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Introduction and hypothesisLimited data exist comparing different surgical approaches in women with advanced vaginal prolapse. This study compared 2-year surgical outcomes of uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) in women with advanced prolapse (stage III-IV) and stress urinary incontinence.MethodsThis was a secondary analysis of a multicenter 2 × 2 factorial randomized trial comparing (1) ULS versus SSLF and (2) behavioral therapy with pelvic floor muscle training versus usual care. Of 374 subjects, 117/188 (62.7%) in the ULS and 113/186 (60.7%) in the SSLF group had advanced prolapse. Two-year surgical success was defined by the absence of (1) apical descent > 1/3 into the vaginal canal, (2) anterior/posterior wall descent beyond the hymen, (3) bothersome bulge symptoms, and (4) retreatment for prolapse. Secondary outcomes included individual success outcome components, symptom severity measured by the Pelvic Organ Prolapse Distress Inventory, and adverse events. Outcomes were also compared in women with advanced prolapse versus stage II prolapse.ResultsSuccess did not differ between groups (ULS: 58.2% [57/117] versus SSLF: 58.5% [55/113], aOR 1.0 [0.5-1.8]). No differences were detected in individual success components (p > 0.05 for all components). Prolapse symptom severity scores improved in both interventions with no intergroup differences (p = 0.82). Serious adverse events did not differ (ULS: 19.7% versus SSLF: 16.8%, aOR 1.2 [0.6-2.4]). Success was lower in women with advanced prolapse compared with stage II (58.3% versus 73.2%, aOR 0.5 [0.3-0.9]), with no retreatment in stage II.ConclusionsSurgical success, symptom severity, and overall serious adverse events did not differ between ULS and SSLF in women with advanced prolapse. ClinicalTrials.gov Identifier: NCT01166373.

The article focuses on the impact of age and racial/ethnic differences on the incidence of symptomatic pelvic organ prolapse during the menopausal transition. Topics include the increased risk of prolapse with aging, the variation in risk by race and ethnicity independent of socioeconomic factors, and the challenges and limitations of research in understanding and addressing health disparities in pelvic floor disorders.

Background: A description of energy-based genitourinary non-surgical devices (energy-based devices) safety data is outlined given their rapid adoption.Objectives: The authors sought to describe adverse events for energy-based devices in the Manufacturer and User Facility Device Experience database and to compare with similar devices and other subspecialty applications. We hypothesized that products with genitourinary applications had similar adverse events to dermatologic or general surgery applications.Methods: The authors used Reed Tech Navigator to compile adverse events reports for all registered energy-based devices. Individual adverse events reports associated with (1) non-ablative, (2) fractionated, (3) unfractionated, (4) radiofrequency, and (5) hybrid laser technologies were categorized. Adverse event characteristics were compared among genitourinary applications (n = 39) and other subspecialty applications within the same devices (n = 79).Results: Eighteen manufacturers were identified, which collectively manufacture 43 products with genitourinary applications. Thirty-nine genitourinary adverse events were reported and isolated to 6 manufacturers with 11 products, of which 82% (n = 32) were injuries, 15% (n = 6) were device malfunction, and 3% (n = 1) were related to improper maintenance. Local treatment reactions were the most commonly reported injury (62%, n = 21). Adverse events varied by device type, with CO2 lasers having more burns and radiofrequency devices having higher rates of sensation loss. Comparing similar technology types, genitourinary energy-based devices had the fewest adverse events reports per device in the Manufacturer and User Facility Device Experience database.Conclusions: Adverse events were reported for one-quarter of the products currently available, and most were local treatment reactions. The reporting of adverse events is equal to that of other subspecialties, suggesting similar risk profiles. Improved reporting is needed to fully evaluate the safety of individual energy-based devices.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Importance: Postoperative urinary retention (POUR) is common after reconstructive pelvic surgery. Little is known about the relationship between older age (≥70 years) and POUR after pelvic organ prolapse surgery., Objectives: We aimed to investigate the relationship between age ≥70 years and POUR. Secondarily, we aimed to determine if duration of urinary catheterization differed by age in women with POUR., Study Design: This was a secondary analysis of a dual-center retrospective study on perioperative adverse events in biologic females aged ≥61 years undergoing prolapse surgery. The primary outcome was POUR, defined as a failed retrograde voiding trial requiring bladder catheterization. The secondary outcome was duration of temporary bladder catheterization. We developed a stepwise multivariable logistic regression model, which included relevant variables with P < 0.10 on univariate analyses and a forced age variable., Results: In this cohort of 2,665 women, mean ± standard deviation age was 71.2 ± 6.7 years, and 54.6% were ≥70 years, POUR occurred in 830 (31.1%) patients. Women with POUR had a lower body mass index and were more likely to have undergone a vaginal prolapse surgery and concomitant hysterectomy/incontinence procedure (P < 0.05). They had higher estimated blood loss (75 vs 50 mL, P < 0.001). On multivariable logistic regression, age ≥70 years was not associated with POUR (adjusted odds ratio 1.02, 95% CI [0.83-1.26]). Age ≥70 years was associated with longer duration of catheterization (5 vs 4 days, P < 0.01)., Conclusion: Age was not associated with POUR when controlling for other clinical factors (body mass index, surgical approach, concomitant hysterectomy/incontinence surgery, and estimated blood loss). These factors may affect POUR in older women and should be considered in perioperative management., Competing Interests: Disclosures and source of funding: This research was supported by the 2023 Wishwa N. Kapoor Catalyst Fund for Trainees in the Clinical and Translational Sciences. M.F. Ackenbom is supported by NIH National Institute on Aging (K23AG073517-01). The authors have no conflicts of interest to report., (Copyright © 2025 American Urogynecologic Society. All rights reserved.)

Importance: Obliterative vaginal surgery is often reserved for older patients with prolapse, but the effect of age as an independent risk factor for perioperative complications in this cohort is poorly understood., Objective: The aim of this study was to assess the association between age and perioperative complications in women undergoing obliterative vaginal surgery., Study Design: This was a retrospective cohort study that included 371 patients undergoing colpocleisis between 2010 and 2013 at a single academic medical center. Seventy demographic and clinical variables, including complications within 12 weeks of surgery, were analyzed. The χ2 and Fisher exact tests were used for categorical variables. Student t and Mann-Whitney U tests were used for continuous variables. Univariate logistic regression was performed to identify predictors of perioperative complications, and candidate variables with P < 0.2 were used in multivariate logistic regression., Results: The mean patient age was 75.4 ± 6.4 years (range, 59-94 years). One hundred ten (29.7%) patients experienced at least 1 complication, the most common of which was urinary tract infection (n = 47, 12.7%). In the final multivariable model, only age (odds ratio, 1.05 per year; 95% confidence interval, 1.01-1.08) remained a significant predictor of perioperative complications. A cut point of age ≥70.5 years maximized sensitivity and specificity for predicting complications., Conclusions: Among women undergoing obliterative vaginal surgery, age is a predictor of perioperative complications. Each increasing year of age increases the complication likelihood by 1.05-fold, such that an 85-year-old woman is 1.05^20 or 2.65 times more likely than a 65-year-old woman to have a complication. A cut point of ≥70.5 years best predicted complications. Despite this association, severe perioperative complications following obliterative surgery are rare., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)

Importance: Understanding the status of pelvic floor disorder (PFD) disparities research will allow the opportunity to advance future pelvic floor equity efforts., Objectives: The aims of the study were to (1) characterize the landscape of PFD disparities literature using the 3 phases of disparities research framework, (2) describe the characteristics of PFD disparities studies, and (3) identify critical knowledge gaps., Study Design: We performed a systematic review of peer-reviewed publications addressing disparities in PFDs among U.S. populations from PubMed, Embase, Scopus, or the Cochrane Database indexed between 1997 and 2022. Using the triphasic framework for advancing health disparities research by Kilbourne et al ( Am J Public Health . 2006;96(12):2113-21), we categorized the included studies into the detecting phase (identifies and measures disparities in historically marginalized populations), understanding phase (establishes disparity determinants), or reducing phase (conducts interventions to alleviate inequities). All screening, coding, and quality reviews were independently performed by at least 2 authors. We used descriptive analysis and the χ 2 test for comparisons., Results: The initial search identified 10,178 studies, of which 123 were included. Of the included studies, 98 (79.7%), 22 (17.9%), and 3 (2.4%) studies were detecting, understanding, and reducing phase research, respectively. The most common disparity category investigated was race and ethnicity (104 studies), and one third of these studies attributed drivers of racial and ethnic differences to structural influences. Publications of detecting phase studies outpaced the growth of understanding and reducing phase research., Conclusions: Most PFD disparities research focused on identifying historically marginalized populations with inadequate progression to understanding and reducing phases. We recommend progressing PFD disparities research beyond the detecting phase to advance health equity in PFD care., (Copyright © 2024 American Urogynecologic Society. All rights reserved.)