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OBJECTIVES The objective of this study was to estimate the amount of oxycodone tablets required for pain control in the 2-week postoperative period after laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) for benign disease. METHODS We conducted a prospective cohort study of English-speaking women 18 years or older undergoing hysterectomy for benign indications. Participants completed a pain survey at baseline and daily for 2 weeks postoperatively. In addition, they recorded the number of oxycodone tablets and other pain medications taken daily for 2 weeks. The primary outcome was the median number of oxycodone tablets (5 mg) consumed after LH or VH during 2 weeks postoperative. RESULTS Eighty-one women underwent VH and 82 underwent LH. Women who underwent VH were older (mean ± SD, 64.2 ± 10.3 years vs 47.5 ± 7.7 years), more parous (2 [interquartile range (IQR), 2-3] vs 2 [IQR, 1-2]), and less likely to be sexually active (51.9% vs 79.3%, P < 0.02). Women in the VH group also had significantly lower baseline pain levels (0 [IQR, 0-1] vs 1 [IQR, 0-4], P < 0.001). All VH participants had surgery for prolapse, whereas only 12.2% in the LH group had surgery for this indication (P < 0.001). Most in the LH group had surgery for fibroids (61%) or abnormal uterine bleeding (15.9%). Women in the VH group consumed significantly less oxycodone tablets postoperatively (median, 4.5 [IQR, 1-9] vs 7 [IQR, 2-18]; P = 0.047) and took oxycodone for less days after discharge (median, 1 [IQR, 0-3] vs 3 [IQR, 1-6]; P < 0.001). CONCLUSIONS Women consume less oxycodone after minimally invasive hysterectomy than previously thought. Those who undergo VH may consume less oxycodone than those who undergo LH.

The objective of this study was to estimate the amount of oxycodone tablets required for pain control in the 2-week postoperative period after laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) for benign disease.We conducted a prospective cohort study of English-speaking women 18 years or older undergoing hysterectomy for benign indications. Participants completed a pain survey at baseline and daily for 2 weeks postoperatively. In addition, they recorded the number of oxycodone tablets and other pain medications taken daily for 2 weeks. The primary outcome was the median number of oxycodone tablets (5 mg) consumed after LH or VH during 2 weeks postoperative.Eighty-one women underwent VH and 82 underwent LH. Women who underwent VH were older (mean ± SD, 64.2 ± 10.3 years vs 47.5 ± 7.7 years), more parous (2 [interquartile range (IQR), 2-3] vs 2 [IQR, 1-2]), and less likely to be sexually active (51.9% vs 79.3%, P0.02). Women in the VH group also had significantly lower baseline pain levels (0 [IQR, 0-1] vs 1 [IQR, 0-4], P0.001). All VH participants had surgery for prolapse, whereas only 12.2% in the LH group had surgery for this indication (P0.001). Most in the LH group had surgery for fibroids (61%) or abnormal uterine bleeding (15.9%). Women in the VH group consumed significantly less oxycodone tablets postoperatively (median, 4.5 [IQR, 1-9] vs 7 [IQR, 2-18]; P = 0.047) and took oxycodone for less days after discharge (median, 1 [IQR, 0-3] vs 3 [IQR, 1-6]; P0.001).Women consume less oxycodone after minimally invasive hysterectomy than previously thought. Those who undergo VH may consume less oxycodone than those who undergo LH.

OBJECTIVE The aim of the study was to evaluate patient responses on a survey of knowledge, perceptions, concerns, and fears about complications related to pelvic reconstructive surgery (PRS). This is the first step to create a simplified, patient-centered Pelvic Floor Complication Scale that evaluates complications from both the patient and surgeon perspective. METHODS Subjects for this prospective study included women older than 18 years planning surgery within 12 weeks or who had undergone PRS more than 6 months ago. Patients were asked open-ended questions about postoperative complications as well as to rank the severity of potential PRS complications (as mild, moderate, severe). Using thematic analysis, responses were coded and analyzed using Dedoose (Version 8.0.35). RESULTS Thirty-three women (16 preop, 17 postop) participated in telephone interviews (n = 26) and focus groups (n = 7). There were no differences in age, race, education, marital status, and previous surgery. Specific complications such as a single urinary tract infection, short-term constipation (

Objective Our objective was to estimate the prevalence of abdominal wall striae among women with and without pelvic organ prolapse (POP) in a population with pelvic floor disorders. Methods This cross-sectional study included nonpregnant women with urinary incontinence and POP presenting to a tertiary urogynecology practice between December 2012 and August 2013. Participants completed a nonvalidated questionnaire about striae, and the degree of abdominal wall striae was quantified on physical examination. Baseline demographics, clinical characteristics, and Pelvic Organ Prolapse Quantification (POP-Q) measurements were recorded. Results One hundred thirty-two women were approached for participation, of which 110 (83%) completed study questionnaires. Of these 110, 59 had POP defined at POP-Q stages 2-4, whereas 51 had normal pelvic support, POP-Q stages 0-1. The mean (SD) age was 55.5 (12) years, and most (78/110) were sexually active. Women with POP were more parous than women without POP (median 2 vs 1, respectively; P = 0.03). However, there was no difference in medical comorbidities, smoking status, or steroid use between groups (P > 0.05). More women with POP reported striae (42/59 [71%] vs 23/51 [45%], P = 0.006) and had quantifiable abdominal wall striae compared with women with normal support (39/59 [66%] vs 22/51 [44%], P = 0.02). On multivariate logistic regression, women with POP were 2.5 times more likely to have striae compared with women without POP after adjusting for skin type and smoking status (odds ratio, 2.5; 95% confidence interval, 1.03-6.06; P = 0.04). Conclusion Women with POP are more likely to have striae compared with women without POP.

The purpose of this review is to discuss the pathophysiology, diagnosis, treatment, and prevention of recurrent urinary tract infection (UTI) in the setting of antimicrobial stewardship. Although recurrent UTI was traditionally thought to occur by repeated ascension of uropathogenic colonizers, newer evidence suggests that a subset of bacteria becomes internalized within uroepithelial cells forming quiescent intracellular reservoirs. These quiescent reservoirs do not elicit an immune response and persist after treatment of acute infection. In time, epithelial turnover results in release of these bacteria potentially leading to recurrent infection. Given the rise in antimicrobial resistance, the concept of antimicrobial stewardship has been developed to promote appropriate use of antimicrobials, improve patient outcomes, decrease microbial resistance, and reduce the spread of infections caused by multidrug-resistant organisms. This has sparked interest in non-antimicrobial measures for UTI prevention. Although cranberry products and probiotics may prevent UTI, the data for their efficacy are limited. Current evidence supports vaginal estrogen use for UTI prevention in postmenopausal women. Daily or post-coital low-dose antimicrobial prophylaxis may also be beneficial, particularly for women who develop UTI despite non-antimicrobial measures. Nevertheless, studies demonstrating the efficacy of antimicrobial prophylaxis are > 10 years old when antibiotic resistance was less common. Prevention of recurrent UTI requires identifying and addressing risk factors for infection. Non-antimicrobial strategies should be recommended whenever possible given increasing antimicrobial resistance. However, more studies are needed to define the ideal populations that may benefit from current non-antimicrobial strategies and to identify other potential ways UTI may be prevented.

OBJECTIVE To determine whether use of a new personalized risk calculator increases patient satisfaction with the decision whether or not to have a prophylactic midurethral sling (MUS) during pelvic organ prolapse (POP) surgery. METHODS We performed a randomized controlled trial involving English-speaking women without symptoms of stress urinary incontinence (SUI) with ≥ stage 2 POP who planned to undergo POP surgery with 1 of 4 fellowship-trained urogynecologists at a single academic center. Women with a history of prior POP or incontinence surgery, or who were pregnant, or unable to complete study forms were excluded. Participants were randomly assigned to standard preoperative counseling or preoperative counseling with the use of a validated, online risk calculator for de novo SUI after POP surgery. The primary outcome was patient satisfaction with the decision for prophylactic MUS placement during POP surgery at 3 months postoperative assessed using the Satisfaction with Decision Scale for Pelvic Floor Disorders. RESULTS Sixty-three women were approached for participation. Forty-two agreed to participate, 41 underwent randomization, and 33 had POP surgery and completed 3-month follow-up. Of these 33, 17 were randomized to the risk calculator and 16 to standard counseling. The mean age was 61.2 ± 9.1 years, and 41% (14/33) had a prophylactic MUS. At 3 months postoperative, there was no difference in Satisfaction with Decision Scale for Pelvic Floor Disorders scores between groups (4.67 ± 0.46 [intervention] vs 4.78 ± 0.34 [control]; P = 0.61). CONCLUSIONS Use of the de novo SUI risk calculator did not increase patient satisfaction with the decision regarding MUS placement during POP surgery.

Background Internet resources are becoming increasingly important for patients seeking medical knowledge. It is imperative to understand patient use and preferences for using the Internet and social networking websites to optimize patient education. Objectives The purpose of this study was to evaluate social networking and Internet use among women with pelvic floor complaints to seek information for their conditions as well as describe the likelihood, preferences, and predictors of website usage. Study Design This was a cross-sectional, multicenter study of women presenting to clinical practices of 10 female pelvic medicine and reconstructive surgery fellowship programs across the United States, affiliated with the Fellows' Pelvic Research Network. New female patients presenting with pelvic floor complaints, including urinary incontinence, pelvic organ prolapse, and fecal incontinence were eligible. Participants completed a 24 item questionnaire designed by the authors to assess demographic information, general Internet use, preferences regarding social networking websites, referral patterns, and resources utilized to learn about their pelvic floor complaints. Internet use was quantified as high (≥4 times/wk), moderate (2–3 times/wk), or minimal (≤1 time/wk). Means were used for normally distributed data and medians for data not meeting this assumption. Fisher's exact and χ 2 tests were used to evaluate the associations between variables and Internet use. Results A total of 282 surveys were analyzed. The majority of participants, 83.3%, were white. The mean age was 55.8 years old. Referrals to urogynecology practices were most frequently from obstetrician/gynecologists (39.9%) and primary care providers (27.8%). Subjects were well distributed geographically, with the largest representation from the South (38.0%). Almost one third (29.9%) were most bothered by prolapse complaints, 22.0% by urgency urinary incontinence, 20.9% by stress urinary incontinence, 14.9% by urgency/frequency symptoms, and 4.1% by fecal incontinence. The majority, 75.0%, described high Internet use, whereas 8.5% moderately and 4.8% minimally used the Internet. Women most often used the Internet for personal motivations including medical research (76.4%), and 42.6% reported Google to be their primary search engine. Despite this, only 4.9% primarily used the Internet to learn about their pelvic floor condition, more commonly consulting an obstetrician-gynecologist for this information (39.4%). The majority (74.1%) held a social networking account, and 45.9% visited these daily. Nearly half, 41.7%, expressed the desire to use social networking websites to learn about their condition. Women P = .018) and to desire using social networking websites to learn about their pelvic floor complaint ( P = .008). The presenting complaint was not associated with Internet use ( P = .905) or the desire to use social networking websites to learn about pelvic floor disorders ( P = .201). Conclusion Women presenting to urogynecology practices have high Internet use and a desire to learn about their conditions via social networking websites. Despite this, obstetrician-gynecologists remain a common resource for information. Nonetheless, urogynecology practices and national organizations would likely benefit from increasing their Internet resources for patient education in pelvic floor disorders, though patients should be made aware of available resources.

Introduccion: Kinesio Taping es una tecnica realizada con aplicacion de cintas elasticas sobre la piel, que se propone producir determinados efectos con fines de prevencion y tratamiento de las lesiones musculoesqueleticas. Sin embargo, los medios por los que tales efectos ocurren continuan siendo investigados e discutidos, principalmente en lo que refiere al uso en el campo de la rehabilitacion y del deporte. Objetivo: Analizar la relacion de la actividad electromiografica encontrada en los musculos vasto lateral (VL) y vasto medial (VM) en dos condiciones: sin aplicacion de Kinesio Taping (GnKT) y con aplicacion de Kinesio Taping (GKT) en una poblacion saludable, con experiencia en entrenamiento de fuerza. Metodos: Dieciocho sujetos del sexo masculino (edad: 28,1 ± 6,9 anos; masa corporal: 85,5 ± 8,3 kg; estatura: 179,5 ± 6,9 cm; longitud de miembro inferior: 97,0 ± 4,2 cm) realizaron el ejercicio de medio agachamiento libre, con velocidad controlada, sin y con aplicacion de Kinesio Taping. La relacion fue verificada por la proporcion de magnitud de activacion (VM/VL), utilizandose los valores de root mean square (RMS). La secuencia para realizacion de los ejercicios en las condiciones mencionadas fue aleatorizada y balanceada. Resultados: Los valores encontrados para la razon VM/VL en la situacion GnKT fueron de 83,96 ± 5,79% para VM y 84,13 ± 7,16% para VL. Ya en la situacion GKT, 84,55 ± 16,97% para VM y 80,53 ± 9,20% para VL. No fueron observadas diferencias significativas en los valores de RMS para la relacion VM/VL sometidos a la aplicacion de Kinesio Taping. Conclusion: La aplicacion de Kinesio Taping no demostro influenciar la relacion de la actividad electromiografica entre los musculos vasto lateral y vasto medial durante la ejecucion del ejercicio de medio agachamiento.

To estimate the prevalence of auditory vaginal air passage among women with and without pelvic organ prolapse (POP) in a population with pelvic floor disorders.This prospective cohort study included women with urinary incontinence and POP who sought consultation at a single center from January 2012 to August 2013. Women with rectovaginal fistula, prior surgery for POP or incontinence, and current pregnancy were excluded. Participants completed a nonvalidated questionnaire about auditory vaginal air passage, also known as vaginal wind. The subset who had pelvic reconstructive surgery completed the same questionnaire 6 months postoperatively. Baseline demographic and clinical characteristics and preoperative and postoperative POP quantification data were collected.One hundred thirty-two women were approached for participation, of whom 110 (83%) completed baseline study questionnaires. Of these 110, 59 had POP and 51 had normal pelvic support. The mean age was 55±12 years. Sixty-nine percent (76/110, 95% confidence interval [CI] 60-78%) experienced vaginal wind an average of 2.1±8.7 times weekly. There was no difference in the prevalence of vaginal wind between women with and without POP. Women with vaginal wind were younger than those without vaginal wind (mean age 52±12 years compared with 62±11 years, P.001). The majority with vaginal wind experienced symptoms during intercourse (65/75 [87%], 95% CI 77-93%) and were at least somewhat bothered by it (49/76 [64%], 95% CI 53-75%), but only 22% (17/76, 95% CI 14-33%) reported a negative effect on quality of life.Vaginal wind is common among women with pelvic floor disorders but is not associated with POP.II.

Our objective was to evaluate whether foley catheter guide use decreased the risk of cystotomy and urethrotomy during retropubic midurethral sling placement.This retrospective cohort study included all women undergoing retropubic synthetic midurethral sling placement at a single academic institution between January 2011 and September 2012. Patients were divided into groups based on whether or not the foley catheter guide was used during surgery. The primary outcome was the incidence of cystotomy.A total of 310 patients underwent retropubic midurethral sling placement. The foley catheter guide was used in 76/310 cases (24.5%). The mean age was 57 ± 11 and mean body mass index was 28 ± 7. More patients in the no-guide group had preoperative urgency (70% versus 58%, p = 0.049), anterior prolapse (95% versus 78%, p0.0001), and concomitant prolapse surgery (65% versus 51%, p = 0.03). There was no difference in preoperative urgency urinary incontinence, medical comorbidities, previous surgical history, intraoperative time, blood loss, or postoperative voiding dysfunction rates between groups. Fourteen of the 310 patients (4.5%) had cystotomies: 1/76 (1.3%) in the foley catheter guide group and 13/234 (5.6%) in the no-guide group (p = 0.12). No patients had urethrotomies. On multiple logistic regression, there was no difference in the odds of cystotomy between groups after adjusting for previous prolapse and anti-incontinence surgery, concomitant prolapse repair, level of first assistant, and retropubic local anesthesia use (AOR = 0.2 [95% CI 0.02-1.7]).Foley catheter guide use did not decrease the risk of intraoperative lower urinary tract injury during retropubic midurethral sling placement. Larger prospective studies are needed to confirm this finding.

While physical activity (PA) is recommended for high blood pressure management, the level of PA practice of hypertensive patients remains unclear. We aimed to assess the association between the level of both PA and blood pressure of individuals consulting in 9 hypertension specialist centres. Eighty-five hypertensive patients were included (59 ± 14 years, 61% men, 12% smokers, 29% with diabetes). Following their consultation, they performed home blood pressure measurement (HBPM) over 7 days (2 in the morning+2 in the evening), they wrote in a dedicated form their daily activities to estimate the additional caloric expenditure using Acti-MET device (built from International physical Activity Questionnaire [IPAQ]). Thus, patients completed a self-administered questionnaire "score of Dijon" (distinguishing active subjects with a score>20/30, from sedentary, Alors que la pratique régulière d’une activité physique (AP) est recommandée en cas d’hypertension artérielle (HTA), le niveau d’AP des sujets hypertendus reste mal connu. Notre objectif était d’étudier l’association entre le niveau d’AP et le caractère contrôlé ou non de l’HTA de sujets vus en consultation dans 9 centres spécialisés en HTA. Quatre-vingt-cinq sujets hypertendus ont été inclus (59 ± 14 ans, 61 % d’hommes, 12 % fumeurs, 29 % diabétiques). Au décours de leur consultation, une automesure tensionnelle (AMT) sur 7 jours (2 mesures le matin + 2 le soir) était réalisée, ainsi qu’un compte rendu de leurs activités quotidiennes permettant d’estimer la dépense calorique additionnelle à l’aide d’une réglette Acti-MET extrapolée du questionnaire international d’activités physiques (IPAQ). Les sujets complétaient ensuite un auto-questionnaire « score de Dijon » sur 30 points (distinguant les sujets actifs, score > 20/30, des sédentaires < 10/30). Les hypertendus contrôlés en AMT (< 135/85 mm Hg) (55 % des sujets), en comparaison aux non contrôlés, étaient plus âgés, avaient une tendance non significative à une dépense calorique déclarée plus élevée (4959 ± 5045 kcal/semaine vs 4048 ± 4199 kcal/semaine, p = 0,3755) et leur score de Dijon (19,44 ± 5,81 vs 18,00 ± 4,32, p = 0,2094) montrait une proportion de sujets « actifs » plus importante (48,9 % vs 34,2 %, p = 0,1773). En conclusion, nos résultats ont objectivé une « tendance » à une AP déclarée plus importante pour les sujets dont l’HTA est contrôlée. Ceci nous encourage à poursuivre par une étude qui inclurait davantage de sujets et dont l’AP serait évaluée par le port pendant 7 jours d’un capteur de type accéléromètre (méthode objective).

A major component of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) included policies directed to encouraging marriage while discouraging nonmarital births. Teen mothers were of particular concern as policymakers argued that there is a link between teenage childbearing and welfare receipt. This paper seeks to reframe the concept of “at-risk” teen mothers by looking to the socially construction of boundaries—an imagery that brings to the forefront the complex relations between young mothers and welfare reform policy. From this standpoint, we discuss how welfare reform might address the multiple issues facing teen mothers including housing, education and training, child care, transportation, health, healthy relationships and parenting skills.

We describe techniques and objective and subjective outcomes for women who underwent midurethral sling (MUS) shortening for persistent stress urinary incontinence (SUI). This is a case series of women who underwent MUS shortening for SUI within 8 weeks of initial MUS placement. Objective and subjective findings including Urinary Distress Inventory (UDI)-6 and Urinary Impact Questionnaire (UIQ)-7 scores are reported, and shortening techniques are described. Between June 2007 and June 2010, three women underwent MUS shortening for persistent SUI within 8 weeks of initial MUS placement. Shortening was performed with either midline plication or mesh excision and reapproximation. Five months postoperative to shortening, one woman reported subjective improvement in SUI symptoms, and two had subjective and objective resolution of SUI. All showed improvement from baseline in UDI-6 and UIQ-7 scores. There were no erosions. MUS shortening may offer a safe and effective option for management of persistent SUI.