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Introduction and hypothesis: Women have a 20% risk of developing a urinary tract infection (UTI) following urogynecologic surgery. This study assessed the association of postoperative UTI with bacteria in preoperative samples of catheterized urine.Methods: Immediately before surgery, vaginal swabs, perineal swabs, and catheterized urine samples were collected, and the V4 region of the 16S ribosomal RNA (rRNA) gene was sequenced. The cohort was dichotomized in two ways: (1) standard day-of-surgery urine culture result (positive/negative), and (2) occurrence of postoperative UTI (positive/negative). Characteristics of bladder, vaginal, and perineal microbiomes were assessed to identify factors associated with postoperative UTI.Results: Eighty-seven percent of the 104 surgical patients with pelvic organ prolapse/urinary incontinence (POP/UI) were white; mean age was 57 years. The most common genus was Lactobacillus, with a mean relative abundance of 39.91% in catheterized urine, 53.88% in vaginal swabs, and 30.28% in perineal swabs. Two distinct clusters, based on dispersion of catheterized urine (i.e., bladder) microbiomes, had highly significant (p < 2.2-16) differences in age, microbes, and postoperative UTI risk. Postoperative UTI was most frequently associated with the bladder microbiome; microbes in adjacent pelvic floor niches also contributed to UTI risk. UTI risk was associated with depletion of Lactobacillus iners and enrichment of a diverse mixture of uropathogens.Conclusions: Postoperative UTI risk appears to be associated with preoperative bladder microbiome composition, where an abundance of L. iners appears to protect against postoperative UTI. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The purpose was to determine if pre-operative guided imagery (GIM) would help women to feel more prepared, less anxious, and have higher satisfaction scores 6 weeks after surgery compared with routine care.Methods: Eligible women planning to undergo pelvic floor surgery were enrolled and randomized. The GIM group received an institution-specific CD that uses GIM to detail day of surgery (DOS) events and expectations. Participants were asked to listen to the CD once daily during the week before surgery. At three time points (surgical consent visit, DOS, and 6-weeks post-operatively), we measured anxiety using the State and Trait Anxiety Inventory for Adults (STADI), in addition to preparedness for surgery and overall satisfaction (ten-point Likert scales). Data were analyzed in SPSS 23 using two-tailed t tests.Results: A total of 38 out of 44 (86%) enrolled participants completed the study (GIM: 18, control: 20). The GIM self-reported compliance rate was 72%, with an average use of 4.8 times (range = 3-8 times). Women in the GIM group reported a significant increase from baseline in preparedness for surgery on both DOS and 6 weeks post-operatively (7.32 ± 1.81 vs 9.11 ± 1.13, p = 0.001) and (7.32 ± 1.81 vs 9.22 ± 0.81, p = 0.001) respectively; a change that was not seen in the control group. Satisfaction was high in both the GIM and the control group (9.55 ± 0.85 and 9.05 ± 1.70, p = 0.263). In all patients, anxiety increased from baseline to DOS and dropped at 6 weeks post-operatively, and was not significantly different in the two groups.Conclusions: Guided imagery improved patient preparedness for pelvic floor surgery with an overnight stay on their DOS and 6 weeks post-operatively. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor physical therapy (PFPT) is a common and effective treatment for several pelvic floor disorders, but there is limited knowledge about adherence to the therapy or what factors influence attendance.Objective: To determine rates of PFPT attendance (initiation and completion) as well as correlates of PFPT attendance.Design: Retrospective cohort analysis.Setting: Urban outpatient clinics at a tertiary medical center treating women with pelvic floor disorders.Participants: Patients prescribed PFPT during the time period January 1, 2014, through January 1, 2015.Main Outcome Measurements: Number of PFPT visits recommended and attended; diagnoses associated with PFPT referral.Results: Two-thirds of participants (66%; 118/180) initiated PFPT but less than one-third (29%; 52/180) completed the full treatment course. On univariate analysis, age, body mass index, diagnosis requiring PFPT treatment, marital or employment status, insurance type, number of comorbidities, incontinence status on examination, and stage of prolapse did not differ between PFPT initiators and noninitiators. Those who self-identified as Hispanic were less likely to initiate PFPT when compared with non-Hispanic patients, although this only trended toward significance (odds ratio 0.40, 95% confidence interval 0.14-1.09; exact P = .078).Conclusions: Two-thirds (66%) of patients initiated PFPT but less than one-third (29%) completed the treatment course. There appears to be an opportunity to augment PFPT attendance, as well as explore racial disparities in attendance.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Lower urinary tract symptoms (LUTS) are highly prevalent in women, and are expected to impose a growing burden to individuals and society as the population ages. The predominance of research related to LUTS has focused on underlying pathology, disease mechanisms, or the efficacy of treatments for women with LUTS. Although this research has been vital for helping to reduce or ameliorate LUTS conditions, it has done little to prevent the onset of LUTS. Health promotion and prevention require an expansion of scientific inquiry beyond the traditional paradigm of studying disease mechanisms and treatment to the creation of an evidence base to support recommendations for bladder health promotion and, in turn, prevention of LUTS. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) introduced the concept of prevention as an important priority for women's urologic research as a prelude to supporting the formation of the Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium. In this article, we introduce the PLUS research consortium to the scientific community; share the innovative paradigms by which the consortium operates; and describe its unique research mission: to identify factors that promote bladder health across the life course and prevent the onset of LUTS in girls and women. [ABSTRACT FROM AUTHOR]

Urinary tract infection (UTI) is clinically important, given that it is one of the most common bacterial infections in adult women. However, the current understanding of UTI remains based on a now disproven concept that the urinary bladder is sterile. Thus, current standards for UTI diagnosis have significant limitations that may reduce the opportunity to improve patient care. Using data from our work and numerous other peer-reviewed studies, we identified four major limitations to the contemporary UTI description: the language of UTI, UTI diagnostic testing, the Escherichia coli-centric view of UTI, and the colony-forming units (CFU) threshold-based diagnosis. Contemporary methods and technology, combined with continued rigorous clinical research can be used to correct these limitations. [ABSTRACT FROM AUTHOR]

Aims: To evaluate patient‐reported outcomes (PROs) of combinations of solifenacin and mirabegron compared with solifenacin and mirabegron monotherapy and with placebo in patients with overactive bladder (OAB) from the SYNERGY trial. Methods: Following a 4‐week placebo run‐in, period patients (≥18 years) with OAB were randomized 2:2:1:1:1:1 to receive solifenacin 5 mg + mirabegron 25 mg (combination 5 + 25 mg), solifenacin 5 mg + mirabegron 50 mg, (combination 5 + 50 mg), solifenacin 5 mg, mirabegron 25 mg, mirabegron 50 mg or placebo for 12 weeks, followed by a 2‐week washout period. At each visit, PROs related to quality of life, symptom bother, and treatment satisfaction were assessed, including OAB‐q Symptom Bother score, health‐related quality of life (HRQOL) Total score, treatment satisfaction‐visual analogue scale (TS‐VAS), and patient perception of bladder condition (PPBC) questionnaires. Results: Overall, 3527 patients were randomized into the study, with 3494 receiving double‐blind treatment. At end of treatment (EoT), both combination groups showed greater improvements in OAB‐q Symptom Bother score compared with the monotherapy groups (nominal P < 0.001). Statistically significant improvements in HRQOL Total scores were observed in the combination groups versus monotherapy groups (P ≤ 0.002). For both combination groups, the OAB‐q Symptom Bother score responder rates at EoT were statistically significantly higher versus mirabegron monotherapy (P < 0.05). The mean adjusted changes from baseline to EoT for PPBC were greater in the combination groups compared with monotherapy groups. Conclusions: PROs showed that combination therapy provided clear improvements and an additive effect for many HRQOL parameters, including OAB‐q Symptom Bother score, HRQOL Total score, and PPBC. [ABSTRACT FROM AUTHOR]