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Aims: The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is undertaking a new cohort study in LURN II including cases and controls., Methods: This new cohort was enrolled to specifically study urinary urgency and urgency urinary incontinence, lower urinary tract symptoms (LUTSs) that are often difficult to treat due to a lack of understanding of their phenotypes and pathophysiologies., Results: This paper will focus on the motivation for the second iteration of LURN and highlight the new research techniques and plans for more thorough phenotyping of this population., Conclusions: This paper will outline the gaps in understanding in treating LUTSs, specifically urinary urgency., (© 2024 The Author(s). Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Importance: Routine screening for urinary incontinence (UI) by primary care providers (PCPs) is recommended., Objectives: We aimed to describe the rate of incident UI diagnosed at annual PCP visits, the prevalence of UI in a large primary care population, and estimate the rate of screening for UI during primary care preventive and annual wellness visits. Secondary aims were to describe PCP knowledge and behavior as they relate to UI screening and diagnosis., Study Design: The electronic health record was used to abstract the number of adult female patients seen by PCPs within a regional health system with a diagnosis of UI before our study period and with a new diagnosis over a 2-year period. Additional new diagnoses and screening practices were found on chart review of an additional 824 representative charts. Primary care providers within the health system were surveyed about their screening practices and knowledge about UI., Results: There were 192,053 women primary care patients seen over 2 years. A total of 5.7% had a UI diagnosis preceding the study period and 3.4% had a UI diagnosis during the study period. A total of 42% of PCPs reported that they screen for UI at least half the time and none were completely satisfied with their ability to screen for UI. Sixteen percent of annual wellness visits had any documentation of screening for UI., Conclusion: In a large primary care population, screening for and detection of UI in women was low., Competing Interests: S.D.P. receives unrelated research support paid to Northwestern University from Omron Healthcare Co, Ltd, and received a speaking honorarium from the National Committee for Quality Assurance and from Omron Healthcare Co, Ltd. S.C. is an expert witness for Ethicon and Johnson and Johnson and is a content expert for MCG Health. K.S.K. is an expert witness for Ethicon and Johnson and Johnson. The other authors have declared they have no conflicts of interest., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

Objective: Financial strain and unmet social needs are associated with greater risk for lower urinary tract symptoms. Little research has examined financial strain and unmet social needs in relation to the more holistic concept of bladder health. This study utilizes baseline data from RISE FOR HEALTH: A U.S. Study of Bladder Health to examine whether financial strain, unmet social needs, and meeting specific federal poverty level threshold levels are associated with lower urinary tract symptoms and poorer perceived bladder health, well-being, and function., Study Design: Participants were 18 years or older, born female or currently identified as a woman, and from the civilian, noninstitutionalized population residing in 50 counties in the United States that included or surrounded 9 recruitment centers. Data were collected through mailed or internet-based surveys. To address research questions, the 10-item Lower Urinary Tract Dysfunction Research Network - Symptom Index and selected Prevention of Lower Urinary Tract Symptoms Research Consortium bladder health scores were separately regressed on each financial strain, unmet social need, and federal poverty level variable, using linear regression adjusting for covariates (age, race/ethnicity, education, and vaginal parity) and robust variance estimation for confidence intervals (CI). Participants with no missing data for a given analysis were included (range of n=2564-3170). In separate sensitivity analyses, body mass index, hypertension, and diabetes were added as covariates and missing data were imputed., Results: The mean age of participants was 51.5 years (standard deviation=18.4). Not having enough money to make ends meet, housing insecurity, food insecurity, unreliable transportation, and percent federal poverty levels of 300% or less were consistently associated with more reported lower urinary tract symptoms and poorer perceived bladder health. For example, compared to food secure participants, women who worried that their food would run out at the end of the month had a Lower Urinary Tract Dysfunction Research Network - Symptom Index score that was 3.4 points higher (95% CI: 2.5, 4.3), on average. They also had lower mean scores across different bladder health measures, each assessed using a 100-point scale: global bladder health (-8.2, 95% CI: -10.8, -5.7), frequency (-10.2, 95% CI: -13.8, -6.7), sensation (-11.6, 95% CI: -15.1, -8.2), continence (-13.3, 95% CI: -16.7, -9.9), and emotional impact of bladder health status (-13.2, 95% CI: -16.5, -9.9). Across analyses, associations largely remained significant after additional adjustment for body mass index, hypertension, and diabetes. The pattern of results when imputing missing data was similar to that observed with complete case analysis; all significant associations remained significant with imputation., Conclusion: Financial strain and unmet social needs are associated with worse LUTS and poorer bladder health. Longitudinal research is needed to examine whether financial strain and unmet social needs influence the development, maintenance, and worsening of lower urinary tract symptoms; different mechanisms by which financial strain and unmet social needs may impact symptoms; and the degree to which symptoms contribute to financial strain. If supported by etiologic research, prevention research can be implemented to determine whether the amelioration of financial strain and social needs, including enhanced access to preventative care, may promote bladder health across the life course., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction and Hypothesis: The objective was to assess long-term mesh complications following total hysterectomy and sacrocolpopexy., Methods: In this second extension study, women from a multicenter randomized trial were followed for more than 36 months after surgery. Owing to COVID-19, participants were assessed through either in-person visits or telephone questionnaires. The primary outcome was the incidence of permanent suture or mesh exposure. Secondary outcomes included surgical success and late adverse outcomes., Results: Out of the 200 initially enrolled participants, 82 women took part in this second extension study. Among them, 46 were in the permanent suture group, and 36 in the delayed absorbable group. The mean follow-up duration was 5.3 years, with the cumulative mesh or suture exposure of 9.9%, involving 18 cases, of which 4 were incident cases. Surgical success after more than 5 years stood at 95%, with few experiencing bothersome bulge symptoms or requiring retreatment. No serious adverse events occurred, including mesh erosion into the bladder or bowel. The most common adverse events were vaginal pain, bleeding, dyspareunia, and stress urinary incontinence, with no significant differences between suture types., Conclusion: The study found that mesh exposure risk gradually increased over time, reaching nearly 10% after more than 5 years post-surgery, regardless of suture type. However, surgical success remained high, and no delayed serious adverse events were reported., (© 2024. The Author(s).)

Importance: Physical health and psychological health represent modifiable factors in the causal pathway of lower urinary tract symptoms (LUTS)., Objectives: Understand the relationship between physical and psychological factors and LUTS over time., Study Design: Adult women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network observational cohort study completed the LUTS Tool and Pelvic Floor Distress Inventory, including urinary (Urinary Distress Inventory), prolapse (Pelvic Organ Prolapse Distress Inventory), and colorectal anal (Colorectal-Anal Distress Inventory) subscales at baseline, 3 months, and 12 months. Physical functioning, depression, and sleep disturbance were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires; relationships were assessed using multivariable linear mixed models., Results: Of 545 women enrolled, 472 had follow-up. Median age was 57 years; 61% and 78% reported stress urinary incontinence and overactive bladder, respectively; and 81% reported obstructive symptoms. The PROMIS depression scores were positively associated with all urinary outcomes (range, 2.5- to 4.8-unit increase per 10-unit increase in depression score; P < 0.01 for all). Higher sleep disturbance scores were associated with higher urgency, obstruction, LUTS Total Severity, Urinary Distress Inventory, and Pelvic Floor Distress Inventory (1.9- to 3.4-point increase per 10-unit increase, all P < 0.02). Better physical functioning was associated with less severe urinary symptoms except stress urinary incontinence (2.3- to 5.2-point decrease per 10-unit increase, all P < 0.01). All symptoms decreased over time; however, no association was detected between baseline PROMIS scores and trajectories of LUTS over time., Conclusions: Nonurologic factors demonstrated small to medium cross-sectional associations with urinary symptom domains, but no significant association was detected with changes in LUTS. Further work is needed to determine whether interventions targeting nonurologic factors reduce LUTS in women., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2023 American Urogynecologic Society. All rights reserved.)

Objective: The purpose of this analysis was to explore adolescent and adult women's preferences for the content and delivery of public health messaging around bladder health. Materials and Methods: This was a directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health and function across the life course. This article reports an analysis of the "Public Health Messaging" code, which includes participants' views on what information is needed about bladder health, attributes of messaging, and preferred locations and delivery methods. Results: Forty-four focus groups were conducted with 360 participants (ages 11-93 years) organized into six age groups. Across age groups, participants wanted messaging on maintaining bladder health and preventing bladder problems. They offered suggestions for a wide variety of methods to deliver bladder health information. Ideas for delivery methods fell into three broad categories: (1) traditional in-person modes of delivery, which included individual communication with providers in clinical settings and group-based methods in schools and other community settings where adolescent and adult women naturally gather; (2) internet-based website and social media delivery methods; and (3) static (noninteractive) modes of delivery such as pamphlets. Participants recommended the development of multiple delivery methods to be tailored for specific audiences. Conclusions: These findings can inform development of broad ranging public health messaging tailored to audiences of all ages with a goal of engaging adolescent and adult women across the bladder health risk spectrum.

Introduction and Hypothesis: We sought to further develop and validate the Surgical Preparedness Assessment (SPA) scale to evaluate patient preparedness for urogynecological surgery., Methods: This was a planned ancillary analysis of a randomized controlled trial (RCT) evaluating the impact of a preoperative telehealth call on patient preparedness for urogynecological surgery. Patients completed the Preoperative Preparedness Questionnaire (PPQ), the modified Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ), the Pelvic Floor Distress Inventory (PFDI-20), the Satisfaction Decision Scale (SDS), and the Decision Regret Scale (DRS). Content validity was established through expert opinion and patient cognitive interviews. Factor analysis identified item grouping into domains. Cronbach's alpha reported internal consistency. Known group validity was assessed by comparing intervention arms. External validity was evaluated by comparing intervention arms and correlations with SDS and DRS., Results: Eleven items and 3 domains met the criteria (information needs, satisfaction and pain, and catheterization). Cronbach's alpha values were acceptable for domains and ranged from 0.74 to 0.93. SPA scores did not correlate with other patient-reported outcomes. Mean SPA scores were lower among women who received a telehealth call vs those who did not (1.30 ± 0.31 vs 1.51 ± 0.44; p = 0.002)., Conclusions: The content-valid SPA demonstrates high internal consistency and known group validity., (© 2022. The International Urogynecological Association.)

Objective: The purpose of this analysis was to explore adolescent and adult women's interest in public health messaging around bladder health and perceptions of its usefulness. Materials and Methods: Directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health across the life course. This article reports an analysis of the "Public Health Messaging" code, which included participants' desire or need for information about bladder health and recommendations for appropriate priority audiences. Results: Forty-four focus groups were conducted with 360 participants organized into six age groups (11-93 years). There was consensus across age groups that more information about the bladder is wanted and needed throughout the life course, as there is currently a lack of reliable educational resources. Information on bladder health was seen as useful and important because it enables people to anticipate negative changes in bladder health and act to prevent these. Several priority audiences were identified based on their risk of developing symptoms, but participants also saw value in educating the general public regardless of risk status. They also recommended education for parents and teachers who are in positions to control bathroom access. Conclusions: Results indicate a uniform desire for information on women's bladder health and a need for more research to develop individual prevention strategies and public health messaging for women of all ages, as well as guidance for organizations with a role in supporting bladder health.

Background: To compare 30-day postoperative complications following abdominoplasty with and without concomitant hysterectomy. Our secondary objective was to compare outcomes following abdominoplasty by route of hysterectomy., Methods: This was a retrospective cohort study using American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database from 2014 to 2018. We included women who underwent abdominoplasty alone (ABP) and abdominoplasty with concomitant hysterectomy (ABP+Hyst). The ABP+Hyst group included both abdominal hysterectomy (ABP+AH) and minimally invasive hysterectomy (ABP+MIH)., Results: Analysis included 9064 women of whom 2.4% had ABP+Hyst (216 ABP+AH and 53 ABP+MIH). Both ABP and ABP+Hyst had similar 30-day postoperative complication rates (11.5% vs. 14.1%, p=.22). Patients with ABP+Hyst had a longer length of hospital stay when compared to ABP alone [2 days (IQR 1-2) vs. 1 day (IQR 0-2), p&lt;.001). Operating time was longer in ABP+Hyst by 76 minutes (p&lt;.001). In a multivariable logistic regression model controlling for age, race, BMI, ASA class, smoking status, hysterectomy, operative time, and major medical comorbidity, concomitant hysterectomy was not associated with increased odds of 30-day postoperative complications. Both ABP+AH and ABP+MIH had low 30-day complication rates (15.3% vs. 9.4%, p=.273). However, ABP+MIH had a 38 minute longer median operating time (p=.008) but with a shorter length of stay by 1 day (p&lt;.001)., Conclusion: Concomitant hysterectomy at the time of abdominoplasty was not associated with an increase in complications during the first 30-days after surgery regardless of route of hysterectomy. These data suggest that selected patients can safely be offered combined surgery., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Study Objectives: To describe changes in length of stay and same-day discharges (SDDs) after minimally invasive hysterectomy (MIH) over the last decade and forecast anticipated utilization over the subsequent decade., Design: Cross-sectional analysis., Setting: American College of Surgeons National Surgical Quality Improvement Program database., Patients: All benign MIH excluding joint cases with concomitant nongynecologic surgery in the 2011 to 2019 National Surgical Quality Improvement Program datasets, identified by Current Procedural Terminology code., Interventions: A descriptive analysis of changes in the estimated length of stay and utilization of SDD from 2011 to 2019. Multivariable negative binomial regression assessed for individual-level risk factors for prolonged hospital stay and autoregressive linear forecasting estimated the growth of SDD through 2029., Measurements and Main Results: A total of 239 220 MIH were identified. Over the 9-year period, SDD increased by 10.7% across all MIH. However, in 2019, SDD represented only 29.8% of total MIH discharges and utilization varied by surgical approach (laparoscopic hysterectomy, 35.4%; vaginal hysterectomy, 18.6%; laparoscopic-assisted vaginal hysterectomy, 19.6%) and a surgical indication of pelvic organ prolapse (32.7% without and 13.9% with prolapse). Multivariable models controlling for patient characteristics showed independent associations of route and indication for MIH and length of stay (adjusted relative rate, 1.30; 95% confidence interval [CI], 1.29-1.32 for vaginal hysterectomy, and adjusted relative rate, 1.12; 95% CI, 1.11-1.14 for prolapse); however, these individual-level factors provided limited information explaining variation in the length of stay (model pseudo-R2, 0.054). Forecasting models suggest that utilization of SDD will grow to 48.5% (95% CI, 38.7-58.4) by the end of 2029., Conclusion: Although the estimated length of stay is decreasing among MIH over time, the utilization of SDD remained low in 2019 and was not explained by patient factors. If current trends hold, SDD utilization is not forecast to exceed 50% through 2029. Additional efforts focused on the provider and institution level are needed to encourage SDD as the standard of care for MIH., (Copyright © 2022 AAGL. Published by Elsevier Inc. All rights reserved.)

Study Objective: Describe the incidence of and risk factors associated with postoperative venous thromboembolism (VTE) in patients undergoing hysterectomy for benign indications with emphasis on the impact of route of surgery., Design: Retrospective cohort., Setting: National Surgical Quality Improvement Project Database., Participants: Data of women aged 18 years and older who underwent hysterectomy for benign indications between 2014 and 2018 were abstracted., Interventions: Cases were identified by Current Procedural Terminology codes and International Classification of Diseases codes. Patient demographics, preoperative comorbidities, American Society of Anesthesiologists (ASA) classification system scores, total operating time, length of stay, readmission, reoperation, VTE including deep vein thrombosis and pulmonary embolism were collected. Cases were stratified by route of hysterectomy., Measurements and Main Results: t test and multivariable logistic regression were used for analysis. A total of 94 940 patients underwent hysterectomy, of which 23 081 (24.3%) underwent abdominal hysterectomy, 56 656 (59.7 %) laparoscopic hysterectomy, and 15 203 (16.0%) vaginal hysterectomy. The overall incidence of VTE was 0.4%. The incidence of VTE was higher for abdominal (0.7%), than laparoscopic (0.3%, p <.001), and vaginal hysterectomy (0.2%, p <.001). Higher ASA classification was independently associated with postoperative VTE. Age, race, body mass index, uterine weight, operative time, multiple medical comorbidities, and smoking status were not independently associated with increased risk of VTE., Conclusion: Postoperative VTE after hysterectomy for benign indications is rare. The risk of postoperative VTE is higher in patients undergoing abdominal hysterectomy compared with minimally invasive hysterectomy including laparoscopic and vaginal routes of surgery. In addition, the risk of VTE may be higher with higher ASA class., (Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: To describe surgical technique and outcomes of early secondary repair of obstetric anal sphincter injury (OASIS) breakdown., Methods: This was a case series of all women presenting to a subspecialty peripartum clinic within 2 months of an OASIS, who ultimately underwent secondary surgical repair between September 2013 and January 2018. Cases were identified using the following CPT codes: 57308 (transperineal fistula repair), 56910 (repair of the perineum), and 46750 (repair of anal sphincter). Four board-certified urogynecologists performed all surgical procedures using the same technique: demographics, delivery data, and preoperative and postoperative data were collected., Results: Eighteen women were identified. The majority (16 [88.9%] of 18) were primiparous; 9 (50%) women underwent spontaneous vaginal delivery and 9 (50%) women underwent forceps-assisted vaginal delivery. Over 70% (13 [72.2%] of 18) suffered a 3rd-degree tear, whereas 5 (27.8%) of 18 had a 4th-degree laceration. The median time after delivery to specialty clinic presentation was 10 days (interquartile range, 5.3-52.5 days). All women were diagnosed with wound breakdown at their initial visit. Seven (38.9%) also had a concomitant rectovaginal fistula.Median time from diagnosis of wound breakdown to secondary operative revision was 19.5 days (interquartile range, 12-26.8 days). Seventeen (94.4%) of the 18 women underwent overlapping external anal sphincteroplasty with perineorrhaphy; of these, 7 (41.2%) also underwent concurrent repair of their rectovaginal fistula. One woman underwent perineorrhaphy alone. At 3 months postoperatively, no women had a wound breakdown or recurrent fistula., Conclusions: In women with OASIS breakdown, early secondary repair is both feasible and successful with meticulous surgical technique., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Objective: The aim of the study was to describe the rate of symptomatic and asymptomatic urinary retention and catheterization in women undergoing initial intravesical onabotulinumtoxinA (BnTA) injection for urgency urinary incontinence (UUI)., Methods: This retrospective chart review included women receiving initial 100 U of BnTA injection for UUI for 5 years. Straight-catheterized postvoid residuals (PVRs) were performed 2 weeks after the injection. Women without the sensation of incomplete bladder emptying, worsened urgency, inability to void, or suprapubic pain but with PVR of greater than 300 mL were characterized as having asymptomatic retention, whereas women with a PVR of greater than 150 and any of these symptoms were diagnosed with symptomatic retention., Results: One hundred eighty-seven 187 patients received initial BnTA injection. The majority were postmenopausal (89%) and white (82%) with a mean age of 65 years and body mass index of 30 kg/m2. One-third of the cohort underwent baseline urodynamic studies. At 2 weeks after injection, 163 patients (87%) followed up, and 17 (10%) had either asymptomatic or symptomatic retention (2% and 8%, respectively). There were no differences in demographic or pretreatment urodynamic parameters in women with and without retention except that women who had previous anti-stress urinary incontinence procedures were more likely to experience retention (53% vs 18%, P = 0.002) despite similar baseline PVRs., Conclusion: We demonstrated that the rate of retention requiring catheterization after 100 U BnTA may be as high as 10% although only 5% develop PVRs for 300 mL and only 2% have asymptomatic retention for 300 mL., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Aim: To describe factors associated with satisfaction with the Axonics sacral neuromodulation (SNM) System at 1 year., Methods: This was a secondary analysis of data collected in the ARTISAN-SNM study-a single arm, prospective, multicenter trial of the Axonics r-SNM System™. ARTISAN-SNM recruited participants with urgency urinary incontinence (UUI) to undergo a single, nonstaged implant of the lead and rechargeable neurostimulator. Participants were considered therapy responders if they had ≥50% reduction in UUI episodes in a 3-day period at 1-month post-implant. Bladder diaries and satisfaction (7-point Likert scale) were assessed at 1 year., Results: In all, 124 participants (110 "responders" and 14 "non-responders") had complete data at baseline, 1 month and 1 year following implant. Most participants were satisfied with Axonics at 1 year: 68.5% were "very satisfied," 25.8% were "moderately satisfied," and 2.4% were "slightly satisfied." At 1 year, treatment efficacy, as measured by electronic bladder diaries, was significantly associated with satisfaction. Participants who were "very satisfied" had a larger reduction in voids per day (p = .01), leaks per day (p = .004), urgent leaks per day (p = .04), and voids in which the urgency was desperate per day (p = .03) compared to those less satisfied. Twelve of the 14 "non-responders" continued to see improvements in symptom reduction from 1 month to 1 year; 9/14 (64%) were "responders" at 1 year with six reporting being "very satisfied" and one reporting being "moderately satisfied.", Conclusion: Satisfaction 1 year after implantation of Axonics SNM is extremely high and correlates with the degree of symptom improvement, which increases over time., (© 2020 Wiley Periodicals LLC.)

Objective: The aim of the study was to compare levator hiatus (LH) and levator area (LA) on transvaginal 3-dimensional (3D) ultrasound (US) and genital hiatus (GH) size by Pelvic Organ Prolapse Quantification (POP-Q) examination before and after minimally invasive sacrocolpopexy., Methods: Women with prolapse (POP) beyond the hymen undergoing minimally invasive sacrocolpopexy without concomitant POP repairs completed Pelvic Floor Distress Inventory short form (PFDI), POP-Q, and transvaginal 3D US before and 14 weeks after surgery. Data were analyzed by 2 urogynecologists, blinded to US image sequence and to corresponding POP-Q scores., Results: Forty-three patients were enrolled; 35 with complete data are included. Patients had a mean ± SD age of 55 ± 11 years. Most were white (89%), vaginally parous (94%), postmenopausal (66%), sexually active (63%), and had stage 3 POP (86%). The majority (89%) had concomitant hysterectomy, and 60% had midurethral slings. At baseline, the mean ± SD PFDI and Prolapse subscale of the Pelvic Floor Distress Inventory scores were 98 ± 50 and 42 ± 22. The median (interquartile range) POP-Q stage decreased after surgery from 3 (3) to 0 (0-1, P < 0.001) and the mean ± SD PFDI scores decreased to 55 ± 42 (P = 0.002). At baseline, the mean ± SD GH and perineal body measurements were 3.5 ± 0.7 and 2.4 ± 0.6 cm. Although the GH size decreased by 0.5 cm after surgery, perineal body was unchanged. Levator hiatus remained unchanged between the baseline and 14-week visits (P = 0.07), whereas LA increased by 0.8 cm2 (P = 0.03). At 14 weeks, the change in LA was not correlated with the change in GH (ρ = -0.2, P = 0.2) or POP stage (ρ = -0.2, P = 0.9)., Conclusions: Restoring the apex with sacrocolpopexy alone reduces GH size on clinical examination; however, it does not impact the size of the underlying LH on US., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)

Approximately one in four American women report bothersome urinary symptoms (e.g., urgency, frequency), which greatly impact quality of life, including mental health. Bidirectional relationships have been found between urinary symptoms and anxiety, such that urinary symptoms worsen emotional distress (i.e., anxiety and depression), and in turn anxiety can exacerbate these symptoms. Current methods to treat urinary symptoms, such as physical therapy and medications, do not address their emotional impact. As such, our multidisciplinary team is conducting a randomized control trial (RCT) of cognitive-behavior therapy (CBT) using the Unified Protocol (UP) versus supportive therapy in the context of integrated behavioral treatment in the urogynecology context. Women with bothersome urinary symptoms and anxiety are recruited from the Northwestern Medicine Integrated Pelvic Health Program (IPHP) -a transdisciplinary clinic including urogynecologists, urologists, colorectal surgeons, nurses, and physical therapists- and Northwestern Medicine Urology. Participants are randomized to one of two interventions: UP or supportive therapy. All participants attend therapy once per week for 12 weeks. Assessments of urinary symptoms, anxiety, and other indicators of psychological and physical functioning are completed at baseline, mid-treatment, post-treatment, and at 3- and 6-month follow-ups using patient-reported outcomes. The study has been preregistered on clinicaltrails.gov (ID: NCT03623880) and is currently ongoing., (© 2020 The Authors.)

Aims: Lower urinary tract symptoms (LUTS) are diverse in type and variable in severity. We examined symptom change within the Symptoms of the Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort study identified clusters over time and tested associations with treatments received., Methods: Patient-reported LUTS and treatment data were collected at multiple time points between baseline and 12 months from the LURN Observational Cohort study. LUTS severity scores were calculated to summarize changes in symptom reporting over time in previously identified LURN clusters. Repeated measures linear regression models tested adjusted associations between cluster membership and severity scores., Results: Four-hundred seventeen men and 396 women were classified into improved, unchanged, and worsened symptoms between baseline and 12 months (men: 44.1%, 40.5%, and 15.3%; women: 55.8%, 33.1%, 11.1%, respectively). Improvement in LUTS severity scores varied by cluster (estimated adjusted mean change from baseline range: -.04 change in standard deviations of severity scores (ΔSD) to -.67 ΔSD). Prostate surgery was associated with improved severity scores (-.63 ΔSD) in men, while stress incontinence surgery was associated with improved severity scores (-.88 ΔSD) in women., Conclusion: Symptom improvement varied by cluster indicating response to therapy differs amongst subtypes of patients with LUTS. The differential improvement of patients in clusters suggests mechanistic differences between clusters and may aid in selecting more targeted treatments in the future., (© 2019 Wiley Periodicals, Inc.)

Purpose: Some patients continue to have bothersome lower urinary tract symptoms despite treatment. We examined characteristics associated with bother from lower urinary tract symptoms in a prospective cohort., Materials and Methods: In this 1-year prospective, observational cohort study we obtained data on patients with lower urinary tract symptoms who were seeking care at a total of 6 tertiary care centers in the United States. Participants answered the AUA-SI (American Urological Association Symptom Index) global urinary bother question at study entry and 12 months later. Multilevel logistic and linear regression was used to identify factors associated with worsening bother and bother at 12 months, respectively., Results: Of the 756 participants 121 (16%) had worsened lower urinary tract symptom bother during the study period. When adjusted for other variables, worsened lower urinary tract symptom bother was more likely among men who were nonwhite (OR 1.79, 95% CI 0.94-3.40) or who had diabetes (OR 1.68, 95% CI 0.86-3.27) and among women with diabetes (OR 1.77, 95% CI 0.85-3.67), prior treatment of lower urinary tract symptoms (OR 2.58, 95% CI 1.22-5.46) or a higher depression level (OR 1.29, 95% CI 1.10-1.52). Baseline factors associated with more severe bother at 12 months in men included more severe bother at baseline, nonwhite race, worse urinary frequency and incontinence, and higher levels of stress (p <0.05). Among women more severe bother at baseline, urinary urgency and frequency, and worse physical function were associated with more severe bother at 12 months., Conclusions: Urinary symptom severity at baseline, race, depression and psychological stress were associated with the bother of lower urinary tract symptoms in a prospective cohort of men and women treated at tertiary care facilities. These findings may inform the clinical care of patients with bothersome lower urinary tract symptoms and direct providers to better prognosticate for patients with challenging lower urinary tract symptoms cases.

Purpose: This document seeks to establish guidance for the evaluation and management of women with recurrent urinary tract infections (rUTI) to prevent inappropriate use of antibiotics, decrease the risk of antibiotic resistance, reduce adverse effects of antibiotic use, provide guidance on antibiotic and non-antibiotic strategies for prevention, and improve clinical outcomes and quality of life by reducing recurrence of urinary tract infection (UTI) events., Materials and Methods: The systematic review utilized to inform this guideline was conducted by a methodology team at the Pacific Northwest Evidence-based Practice Center. A research librarian conducted searches in Ovid MEDLINE (1946 to January Week 1 2018), Cochrane Central Register of Controlled Trials (through December 2017) and Embase (through January 16, 2018). An update literature search was conducted on September 20, 2018., Results: When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low). Such evidence-based statements are provided as Strong, Moderate, or Conditional Recommendations. In instances of insufficient evidence, additional guidance is provided as Clinical Principles and Expert Opinions., Conclusions: Our ability to diagnose, treat, and manage rUTI long-term has evolved due to additional insights into the pathophysiology of rUTI, a new appreciation for the adverse effects of repetitive antimicrobial therapy, rising rates of bacterial antimicrobial resistance (AMR), and better reporting of the natural history and clinical outcomes of acute cystitis and rUTI. As new data continue to emerge in this space, this document will undergo review to ensure continued accuracy.

Objective: We describe the management and outcomes of ureterovaginal fistulas over a 13-year period and present a treatment algorithm., Methods: We performed a review of ureterovaginal fistula cases between January 2005 and December 2017 at our tertiary academic center. Demographics, diagnostic approaches, and treatment outcomes were assessed., Results: Nineteen cases of ureterovaginal fistula were identified. Fistulas developed after hysterectomy in 18 cases and cesarean delivery in 1 case. Our primary treatment was conservative management with ureteral stenting in 12 and reimplantation in 6 cases. There was 1 case of spontaneous resolution. Ureteral stenting was successful in 11 (92%) of 12 patients. Stents were left in place for an average of 66 days (27-92 days). Complications of stents included pyelonephritis in 2 cases (18%) and stricture in 1 case (9%). Ultimately, conservative management was successful in treating ureterovaginal fistulas in 10 (83%) of 12 cases. The indications for primary ureteral reimplantation were concurrent vesicovaginal fistula in 3 cases, history of ureteral injury with surgical repair during the index surgery in 2 cases, and a 1-year delay in diagnosis in 1 case. A variety of follow-up surveillance methods were used, including tampon tests, computed tomographic urograms, retrograde pyelograms, and MAG-3 Lasix renal scans., Conclusions: In carefully selected patients, ureteral stenting results in high cure rates for posthysterectomy ureterovaginal fistulas and should be considered first-line therapy. Complicated ureterovaginal fistulas may be best managed by primary ureteral reimplantation.

Introduction and Hypothesis: This study adapted the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) into the Tigrigna language of northern Ethiopia and validated the their reliability and validity through patient interviews., Methods: Expert translation, cognitive interviewing, and patient interviews using translated questionnaires were conducted. A subset of women was reinterviewed 1 week later. Intraclass correlation coefficients (ICC), Bland-Altman analysis, and Cronbach's alpha values were assessed. Total and subscale scores were compared between women with and without pelvic floor disorders (PFDs) using the Mann-Whitney U test. Spearman's correlation coefficients were used to compare severity of pelvic organ prolapse (POP) stage according to the POP Quantification (POP-Q) system and PFDI-20 and PFIQ-7 and subscale scores., Results: Ten women participated in cognitive interviewing and 118 age 49 ± 10 years, mean ± standard deviation (SD) with and without PFDs were interviewed using the translated questionnaires, both of which presented adequate face validity and test-retest reliability [intraclass correlation coefficient (ICC) 0.765-0.969, p < 0.001]. Construct validity was significant between clinical symptoms and full forms (p <0.001) and their subscales (p <0.001), except for the Pelvic Organ Prolapse Impact Questionnaire (POPIQ). Differences between first and second scores on total PFDI-20 and PFIQ-7 and subscales largely fell within 0 ± 1.96 SD. Cronbach's alpha values were 0.891-0.930 for PFDI-20 and 0.909-0.956 for PFIQ-7 (p < 0.001). Analysis of known groups showed differences PFDI-20 and PFIQ-7 scores between women with and without PFDs (p <0.001 for full forms and subscales, except for anal incontinence (AI) and the Urinary Impact Questionnaire (UIQ)/POPIQ., Conclusion: The translated Tigrigna versions of the PFDI-20 and PFIQ-7 questionnaires are reliable, valid, and feasible tools to evaluate symptoms and quality of life (QoL) of Tigrigna-speaking Ethiopian women with PFDs.

Aims: Bowel symptoms, pelvic organ prolapse, and sexual dysfunction are common, but their frequency among women with lower urinary tract symptoms (LUTS) has not been well described. Our aims were to describe pelvic floor symptoms among women with and without urinary incontinence (UI) and among subtypes of UI., Methods: Women with LUTS seeking care at six U.S. tertiary care centers enrolled in prospective cohort study were studied. At baseline, participants completed the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-IR), and PROMIS GI Diarrhea, Constipation, and Fecal Incontinence Scales., Results: Mean age among the 510 women was 56.4 ± 14.4 years. Women who reported UI (n = 420) had more diarrhea and constipation symptoms (mean scores 49.5 vs 46.2 [P = 0.01] and 51.9 vs 48.4 [P < 0.01], respectively) at baseline. Among sexually active women, mean PISQ-IR subscale scores were lower among those with UI (condition specific: 89.8 vs 96.7, P < 0.01; condition impact: 79.8 vs 92.5, P < 0.01). Women with mixed urinary incontinence (MUI) (n = 240) reported more prolapse symptoms, fecal incontinence, and worse sexual function compared to those with stress urinary incontinence (SUI) and urgency urinary incontinence (UUI)., Conclusions: Women presenting with LUTS with UI reported significantly worse constipation, diarrhea, fecal incontinence, and sexual function compared to women without UI. In women with UI, sexual function and pelvic organ prolapse (POP) symptoms were worse in those with MUI compared to SUI and UUI., (© 2018 Wiley Periodicals, Inc.)

Purpose: We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms., Materials and Methods: This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity., Results: We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Caucasian, 47% were obese and 14% reported diabetes. Urinary incontinence was reported by 420 women (82.4%), including stress urinary incontinence in 70, urgency urinary incontinence in 85, mixed urinary incontinence in 240 and other urinary incontinence in 25. On adjusted analyses there was no difference in any mental health, sleep or physical function measure based on the presence vs the absence of urinary incontinence. Among women with urinary incontinence PROMIS anxiety and sleep disturbance scores were higher in those with mixed urinary incontinence than stress urinary incontinence. Increasing urinary incontinence severity was associated with higher PROMIS depression and anxiety scores, and higher PSS scores. However, higher urinary incontinence severity was not associated with a difference in sleep or physical function., Conclusions: Among treatment seeking women with lower urinary tract symptoms, increasing urinary incontinence severity rather than the presence or type of urinary incontinence was associated with increased depression, anxiety and stress., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: The primary objective of this study was to evaluate reasons for seeking care among men and women with lower urinary tract symptoms., Materials and Methods: Participants were recruited from urology and urogynecology clinics, and the community. The sample was enriched with persons expected to have abnormal or diminished bladder sensations (eg participants with lower back surgery and participants 65 years old or older). Interviews were performed in person beginning with an open-ended assessment of urinary symptoms and associated bother followed by more directed questions, including reasons for seeking or not seeking treatment. We also examined the relationship between symptom frequency and bother using the LUTS (Lower Urinary Tract Symptoms) Tool., Results: A total of 88 participants, including 38 men and 50 women, with a mean ± SD age of 52.2 ± 14.3 years provided information about urinary symptoms, including a range of quality of life consequences and coping behaviors. They sought treatment mostly because of new, continuing or bothersome symptoms. Factors associated with not seeking treatment included low symptom severity and concerns about the costs vs the benefits of treatment (eg side effects of medication). Symptom frequency and bother were associated with each other across symptoms assessed by the LUTS Tool., Conclusions: In this large qualitative study we obtained useful insights into the impact of lower urinary tract symptoms from the perspective of the person with the symptoms. Removing barriers and misconceptions about the treatment of lower urinary tract symptoms may increase the number of people who seek clinical care and improve the clinical course of men and women who experience lower urinary tract symptoms., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To report outcomes and complications in approximately 450 women who underwent isolated minimally invasive abdominal sacrocolpopexy (ASC) for the management of pelvic organ prolapse (POP)., Material and Methods: We retrospectively reviewed the electronic medical records of women who underwent minimally invasive ASC (laparoscopic ASC [LASC] or robotic ASC [RASC]) for symptomatic POP at Loyola University Chicago Medical Center from 2007 to 2012. Polypropylene mesh was used and the decision to reperitonealize the mesh was left to surgeon discretion. Data collected included demographics, Pelvic Floor Distress Inventory questionnaire, intraoperative and postoperative details, and POP quantification., Results: Four hundred twenty-eight women underwent minimally invasive ASC-232 LASC and 226 RASC. Most women (86%) did not undergo reperitonealization of the mesh. Median follow-up was 13 weeks (range, 2-268 weeks) for complications and 13 weeks (range, 2-104 weeks) for anatomic outcomes.Postoperatively, 88.6% of women had stage 0/I, 10.7% had stage II, and 2 women had stage III POP. Twelve (2.6%) underwent reoperation, 6 for POP (3 posterior repairs, 2 repeat ASC, 1 perineorrhaphy) and 6 for bowel complications. Fourteen women had postoperative bowel complications; half of which resolved with conservative treatment. There were no differences between anatomic and functional outcomes or bowel complications between LASC and RASC. Reoperation rates for bowel complications in women who underwent reperitonealization of the mesh were similar to those who did not (1.5% vs 1.0%, P = 0.86)., Conclusions: Minimally invasive ASC without concomitant vaginal repair is an effective and safe procedure for the surgical management of POP with low rates of reoperation and complications.

This month we focus on current research in pelvic organ prolapse. Dr. Kenton discusses five recent publications, which are concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.

Introduction and Hypothesis: We aimed to determine patient recall of specific surgical risks and benefits discussed during consent for midurethral sling (MUS) surgery immediately after consent and at 6 weeks follow-up. Specifically we sought to determine whether or not women recalled specific risks related to the placement of mesh., Methods: Surgeons consented patients for MUS in their usual fashion during audio recorded consent sessions. After consent and again at 6 weeks postoperatively, women completed a checklist of risks, benefits, alternatives, and general procedural items covered during consent. In addition, women completed the Decision Regret Scale for Pelvic Floor Disorders (DRS-PFD). Audio files were used to verify specific risks, benefits, alternatives, and procedural items discussed at consent. Recall of specific risks, benefits, and alternatives were correlated with DRS-PFD scores., Results: Sixty-three women completed checklists immediately post consent and at 6 weeks postoperatively. Six-week recall of benefits, alternatives, and description of the operation did not change. Surgical risk recall as measured by the patient checklist deteriorated from 92 % immediately post consent to 72 % at 6 weeks postoperatively (p < .001). Recall of the risk for mesh erosion declined from 91 to 64 % (p < .001). Recall that mesh was placed during the MUS procedure declined from 98 to 84 % (p = .01). DRS-PFD scores were correlated with poorer surgical risk recall and surgical complications (r = .31, p = .02)., Conclusions: Recall of MUS surgery risks deteriorated over time. Specifically, women forgot that mesh was placed or might erode. Further investigations into methods and measures of adequate consent that promote recall of long-term surgical risks are needed.

Objective: This study aims to develop a Vulvovaginal Symptoms Questionnaire (VSQ) to determine the symptoms, emotions, life impact, and sexual impact of vulvovaginal symptoms on postmenopausal women., Methods: We developed a questionnaire that focuses on vulvovaginal symptoms based on modifications to Skindex-16, a validated questionnaire for measuring the impact of skin disease. We recruited postmenopausal women seeking routine gynecologic care to test the psychometric properties of the VSQ. Test-retest reliability was assessed 2 to 4 weeks after their initial recruitment and measured using intraclass coefficients. Four distinct a priori scales of the VSQ were developed: symptoms, emotions, life impact, and sexual impact. Confirmatory factor analysis was performed to verify the four a priori scales by evaluating the goodness of fit of a final confirmatory factor analysis model. The internal consistency of the scales was assessed by calculating Cronbach's α coefficients., Results: The VSQ is a 21-item written questionnaire with four scales: symptoms, emotions, life impact, and sexual impact. One hundred twenty postmenopausal women participated in the psychometric validation of the VSQ. The test-retest reliability measured by intraclass coefficients was 0.75, 0.60, 0.55, and 0.65 for the symptoms, emotions, life impact, and sexual impact scales, respectively. The goodness of fit of the confirmatory factor response model was confirmed. The Cronbach's α coefficients were 0.76, 0.87, 0.83, and 0.82 for the respective scales., Conclusions: The VSQ is a reliable and internally consistent instrument for measuring vulvovaginal symptoms in postmenopausal women.

Introduction and Hypothesis: Uterine morcellation during laparoscopy for pelvic floor repair has prompted adoption of uterine screening tests by some surgeons. We report a case series of uterine malignancy incidentally diagnosed at the time of pelvic floor surgery., Methods: We reviewed records from patients undergoing hysterectomy for pelvic organ prolapse (POP) and/or urinary incontinence (UI) from January 2004 to December 2009 and abstracted preoperative screening trends and final pathologic diagnoses., Results: Of the 708 women in the study, 125 (18%) had preoperative endometrial biopsy (EB), 43 (6%) had pelvic ultrasound (US), and 21 (3%) had EB and US. Surgical route included vaginal (58%), abdominal (23%), and laparoscopic (18%). Most (97.1%) final pathologic diagnoses were benign. Five cancers (0.6%) were detected; four of these women had normal preoperative screening, including EB (2), US (1), or both tests (1)., Conclusions: Screening with EB + US was found to be ineffective in our cohort of patients due to the low prevalence of undetected uterine cancer in asymptomatic women planning POP/UI surgery.

Aims: The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item urinary incontinence (UI) symptom questionnaire, was developed and validated to distinguish stress and urge UI. This study's objective was to evaluate QUID validity and responsiveness when used as a clinical trial outcome measure., Methods: Participants enrolled in a multi-center trial of non-surgical therapy (continence pessary, pelvic floor muscle training or combined) for stress-predominant UI and completed baseline and 3-month diaries, the Urinary Distress Inventory (UDI) and QUID. Data from all treatment groups were pooled. QUID internal consistency (Cronbach's alpha) and convergent/discriminant validity (Pearson correlations) were evaluated. Responsiveness to change was assessed with 3-month score outcomes and distribution-based measurements., Results: Four hundred forty-four women (mean age 50) were enrolled with stress (N = 200) and mixed (N = 244) UI; 344 had 3-month data. Baseline QUID Stress and Urge scores (both scaled 0-15, larger values indicating worse UI) were 8.4 +/- 3.2 and 4.5 +/- 3.3, respectively. Internal consistency of QUID Total, Stress, and Urge scores was 0.75, 0.64 and 0.87, respectively. QUID Stress scores correlated moderately with UDI-Stress scores (r = 0.68, P < 0.0001) and diary stress UI episodes (r = 0.41, P < 0.0001). QUID Urge scores correlated moderately with UDI-Irritative scores (r = 0.68, P < 0.0001) and diary urge UI episodes (r = 0.45, P < 0.0001). Three-month QUID Stress and Urge scores improved (4.1 +/- 3.4 and 2.2 +/- 2.7, both P < 0.0001). QUID Stress score effect size (1.3) and standardized response mean (1.2) suggested a large change after therapy., Conclusion: The QUID has acceptable psychometric characteristics and may be used as a UI outcome measure in clinical trials., ((c) 2010 Wiley-Liss, Inc.)

Objective: The objective of the study was to correlate the presence of major levator ani muscle (LAM) injuries on magnetic resonance imaging (MRI) with fecal incontinence (FI), pelvic organ prolapse (POP), and urinary incontinence (UI) in primiparous women 6-12 months postpartum., Study Design: A published scoring system was used to characterize LAM injuries on MRI dichotomously (MRI negative, no/mild vs MRI positive, major)., Results: Major LAM injuries were observed in 17 of 89 (19.1%) women who delivered vaginally with external anal sphincter (EAS) injuries, 3 of 88 (3.5%) who delivered vaginally without EAS injury, and 0 of 29 (0%) who delivered by cesarean section before labor (P=.0005). Among women with EAS injuries, those with major LAM injuries trended toward more FI, 35.3% vs 16.7% (P=.10) and POP, 35.3% vs 15.5% (P=.09), but not UI (P=1.0)., Conclusion: These data support the growing body of literature suggesting that both EAS and LAM are important for fecal continence and that multiple injuries contribute to pelvic floor dysfunction., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Objective: The objective of the study was to determine the prevalence, risk factors, and impact on quality-of-life (QOL) that fecal incontinence (FI) symptoms have on women seeking treatment for urge urinary incontinence (UUI)., Study Design: Baseline sociodemographic, history, physical examination, and validated questionnaire data were analyzed in 307 women enrolled in the Behavior Enhances Drug Reduction of Incontinence study for associations with FI. FI was defined as loss of liquid/solid stool occurring at least monthly. Multivariable logistic regression models compared women with FI and UUI with women with only UUI., Results: Prevalence of monthly FI was 18%, liquid stool (12%), and solid stool (6%). In multivariable analysis, FI was associated with vaginal delivery, posterior vaginal wall prolapse, higher body mass index, and UUI symptoms. QOL was worse in women with FI/UUI than isolated UUI., Conclusion: Women seeking treatment for UUI have high rates of monthly FI with a negative impact on QOL.

To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders. We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6-12-months postpartum. Anatomy was compared between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P < 0.01 was considered statistically significant. A deeper sacral hollow was significantly associated with fecal incontinence (P = 0.005). Urinary incontinence was marginally associated with a wider intertuberous diameter (P = 0.017) and pelvic arch (P = 0.017). There were no significant differences in pelvimetry measures between women with and without prolapse (e.g., vaginal or cervical descent to or beyond the hymen). We did not detect meaningful differences in soft tissue dimensions for women with and without these pelvic floor disorders. Dimensions of the bony pelvis do not differ substantially between primiparous women with and without postpartum urinary incontinence, fecal incontinence and prolapse.

Objective: The purpose of this study was to compare outcomes after sacrocolpopexy (SC) between obese and healthy-weight women., Study Design: Baseline and postoperative data were analyzed from the Colpopexy And Urinary Reduction Efforts (CARE) randomized trial of SC with or without Burch colposuspension in stress continent women with stages II-IV prolapse. Outcomes and complications were compared between obese and healthy-weight women., Results: CARE participants included 74 obese (body mass index >/=30 kg/m(2)), 122 overweight (25-29.9 kg/m(2)), and 125 healthy-weight (18.5-24.9 kg/m(2)) women, and 1 underweight (< 18.5 kg/m(2)) woman. Compared to healthy-weight women, obese women were younger (59.0 +/- 9.9 vs 62.1 +/- 10.3 yrs; P = .04), more likely to have stage II prolapse (25.7% vs 11.2%; P = .01), and had longer operative times (189 +/- 52 vs 169 +/- 58 min; P = .02). Two years after surgery, stress incontinence, prolapse, symptom resolution, and satisfaction did not differ between the obese and healthy-weight groups., Conclusion: Most outcomes and complication rates after SC are similar in obese and healthy-weight women.

Objective: The objective of the study was to evaluate changes in bowel symptoms after sacrocolpopexy., Study Design: This was a prospectively planned, ancillary analysis of the Colpopexy and Urinary Reduction Efforts study, a randomized trial of sacrocolpopexy with or without Burch colposuspension in stress continent women with stages II-IV prolapse. In addition to sacrocolpopexy (+/- Burch), subjects underwent posterior vaginal or perineal procedures (PR) at each surgeon's discretion. The preoperative and 1 year postoperative Colorectal-anal Distress Inventory (CRADI) scores were compared within and between groups using Wilcoxon signed-rank and rank-sum tests, respectively., Results: The sacrocolpopexy + PR group (n = 87) had more baseline obstructive colorectal symptoms (higher CRADI and CRADI-obstructive scores: P = .04 and < .01, respectively) than the sacrocolpopexy alone group (n = 211). CRADI total, obstructive, and pain/irritation scores significantly improved in both groups (all P < .01). Most bothersome symptoms resolved after surgery in both groups., Conclusion: Most bowel symptoms improve in women with moderate to severe pelvic organ prolapse after sacrocolpopexy.

Objective: The objective of the study was to measure associations between bowel symptoms and prolapse., Study Design: Baseline data were analyzed from 322 women in the Colpopexy And Urinary Reduction Efforts trial of sacrocolpopexy with or without Burch colposuspension. Women completed the Colorectal-Anal Distress Inventory and Colorectal-Anal Impact Questionnaire and underwent Pelvic Organ Prolapse Quantification. Associations between symptoms and questionnaire scores and Pelvic Organ Prolapse Quantification measures were assessed., Results: Mean age was 61 +/- 10 years. Pelvic Organ Prolapse Quantification stages were II (14%), III (67%), and IV (19%). Colorectal-Anal Distress Inventory symptoms did not increase with prolapse stage. Colorectal-Anal Distress Inventory obstructive subscale scores were higher in stage II women (median 29 [interquartile range 8,92] versus 17 [0,33] and 25 [0,38] for stages III and IV, respectively; adjusted P = .01). The few statistically significant correlations between symptoms and vaginal descent were negative and weak (less than 0.2)., Conclusion: Bowel symptoms and questionnaire scores do not increase with prolapse stage in women presenting for sacrocolpopexy.

Objective: The purpose of this study was to assess factors that influence patient satisfaction 1 year after pelvic reconstructive surgery., Study Design: We previously reported the objective success, goals, and expectations of a cohort of 78 patients 3 months after surgery. A second blinded independent physician investigator contacted the same patients by phone to reassess these items 1 year after surgery. Data were analyzed with the Spearman correlation, the Mann-Whitney test, the chi-squared test of association, and the Friedman test., Results: Seventy patients (89%) of the original cohort completed the second assessment. Although group satisfaction and goal achievement were stable (P < .01), 70% of patients reported a change in their satisfaction ratings between 3 months and 1 year (rho = 0.3). Reduced satisfaction between 3 and 12 months after surgery was strongly associated with decreased goal achievement (rho = 0.47; P = .006). Fifty-six percent of patients reported urge incontinence symptoms after surgery (44% de novo and 12% persistent). Urge incontinence was the most common reason for patient dissatisfaction after surgery (P = .04)., Conclusion: Symptoms of urge incontinence and reduced achievement of subjective surgical goals are associated with decreased long-term patient satisfaction after reconstructive pelvic surgery.

Objective: The purpose of this study was to estimate the prevalence and impact upon quality of life of anal incontinence (AI) in women aged 18 to 65., Study Design: Consecutive women presenting for general gynecologic care were given a bowel function questionnaire. Women with AI were prompted to complete the Fecal Incontinence Severity Index (FISI) and Fecal Incontinence Quality of Life Scale (FIQL)., Results: The cohort was composed of 457 women with a mean age of 39.9 +/- 11 years. AI prevalence was 28.4% (95% CI 24.4-32.8). After logistic regression, IBS (OR 3.22, 1.75-5.93), constipation (OR 2.11, 1.22-3.63), age (OR 1.05, 1.03-1.07), and BMI (OR 1.04, 1.01-1.08) remained significant risk factors. The mean FISI score was 20.4 +/- 12.4. Women with only flatal incontinence scored higher, and women with liquid loss scored lower on all 4 scales of the FIQL., Conclusion: AI is prevalent in women seeking benign gynecologic care, and liquid stool incontinence has the greatest impact upon quality of life.

Aims: Our aim was to describe the location of urinary urgency or bladder discomfort in patients with painful bladder syndrome (PBS) and controls., Methods: Patients with symptomatic diagnoses of PBS, overactive bladder (OAB) syndrome, stress urinary incontinence (SUI), and asymptomatic controls were asked to indicate the location of their urinary urge/urgency/discomfort on a body map., Results: We present results for 30 PBS patients, 25 OAB patients, 15 SUI patients, and 15 asymptomatic controls. In asymptomatic subjects and those with SUI, the urge to void was localized to the suprapubic region only. More than half (53%) of patients with PBS and a minority (20%) of those with OAB localized their urinary urgency/discomfort to both suprapubic and vulvar/urethral locations. Some patients with PBS also localized their urinary discomfort to other body sites including low back, upper and lateral buttocks, lower abdomen, and upper thighs., Conclusions: In most patients with PBS and some with OAB, complaints of bladder discomfort or urgency may refer to sensations that are localized at sites other than suprapubic. The etiology of widespread sensation may include an expansion of dermatomes of referral of bladder sensation, and/or the presence of associated somatic abnormalities., ((c) 2005 Wiley-Liss, Inc.)

We report a case of bilateral sliding hernia of the bladder in a 64-year-old woman who presented with suprapubic pain and nocturia and was diagnosed by voiding diary and cystogram.

Objective: This study was undertaken to study the relationship between achievement of patient goals, overall satisfaction, and objective outcome measures., Study Design: After Institutional Review Board approval, we prospectively evaluated 78 women undergoing pelvic reconstructive surgery at Loyola University Medical Center. After informed consent for surgery, patients were asked to state their goals for surgery. In a follow-up telephone conversation, these goals were reviewed and negotiated to modify expectations. The same physician investigator contacted women 3 months after surgery to assess goal achievement, overall satisfaction, and their surgical experience. Date were analyzed with Spearman correlation and Mann-Whitney tests., Results: Of 78 women, 75% indicated that they met most of their goals, and 72% were more than 80% satisfied. Patient satisfaction was moderately correlated to goal achievement (rho=0.57, P<.001). Objective cure, defined as no urodynamic stress incontinence and stage 0 or I prolapse, was not related to satisfaction (P=.14). Dissatisfaction was highly associated with feeling "unprepared for surgery" (P<.001)., Conclusion: Objective and subjective outcomes are necessary to predict patient satisfaction.

Synthetic materials are frequently used in gynecologic surgical procedures to repair pelvic floor hernias and prolapse and to form barriers to adhesion formation. Mesh erosion into the vagina and lower urinary tract are known complications. We report 2 cases of polytetrafluoroethylene mesh erosion into the rectum.