Intravesical invasion of a Mersilene tape and secondary stone formation

Letter to the editor: does estrogen deprivation affect pelvic floor muscle contractility?

Commentary on: Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial

Commentary on “Risk factors and outcome of repair of obstetric anal sphincter injuries as followed up in a dedicated perineal clinic”

Use of multimedia during informed consent: novelty or necessity Abstract The process of informed consent is an integral part of the preoperative encounter. In theory, it has the potential to educate patients, enabling them to reach a true autonomous decision regarding the treatment offered. Unfortunately, in recent years informed consent has become overly complicated for the average patient. Questions have been raised regarding the ability of the process, as practiced nowadays, to actually increase knowledge and achieve its goals. In search of new ways to increase patient comprehension, researchers have suggested use of multimedia during the process of informed consent. Visualization of complex ideas, interactive learning and tailoring the procedure to fit patient needs are all advantages presented by use of multimedia during the process. Several randomized prospective trials have looked into this topic and have presented promising data in favor of multimedia use. Informed consent is a process with unfulfilled potential, and use of multimedia may be part of the solution. In our opinion, it is time to change the way we educate patients.

Utilization of CT for InterStim sacral neuromodulation lead placement in a patient with morbid obesity

Teaching learners to raise the roof: a vaginal surgery simulator for apical suspension Abstract Introduction and hypothesis The objective was to discuss the importance of apical suspension following vaginal hysterectomy and demonstrate a surgical model to aide in educating learners on a variety of apical suspension procedures. Methods Rates of pelvic organ prolapse are not insignificant following hysterectomy. Re-support of the vaginal apex should be performed at the time of hysterectomy in those with or without a diagnosis of prolapse. Exposure to vaginal apical support procedures may be limited owing to declining rates of vaginal hysterectomy and limited trainee work hours. Surgical models are increasingly being used to supplement operating room experience. The model we present was originally developed for hysterectomy, although its design allows for teaching a variety of apical support procedures that incorporate the uterosacral ligament (USL) for support. We demonstrate performing a USL suspension, internal McCall suture, and modified McCall suture using the model. Results The model is constructed from readily available supplies, is multi-use, and inexpensive. It allows learners to identify relevant anatomy, understand/visualize surgical steps, and practice suturing technique. Conclusion Pelvic organ prolapse is common in women, although opportunities to teach apical suspension procedures may be limited. The proposed vaginal surgery simulator can be used to supplement the experience of gynecological surgery trainees with apical suspension procedures.

Follow-up postoperative calls to reduce common postoperative complaints among urogynecology patients Abstract Introduction and hypothesis The purpose of our study was to identify the most common reasons why postoperative urogynecology patients called their surgeon within the first 6 weeks of surgery. We hypothesize that implementing a follow-up postoperative call (FPC) policy would decrease the number of patient-initiated calls within this postoperative period. Methods This is a prospective before-and-after cohort study that was conducted in two phases. The initial phase identified the most common reasons why patients call within 6 weeks of their inpatient or outpatient urogynecological surgery. In the second phase, an intervention was implemented where each postoperative patient was called within 48 to 72 h of discharge: the intervention group. The primary outcome was the number of phone calls initiated by patients during the 6-week postoperative period. Results There were 226 patients in the control group and 233 patients in the intervention group. Significantly fewer calls were initiated by patients in the intervention group, both groups having a median of 1 call per person, range 0–8 in the control group and 0–10 in the intervention group (p = 0.04). The five most common complaints were as follows: pain (20.4%), medication management (17.4%), disability paperwork (15.5%), and laboratory results (11.5%). There was a significant reduction in calls concerning constipation, laboratory/pathology results, and disability insurance claims after implementing the FPC policy. Conclusions The implementation of the FPC policy resulted in fewer patient-initiated calls. As such, there were significant reductions in postoperative complaints of constipation, vaginal bleeding, incomplete bladder emptying, and inquiries into laboratory results and disability paperwork.

Hysterectomy associated with de novo lower urinary tract symptoms in a Taiwanese population: a nationwide, population-based study Abstract Introduction and hypothesis The effect of hysterectomy on vesicourethral functions remains controversial. The objective of this study was to examine the association between hysterectomy and de novo lower urinary tract symptoms (LUTSs). Methods We identified 8514 patients who had undergone hysterectomy between January 1, 2000, and December 31, 2012, from Taiwan’s National Health Insurance (NHI) Research Database. A control cohort, comprising 34,056 age-matched patients who had not undergone hysterectomy, was created for comparison. All hysterectomy and control patients were followed up until diagnosis as having LUTSs (dysuria, urinary retention, incontinence, and increased urinary frequency and urgency), withdrawal from the NHI system, death, or December 31, 2013. Patients were excluded if LUTSs were diagnosed before or at the time of hysterectomy. Results The adjusted hazard ratio (aHR) of subsequent de novo LUTSs was higher in the hysterectomy patients [1.57, 95% confidence interval (CI) 1.46–1.70] than in the controls during the follow-up period. Compared with the controls, the highest risk of de novo LUTSs was noted in patients who had undergone vaginal hysterectomy (VH; aHR 1.89, 95% CI 1.57–2.28) followed by those who had undergone laparoscopy-assisted VH (LAVH; aHR 1.74, 95% CI 1.56–1.94). Conclusions We found that undergoing hysterectomy was associated with increased risks of developing lower urinary tract symptoms in women. This association was more pronounced for women undergoing the vaginal or laparoscopically assisted hysterectomy. Further large-scale prospective studies or clinical trials are needed to explore whether causality exists.

Severe pelvic organ prolapse. Is there a long-term cure? Abstract Introduction and hypothesis Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications. Methods This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was “composite surgical success” defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp < 0) (anatomical success), (2) no vaginal bulge symptoms and (3) no re-treatment for prolapse recurrence. Results The median follow-up was 7 years (range 3–10 years) with a composite surgical success rate of 95.7% (90/94). Failures (4.3%) included one (1.1%) case of anatomical recurrence (Bp: +1), one woman (1.1%) reporting vaginal bulge symptoms and two women (2.1%) who underwent a posterior colporrhaphy 6 and 12 months after primary surgery (reoperation rate: 2.1%). Two of 94 patients (2.1%) had been treated for mesh extrusion of the vaginal cuff prior to the follow-up visit. Conclusions The combined VALS technique can be considered a safe and effective procedure for the treatment of severe POP allowing a long-term anatomical restoration of all compartments with excellent functional outcomes.