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Introduction and Hypothesis: This study surveyed urogynecologists and Advanced Practice Providers (APPs) in the USA to gauge their interest and willingness to embrace customizable pessaries as a viable treatment option. We hypothesize that clinicians might be interested in using customizable pessaries in their practice., Methods: A cross-sectional survey was conducted among urogynecologists and their APPs who fit pessaries to gain insights into their experiences with standard pessaries and perspectives on the value and feasibility of customizable devices. The survey was distributed through email lists associated with women's health and pelvic floor disorders and gathered data on the difficulty in fitting pessaries and the perceived advantages of integrating customizable options into clinical practice., Results: There were 122 participants, including 76 physicians and 46 APPs. Thirty-five percent of clinicians advocated for pessaries as a first-line therapy for pelvic floor disorders. APPs were more inclined to recommend pessaries as a primary therapy than physicians (p < 0.01). Fifty-three percent of providers reported occasional difficulties, and 12% reported frequent difficulties fitting patients with standard-shaped pessaries. APPs were significantly more likely to encounter fitting issues due to pessary shape (p = 0.023). Clinicians suggested additional practices, such as modifying pessaries to enhance retention in patients with an enlarged genital hiatus, shortened vaginas, or apical narrowing., Conclusions: This study indicates that clinicians are inclined to incorporate customizable pessaries into their treatment protocols for pelvic floor disorders, emphasizing the need for continued innovation in pessary customization that prioritizes a patient-centric approach to pelvic floor disorder management., (© 2024. The International Urogynecological Association.)

Background Industry payments to physicians exceed millions of dollars. Payments can influence physicians' practices and potentially impact trainees. Objective To examine the magnitude of industry payments to obstetrics and gynecology (OB/GYN) and urology residency directors and department chairs in the United States. Methods For this retrospective cross-sectional study, program directors and department chairs of OB/GYN and urology residency programs were identified in December 2021. Nonresearch payments between August 1, 2013, and December 31, 2020, from drug or device manufacturers to program directors and department chairs of OB/GYN and urology residency programs were compiled from the Centers for Medicare & Medicaid Services Open Payments Database. Statistical analysis was conducted using the Kruskal-Wallis test and a linear mixed-effects model. Results A total of 19 903 payments, totaling $6,041,585, were provided to 396 physicians, with a median of $232.62 per physician over the 6 years analyzed. Urologists received more payments and higher amounts per payment than OB/GYNs (7820 vs 12 083, P <.01; $1,689,519.48 vs $4,352,066.40, P <.01). Department chairs received more payments per year than program directors (8 vs 4, P <.01). There were also geographic differences, with higher payments in the Northeast US region ($131.10 more, P <.01). Based on the linear mixed-effects model, 3 variables predicted the magnitude of industry payments received: physician age, number of years in leadership position, and geographic location. Conclusions Urologists and OB/GYN US residency program directors and department chairs received considerable nonresearch industry payments from 2013 to 2020.

Objective: To determine the effect of the initiation of COVID-19-related restrictions on the volume of surgical cases performed by otolaryngology trainees., Study Design: Multi-institutional retrospective analysis of resident surgical case logs., Setting: Accredited residency training programs in otolaryngology head and neck surgery., Methods: Resident surgical case logs were combined from 6 residency training programs from different regions of the United States. Case volumes were compared between the calendar year before March 1, 2020, and the year afterward. Subgroup analyses were performed for the type of hospital (university, pediatric, veteran, county) and the key index cases by subspecialty., Results: All 6 participating residency programs had a decrease in resident operative case volume. Surgical volume decreased from a mean of 6014 to 4161 (P < .05). There were decreases observed in key index cases in every subspecialty (P < .01), without statistical differences seen among subspecialties. There were decreases observed in every hospital type (university, pediatric, veteran, county) without statistical differences among types. Postgraduate year 5 residents were the most affected by volume reductions (51.6%), and postgraduate year 3 residents were the least affected (1.4%)., Conclusion: In the year following initiation of COVID-19-related restrictions, there was a significant decrease in trainee surgical case volumes within residencies for otolaryngology-head and neck surgery. There were no statistical differences in the volume decreases seen at different institutions, among hospital types, or within various subspecialties., (© 2022 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Introduction We conducted a survey to describe the practice characteristics of anesthesiologists who have passed the American Board of Anesthesiology (ABA) Pediatric Anesthesiology Certification Examination. Methods In July 2017, a list of anesthesiologists who had taken the ABA Pediatric Anesthesiology Certification Examination (hereafter referred to as "pediatric anesthesiologists") was obtained from the American Board of Anesthesiologists (theaba.org). Email contact information for these individuals was collected from departmental rosters, email distribution lists, hospital or anesthesia group profiles, manuscript author contact information, website source code, and other publicly available online sources. The survey was designed using Qualtrics (Qualtrics, Provo, Utah; Seattle, Washington), a web-based tool, to ascertain residency/fellowship training history and current practice characteristics that includes: years in practice, clinical work hours per week, primary hospital setting, practice type, supervision model, estimated percentage of cases by patient age group, and percentage of respondents who cared for any patient undergoing a fellowship-level index cases within the previous year. The invitation to complete the survey included a financial incentive - the chance to win one of twenty $50 Amazon gift cards. Results There were 3,492 anesthesiologists who had taken the Pediatric Anesthesiology Certification Examination since 2013. Surveys were sent to those whom an email address was identified (2,681) and 962 complete survey responses were received (35.9%, 962/2,681). Over 80% (785) of respondents completed a pediatric anesthesiology fellowship. Of these, 485 respondents (50.4%) work in academic practice, 212 (22.0%) in private practice, 233 (24.2%) in private practice and have academic affiliations, and 32 (3.3%) as locum tenens or in other practice settings. The majority of respondents (64.3%) in academic practice work in freestanding children's hospitals. Pediatric anesthesiologists in academic practice and private practice with academic affiliations reported caring for a greater number of younger children and doing a wider variety of index cases than respondents in private practice. Conclusion The extent to which pediatric anesthesiologists care for pediatric patients - particularly young children and those undergoing complex cases - varies. The variability in practice characteristics is likely a result of differences in hospital type, anesthesia practice type, geographic location, and other factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Muffly et al.)

Objectives: The aim of this study was to assess how the projected increase in prevalence of pelvic floor disorders (PFDs) will impact the number of patients per female pelvic medicine and reconstructive surgery (FPMRS) subspecialist between 2015 and 2045., Methods: We performed a workforce analysis of FPMRS subspecialists in the United States by developing a model to predict the number of FPMRS subspecialists in 5-year increments from 2015 to 2045. Our model allowed for selection of the number of current FPMRS subspecialists, the number and sex of new FPMRS subspecialists added per year, and retirement age of FPMRS subspecialists. The number of women with PFDs from 2015 to 2045 was then predicted by applying published, age-specific prevalence rates to the 2012 US Census Projections for women aged 20 years or older. For our primary outcome, we divided the projected number of patients by the projected number of FPMRS subspecialists every 5 years from 2015 to 2045., Results: The model predicts the number of FPMRS subspecialists will increase from 1133 to 1514 with a sex shift from 46% female to 81% female between 2015 and 2045. The number of women with ≥1 PFD is predicted to increase from 31.4 million in 2015 to 41.9 million in 2045. For our primary outcome, the number of patients per FPMRS subspecialist is projected to range from 27,870 in 2015 to 27,650 in 2045., Conclusions: The current ratio of patients per FPMRS subspecialist appears high and is predicted to remain near current levels over the next 30 years. These projections support the need for continued training of physicians skilled in treating PFDs.

Background: The number of robotically assisted hysterectomies is increasing, and therefore, the opportunities for trainees to become competent in performing traditional laparoscopic hysterectomy are decreasing. Simulation-based training is ideal for filling this gap in training., Objective: The objective of the study was to design a surgical model for training in laparoscopic vaginal cuff closure and to present evidence of its validity and reliability as an assessment and training tool., Study Design: Participants included gynecology staff and trainees at 2 tertiary care centers. Experienced surgeons were also recruited at the combined International Urogynecologic Association and American Urogynecologic Society scientific meeting. Participants included 19 experts and 21 trainees. All participants were recorded using the laparoscopic hysterectomy cuff closure simulation model. The model was constructed using the an advanced uterine manipulation system with a sacrocolopexy tip/vaginal stent, a vaginal cuff constructed from neoprene material and lined with a swimsuit material (nylon and spandex) secured to the vaginal stent with a plastic cable tie. The uterine manipulation system was attached to the fundamentals of laparoscopic surgery laparoscopic training box trainer using a metal bracket. Performance was evaluated using the Global Operative Assessment of Laparoscopic Skills scale. In addition, needle handling, knot tying, and incorporation of epithelial edge were also evaluated. The Student t test was used to compare the scores and the operating times between the groups. Intrarater reliability between the scores by the 2 masked experts was measured using the interclass correlation coefficient., Results: Total and annual experience with laparoscopic suturing and specifically vaginal cuff closure varied greatly among the participants. For the construct validity, the participants in the expert group received significantly higher scores in each of the domains of the Global Operative Assessment of Laparoscopic Skills Scale and for each of the 3 added items than did the trainees. The median total Global Operative Assessment of Laparoscopic Skills Scale score (maximum 20) for the experts was 18.8 (range, 11-20), whereas the median total Global Operative Assessment of Laparoscopic Skills Scale score for the trainees was 10 (range, 8-18) (P = .001). The overall score that included the 3 new domains (maximum 35) was 33 (range, 18-35) for the experts and 17.5 (range, 14-31.5) for trainees (P = .001). For the face validity testing, the majority of the study participants (32 [85%]) agreed or strongly agreed that the model is realistic and all participants agreed or strongly agreed that the model appears to be useful for improving technique required for this task. For the interrater reliability, the scores assigned by each observer had an interclass correlation coefficient of 0.8 (95% confidence interval, 0.7-0.93)., Conclusion: This model is easily constructed and has an acceptable cost. We have demonstrated evidence of construct validity. This is a valuable education tool that can serve to improve skills, which are essential to the gynecological surgeon but are often lacking in residency training because of national changes in practice patterns., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Study Objective: To develop a valid laparoscopic sacrocolpopexy simulation model for use as an assessment and learning tool for performing this procedure., Design: Simulation study (Canadian Task Force classification II-2)., Setting: Two tertiary academic centers., Intervention: A training model was developed to simulate performance of a laparoscopic sacrocolpopexy. Construct validity was measured by comparing observed masked performances on the model between experienced Female Pelvic Medicine and Reconstructive Surgeons (experts) and upper level trainees. All videotaped performances were scored by 2 surgeons who were masked to subject identity and using the valid and reliable Global Operative Assessment of Laparoscopic Skills scale., Measurements and Main Results: The expert group included Female Pelvic Medicine and Reconstructive Surgeons (n = 5) experienced in laparoscopic sacrocolpopexy, and the trainee group (n = 15) included fourth-year gynecology residents (n = 5) and fellows in Female Pelvic Medicine and Reconstructive Surgery and in Minimally Invasive Gynecologic Surgery (n = 10). The experts performed significantly better than the trainees in total score and in every domain of the Global Operative Assessment of Laparoscopic Skills scale (median [range] score: expert group, 33 [30.5-39] vs. trainee group, 20.5 [13.5-30.5]; p = .002). Previous surgical experience had a strong association with performance on the model (rho > 0.75). Most subjects "agreed" or "strongly agreed" that the model was authentic to the live procedure and a useful training tool. There was strong agreement between masked raters (interclass correlation coefficient 0.84)., Conclusion: This simulation model is valid and reliable for assessing performance of laparoscopic sacrocolpopexy and may be used for practicing key steps of the procedure., (Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.)

Objective: We sought to determine the attributes of successful and unsuccessful fellowship applicants of the American Board of Obstetrics and Gynecology Inc (ABOG)-approved fellowship programs and to identify salient differences between subspecialty applicants., Study Design: Anonymous questionnaires were completed by obstetrics and gynecology fellowship applicants using a web-based survey after match day of 2012. Fellowship applicant practices were evaluated and included importance of prematch preparations, interview process, networking practices, and postmatch reflections., Results: A total of 327 fellowship applicants applying to programs accredited by the ABOG were surveyed, and 200 completed the survey (61% response rate). A comparison between prematch educational preparations pursued by applicants showed that matched applicants were more likely to come from allopathic medical schools (94%), attain membership in Alpha Omega Alpha and/or Phi Beta Kappa (27%), and receive a letter of recommendation from a nationally known subspecialist (77%) than unmatched applicants (P = .03, .005, and .007, respectively). Applicants to reproductive endocrinology and infertility were more likely than female pelvic medicine and reconstructive surgery to be members of academic honor societies (P = .008). Research publication was common among matched subspecialist applicants, with over half publishing 1-3 peer-reviewed manuscripts prior to matching. Applicants to gynecologic oncology did more visiting electives than any other specialty applicants (P < .001)., Conclusion: Successful obstetrics and gynecology fellowship applicants have superior prematch preparations, strong letters of recommendation from leaders in their field of interest, and multiple research publications. These data will guide applicants to a critical self-analysis before deciding to apply., (Copyright © 2014 Mosby, Inc. All rights reserved.)

The 2 major functions of the lower urinary tract are the storage and emptying of urine. These processes are controlled by complex neurophysiologic mechanisms and are subject to injury and disease. When there is disruption of the neurologic control centers, dysfunction of the lower urinary tract may occur. This is sometimes referred to as the "neurogenic bladder." The manifestation of dysfunction depends on the level of injury and severity of disruption. Patients with lesions above the spinal cord often have detrusor overactivity with no disruption in detrusor-sphincter coordination. Patients with well-defined suprasacral spinal cord injuries usually present with intact reflex detrusor activity but have detrusor sphincter dyssynergia, whereas injuries to or below the sacral spinal cord usually lead to persistent detrusor areflexia. A complete gynecologic, urologic, and neurologic examination should be performed when evaluating patients with neurologic lower urinary tract dysfunction. In addition, urodynamic studies and neurophysiologic testing can be used in certain circumstances to help establish diagnosis or to achieve better understanding of a patient's vesicourethral functioning. In the management of neurogenic lower urinary tract dysfunction, the primary goal is improvement of a patient's quality of life. Second to this is the prevention of chronic damage to the bladder and kidneys, which can lead to worsening impairment and symptoms. Treatment is often multifactorial, including behavioral modifications, bladder training programs, and pharmacotherapy. Surgical procedures are often a last resort option for management. An understanding of the basic neurophysiologic mechanisms of the lower urinary tract can guide providers in their evaluation and treatment of patients who present with lower urinary tract disorders. As neurologic diseases progress, voiding function often changes or worsens, necessitating a good understanding of the underlying physiology in question.

Background: Laparoendoscopic single-site surgery (LESS) allows better cosmesis and decreased pain when compared with traditional laparoscopy (TL). Instrument crowding and diminished triangulation are limitations. This study evaluates a novel single-port surgical platform (NSP) designed to facilitate the transition from TL to LESS (TransEnterix SPIDER, Durham, NC)., Methods: NSP and TL were compared using standardized dry lab tasks. Feasibility of NSP in gynecology was assessed using the porcine model., Results: Completion times with NSP were longer for ring transfer (P = .025) and trended longer for disc cutting (P = .074). Disc cutting accuracy was lower with NSP versus TL (P = .008). NSP operative times for hysterectomy, pelvic and para-aortic node dissection were 22.3, 13.3, and 26 minutes, respectively, without complications. Fatigue and lack of integrated bipolar cautery were limitations of NSP., Conclusion: While application of NSP to gynecology appears feasible, lower performance when compared with TL underscores the need for caution when applying NSP to humans.

A variety of surgical meshes are available to correct pelvic organ prolapse. This article discusses benefits and risks of vaginal mesh use. Emphasis is placed on the appropriate surgical technique to improve outcomes and minimize mesh complications. Placement options are reviewed with the discussion of self-tailored mesh, trocar-based mesh kits, and non-trocar mesh kits. This article also reviews the management of mesh complications including the technique for mesh removal.

Background: Small cell carcinoma of the ovary, hypercalcemic type is a rare and aggressive malignancy found in reproductive-age women., Case: We report a 22-year-old pregnant woman found to have symptomatic paraneoplastic hypercalcemia associated with small cell carcinoma of the ovary, hypercalcemic type. She was primarily treated with conservative surgery and chemotherapy secondary to desired pregnancy. She died of the disease 10 months from primary diagnosis., Conclusions: Small cell carcinoma of the ovary, hypercalcemic type is a very aggressive type of ovarian malignancy with a poor prognosis.

Objective: The purpose of this study was to evaluate the knot integrity of 3 commonly used sutures in sacrocolpopexy that were tied conventionally (by hand) and robotically., Study Design: Knots were tied with polyglactin 910, polypropylene, and polyester, with 5-6 knots tied, depending on the suture used. We compared the knots that were subjected to tensile force until the suture broke or untied., Results: The mean force that was required for the suture to untie was 47.7 +/- 18.8 (SD) Newtons and was seen only among the robotically tied polyglactin 910 knots. Robotically tied polyglactin 910 knots were significantly weaker than all other robotic and conventional knots that were tested (P < .05). The tying modality and material interaction was significant (P < .001), which suggests that the effect of suture material varied, depending on the tying modality., Conclusion: Knot failure rates for conventional or robotically tied suture varied based on the suture material that was used.

Background: The goal of this case is to review the zoonotic infection, human granulocytic ehrlichiosis, presenting with pyrexia. Case. A 22-year-old multigravid female presented to the emergency department with a painful skin rash, high fever, and severe myalgias. The patient underwent a diagnostic evaluation for zoonotic infections due to her geographical and seasonal risk factors. Treatment of human granulocytic ehrlichiosis was successful though the patient spontaneously aborted presumably due to the severity of the acute illness., Conclusion: Treatment of human granulocytic ehrlichiosis in pregnancy presents unique challenges. Management of pyrexia during pregnancy is limited to external cooling in the setting of thrombocytopenia and elevated aminotransferases. Extensive counseling regarding teratogenic potential of medications allows the patient to weigh the pros and cons of treatment.