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This study aims to determine whether the use of preoperative transdermal scopolamine is associated with an increased risk of postoperative urinary retention in urogynecologic surgeries.This is a retrospective chart review study of women who underwent surgery between January 1, 2018, and December 31, 2020. Patients who received a scopolamine patch versus those who did not were compared using demographic and perioperative variables utilizing Pearson's chi-squared test and t-test of Wilcoxon rank-sum. A logistic regression was performed to evaluate the effect of scopolamine on the patients' postoperative voiding trial results, controlling for confounders. P-value0.05 was considered statistically significant.A total of 449 women underwent a vaginal or laparoscopic hysterectomy, midurethral sling placement, uterosacral or sacrospinous ligament suspension, sacrocolpopexy, anterior/posterior colporrhaphy, or other urogynecologic surgeries with 109 (24.2%) having received transdermal scopolamine. A significantly higher number of women with preoperative scopolamine [n = 50 (45.9%)] failed their voiding trial compared to those without scopolamine [n = 100 (29.4%), p = 0.0016]. The adjusted model yielded an odds ratio of 1.75 (95% CI: 1.08-2.85) of a failed voiding trial in the scopolamine group. When comparing the odds of failing voiding trial by surgery type, those with a midurethral sling placed during surgery had an adjusted odds ratio of 3.12 (95% CI: 2.01-4.87), as compared to those without a midurethral sling.Use of a transdermal scopolamine patch for nausea and vomiting prophylaxis is associated with increased risk of postoperative urinary retention across all urogynecologic surgeries.

To determine if women with endometriosis experience lower urinary tract symptoms (LUTSs) more often than those without.Cross-sectional analysis at enrollment in a longitudinal cohort.Enrollment at 2 academic hospitals and from the local community.This analysis included 1,161 women with (n = 520) and without (n = 641) surgically confirmed endometriosis who were enrolled in the Women's Health Study: from Adolescence to Adulthood between 2012 and 2018.Not applicable.Prevalence of LUTSs, including stress incontinence, urgency and frequency, straining with urination, incomplete bladder emptying, hematuria, dysuria, and bladder pain using standardized questionnaires.The primary outcomes were that women with endometriosis reported the following more often than those without: difficulty passing urine (7.9% vs. 2%; crude odds ratio [OR], 4.14 [95% confidence interval {CI}, 2.19-7.80]; adjusted OR [aOR], 4.31 [95% CI, 2.07-8.95]); still feeling full after urination (18.8% vs. 4.7%; crude OR, 4.73 [95% CI, 3.08-7.25]; aOR, 4.67 [95% CI, 2.88-7.56]); having to urinate again within minutes of urinating (33.1% vs. 17.0%; crude OR, 2.41 [95% CI, 1.83-3.18]; aOR, 2.49 [95% CI, 1.81-3.43]), dysuria (11.7% vs. 4.9%; crude OR, 2.55 [95% CI, 1.62-4.01]; aOR, 2.38 [95% CI, 1.40-4.02]); and pain when the bladder is full (23.0% vs. 4.9%; crude OR, 5.79 [95% CI, 3.82-8.78]; aOR, 6.04 [95% CI, 3.74-9.76]). For the secondary outcomes, among female participants with endometriosis, we observed that the odds of LUTS did not differ by the revised American Society for Reproductive Medicine stage (I/II vs. III/IV) or duration of endometriosis-associated symptoms.Women with surgically confirmed endometriosis were more likely to report LUTS than those without.

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.

Objective We evaluated patterns of outpatient visits seen for urinary incontinence (UI) among women 65 years or older in the Nurses' Health Study and the general Medicare population. We were interested in understanding whether nurses, with high health literacy, may receive more care for UI than the general population. Methods Medicare Fee for Service claims data for women aged 66-91 years were compared for Nurses' Health Study participants (n = 3,213) and a propensity-matched sample from general Medicare Fee for Service beneficiaries (n = 3,213) with 1 or more outpatient evaluation and management visits for UI in 2012. We examined the mean number of outpatient visits for UI and the type of provider seen, using t tests and χ2 tests. Providers were categorized as specialist and nonspecialist providers using taxonomy codes. Results The percentage of women 65 years or older who had an outpatient visits for UI over 12 months was 6.4% in the Nurses' Health Study cohort and 5.4% in the general population. The mean number of office visits for UI in 2012 was similar between nurses and the matched general population (mean = 1.8 vs 1.8; P = 0.3). A small percentage of women saw both nonspecialists and specialists for UI (9.3% in the Nurses' Health Study and 10.0% in the Center for Medicare Services cohorts). Conclusions We found that less than 7% of older women had outpatient evaluation of UI symptoms during a 12-month period, despite UI being very common in this age group. This was similar in nurses and the general population, suggesting that even high health care literacy does not increase UI care seeking.

To define the reasons for hospital readmissions following surgery for pelvic organ prolapse by surgical approach. Patients undergoing surgery for pelvic organ prolapse from 2012 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology and International Classification of Diseases codes. Hazard risks of readmission by surgical approach (vaginal, laparoscopic, abdominal, or combined) were determined by multivariable cox regression. Diagnoses and timing of readmission by surgical approach were examined. Of 57,233 women undergoing surgery for pelvic organ prolapse during the study period, 1073 (1.9%) were readmitted to the hospital within 30 days postoperatively. After adjusting for prespecified potential confounders, laparoscopic and abdominal surgical approaches were associated with higher risks of readmission relative to a vaginal approach (aHR 1.30, 95% CI 1.08–1.57, and 1.97, 95% CI 1.44–2.71, respectively). The most common reason for readmission was a gastrointestinal issue among those undergoing both laparoscopic (28.0%) and abdominal surgery (30.2%). Surgical site infection was the most common readmission diagnosis among women undergoing vaginal surgery (16.2%). Of the 418 women readmitted within 7 days of surgery, the most common diagnoses were gastrointestinal issues (26.6%), medical disorders (12.0%), or surgical complications (e.g., bleeding) (11.0%). Women undergoing laparoscopic or abdominal surgery for pelvic organ prolapse were at higher risk of readmission relative to those undergoing surgery via a vaginal approach. The reasons and timing of readmission differed based on surgical approach.

BackgroundUrinary incontinence (UI) is prevalent in women and has been associated with decreased quality of life and institutionalization. Despite this, and the fact that several treatment options exist, few women discuss UI with clinicians. The aim of this study was to examine the proportion of middle aged and older women with urinary incontinence who have discussed UI with clinicians, focusing on female health professionals as a way to examine this question outside of issues of health care access.MethodsData are from the Nurses Health Studies (NHS), two ongoing observational, prospective, cohort studies. The surveys collected detailed information about UI, including frequency, amount and type. Women were also asked if they had discussed UI with a clinician. We used multivariable-adjusted logistic regression to estimate odds ratios (OR) of participants reporting discussion about UI.Results94,692 women with UI aged 49–91 years old were included in this study. Of these, 34% reported that they had discussed their incontinence with a clinician. Women with daily UI had 4.4 times greater odds of discussing it with clinicians when compared to those with monthly UI (OR = 4.36, 95% confidence interval [CI] 4.06–4.69). When controlling for severity of symptoms, the oldest women, greater than eighty years, were 20% less likely to have discussed UI with their clinician, compared to the youngest women (OR = 0.81, 95% CI 0.73–0.89).ConclusionsA minority of women with UI, even among health professionals, discuss their symptoms with clinicians. Oldest women were the least likely to discuss their UI with a provider.

PURPOSE: To describe changes in bladder health, defined as “a complete state of physical, mental, and social well-being related to bladder function that permits daily activities, adapts to short-term stressors, and allows optimal well-being,” in women over time. MATERIALS AND METHODS: We used data on 15 lower urinary tract symptoms (LUTS) and interference from urinary experiences assessed at the baseline and five-year follow-up interviews of the Boston Area Community Health (BACH) Survey to estimate changes in bladder health over time in women. Associations between baseline and follow-up bladder health (defined as the maximum frequency of LUTS or interference at each time point) were calculated by ordinal logistic regression and generalized linear models. RESULTS: 2,526 women provided complete information on bladder health at baseline and follow-up. Over the five-year follow-up, 6.5% of women maintained optimal bladder health (no LUTS or interference), 33.6% developed worse bladder health (including 10.4% who transitioned from optimal to less than optimal health), 31.4% maintained their less than optimal bladder health status, and 28.7% improved. Despite these changes, women with poorer bladder health at baseline were still more likely to have poorer bladder health five years later (e.g., multivariable-adjusted relative risk=3.27, 95% confidence interval: 2.49-4.29 for severe LUTS/interference at follow-up among those with severe LUTS/interference at baseline). CONCLUSIONS: Findings from our large secondary analysis of BACH Survey data suggest considerable variability in bladder health over time, and underscore the importance of bladder health promotion to prevent the initial onset and progression of poor bladder health in women.

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.

We evaluated patterns of outpatient visits seen for urinary incontinence (UI) among women 65 years or older in the Nurses' Health Study and the general Medicare population. We were interested in understanding whether nurses, with high health literacy, may receive more care for UI than the general population.Medicare Fee for Service claims data for women aged 66-91 years were compared for Nurses' Health Study participants (n = 3,213) and a propensity-matched sample from general Medicare Fee for Service beneficiaries (n = 3,213) with 1 or more outpatient evaluation and management visits for UI in 2012. We examined the mean number of outpatient visits for UI and the type of provider seen, using t tests and χ2 tests. Providers were categorized as specialist and nonspecialist providers using taxonomy codes.The percentage of women 65 years or older who had an outpatient visits for UI over 12 months was 6.4% in the Nurses' Health Study cohort and 5.4% in the general population. The mean number of office visits for UI in 2012 was similar between nurses and the matched general population (mean = 1.8 vs 1.8; P = 0.3). A small percentage of women saw both nonspecialists and specialists for UI (9.3% in the Nurses' Health Study and 10.0% in the Center for Medicare Services cohorts).We found that less than 7% of older women had outpatient evaluation of UI symptoms during a 12-month period, despite UI being very common in this age group. This was similar in nurses and the general population, suggesting that even high health care literacy does not increase UI care seeking.

To define the reasons for hospital readmissions following surgery for pelvic organ prolapse by surgical approach.Patients undergoing surgery for pelvic organ prolapse from 2012 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology and International Classification of Diseases codes. Hazard risks of readmission by surgical approach (vaginal, laparoscopic, abdominal, or combined) were determined by multivariable cox regression. Diagnoses and timing of readmission by surgical approach were examined.Of 57,233 women undergoing surgery for pelvic organ prolapse during the study period, 1073 (1.9%) were readmitted to the hospital within 30 days postoperatively. After adjusting for prespecified potential confounders, laparoscopic and abdominal surgical approaches were associated with higher risks of readmission relative to a vaginal approach (aHR 1.30, 95% CI 1.08-1.57, and 1.97, 95% CI 1.44-2.71, respectively). The most common reason for readmission was a gastrointestinal issue among those undergoing both laparoscopic (28.0%) and abdominal surgery (30.2%). Surgical site infection was the most common readmission diagnosis among women undergoing vaginal surgery (16.2%). Of the 418 women readmitted within 7 days of surgery, the most common diagnoses were gastrointestinal issues (26.6%), medical disorders (12.0%), or surgical complications (e.g., bleeding) (11.0%).Women undergoing laparoscopic or abdominal surgery for pelvic organ prolapse were at higher risk of readmission relative to those undergoing surgery via a vaginal approach. The reasons and timing of readmission differed based on surgical approach.

This clinical consensus statement on vaginal energy-based devices (EBDs) reflects statements drafted by content experts from the American Urogynecologic Society's EBD writing group. The American Urogynecologic Society's EBD writing group used a modified Delphi process to assess statements that were evaluated for consensus after a structured literature search. A total of 40 statements were assessed and divided into 5 categories: (1) patient criteria, (2) health care provider criteria, (3) efficacy, (4) safety, and (5) treatment considerations. Of the 40 statements that were assessed, 28 reached consensus and the remaining 12 did not. Lack of evidence was among the main reasons that vulvovaginal EBD treatment statements did not reach consensus.

This committee opinion reviews the laser-based vaginal devices for treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The United States Food and Drug Administration has issued a warning for unsubstantiated advertising and use of energy-based devices. Well-designed case-control studies are required to further investigate the potential benefits, harm, and efficacy of laser therapy in the treatment of genitourinary syndrome of menopause, vaginal laxity, and stress urinary incontinence. The therapeutic advantages of nonsurgical laser-based devices in urogynecology can only be recommended after robust clinical trials have demonstrated their long-term complication profile, safety, and efficacy.

Mixed urinary incontinence (UI) is, on average, more severe than urgency UI or stress UI. We tested the hypothesis that mixed UI is a more advanced stage of UI by comparing transition probabilities among women with stress, urgency, and mixed UI. We used data from the General Longitudinal Overactive Bladder Evaluation Study-UI, which included community-dwelling women, aged 40+ years, with UI at baseline. Study participants completed two or more consecutive bladder health surveys every 6 months for up to 4 years. Using sequential 6-month surveys, transition probabilities among UI subtypes were estimated using the Cox-proportional hazards model, with the expectation that probabilities from stress or urgency UI to mixed UI would be substantially greater than probabilities in the reverse direction. Among 6,993 women 40+ years of age at baseline, the number (prevalence) of women with stress, urgency, and mixed UI was 481 (6.9%), 557 (8.0%), and 1488 (21.3%) respectively. Over a 4-year period, the transition probabilities from stress UI (34%) and urgency UI (27%) to mixed UI was significantly higher than probabilities from mixed to stress UI (6%) or to urgency UI (rate = 9%). The adjusted transition hazard ratio for stress UI and urgency UI was 2.06 (95% CI: 1.73-2.92) and 1.85 (95% CI: 1.63-2.57) respectively compared with mixed UI. The substantially higher transition from stress UI and urgency UI to mixed UI supports the hypothesis that mixed UI might represent a more advanced stage of UI that may have implications for understanding disease progression.

OBJECTIVE The objective of this study was to determine if weight loss surgery is associated with decreased prevalence of urinary incontinence (UI) and pelvic organ prolapse (POP) symptoms. METHODS A survey was conducted among previously morbidly obese women who underwent bariatric surgery at Brigham and Women's Hospital, Boston from 2007 to 2015. In addition to the Pelvic Floor Distress Inventory 20, we collected demographic and clinical data including symptoms of and treatment for UI and POP before surgery. Participants were divided into 4 quartiles based on self-reported postsurgical weight loss: less than 26.1 kg, 26.1 to 36.2 kg, 36.3 to 46.2 kg, and greater than 46.2 kg. Cox proportional hazard ratios were used to estimate risk of UI and POP by quartile. Kruskal-Wallis test was used to compare bother scores between the groups. RESULTS A total of 447 women responded to the survey. Mean follow-up from surgery was 5 years. Women with Roux-en-Y gastric bypass had significantly greater weight loss than gastric banding or sleeve gastrectomy. The adjusted hazard ratios of current UI, stress UI, urgency UI, and prolapse decreased with increasing weight loss quartile (P trend

There has been renewed interest in the management of postoperative pain after benign gynecological surgery. The purpose of the study was to determine if the use of intraoperative and immediate postoperative pain medication differs between vaginal and laparoscopic surgery in women with pelvic organ prolapse.The study included women who had undergone pelvic organ prolapse repair between 2014 and 2019 in two tertiary care hospitals. We collected demographic data and pain medication used during and after surgery, including opioids, local anesthetics, gabapentin, ketorolac, ibuprofen, and acetaminophen. Data analyses were performed using STATA Version 16.1. A p value0.05 was considered to indicate statistical significance.A total of 195 women were included in the study, with 98 in the vaginal and 97 in the laparoscopic group. Intraoperative opioid use in the two groups was similar (25 morphine milligram equivalent [MME], p = 0.34). However, women in the laparoscopic group received significantly more intravenous and local anesthesia (lidocaine: 60 vs 40 mg; bupivacaine 49.6 vs 20 ml, p 0.001). Postoperatively, although women in the vaginal group required almost twice as many narcotics as those in the laparoscopy group (MME = 28 vs 15, p 0.001), after controlling for confounders in the multivariate analysis, there were no differences in postoperative pain requirements between the two groups. Recovery time had a significant impact on opioid and acetaminophen use (p 0.05).Use of pain medication was similar in the intraoperative and immediate postoperative period after pelvic organ prolapse surgery when comparing the vaginal and laparoscopic approaches after controlling for potential confounding factors.

Urinary incontinence subtypes often differ by symptom severity and treatment profiles; in particular, mixed urinary incontinence is generally associated with worse symptoms and less successful treatment. Yet, limited information exists on the natural history of different urinary incontinence subtypes, which could help to better identify and treat patients prior to development of more intractable disease.To evaluate the onset of urinary incontinence subtypes, and transitions between subtypes over 8 years, using 2 large cohorts of middle-aged and older women with incident urinary incontinence.We identified 10,349 women with incident urinary incontinence (stress, urgency, and mixed subtypes) from the Nurses' Health Study and the Nurses' Health Study II who were 41-83 years of age, using repeated mailed questionnaires. We defined stress urinary incontinence as leakage with coughing, sneezing, or activity; urgency urinary incontinence as urine loss with a sudden feeling of bladder fullness or when a toilet was inaccessible; and mixed urinary incontinence when women reported that stress and urgency symptoms occurred equally. In subsequent questionnaires 4 and 8 years later, we continued to track symptom severity and subtypes. In addition, to obtain predicted probabilities of urinary incontinence subtypes 4 years and 8 years after urinary incontinence onset, we used multivariable-adjusted generalized estimating equations with a multinomial outcome.At urinary incontinence onset in 2004-2005, 56% of women reported stress urinary incontinence symptoms, 23% reported urgency urinary incontinence symptoms, and 21% reported mixed urinary incontinence symptoms. Women with stress urinary incontinence or urgency urinary incontinence at onset were likely to report the same urinary incontinence type 4 and 8 years later (stress urinary incontinence at onset: 70% and 60% reported stress urinary incontinence at years 4 and 8, respectively; urgency urinary incontinence at onset: 68% and 64% reported urgency urinary incontinence at years 4 and 8, respectively). Nonetheless, for both stress and urgency urinary incontinence, women with more severe symptoms at onset were more likely to progress to mixed urinary incontinence. Women with mixed urinary incontinence at onset had more variation over time, although the largest subset continued to report mixed urinary incontinence (45% reported mixed urinary incontinence at year 4; 43% reported mixed urinary incontinence at year 8). Few women across all urinary incontinence subtypes reported resolution of symptoms over 4-8 years of follow-up (4-12%). When considering the likelihood of remaining with or progressing to mixed urinary incontinence over follow-up, according to age, body mass index, and urinary incontinence severity, we found that older and younger women had similar predicted probability of remaining with or progressing to mixed urinary incontinence (eg, women60 years of age at onset with severe mixed urinary incontinence had a 54% (95% confidence interval, 53-55) probability of mixed urinary incontinence 8 years later, vs 57% (95% confidence interval, 56-58) of women ≥70 years of age with severe mixed urinary incontinence at onset). Obese women were somewhat more likely to progress to mixed urinary incontinence regardless of urinary incontinence type at onset (eg, women with body mass index25 kg/mMost women with incident stress and urgency urinary incontinence continued to experience similar subtype symptoms over 8 years. However, obese women and those with more severe symptoms were more likely to remain with or progress to mixed urinary incontinence.

Urinary incontinence (UI) is a burdensome condition with high prevalence in middle-aged to older women and an unclear etiology. Advances in our understanding of host-microbe interactions in the urogenital tract have stimulated interest in the urinary microbiome. DNA sequencing and enhanced urine culture suggest that similarly to other mucosal sites, the urinary bladder of healthy individuals harbors resident microbial communities that may play distinct roles in bladder function. This review focused on the urobiome (expanded quantitative urine culture-based or genomic sequencing-based urinary microbiome) associated with different subtypes of UI, including stress, urgency and mixed urinary incontinence, and related syndromes, such as interstitial cystitis and overactive bladder in women, contrasted to urinary tract infections. Furthermore, we examined clinical evidence for the association of the urinary microbiome with responses to pharmacotherapy for amelioration of UI symptoms. Although published studies are still relatively limited in number, study design and sample size, cumulative evidence suggests that certain Lactobacillus species may play a role in maintaining a healthy bladder milieu. Higher bacterial diversity in the absence of Lactobacillus dominance was associated with urgency UI and resistance to anticholinergic treatment for this condition. UI may also facilitate the persistence of uropathogens following antibiotic treatment, which in turn can alter the commensal/potentially beneficial microbial communities. Risk factors of UI, including age, menopausal status, sex steroid hormones, and body mass index may also impact the urinary microbiome. However, it is yet unclear whether the effects of these risks factors on UI are mediated by urinary host-microbe interactions and a mechanistic link with the female urogenital microbiome is still to be established. Strategies for future research are suggested.

OBJECTIVE: The aim of this investigation was to examine how often outpatient visits addressing urinary incontinence among women with self-reported incontinence symptoms occur and to explore characteristics associated with having an outpatient visit for incontinence. METHODS: We studied 18,576 women from the Nurses’ Health Study, ages 65 years and older, who reported prevalent incontinence symptoms in 2012 on a mailed questionnaire and were linked with Medicare utilization data. We compared women with and without claims for outpatient visits for urinary incontinence, including considering demographic, personal, and clinical characteristics. We controlled for potential confounding factors including age, race, parity, body mass index, medical co-morbidities, smoking status, health seeking behavior, disability, physical function, and geographic region, using logistic regression models. RESULTS: In this linkage between symptom report and insurance claims data, we found that only 16% of older women with current incontinence symptoms also had an outpatient visit addressing incontinence in the prior 2 years. In multivariable-adjusted models, incontinence severity (OR=3.75, 95% CI:3.10-4.53 comparing women with severe vs. slight) and type of incontinence (OR=1.80, 95% CI:1.56-2.08 comparing women with urgency vs. stress) were the strongest predictors of having an outpatient evaluation. CONCLUSION: Overall, only a small percentage of women who report urinary incontinence symptoms also have medical outpatient visits for incontinence, a marker of care-seeking. Our study highlights the discordance between the high prevalence of incontinence in older women and the lack of clinical assessment despite symptoms, even among nurses with high healthcare literacy.

Background There are various indications and approaches for hysterectomy; yet, the difference in long-term risk of subsequent prolapse after surgery is not well studied. Objective To assess the risk of prolapse after abdominal, vaginal, and laparoscopic or robotic hysterectomy for up to 17 years from surgery. Study Design A retrospective chart review study of women undergoing hysterectomy across all indications (benign and malignant) between 2001 and 2008 was conducted. An equivalent random sample of hysterectomy patients was selected each year. We compared demographic and other surgical characteristics data including age, race, parity, body mass index, indication and year of hysterectomy, blood loss, cervix removal, cuff suspension, and complications using chi-square, Kruskal-Wallis test, and Fisher’s exact across the 3 groups. Presence and treatment of subsequent prolapse (based on patient symptoms, pelvic exam, International Classification of Diseases, Ninth Revision diagnosis, and current procedural terminology pessary or surgical codes) were compared with Kaplan-Meier survival analysis and Cox proportional hazards regression. Results Of the 2158 patients, 1459, 375, and 324 underwent open, vaginal, and laparoscopic or robotic hysterectomy, respectively. The vaginal group (56) was older than the abdominal (52) or laparoscopic or robotic (49) groups, with a P value of Conclusion At the 17-year follow-up, the route of hysterectomy is not associated with a difference in recurrence, grade, or subsequent treatment of prolapse when the indication for hysterectomy is considered. Prolapse, as an indication for hysterectomy, increases risk for recurrence. Women planning a hysterectomy should be counseled appropriately about the risk of subsequent prolapse.

The prevalence of pelvic floor disorders (PFD) and their impact on quality of life of women vary among different populations. The purpose of this study was to assess the prevalence of symptoms of PFD, and their degree of bother in a convenience sample of Lebanese women, and to evaluate health-care seeking (HCS) behavior related to PFD. Women visiting clinics in a University Medical Center in Beirut, Lebanon, completed the self-filled validated Arabic version of the Global Pelvic Floor Bother Questionnaire (PFBQ). Data covering demographics, comorbidities, and HCS behavior related to PFD were collected. Total individual PFBQ scores, individual PFD symptom scores and HCS behavior were correlated to demographic data and comorbidities. The study participants included 900 women. PFBQ scores were significantly higher in women of older age, women with a lower level of education, women with higher vaginal parity, and women who engaged in heavy lifting/physical activity. BMI >25 kg/m2 was the strongest independent risk factor for the presence of PFD symptoms. The overall prevalence of urinary incontinence was 42 %. Anal incontinence was the most bothersome PFD. Almost two thirds of the women reported HCS due to any aspect of PFD. Among symptomatic women who believed that their PFD warranted HCS, financial concern was the most common obstacle irrespective of age and educational level. In this convenience sample of Lebanese women, PFD symptoms were common and were significantly correlated with demographic characteristics and self-reported comorbidities. The key reason for not seeking health care related to PFD was financial concern.

Objective To determine the effect of bariatric surgery (BS) on the prevalence of pelvic floor dysfunctions (PFD), specifically on urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI). Data Sources A systematic review (PROSPERO registration no. CRD42017068452) with a literature search was performed using the PubMed, Scopus, and SciELO databases for all publications related to BS and PFD, with no language restrictions, from inception to September 2018. Methods of Study Selection Two authors screened for study eligibility and extracted data. Only prospective cohorts assessing women with morbid obesity and the prevalence of PFD before and after BS in multiple academic and private centers were included. UI, POP, and FI were defined according to the International Urogynecological Association/International Continence Society joint consensus, and diagnosis was made based on self-report or questionnaires. Tabulation, Integration, and Results Our search strategy retrieved 957 results. Of those, 28 studies were included for full analysis, and 20 studies (n = 3684 patients) were selected for final analysis. The main reasons for exclusion were missing data before and after BS (n = 7) and combined data of men and women who underwent BS (n = 1). Laparoscopic Roux-en-Y gastric bypass was the most common surgical technique. Pooled analysis (16 studies) showed that women had a mean body mass index reduction of 12.90 kg/m 2 after treatment (95% confidence interval [CI], -14.82 to -10.97; p Conclusion BS has a significant impact on reducing UI, but FI and POP, in obese women.

BACKGROUND: Symptoms of urinary incontinence are commonly perceived to vary over time; yet, there is limited quantitative evidence regarding the natural history of urinary incontinence, especially over the long-term. OBJECTIVE: To delineate the course of urinary incontinence symptoms over time, using two large cohorts of middle-age and older women, with data collected over 10 years. STUDY DESIGN: We studied 9,376 women from the Nurses’ Health Study, age 56–81 years at baseline, and 7,491 women from Nurses’ Health Study II, age 39–56 years, with incident urinary incontinence in 2002–3. Urinary incontinence severity was measured by the Sandvik severity index. We tracked persistence, progression, remission, and improvement of symptoms over 10 years. We also examined risk factors for urinary incontinence progression using logistic regression models. RESULTS: Among women age 39–56 years, 39% had slight, 45% had moderate, and 17% had severe urinary incontinence at onset. Among women age 56–81 years, 34% had slight, 45% had moderate, and 21% had severe urinary incontinence at onset. Across ages, most women reported persistence or progression of symptoms over follow-up; few (3–11%) reported remission. However, younger women and women with less severe urinary incontinence at onset were more likely to report remission or improvement of symptoms. We found that increasing age was associated with higher odds of progression only among older women (age 75–81 versus 56–60 years, odds ratio=1.84, 95% confidence interval: 1.51, 2.25). Among all women, higher body mass index was strongly associated with progression (younger women: odds ratio=2.37, 95% confidence interval: 2.00, 2.81 body mass index ≤30 vs. < 25 kg/m(2); older women: odds ratio=1.93, 95% confidence interval: 1.62, 2.22). Additionally, greater physical activity was associated with lower odds of progression to severe urinary incontinence (younger women: odds ratio=0.86, 95% confidence interval: 0.71, 1.03, highest vs. lowest quartile of activity; older women: odds ratio=0.68, 95% confidence interval: 0.59, 0.80). CONCLUSIONS: Most women with incident urinary incontinence continued to experience symptoms over 10 years; few had complete remission. Identification of risk factors for urinary incontinence progression, such as body mass index and physical activity, could be important for reducing symptoms over time.

Single-incision midurethral slings were introduced in 2006 with the goal of providing shorter operative time, less postoperative pain, and decreased rates of injury to surrounding structures (eg, bladder and/or obturator nerve). Although unrecognized bladder injury during SIMS placement is a rare complication, it can lead to irritative voiding symptoms and recurrent urinary tract infections. We present the case of minimally invasive approach to remove an extruded sling.

Our aim was to clinically validate the Bladder Health Survey (BHS) for detecting urinary incontinence (UI) in population-based surveys. A random sample of women ≥40 years was recruited from primary care practices. We assessed the BHS content validity with an expert advisory board. Test–retest reliability of UI questions was measured. BHS UI definitions included noncases, active (more than three symptoms in the prior 6 months), inactive (past but no current symptoms), and incident (new onset over the past 2 years) cases. To assess criterion validity, we compared BHS diagnosis to an expert clinical diagnosis using structured history, pelvic exam, voiding diary, and urodynamics (if needed). Construct validity was assessed comparing the BHS UI score and case status to Sandvik’s score. Among 322 patients, the BHS identified 17 % as noncases, 70 % as active, 10 % as inactive, and 3 % as incident cases. Using the clinical diagnosis as the gold standard, the percent of true-positive UI cases was 98 % (active), 84 % (inactive), and 80 % (incident). A total of 75 % of BHS noncases were true negatives. The receiver operating characteristic c-statistic was 0.86. Sensitivity and specificity of the BHS were 91 % and 84 %, respectively. The Sandvik score for active cases (median = 4) was significantly greater than it was for inactive (median = 1), incident (median = 1), and noncases (median = 0) (p

We sought to explain variation in female age specific incidence rates for urinary incontinence using published, population based studies.We performed an extensive MEDLINE® review of published, population based studies of the female urinary incontinence incidence rate from 1966 to 2011 using a combination of symptom and epidemiological search terms. A total of 18 reports described 17 unique incidence studies. We abstracted the features of each study (eg sample size, followup, etc) along with detailed data on 109 age specific incidence rates (ie new cases per 1,000 person-years). Because the Nurses' Health Study had unique demographics and was dominant in sample size, analyses were completed with and without this study. Weighted (ie square root of sample size) linear regression was used to determine factors (ie age, source population, race, frequency score, etc) explaining variance among age specific incidence rates.Age and case definition accounted for 60% of the variation in incidence rates among studies. The age specific incidence was less than 2/1,000 person-years before age 40 years and it increased thereafter. For a given age group incidence rates varied as much as sixfold across studies, a finding that was largely explained by variation in case definition.The case definition accounts for substantial variation in urinary incontinence incidence estimates. Developing standards for reporting would provide a foundation for policy guidance and understanding etiology. We recommend that quantitative frequency criteria (eg 2 times or more per month) be reported vs vague thresholds (eg sometimes or often).

Objective To compare success rates between anterior colporrhaphy and abdominal paravaginal defect repair for treatment of anterior vaginal wall prolapse. Methods This was a prospective randomized controlled trial comparing anterior colporrhaphy plus polyglactin 910 mesh (vaginal) to paravaginal defect repair (abdominal) in women with symptomatic anterior vaginal wall prolapse. Pelvic organ prolapse quantification staging (POP-Q), pelvic floor distress inventory, pelvic floor impact questionnaire, and pelvic organ prolapse/urinary incontinence sexual questionnaires were administered pre and post-operatively. Women were followed up to 2 years. The primary outcome was anterior POP-Q stage, with failure defined as ≥stage II. Results We enrolled 70 patients, 35 in each group. Demographic and most peri-operative characteristics were similar between the groups. Mean anterior vaginal wall prolapse repair time (39 min) was shorter for vaginal versus abdominal repair (60 min; P

Urinary incontinence (UI) is very common and heterogeneous among women with limited knowledge of progression or prognosis. Evidence based on clinical epidemiology can help to better understand the natural history of UI. We examine the challenges of UI definition and its subtypes, its impact on quality of life and health-seeking behavior. We review the proposed pathophysiology of UI subtypes and known risk factors as they relate to our current knowledge of the disease state. Finally, we emphasize the role of epidemiology in the process of acquiring new insight, improving knowledge, and translating this information into clinical practice. Stress UI is most common overall, but mixed UI is most prevalent in older women. The three UI subtypes have some common risk factors, and others that are unique, but there remains a significant gap in our understanding of how they develop. Although the pathophysiology of stress UI is somewhat understood, urgency UI remains mostly idiopathic, whereas mixed UI is the least studied and most complex subtype. Moreover, there exists limited information on the progression of symptoms over time, and disproportionate UI health-seeking behavior. We identify areas of exploration (e.g., epigenetics, urinary microbiome), and offer new insights into a better understanding of the relationship among the UI subtypes and to develop an integrated construct of UI natural history. Future epidemiological strategies using longitudinal study designs could play a pivotal role in better elucidating the controversies in UI natural history and the pathophysiology of its subtypes leading to improved clinical care.

We sought to understand variations in the expression and temporal relation of bladder control episodes among women with mixed urinary incontinence.A random sample of women 40 years old or older with mixed urinary incontinence on GLOBE-UI (General Longitudinal Overactive Bladder Evaluation-Urinary Incontinence) was recruited in a digital daily diary study using a smartphone application. When a bladder control event occurred, women were instructed to answer episode specific questions. Episodes were defined as urgency, and urinary incontinence with and urinary incontinence without urgency. Women and episodes were compared by the type of activity preceding each episode. Urinary incontinence episodes were further defined as stress urinary incontinence, urgency urinary incontinence, stress induced urgency urinary incontinence and other. The chi-square and Wilcoxon tests were used for categorical and continuous variables, respectively.Of 40 women with a mean age of 65.5 years 35 provided complete 30-day diary data. Of the 950 bladder control episodes reported 25% were urgency only, 55% were urinary incontinence with urgency and 19% were urinary incontinence without urgency. Of the urinary incontinence episodes without urgency 82% occurred after a stress activity (eg coughing or sneezing). Notably, a stress activity also occurred just before 52.5% of the urgency urinary incontinence episodes (p0.001). A total of 24 women (69%) reported at least 1 episode of stress induced urgency urinary incontinence, which was the most prevalent urinary incontinence subtype episode, followed by urgency urinary incontinence and stress urinary incontinence (29% vs 27% and 16%, respectively). The mean number of daily episodes was 1 or 2 across all groups.Women with mixed urinary incontinence express a heterogeneous set of bladder control episodes with stress induced urgency urinary incontinence as the dominant type.

The objective of the study was to estimate prevalence of urinary incontinence (UI) health care utilization in women from the population up to specialty care.The General Longitudinal Overactive Bladder Evaluation-UI (GLOBE-UI) is a population-based study on the natural history of UI in women ≥ 40 years of age. Prevalence of UI was estimated by using the Bladder Health Survey (BHS). Survey data were linked with electronic health records to build the different steps of the iceberg of disease. Descriptive statistics were used to estimate the prevalence estimates at all levels of the iceberg.A total sample of 7,059 women received the BHS. Of those, 3,316 (47 %) responded. Prevalence of UI was 1,366 (41 %). Women with or without UI did not differ by age or marital status. However, women with versus without UI were more parous (91 vs 87 %), significantly more overweight or obese (74 vs 61 %), and more likely to have a college education or higher (54 vs 46 %), P0.01. Nine hundred fifty-eight (73 %) women with UI reported duration of more than 2 years and 72 % reported moderate to severe UI symptoms. Of all 1,366 women with BHS UI diagnosis, only 339 (25 %) sought care, 313 (23 %) received some care, and 164 (12 %) received subspecialty care.UI is a highly prevalent disease. Only a minority with UI appears to seek care and a fraction sees a pelvic floor specialist. It is important not only to educate women, but also primary care providers about this highly prevalent yet treatable condition.

Aims To determine predictors of health care utilization in women with urinary incontinence (UI) from the population to specialty care.

We report a case of remote spontaneous rupture of urinary bladder following cystourethroscopy with hydrodistention and a bladder biopsy in a patient with interstitial cystitis. This required abdominal exploration with cystorrhaphy. This case emphasizes a unique and dangerous complication of this procedure in a patient with interstitial cystitis.

To estimate the relationship between the history of childhood dysfunctional voiding and urinary incontinence (UI) in adult women with and without clinical UI and to estimate its relationship with stress, urge, and mixed UI. Using a case–control study, we surveyed adult women with or without UI using a validated dysfunctional voiding questionnaire. Cases were clinically classified as stress, urge, or mixed UI. Patient characteristics were compared using Student’s t-test, chi-square test, and Fisher’s exact test. Confounders were controlled through logistic regression. We compared the history of childhood dysfunctional voiding status among the three UI subtypes using multinomial logistic regression. We recruited 267 cases (120 stress, 37 urge, 98 mixed, and 12 other UI) and 107 controls. Mean age of cases and controls were 58 and 52 years and BMI 26 and 23 kg/m², respectively. Fifty-six percent of cases (48% stress, 65% urge, and 62% mixed UI) had a prevalence of childhood dysfunctional voiding compared to controls (40%) (P = 0.06). After adjusting for confounders, women with adult UI had a twofold increased odds (95% CI = 1.2–3.4, P = 0.006) of childhood dysfunctional voiding compared with controls. The highest prevalence of dysfunctional voiding was with urge UI (OR = 4.4, 95% CI = 1.8–10.7) followed by mixed UI (OR = 2.7, 95% CI = 1.5–5.2), and finally stress UI (OR = 1.4, 95% CI = 0.8–2.5). Childhood dysfunctional voiding may predict adult bladder control problems. This association is strongest in women with urge UI followed by mixed UI, but not different between women with stress UI and controls.

OBJECTIVES : To determine the relationship between overactive bladder (OAB), with or without urinary incontinence (UI), and hyperlipidemia. METHODS : A random sample of 8077 primary care patients were recruited for the General Longitudinal Overactive Bladder Evaluation. This was a prospective population-based survey to determine severity and occurrence of urgency, frequency, nocturia, and UI. A composite score of 5+ (range, 0-12) was considered to be a case status for OAB, and 2+ (range, 0-6) for UI. Data on hyperlipidemia were pulled out from the electronic medical records of all corresponding patients. Baseline covariates included age, education, body mass index, marital status, and other comorbidities. Logistic regression models were fit predicting OAB status (with or without UI) with prevalent hyperlipidemia as the main predictor. RESULTS : A total of 3599 (45%) women older than 40 years completed the survey, with a mean (SD) age of 59 (13) years, median parity of 2 (range, 1-3), 66% being overweight or obese, 90% with at least high school education, and 66% married. The prevalence of OAB and UI was 33% and 35%, respectively. Prevalence of hyperlipidemia was 22%. The unadjusted odds ratio (OR) of OAB for those with versus without hyperlipidemia was significant: OR = 1.20 (95% confidence interval, 1.02-1.42; P = 0.029). After adjustment, this association was no longer significant: OR = 0.97 (95% confidence interval, 0.81-1.16; P = 0.726). Among women with OAB and UI, there was no association with hyperlipidemia before and after adjustment (P = 0.5). CONCLUSIONS : Although on the surface there seems to be an association between OAB and hyperlipidemia, this association is primarily accounted for by other confounders.

Aim To determine the relation between urgency alone, or in combination with frequency and nocturia, and adaptive behavior in overactive bladder (OAB) syndrome. Methods We used survey data from the General Longitudinal Overactive Bladder Evaluation (GLOBE) of primary care patients over 40. Participants (n = 2,752: 1,557 females; 1,195 males) completed the same survey at two time points, 6 months apart. Questions assessed OAB symptoms and adaptive behavior. We estimated correlation coefficients (R2) between urgency, frequency, and nocturia symptom scores (alone and in combination) and adaptive behavior measures at baseline and change in symptom scores and behavioral measures from baseline to 6 months. Results At baseline, urgency was the dominant predictor of all behavioral measures for females (R2 = 0.19–0.48) and males (R2 = 0.15–0.39). Lower R2 values were observed for the change in measures from baseline to 6 months, but again change in urgency was the strongest predictor of change in adaptive behavior (R2 = 0.04–0.13 in females, and 0.02–0.08 in males). The correlation between symptoms and measures of adaptive behavior was almost completely explained by the urgency score. Frequency and nocturia did not substantially improve the overall correlation. Conclusion The relation between measures of OAB symptoms and adaptive behavior at baseline and over time are largely explained by urgency, not by frequency and nocturia. Neurourol. Urodynam. 30:406–411, 2011. © 2011 Wiley-Liss, Inc.

To understand variation in prevalence of urinary incontinence (UI) and risk factors, given different definitions.The National Health and Nutrition Examination Survey 2001-2002 data on UI were used. Prevalence, severity, and associated risk factors of stress, urge, mixed, and any UI were estimated in 2,875 adult women. Severe UI was defined as incontinence a few times or more per week. Moderate UI was defined as an incontinence frequency of a few times per month only, and mild UI was defined as incontinence frequency of a few times per year only. Odds ratios for the association of potential risk factors were examined in a logistic regression model.The overall prevalence of stress, urge, mixed, and any UI was 23.7%, 9.9%, 14.5%, and 49.2%, respectively. Prevalence of stress UI peaked at the fifth decade. Prevalence of urge and mixed UI increased with age. The largest number of risk factors and the strongest associations were found with severe UI. Age, ethnic background, and weight were significant risk factors common to all UI severity levels. Although parity and hysterectomy were risk factors for moderate and severe UI, they were not for mild UI.Prevalence of UI varies substantially by type and case definition. The stronger associations of known risk factors with severe UI and the lack of risk factors with lesser UI severity types suggest that severe UI includes primarily clinically significant cases, whereas mild UI represents transient or nonpathologic states that may not be clinically significant.III.

Objective This trial was designed to investigate the effectiveness of extended release versus immediate release oxybutynin in reducing symptoms of overactive bladder in a community-dwelling female population over the age of 65. Methods This was a prospective randomized 12-week, open-label study. The primary outcome was number of micturitions per 24 hours, 12 weeks after treatment. The a priori sample size estimate was 60 patients per group. Results Of the 318 women approached, only 72 women (23%) were enrolled over 34 months (33 in the immediate release group, and 39 in the extended release group). The study was stopped prematurely because of recruitment difficulties and an interim analysis revealing the need for a much larger sample than had been estimated to show a significant difference between treatments. After 12 weeks of treatment, there was no difference between the oxybutynin extended release and immediate release groups in the number of micturitions per 24 hours or in other outcomes. Conclusion This study did not demonstrate differences between oxybutynin extended release and immediate release and in reducing symptoms of overactive bladder or quality of life, possibly because the study did not reach the necessary sample size. The difficulty in recruiting subjects for the trial likely resulted from the onerous study requirements (4 study visits required over 12 weeks) and the downtown location of the study centres: these factors would cause particular difficulties for women overage 65 with overactive bladder, for whom travelling may be a problem. Evidence is needed to guide prescribing for older patients, but designing research to obtain adequate sample sizes is difficult. Studies in older subjects should ensure that a much larger budget is allocated for recruitment than would be allocated for studies in younger subjects, that meticulous attention is paid to issues of transport and access, and that support is provided for subjects who agree to take part in research.

To determine whether a history of childhood dysfunctional voiding is associated with urinary incontinence in adulthood.Using a case-control study, we surveyed patients presenting with or without urinary incontinence. Cases were patients referred to a tertiary urogynecology clinic, and controls were patients referred to a general gynecology clinic. Patients completed a validated childhood questionnaire about dysfunctional voiding. A total score of 6 or more in girls is indicative of dysfunctional voiding, a condition characterized by urgency, frequency, constipation, urinary or fecal incontinence, and/or urinary tract infections. Using an alpha of 0.05, a power of 80%, and a baseline prevalence of dysfunctional voiding of 8%, we determined that 170 patients were needed to show a 3-fold difference between groups.Cases (n = 84) and controls (n = 86) had similar baseline characteristics except for body mass index and incidence of previous pelvic surgery. Although the total dysfunctional voiding score was higher in cases than controls (7.3 versus 5.0, respectively; P = .001), the difference in the number (%) of patients with history of childhood dysfunctional voiding between the 2 groups was not significant (47 [56%] versus 36 [42%], respectively; odds ratio 1.76, 95% confidence interval 0.96-3.24; P = .07). When all patients from both groups were combined, there was a higher prevalence of a history of childhood dysfunctional voiding in women with or without current urinary frequency (P = .004), urgency (P = .03), stress incontinence (P = .01), and urge incontinence (P = .009).Women with adult lower urinary tract symptoms may have a higher prevalence of history of childhood dysfunctional voiding.II-2.

Objectives: This paper reviews the literature on the prevalence of urinary incontinence (UI) and demonstrates its impact as a worldwide problem. Methods: A MEDLINE search was performed to review population-based studies in English. Studies were grouped according to demographic variables and type of incontinence. Risk factors, help-seeking behavior, and quality of life measures were analyzed. Results: The median prevalence of female UI was 27.6% (range: 4.8–58.4%) and prevalence of significant incontinence increased with age. The commonest cause of UI was stress (50%), then mixed (32%) and finally urge (14%). Risk factors included parity, obesity, chronic cough, depression, poor health, lower urinary tract symptoms, previous hysterectomy, and stroke. Although quality of life was affected, most patients did not seek help. Conclusion: UI is a prevalent cross-cultural condition. Future studies should rely on universally accepted standardized definitions to produce meaningful evidence-based conclusions, as well as project the costs of this global healthcare problem.

Synthetic mesh is commonly used in urogynecologic surgical procedures for correction of stress urinary incontinence and pelvic organ prolapse. Bladder mesh extrusion is a recognized complication and frequently requires extensive mesh resection. We present a case of intravesical polypropylene mesh extrusion following a combined mesh kit and midurethral sling placement. A novel transurethral approach, employing Endoloop sutures with endoscopic scissors, was used to resect the protruding mesh located in close proximity to a ureteral orifice. Medline was searched for other minimally invasive treatment strategies for bladder mesh extrusion. Various techniques for minimally invasive resection of extruded intravesical mesh have been described in the literature. Our strictly transurethral approach avoids the use of an energy source and eliminates the need for open or extensive surgery. Advantages of this new transurethral operative technique include decreased risk of injury associated with the use of an energy source within the bladder and avoidance of open surgical complications.

The objective was to estimate the impact of stress and urgency urinary incontinence (UI) on the quality of life (QOL), and to determine whether the impact varies according to UI severity. We used data from the General Longitudinal Overactive Bladder Evaluation–UI study in women. Stress and urgency UI symptom severity scores ranged from 0 to 8. We used logistic regression to test the relation among different severity levels of stress and urgency UI, and their interaction with the Incontinence Impact Questionnaire (IIQ-7). This was categorized according to percentage ranges as 0–40 % (reference), 41–80 %, and 81–100 %. Both stress and urgency UI were significantly associated with IIQ-7. Higher scores had higher odds ratios (ORs). The OR for urgency vs stress UI was greater at the same severity level. For instance, comparing IIQ-7 quintiles (0–40 % vs 41–80 %), the OR for an association with an urgency UI score of 5–6 was 5.27 (95 % CI = 3.78–7.33) vs 2.76 (95 % CI = 2.07–3.68) for a stress UI score of 5–6. Both UI subtypes were more strongly related to the upper (81–100 %) than the to the lower (41–80 %) quintiles. There was a strong positive urgency UI and stress UI interaction with the upper (i.e., 81–100 %) but not the two next lower (41–80 %) quintiles. The impact of UI subtypes on QOL varies according to the score of IIQ-7, stress and urgency UI, and their interaction. Urgency vs stress UI has a stronger impact. The effect is greatest for high IIQ-7 scores with a significant share mediated by the interaction of the two UI subtypes.

Minimally invasive alternatives to abdominal sacrocolpopexy have been shown to be equivalent with low overall complication rates. A small number of direct mesh-related gastrointestinal complications have been reported in the literature. Sacrocolpopexy with mesh retroperitonealization is recommended to minimize bowel adhesions. A 53-year-old nulligravid woman presented with persistent right lower-quadrant pain 1 year after laparoscopic sacrocolpopexy. The polypropylene mesh used during the case was retroperitonealized. Computed tomography (CT) prior to surgical exploration revealed no obvious pathology. On diagnostic laparoscopy, appendiceal adhesion to mesh requiring an appendectomy was observed. The patient’s symptoms resolved after surgical intervention. Appendiceal adhesion to surgical mesh leading to chronic discomfort is a potential complication of intraperitoneal synthetic mesh placement. Our case emphasizes that bowel adhesions may occur even after proper mesh retroperitonealization. Appendiceal adhesion to the surgical site is a potential complication of retroperitonealized synthetic mesh placement at the time of sacrocolpopexy.

Background: To assess the utility and safety of three different longterm indwelling intravenous catheters in patients with gynecologic malignancies. Study Design: A retrospective review was performed of the records of all women with gynecologic malignancies who required longterm venous access catheters and ports between 1990 and 1997. Results: Two hundred sixty-eight women underwent placement of 308 indwelling catheters, of which 305 were available for analysis. Of those, 68 (22%) were Hickman catheters, 162 (53%) were infusaports, and 75 (25%) were Peripheral Access System (PAS) ports. Venous access was obtained percutaneously in 152 (50%) patients and by cutdown in 153 (50%). Prophylactic anticoagulation was used with 96 catheters (31%). Catheter placement was associated with 12 (4%) immediate complications and 87 (29%) delayed complications. The average duration of a catheter in place was 5.6 months for the Hickman, 12.5 months for the infusaport, and 16.0 months for the PAS port (p Conclusions: Infusaports and PAS ports were associated with a lower risk of infection and have a longer life than Hickman catheters. The cutdown approach was associated with a lower complication rate. Low-dose prophylactic anticoagulation should be given to all patients with longterm central venous catheters.

BACKGROUND: The transobturator tape procedure is reported to be an effective procedure with low complication rates. CASE: A 45-year-old woman underwent surgery for prolapse and incontinence. The surgery included transobturator tape. Intraoperative cystoscopy was not performed. Postoperatively, a mesh erosion into the bladder on the left side and a large cystocele were diagnosed. The patient underwent a combined transurethral and suprapubic mesh resection. Six months later, she had another mesh erosion on the contralateral side. This time, a complete vaginal resection of the mesh was performed. CONCLUSION: Intraoperative cystoscopy should be considered after a transobturator tape procedure. Bilateral mesh erosion may result from motion of a cystocele against a fixed transobturator tape. Concurrent repair of the cystocele to prevent future mesh erosions may be warranted.

The objective of this analysis was to describe urinary incontinence (UI) incidence and persistence over 5 years in association with treatment status, sociodemographic, medical, and lifestyle factors, in a racially/ethnically diverse population-based female sample. The Boston Area Community Health Survey enrolled 3,201 women aged 30-79 years of black, Hispanic, and white race/ethnicity. Five-year follow-up was completed by 2,534 women (conditional response rate 83.4 %), allowing population-weighted estimates of UI incidence and persistence rates. Predictors of UI were determined using multivariate logistic regression models. Incidence of UI at least monthly was 14.1 % and weekly 8.9 %. Waist circumference at baseline and increasing waist circumference over 5-year follow-up were the most robust predictors of UI incidence in multivariate models (P ≤ 0.01). Among 475 women with UI at baseline, persistence was associated with depression symptoms [monthly UI, odds ratio (OR) = 2.39, 95 % confidence interval (CI) 1.14–5.02] and alcohol consumption (weekly UI, OR = 3.51, 95 % CI 1.11–11.1). Among women with weekly UI at baseline, 41.7 % continued to report weekly UI at follow-up, 14.1 % reported monthly UI, and 44.2 % had complete remission. Persistence of UI was not significantly higher (58.2 % vs. 48.0 %, chi-square P = 0.3) among untreated women. Surgical or drug treatment for UI had little impact on estimates for other risk factors or for overall population rates of persistence or remission. Women with higher gains in waist circumference over time were more likely to develop UI, but waist circumference was not predictive of UI persistence. UI treatments did not affect associations for other risk factors. Additional research on the role of alcohol intake in UI persistence is warranted.

Previous studies report higher prevalence of depression among women with urgency (UUI) or mixed (MUI) urinary incontinence than those with stress UI (SUI). UUI is the dominant type among black women, whereas SUI is the predominant type among white women. Thus, UI-related mental health issues could be a key consideration among black women. We hypothesized that the association between UI and depression might be stronger in black versus white women. These cross-sectional analyses assessed 934 black and 71,161 white women aged 58–83 in the Nurses’ Health Study, which was established among women living in the USA. Depressive symptoms were assessed using the ten-item Center for Epidemiologic Studies Depression Scale (CESD-10). Multivariate adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for high depressive symptoms (CESD-10 score ≥ 10) according to self-reported UI frequency, severity, and type were calculated using logistic regression models. Although point estimates for associations of UI frequency, severity, and type with high depressive symptoms were higher in black women, differences in ORs between black versus white women were not statistically significant. For example, the OR for at least weekly UI compared with no UI was 2.29 (95 % CI 1.30–4.01) in black women and 1.58 (95 % CI 1.49–1.68) in white women (p interaction = 0.4). We found no statistically significant differences in UI frequency, severity, and type with high depressive symptoms in black versus white women. However, the small number of black women in this study with high depressive symptoms limited statistical power to detect significant interactions. Thus, these results should be interpreted with caution.

BACKGROUND: Female urethral diverticulum is a rare finding, less often diagnosed during pregnancy. There are few reports in the literature on urethral diverticulum in pregnancy with most undergoing expectant management. CASE: A young woman presented during the third trimester of pregnancy with pelvic and vaginal pain and a vaginal bulge. On examination, she was noted to have a 5-cm periurethral mass consistent with a urethral diverticulum. We describe the successful excision of this diverticulum during pregnancy. CONCLUSION: The procedure was performed without adverse consequences to the pregnancy, and the patient had a normal course for the remainder of her pregnancy and an uneventful cesarean delivery.