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A letter to the editor in response to the article "Preventing Ureteral Injury at Hysterectomy: An Expert Approach," by Javier F. Magrina in the October 2014 issue is presented.

Importance: Sacrocolpopexy is essential in the surgical management of advanced pelvic organ prolapse, and selecting the appropriate route for concomitant hysterectomy is critical., Objectives: The aim of this study was to evaluate the effect of the hysterectomy route at the time of robot-assisted laparoscopic sacrocolpopexy (RA-SCP) on mesh exposure. Secondary outcomes were perioperative complications and prolapse recurrence., Study Design: This was a retrospective cohort study of 405 patients who underwent an RA-SCP at our institution from January 2013 to July 2019 with at least 6 month follow-up; the patients were grouped with respect to hysterectomy route as robot-assisted supracervical hysterectomy (SCH), total vaginal hysterectomy (VH), and posthysterectomy (PH). The primary outcome measure was mesh exposure. Short-term complications and anatomic failure were also analyzed., Results: Two hundred three of our patients (50.1%) had a concomitant SCH, 93 (23.0%) had a concomitant VH, and 109 (26.9%) were PH at the time of their robotic sacrocolpopexy. Sacrocolpopexy mesh exposure occurred in 4 patients (1%), with an additional 6 patients (1.5%) with midurethral sling mesh exposure. Mesh exposure rates did not differ significantly between groups. At 6 months after surgery, anatomic failure rates did not differ significantly between groups (P = 0.69).Intraoperative and postoperative complication rates were low (bowel obstruction, 2.0%; bladder injury, 1.2%, after excluding those caused by sling trocars; venous thromboembolism, 0.7%; transfusion, 0.5%). Postoperative infection and readmission rates did not differ significantly between groups., Conclusions: Patients with different routes of hysterectomy at the time of RA-SCP have similar mesh exposure and prolapse recurrence rates. Serious complications are rare in all groups., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2025 American Urogynecologic Society. All rights reserved.)

Importance: To study alternative voiding trial (VT) methods after urogynecologic surgery that may potentially decrease catheterization., Objective: The aim of the study is to compare voiding assessment based on a minimum spontaneous voided volume of 150 mL with the standard retrograde fill (RF) approach in women after urogynecologic procedures., Study Design: Women undergoing urogynecologic surgery were randomized to RF or spontaneous void (SV) groups. Women in the RF group had their bladders backfilled with 300 mL of saline before catheter removal, those in the SV group did not. To pass the VT, patients in the RF group were required to void 150 mL at one time within 60 minutes, and patients in the SV group had to do the same within 6 hours. The primary outcome was the VT failure rate. We also compared the false pass rate, urinary tract infections, satisfaction, and preference of VT method., Results: One hundred nine women were enrolled in the study, 54 had SV and 55 underwent RF. Baseline characteristics were not significantly different other than history of prior hysterectomy. There was no significant difference in procedures between the groups. There was no difference in VT failure rate between the groups-SV (7.4%) and RF (12.7%, P = 0.39). The false pass rate was 0 in each group. Urinary tract infection rates were similar between SV (14.8%) and RF (14.5%) groups ( P = 0.34). Patient satisfaction for VT method was not significantly different., Conclusions: Spontaneous VT was not superior to retrograde void trial. Therefore, we cannot recommend one method of VT after urogynecologic surgery.CondensationVoiding assessment based on minimum SV of 150 mL is comparable with VT with RF after surgeries for prolapse and urinary incontinence., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2022 American Urogynecologic Society. All rights reserved.)

Objective: To compare the effect of obesity on perioperative outcomes in women undergoing laparoscopic hysterectomy., Study Design: In this retrospective cohort study, perioperative outcomes of all women who underwent laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign conditions were compared between obese (body mass index > or = 30 kg/m2) and nonobese women., Results: Baseline characteristics were similar between 320 (33.0%) obese and 550 (67%) nonobese women except for race and the rates of hypertension and diabetes. The adjusted rates of urinary tract injury, vaginal cuff dehiscence, postoperative fever, and ileus were similar between the groups. For obese women, however, bleeding requiring transfusion was almost 3-fold (3.1 vs. 1.1%, adjusted odds ratio [AOR] 2.93, 95% confidence interval [CI] 1.10-7.80) and laparotomy risk was approximately 2-fold (7.5 vs. 3.5%, AOR 2.35, 95% CI 1.30-4.24) increased. The rate of urinary tract injury was 3.2% when obese women had TLH, but it was 0.3% for LSH performed on nonobese women. Of all 7 cuff dehiscences, 5 (71%) occurred in nonobese women undergoing TLH., Conclusion: Obesity increased the risk of bleeding requiring transfusion and conversion to laparotomy but did not influence the other perioperative complications. On subgroup analysis, LSH in nonobese women seems to result in best outcomes.

Background: Both ectopic prostate tissue in the female genital tract and vaginal myofibroblastoma have rarely been reported in the literature. Tamoxifen use has been associated with the development of vaginal myofibroblastoma., Case: A 76-year-old, multiparous woman who had taken tamoxifen for breast cancer presented with postmenopausal bleeding and a vaginal mass. Endometrial work-up revealed a benign polyp, and the polypoid tumor in the vagina was found to be a myofibroblastoma harboring ectopic prostatic glands., Conclusion: To our knowledge this is the first case of these two rare pathologic entities occurring together. Of note, this patient also had a history of tamoxifen therapy, like some of the previous patients with vaginal myofibroblastoma.

With the aging population in the United States, there has been a renewed interest in pessaries as a conservative alternative to surgical repair for pelvic organ prolapse (POP). They present a good option for patients who have not completed childbearing, do not desire surgery, or are poor surgical candidates. Long-term pessary use is a safe and effective option for patients with POP and stress urinary incontinence. Although serious side effects are infrequent, insertion and removal of most pessary types still pose a challenge for many patients. Pessary design should continue to improve, making its use a more attractive option.

Background: Despite the tremendous advances made in the management of genital herpes, neonatal herpes has not been completely eradicated. In addition, the time from the onset of symptoms in the neonate to the diagnosis of herpes and institution of antiviral medication has remained unchanged in the past 20 years., Case: Neonatal herpes infection resulted from primary, first-episode peripartum genital herpes in the mother. Due to a high index of suspicion, herpes testing was performed on the infant and neonatal herpes diagnosed. Subsequently, the mother developed evidence of primary herpes infection., Conclusion: This case report illustrates the problems with current management strategies for prevention of neonatal herpes.