar posibles factores de riesgo que predigan la falla. Métodos: Análisis retrospectivo de pacientes tratadas con la técnica entre los años 2008-2010. Se realizó análisis univariado y multivariado para identificar factores de riesgo asociados a la falla y se construyeron curvas libre de falla anatómica a fin de evaluar la durabilidad. Resultados: 68 pacientes cumplieron los criterios de inclusión. La edad promedio fue 71,9±5,7 años; 95,6% fueron clasificadas en etapa III o IV según POP-Q. El tiempo operatorio fue de 54 ± 20 minutos. Seguimiento promedio de 21 meses; la tasa de recidiva anatómica fue de 14,7%. La tasa de incontinencia de orina de esfuerzo (IOE) de novo fue de 5,9%. El análisis univariado identificó como factor predictor de recidiva el flujo vaginal posoperatorio; en análisis multivariado de Cox, esa condición mantuvo significancia estadística (OR 6,3). Se identificó como factor de riesgo el no acatamiento de la técnica quirúrgica (OR 7,2). Conclusión: La colpoperineocleisis de Labhardt es una técnica segura, con baja tasa de complicaciones, una tasa de recurrencia aceptable y baja tasa de IOE de novo. Pilar del éxito es evitar la infección y respetar la técnica quirúrgica. Es necesario estudios comparativos con otras técnicas oclusivas, como también evaluar el rol de la infección como causa de falla de la técnica. Introduction: Genital prolapse affects up to 50% of multiparous women, impacting their quality of life and self-image. At our Institution Labhardt's colpoperineocleisis is usually proposed to older patients, without sexual activity, regardless the type or grade of prolapse. Objective: To evaluate the results with this technique and identify potential risk factors predicting the failure. Methods: Analysis of a retrospective cohort of patients treated with this technique between 2008 and 2010. Univariate and multivariate analysis were carried out to identify risk factors and failure-free curves were built to estimate durability. Results: 68 patients met the inclusion criteria. Average age was 71.9 ± 5.7 years; 95.6% of patients were classified as stage III or IV based on POP-Q system. Operative time was 54 ± 20 min. At 21 months of follow-up, recurrence rate was 14.7%. De novo stress urine incontinence (SUI) was diagnosed in 5.9% of patients. In univariate analysis, post operative vaginal discharge was identified as predicting factor for defect recurrence. In Cox analysis, this condition remained significant (OR 6.3), In addition, failure to observe the surgical technique was also identified as risk factor for defect recurrence (OR 7.2). Conclusion: Labhardt 's colpoperineocleisis is a safe technique, with low complication rate, acceptable recurrence rate, and low de novo SUI rate. Mainstay for success is to avoid infection and observe the surgical technique. Comparative studies with other occlusive techniques might be carried out, as well as exploring the role of infection as predisposing condition for failure.

As the surgical correction of pelvic organ prolapse has continued to evolve, robotic-assisted abdominal sacrocolpopexy (RASC) has gained increasing popularity. Studies have shown equivalent subjective and objective outcomes compared with the "gold standard" abdominal sacrocolpopexy. Additionally, this approach is associated with a shorter hospital stay and less cost than the traditional open procedure. Although there is a learning curve associated with RASC, the basic principles of the procedure are the same. Herein, we discuss the robotic techniques for repair of pelvic organ prolapse as well as discuss the currently available literature regarding RASC.

Antecedentes: El prolapso de los órganos pelvianos (POP) es una enfermedad prevalente. Los pesarios vaginales son una opción de tratamiento. Algunos especialistas prefieren la cirugía como el tratamiento de elección. Objetivo: Describir la respuesta subjetiva y complicaciones asociadas al uso de pesarios en pacientes ≤65 años con POP en el Hospital Dr. Sotero del Río. Métodos: Estudio retrospectivo de pacientes con POP sintomático ≤65 años con indicación de pesario, entre julio de 2009 y noviembre de 2012. Para la evaluación de los resultados subjetivos del uso de pesarios, se utilizó la escala PGI-I. Resultados: Cuarenta y nueve pacientes cumplieron los criterios de inclusión. En 39 pacientes el fitting fue exitoso. Veinticinco de las 39 pacientes, fueron capaces de acceder y usar el pesario, de las cuales 6 abandonaron el tratamiento. La mediana de la edad fue 62,5 años. Un 48% eran sexualmente activas. La mediana de seguimiento fue 9 semanas. Según POP-Q un 60% se encontraba en etapa III. El tipo de pesario más utilizado fue el Gellhorn. Trece pacientes presentaron efectos adversos, siendo lo más frecuente el flujo vaginal (40%). La respuesta subjetiva de mejoría estuvo disponible en 15 (64%) de 25 pacientes. Un 88% notaron mejoría subjetiva importante. Conclusión: El uso de pesarios vaginales en pacientes menores de 65 años con POP es factible, asociado a mejoría subjetiva de los síntomas, con baja tasa de complicaciones. Son necesarios estudios prospectivos de mayor tamaño muestral para evaluar este subgrupo. Background: Pelvic organ prolapse (POP) is a common disease. Vaginal pessaries are a treatment option. Some specialists prefer surgery as the treatment of choice. Objective: To describe the subjective response and complications associated with the use of pessaries in patients ≤65 years old with POP in Dr. Sotero del Rio Hospital. Methods: Retrospective study of patients with symptomatic POP ≤ 65 and use pessary between July 2009 and November 2012. And assessment of the subjective results of using the PGI-I pessaries scale was used. Results: 49 patients met the inclusion criteria. In 39 patients the fitting was successful. 25 of 39 patients were able to access and use the pessary. 6 patients discontinued treatment. The median age was 62.5 years. 48% were sexually active. Median follow-up was 9 weeks. According POP-Q 60 % were in stage III. The type of pessary was the most used Gellhorn. 13 patients had adverse effects. The subjective response improvement was available in 15 (64%) of 25 patients. 88 % noted significant subjective improvement. Conclusion: The use of vaginal pessaries in patients under 65 with POP is feasible, associated with subjective improvement in symptoms, with low complication rate. Prospective studies are needed with larger sample sizes to evaluate this subgroup.

The Prolapse Quality of Life (P-QOL) questionnaire is a specific health-related quality of life (HRQL) instrument to assess the impact of POP on women. It has been validated in English-speaking women and to date has been translated into several other languages. However, currently there is no Spanish translation of the P-QOL questionnaire. The aim of this study was to translate the P-QOL questionnaire into Spanish and to assess its feasibility, validity, and reliability. Following a forward- and back-translation of the original English P-QOL questionnaire into Spanish language, the translated questionnaire was reviewed by a group of patients as well as an expert panel to assess its comprehensibility. In this cross-sectional study women with POP symptoms were recruited from a tertiary referral teaching hospital. Women were defined as symptomatic if they report feeling a lump/bulge/pressure in the vagina. The Spanish translated P-QOL questionnaire was self-administered to all women. Reliability, content, and construct validity were evaluated using the Cronbach’s alpha coefficient, ANOVA, and Spearman’s correlation tests. One hundred and twenty-eight women were studied. There were no missing items. The Cronbach’s alpha ranged from 0.626 to 0.866 across domains, demonstrating the good reliability of the Spanish P-QOL. The severity of symptoms was related to the worst quality of life, but the severity of POP was not related to poorer QoL. The Spanish translated version of the P-QOL is a reliable, consistent and valid instrument to assess symptom severity and QoL impact in Chilean women with POP.

Genital prolapse affects up to 50 % of multiparous women and has an impact on quality of life (QoL) for many. Vaginal obliterative techniques are relevant in older patients who are not sexually active. We performed Labhardt’s colpoperineocleisis in such patients. The objective was the evaluation of subjective outcomes of this technique using PGI-I. Retrospective cohort analysis of patients. We performed a bivariate, multivariate analysis, and survival curves for subjective improvement. Seventy-four cases were analyzed. Average age of the patients was 72 years, median parity 4, 95.9 % POP-Q stage III or IV, anterior leading edge defect in 61.1 %. Operating time: 54 min, estimated blood loss 70 ml, no intraoperative complications, 12 patients had protocol deviations with changes in the recommended type of suture. Median hospital stay was 2 days and average follow-up 24.9 months. There was 13.5 % anatomical recurrence, 3 of which (30 %) were in patients with protocol deviations. 1.9 % developed clinically significant de novo stress urinary incontinence (SUI). PGI-I: 64 (86 %) reported subjective improvement and 10 did not. In the subjective improvement group, 98.4 % reported being very much or much better. In the non-subjective improvement group 80 % reported that they were the same as before surgery and 20 % were worse. In bivariate analysis anatomical recurrence showed significance and persisted after multivariate analysis with an OR of 8322 for subjective failure. Labhardt’s colpoperineocleisis is a safe technique with good subjective results. It has few complications, an acceptable recurrence rate, and a low rate of de novo SUI. It may be important to use the #0 or #1 polydioxanone sutures, as these are associated with better outcomes in this series. Comparative studies with other obliterative techniques are needed.

Antecedentes: Se estima que entre 25-50% de las mujeres sufrirá de alguna alteración del piso pélvico durante su vida. La función sexual es un concepto complejo y multidimensional. Se ha planteado que a mayor sintomatología de alteraciones de piso pélvico, las mujeres presentan mayores inconvenientes en su respuesta sexual. Objetivo: Describir la función sexual de un grupo de mujeres que presentan algún tipo de trastorno de piso pélvico. Método: Estudio descriptivo a 195 mujeres con diagnóstico de alteraciones de piso pélvico utilizando un cuestionario que incluía evaluación de aspectos sociodemográficos y de la función sexual con instrumento PISQ-12. Para el análisis se utilizaron medidas de tendencia central y dispersión. Resultados: 73,7% de las mujeres refieren tener algún grado de insatisfacción con su vida sexual actual afectando principalmente el área del deseo sexual. Dentro de las limitaciones en la relación sexual reportadas se encuentran: orgasmos menos frecuentes (70,5%), dispareunia (89,5%), problemas de erección (40%) y eyaculación precoz (47,4%) en sus parejas. Conclusión: Las mujeres reportan niveles de insatisfacción con su vida sexual, disminución de su deseo sexual, dolor durante la relación sexual y disminución de la intensidad del orgasmo. Es importante incorporar en la atención de este grupo de mujeres una evaluación sistemática de la función sexual, centrándose no solo en la respuesta sexual femenina, sino que también identificando aquellas limitaciones de la mujer y de la pareja que pueden estar influyendo en su satisfacción sexual. Background: It is estimated that between 25- 50% of women will suffer from a pelvic floor disorder during their lifetime. Sexual function is a complex and multidimensional concept. It has been suggested that to greater symptoms of pelvic floor disorders, women have major problems in sexual response. Objective: To describe the sexual function of a group of women with any pelvic floor disorder in a public hospital of Santiago, Chile. Method: A descriptive study of 195 women diagnosed with pelvic floor disorders using a questionnaire that included assessment of sociodemographic and sexual function instrument PISQ-12. For the analysis used measures of central tendency and dispersion. Results: 73.7% of referred women have some degree of dissatisfaction with their current sex life mainly affecting the area of sexual desire. Within the limitations in sexual intercourse reported are: less intense orgasms (70.5%), dyspareunia (89.5%), erectile dysfunction (40%) and premature ejaculation (47.4%) in their partners. Conclusion: Women report levels of dissatisfaction with their sex life, decreased sexual desire, pain during intercourse and decreased intensity of orgasm. It is important to incorporate in the care of these women a systematic assessment of sexual function focusing not only on the female sexual response, but also identifying those limitations of women and couples that may be influencing women's sexual satisfaction.