Female Pelvic Surgery Research Articles

COMET (Composite Outcomes of Mesh vs suture Techniques for prolapse repair)- Protocol for a single blind randomized controlled multicenter trial testing surgical innovation in female pelvic surgery.

Pelvic organ prolapse (POP) increases in incidence and severity with aging. At least 1 in 4 women seek pelvic floor care and many more suffer with concurrent symptoms of bowel, bladder and sexual dysfunction, which can have a large impact on quality of life. It is estimated that 1 in 5 women will undergo surgery for POP. POP is difficult to cure with existing surgeries and therefore treatment failure and reoperations are common. Surgical innovation in this area is urgently needed and we have developed a novel technique of bilateral sacrospinous vaginal vault fixation with synthetic mesh arms (BSSVF-M). Based on preliminary studies it may be more successful, durable and cost-effective than standard sacrospinous ligament suspension with sutures (SSLS). Preliminary development and exploration studies showed safety and efficacy of BSSVF-M. Following an established framework for research in surgical innovations, we now wish to conduct a randomized comparative effectiveness trial for assessment of this novel technique. This is a multi-center randomized controlled trial in Canada comparing the surgical techniques of BSSVF-M vs. SSLS to address apical prolapse. In total, 358 women with symptomatic POP at five centers will be randomized with 80% power to detect a 15% difference in primary composite outcome and accounting for a 15% loss to follow-up over 2 years. The primary objective is to investigate BSSVF-M vs. SSLS using an established composite of 3 objective signs and 1 subjective symptom of POP measured 2 years postoperatively. Secondary objectives: 1) To determine changes in condition-specific pelvic symptoms, quality of life, pain and condition-specific body image post BSSVF-M vs. SSLS using validated questionnaires; 2) To determine changes in sexuality post BSSVF-M vs. SSLS; 3) To determine global impression of improvement, adverse events (validated classification scheme), reoperations and health utility post BSSVF-M vs. SSLS; 4) To determine the cost-effectiveness of BSSVF-M vs SSLS. Study Registration at clinicaltrials.gov (NCT02965313). There is a need for innovation to improve the surgical approach to vaginal apical suspension. Despite controversies with mesh, it has been shown to be safe when used appropriately and to have higher durability when compared with sutures. As well, the importance of restoring anatomy and tension-free surgical approach in pelvic reconstructive surgery has led to better long-term outcomes and fewer side effects. These principles have been applied when developing the novel BSSVF-M technique. Anticipated challenges of this trial include recruitment, compliance problems and loss to follow up However, the robust methodology will provide evidence on the best surgical approach to correct POP, a common condition among aging women.

Reducing urinary tract infection in female pelvic surgery: A retrospective cohort study.

To compare prebundle versus postbundle implementation urinary tract infection (UTI) rates among inpatients within 6 weeks of clean-contaminated pelvic reconstructive surgery. The authors conducted a retrospective cohort study from September 2019 to December 2021 at a tertiary hospital. The bundle strategy included the following: universal preoperative UTI check with treatment if positive, replacing prolonged postoperative voiding trials on the ward with earlier discharge and indwelling catheter removal by a nurse continence advisor the next day, and daily cranberry extract for 6 weeks postoperatively. UTI was defined as positive urine culture (≥100 000 colony-forming unit per mL) in a symptomatic patient. Data analysis involved hypothesis testing and logistic regression. The authors reviewed 132 postbundle inpatient charts and retained 93 for analyses. The results were compared with 204 prebundle inpatient charts. The rate of postoperative UTI decreased from 17.6% in the prebundle group to 6.5% after bundle implementation (P = 0.01). The adjusted odds ratio for postbundle versus prebundle likelihood of UTI was 0.35 (95% confidence interval, 0.13-0.98; P = 0.045). Significantly more postbundle patients compared with prebundle patients were discharged home on the first day postoperatively (76.3% vs. 37.7%, P < 0.001). A clinical bundle can significantly decrease both UTI rates and hospital stay after pelvic reconstructive surgery.

The effect of tamsulosin in postoperative urinary retention: a meta-analysis of randomized controlled trials.

Tamsulosin is a therapeutic drug of alpha-adrenergic antagonists. Previous randomized controlled trials and retrospective analyses have proved the efficacy of tamsulosin on many urinary system diseases. However, there is still a conflict about whether tamsulosin could prevent postoperative urinary retention (POUR). This meta-analysis aims to probe into the efficacy of tamsulosin for preventing POUR versus placebo. We searched MEDLINE, EMBASE, and Cochrane Library from December 31, 1999 to April 30, 2022, for randomized controlled trials (RCTs). Studies that were not RCTs or without negative controls were excluded. Cochrane Collaboration harmonized criteria were used to assess the risk of bias in included studies. Revman (version 5.3) software was invited to synthesize the results. We performed subgroup analyses to explore the factors that could influence tamsulosin's efficacy in POUR prevention. Our meta-analysis pooled 13 RCTs with 2163 patients. We concluded that tamsulosin brought about a significant reduction in the risk of POUR versus placebo (13.54% vs 20.88% for tamsulosin vs placebo, RR = 0.63, 95% CI 0.47 to 0.84, P = 0.002). Tamsulosin could significantly reduce the risk of POUR in abdominal (11.52% vs 20.25% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.88, P = 0.02) and female pelvic surgery (15.57% vs 31.50% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.82, P = 0.006) but not in spinal surgery (13.45% vs 12.75% for tamsulosin vs placebo, RR = 1.07, 95% CI 0.72 to 1.60, P = 0.73) and lower limb surgery (21.43% vs 33.33% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.35 to 1.14, P = 0.13). The preventive effect of postoperative (17.70% vs 33.93% for tamsulosin vs placebo, RR = 0.53, 95% CI 0.33 to 0.85, P = 0.008) and postoperative with preoperative tamsulosin (13.96% vs 23.44% for tamsulosin vs placebo, RR = 0.64, 95% CI 0.43 to 0.93, P = 0.02) on POUR were significantly better than preoperative management (11.95% vs 14.63% for tamsulosin vs placebo, RR = 0.62, 95% CI 0.23 to 1.65, P = 0.34). Postoperative catheter placement appears to have a negative impact on the POUR-preventive effect of tamsulosin. (9.37% vs 16.46% for tamsulosin vs placebo, RR = 0.51, 95% CI 0.31 to 0.83, P = 0.007) Tamsulosin showed significantly effect on POUR prevention in patients during spinal (15.07% vs 26.51% for tamsulosin vs placebo, RR = 0.52, 95% CI 0.31 to 0.90, P = 0.02) and epidural anesthesia (12.50% vs 29.79% for tamsulosin vs placebo, RR = 0.42, 95% CI 0.18 to 1.00, P = 0.05) but not in general anesthesia (12.40% vs 18.52% for tamsulosin vs placebo, RR = 0.68, 95% CI 0.45 to 1.03, P = 0.07). Tamsulosin shows better outcomes for preventing POUR than placebo. Besides, tamsulosin showed a different effect on POUR prevention in the various surgical sites, anesthesia, medication management, and catheter use. However, our conclusions still have some limitations due to the lack of evidence.

Preferences of patients with cancer for psychological counseling: a cross-sectional study using full-profile conjoint analysis in Japan

Abstract Background: Psychological counseling is an effective nonpharmacological intervention for patients with cancer experiencing psychological distress. This study used a conjoint analysis approach to assess the preferences of patients with cancer for psychological counseling. Methods: We conducted a single-center, cross-sectional study using a self-report questionnaire. Data were collected from outpatients and inpatients in the departments of respiratory medicine, gastrointestinal surgery, female pelvic surgery, and head and neck surgery at a university hospital between March 2018 and March 2020. The questionnaire was developed using semistructured interviews with 10 clinical psychologists. It included 48 scenarios to determine patients' preferences for counseling based on a combination of the type, length, cost, and frequency of counseling. We performed a conjoint analysis, calculating the relative importance and part-worth utility value of each factor. Results: The results of the conjoint analysis showed that patients with cancer considered counseling type as the most important factor (relative importance: 37.5%), followed by frequency (23.4%), cost (19.6%), and length (19.5%). Patients with cancer valued life reviews more highly than problem-solving, emotional control, and emotional expression. However, women and younger patients valued counseling for emotional control the most, and patients with advanced cancer valued counseling for problem-solving the most. Conclusions: The results suggest that patients with cancer consider the type and content of counseling to be the most important factors in their decision process, although these preferences vary with individual characteristics. This is the first study to clarify the preferences of patients with cancer for psychological counseling using a conjoint analysis, and it proposes a new economic approach in the field of psycho-oncology.

Obstetrics and Gynecology Residents Self-perceived Competency Regarding Female Pelvic Medicine and Surgery: An Internet-based Cross-sectional Survey

Background: The aim of our study was to assess factors associated with residents’ perceived competency regarding female pelvic medicine and reconstruction surgery (FPMRS).&#x0D; Methods: We conducted an Internet-based cross-sectional survey. Obstetrics and gynecology residents’ self-perceived competence in clinical skills for management of pelvic floor disorders were questioned. Competency in different aspects was analyzed concerning the availability of fellowship-trained professor, rotation, and fellowship training program.&#x0D; Results: 1168 residents of four levels of residency participated in this study. 760 (65.06 %) of residents were not trained by a fellowship-trained attendant. Of 409 (35.01%) responders who were trained by board-certified fellowship, 334 had FPMRS rotation in their residency program. Senior residents were significantly more confident than residents in the first and second years. 695 (59.50 %) of residents reported participating in the pelvic floor surgeries; however, only 15.3 % were served as primary surgeons. Where pelvic floor education had been provided by a fellowship-trained attendant, more perceived competency was evident in all fields of clinical skills except performance as primary surgeon and management of emergency cases. Among residents trained by board-certified FPMRS attendants, there were no significant differences regarding FPMRS rotation or fellowship training programs. 88.69 % of residents declared that a comprehensive course in the field of FPMRS is needed in the residency curriculum.&#x0D; Conclusion: This study demonstrates that being trained by board-certified FPMRS attendants has significant effect on residents’ self-perceived competency. Residency education was not compromised by fellowship training program.

11 Differences in medicare payments by gender and training track in female pelvic and reconstruction medicine and surgery

Gender disparities in medicine have been well established, with differences in attainment of roles in administration, and differences in physician income. Our objective was to determine Medicare payment differences by gender and specialty training track of FPMRS surgeon. Medicare payments from the Provider Utilization Aggregate Files were used to determine the payments made by Medicare to urogynecologists. This database was merged with the NPI registry with information on subspecialty training and years since graduation, along with the geographic pricing cost index to account for Medicare payment adjustments. Physicians with <90% female patients, and graduated medical school <7 (OBGYN) and <8 years ago (urology) were excluded. Effects of gender, specialty of training, number of services, years of practice, and geographic pricing cost index on physician reimbursement were evaluated using linear mixed modeling. There were 578 surgeons with FPMRS subspecialty training met inclusion criteria. Of those 517 (89%) trained as gynecologists, while 61 (11%) trained as urologists. 265 (51%) of the gynecology trained surgeons were women, and 39 (80%) of urology trained surgeons were women. Among urology trained surgeons the median female surgeon was paid $85,962 while the males were paid $121,531, or a 41% difference in payments, while women urology trained FPMRS surgeons performed a median of 1,135 services, while male surgeons performed a median of 1,793 services or a 57% difference in volume. Among gynecology trained surgeons the median female payments were $59,277 while performing 880 services, and male gynecology trained surgeons received a median of $66,880 and performed 791 services, representing a difference of 12% in payments and 11% in services. Male physicians were paid more than female physicians while controlling for specialty training, number of services, years of practice, and geographic pricing cost index. Despite Medicare payments being based on an equation, differences in reimbursement by physician gender continue to exist in FPMRS. Female surgeons in FPMRS receive lower payments from Medicare. The differences in reimbursement could not be solely explained by differences in patient volume, area of practice, or years of experience, suggesting that similar to other fields in medicine, women in FPMRS are not paid as much as male physicians.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Management of Vaginal Mesh Exposures Following Female Pelvic Reconstructive Surgery.

To discuss considerations and current evidence for the diagnosis and management of vaginal mesh exposures following female mesh-augmented anti-incontinence and pelvic organ prolapse surgery. Since the introduction of mesh into female pelvic surgery, various applications have been reported, each with their own unique risk profile. The most commonly encountered mesh-related complication is vaginal mesh exposure. Current evidence on the management of vaginal mesh exposure is largely limited to observational studies and case series, though this is continuing to expand. We present a synthesis of the available data, as well as clinical and surgical approaches to managing this complication. It is important for surgeons to be familiar with the management of vaginal mesh exposures. Depending on thepatient's presentation and goals, there is a role for conservative measures, mesh revision, or mesh excision. Further study is warranted to standardize mesh resection techniques and explore non-surgical treatments.

Anterior Vaginal Wall Prolapse Repair and the Rise and Fall of Transvaginal Mesh. Did We Come Full Circle? A Historical Perspective

ObjectiveTo present a brief historical review of treatment options for pelvic organ prolapse with a focus on anterior vaginal wall defects and highlight changing practice patterns in the era of synthetic mesh controversy. MethodsA MEDLINE and PubMed search was performed using the keywords pelvic organ prolapse, anterior colporrhaphy, and cystocele followed by a manual search of bibliographies. ResultsAncient treatments included Hippocratic succession, local astringent, and use of pomegranates as crude pessaries. More sophisticated surgical techniques evolved in the 19th century with further refinement in the early 20th century. Numerous native tissue apposition techniques were popularized by Kelly, Kennedy, Burch, and Raz. Due to poor durability, surgeons sought alternate approaches including biologic and synthetic grafts. Synthetic transvaginal mesh (TVM) initially included use of Tantalum and Marlex to repair anterior wall defects. Both were eventually abandoned due to complications. TVM was re-designed, re-marketed, and re-introduced. Type 1 polypropylene monofilament TVM use became ubiquitous in female pelvic surgery peaking between 2004 and 2008. Initial promising outcomes were soon eclipsed by a surge of adverse events leading to multiple FDA warnings, reclassification to Class III, high-risk medical device, and ultimately a complete recall in 2019. ConclusionThe bidirectional pendulum swing on use of synthetic TVM has been occurring since its introduction 50 years ago. In the current era of mesh controversy, more practitioners are now revisiting previously described native tissue and biologic graft techniques. It appears that history has repeated itself.

Resumption of Elective Surgery following COVID-19 Outbreak, Guideline for Female Pelvic Medicine and Surgery

Division of Female Pelvic Medicine and Surgery, Department of Obstetrics and Gynecology, Emam Khomeini Hospital, Tehran University of medical sciences proposed a clinically relevant algorithm to guide appropriate decision making based on underlying risk stratification and resource utilization in order to resume elective surgeries, following COVID-19 pandemic crisis. The consequence of standardized decision-making factors and transparency of the principles will provide more assurance, consistency, and reliability on both sides, care providers and the patient. It also will decrease ethical dilemmas and moral criticism for surgeons. Eventually, this approach is applicable in any other disaster preparedness as a logical stratification of surgical indications for the female pelvic floor surgical procedures.

EDITORIAL COMMENT

In the past decade, we witnessed a dramatic change in female pelvic surgery. We started by offering slings and meshes to all the patients that needed a procedure to correct stress urinary incontinence and pelvic organ prolapse, and ended up banning them all. The complications correlated with mesh surgery were so dramatic that some national regulating bodies around the world interdicted their use. Many pelvic floor surgeons encountered a new clinical entity, known as “mesh-o mania”. Many patients, even the ones with a perfectly successful outcome and without complications, asked meshes to be removed. The real incidence of the complications associated with mesh surgery is not really known. There are clear outcome advantages in the use of meshes compare to the procedures we used in the pre-mesh era: stress urinary incontinence and correction of the apical components of the vagina are some examples of it.

Transvaginal bladder-neck closure: a step-by-step video for female pelvic surgeons

Transvaginal bladder-neck closure is a definitive surgical option for urethral erosion due chronic bladder catheterization in patients with neurogenic bladder. Surgeons who perform female pelvic reconstructive surgery have limited exposure to this procedure in their training. The purpose of this video is to demonstrate a transvaginal bladder-neck closure due to urethral erosion in a patient with neurogenic bladder due to persistent neuropathy from Guillain-Barré syndrome managed with prolonged catheter drainage. We used a live-action surgical demonstration to describe transvaginal bladder-neck closure with urinary diversion. This video provides a step-by-step approach to transvaginal bladder-neck closure as treatment for urethral erosion from chronic catheterization. This video can be used to educate and train those performing female pelvic reconstructive surgery. Surgeons who perform female pelvic surgery should be familiar with the complications of chronic Foley catheterization and treatment options that include transvaginal bladder-neck closure. This video may be used to facilitate reproducibility and comprehension of this procedure.

LeFort colpocleisis: a step-by-step simulation video for Female Pelvic Surgeons

LeFort colpocleisis is a minimally invasive surgical option for patients with pelvic organ prolapse who no longer desire sexual activity. Pelvic surgeons have limited exposure to this procedure during their training, and are therefore less likely to offer this procedure to their patients. We use a split screen live action surgery, side by side with a low cost 3D model of a prolapse to describe a LeFort colpocleisis step by step. This video is an easily reproducible guide to the steps and surgical techniques necessary to successfully perform a LeFort colpocleisis. The simulation model can be used to educate and train those performing female pelvic surgery. Pelvic surgeons should be able to offer LeFort colpocleisis to their patients. This video may be used to facilitate the understanding and reproducibility of the procedure.

Urogynecology and Reconstructive Pelvic Surgery. 4th ed.

This is a truly comprehensive textbook that covers the whole spectrum of female pelvic medicine and reconstructive surgery (FPMRS). It starts with reviewing the history of female pelvic surgery, gynecology, and female urology. This is a nice setup for covering the latest evolutions in FPMRS such as female sexual dysfunction, robotic surgery for pelvic organ prolapse, and surgical management of detrusor compliance abnormalities. The basic science part includes chapters that are dedicated to the physiology of the pelvic muscles, vagina, and anorectum. In addition, the chapter on the psychosocial impact of pelvic floor disorders provide the reasons for trying to master this difficult to learn field. A welcome addition to this edition is the step-by-step instructions on regular and video urodynamics. But perhaps more important may be the two dedicated two chapters and interspersed review of possible surgical complications and their method of management. Four chapters are dedicated to fecal incontinence and defecation disorders, and the book ends with explaining on what to use in measuring outcomes and quality of life in pelvic floor research. This book should be seriously considered by anyone involved in FPMRS.

2-Octyl Cyanoacrylate Skin Adhesive for Topical Skin Incision Closure in Female Pelvic Surgery

Background: 2-octyl cyanoacrylate (2OCA) high viscosity tissue adhesive (Medline Industries, Inc., Mundelein, IL) is a liquid topical skin adhesive. 2OCA offers the same design features and clinical utility in terms of flexibility, strength, and low complication rate as the commercially available 2OCA tissue adhesives. Additionally, 2OCA features high viscosity allowing for better control during the application process, polymerization without the use of an external activator, and a distinctive violet color for ease of application visualization. Objective: The aim of this prospective case series is to descriptively report clinical data with the application of 2OCA as a topical incision closure system in female pelvic surgery. The primary outcomes included: incisional pain, incisional dehiscence, and post-operative bleeding. The secondary outcome included drying times of the adhesive with regard to incision length. Methods: A prospective open-label observational case series study was conducted to evaluate the use of 2OCA in surgical wound closure of the topical skin in adult patients undergoing gynecologic surgical procedures. A total of 50 adult women undergoing gynecologic surgery were enrolled. 2OCA was applied only by surgeons who had undergone product training to the incisions in a standardized, protocol-defined fashion. Drying times for the adhesive and photography were recorded intraoperatively. Post treatment follow-up was conducted with queries of pain level, incisional dehiscence, and incisional bleeding immediately post-operatively, 48 hours, 5 - 10 days and 14 days post-treatment. Adverse events were documented. Results: 2OCA was applied to a total of 154 incisions from the 50 patients enrolled to the study. The procedures included: 16 laparoscopic total hysterectomies, 4 diagnostic laparoscopies, 2 laparoscopic myomectomies, 2 laparoscopic bilateral or unilateral salpingo-oophorectomies, 5 total robotic-assisted laparoscopic surgeries (2 total hysterectomies, 1 supracervical hysterectomy, 1 sacrocolpopexy, and one excision of endometriosis), 7 sacral neuromodulation procedures, and 18 midurethral slings. The overall rate of incisional dehiscence was 3% (4/154). The rate of reported incisional bleeding was 3% (4/154). There was 1 incisional infection. The pain reports based on a 10-point scale had a mean of 4.96 immediately post-operatively, which decreased to a mean score < 1 (0.2) by post-op day (POD) 14. The mean drying times for the various lengths of incisions included the following: 1.28 minutes for incisions ≤ 5 mm, 1.53 minutes for 6 - 8 mm, 1.66 minutes for 10 mm - 20 mm, and 1.57 minutes for the 40 - 50 mm incisions. In 23% (36/154) of incisions 2OCA was the sole method of skin closure. Conclusion: This study demonstrates that 2OCA is safe to use in gynecologic surgical incisions with low rates of post-operative incisional bleeding and incisional dehiscence. Post-operative reports of pain maintained expected levels for recovery. 2OCA is a practical alternative or augmentation to traditional suture closure of skin incisions at the time of gynecologic surgery.

History and Development of an Integrated Model of Care for Female Pelvic Medicine and Surgery

Urologists and gynecologists manage most of the patients with female pelvic floor disorders. However, lack of a single focused approach among these two disciplines and other related fields may hinder advances in clinical care and research. Herein, along with describing the background of birth of the new subspeciality, we present a practical approach by which we established an integrated model of care and discovery for FPFD at our institution. With the recent approval of this subspeciality by the Accreditation Council for Graduate Medical Education (ACGME), it is plausible that other institutions would wish to initiate similar steps toward establishment of an integrated model of care for FPFD, and hence move this new subspecialty to its new frontiers.

Interobserver variability when employing the IUGA/ICS classification system for complications related to prostheses and grafts in female pelvic floor surgery

To unify and organize reporting, an International Urogynecological Association (IUGA)/International Continence Society (ICS) expert consortium published terminology guidelines with a classification system for complications related to implants used in female pelvic surgery. We hypothesize that the complexity of the codification system may be a hindrance to precision, especially with decreasing levels of postgraduate expertise. Residents, fellows, and attending physicians were asked to code seven test cases taken from published literature. Category, timing, and site components of the classification system were assessed independently and according to the level of training. Interobserver reliability was calculated as percent agreement and Fleiss' kappa statistic. A total of 24 participants (6 attending physicians, 3 fellows, and 15 residents) were tested. The percent agreement showed significant variation when classified by level of training. In all categories, attending physicians had the greatest percentage agreement and largest kappa. The most agreement was seen when attending physicians classified mesh complications by time, 71% agreement with kappa 0.73 [95% confidence interval (CI) 0.58-0.88]. For the same task, the percentage agreement for fellows was 57%, kappa 0.55 (95% CI 0.23-0.87) and with residents 57%, kappa 0.71([95% CI 0.64-0.78). Interestingly, the site component of the classification system had the least overall agreement and lowest kappa [0%, kappa 0.29 (95% CI 0.26-0.32)] followed by the category component [14%, kappa 0.48 (95% CI 0.46-0.5)]. The IUGA/ICS mesh complication classification system has poor interobserver reliability. This trended downward with decreasing postgraduate level; however, we did not have sufficient statistical power to show an association when stratifying by all training levels. This highlights the complex nature of the classification system in its current form and its limitation for widespread clinical and research application.

A Touch-Controlled Laparoscope Manipulator: Preliminary Trial to Evaluate the Performance on Female Porcine Pelvic Surgery and an Initial Experience in A Human Robot-Assisted Laparoscopic Segmental Salpingectomy

A Touch-Controlled Laparoscope Manipulator: Preliminary Trial to Evaluate the Performance on Female Porcine Pelvic Surgery and an Initial Experience in A Human Robot-Assisted Laparoscopic Segmental Salpingectomy

Evaluating Single-incision Slings in Female Stress Urinary Incontinence: The Usefulness of the CONSORT Statement Criteria

To evaluate the usefulness and applicability of the Consolidated Standards of Reporting Trials (CONSORT) for journal articles reporting randomized, controlled trials evaluating single-incision slings in the treatment of female stress urinary incontinence. Original articles reporting randomized, controlled trials assessing single-incision slings in the treatment of female stress urinary incontinence were searched for in the PubMed and Embase databases in 2011. Reporting quality was studied by 2 hospital pharmacists and 2 urologic surgeons. Primary outcome was the score out of 20 in the abstract CONSORT checklist. Secondary outcomes were the scores in the standard CONSORT checklist and the extension CONSORT additional items for trials assessing nonpharmacologic treatments. Among 135 articles retrieved, 8 met the inclusion criteria and were assessed. Abstract scores ranged from 4.7-14.1. Standard scores were >10.0 out of 20 for most articles; the extension scores did not exceed 5.0 out of 10. Four reported trials were not identified as randomized in the title. The interventions were incompletely reported. Four articles reported whether blinding was achieved but lack of blinding was never discussed as a potential source of bias. Few articles reported the operators and centers characteristics and their impact on statistical analysis. The combination of the 3 checklists was considered a useful guideline to enhance and assess the reporting quality of a surgical trial. Our results support the further use of CONSORT criteria as a basic standardized tool in all stages of clinical evaluation for any prosthetic device in female pelvic surgery.

Postoperative management and restrictions for female pelvic surgery: a systematic review

We sought to systematically review the literature regarding the effect of postoperative restrictions on clinical outcomes after pelvic surgery. English-language articles were identified by a MEDLINE and Cochrane Central Register of Controlled Trials search from inception to July 2010. We used key words describing various gynecologic surgical procedures and postoperative activities, including mobility, lifting, work, coitus, and exercise. Randomized and nonrandomized studies comparing interventions with outcomes of interest were included. The literature search yielded of 3,491 articles; 115 full-text articles were reviewed, and 38 met eligibility criteria and are reported and analyzed here. Our analysis revealed that expedited discharge protocols and early postoperative feeding and catheter removal result in shorter hospital stay without negative health outcomes. However, there are limited data to guide many other aspects of postoperative care, particularly regarding exercise and resumption of sexual activity after surgery. There is good evidence to support early postoperative feeding and catheter removal after pelvic surgery. There are limited data to guide many other aspects of postoperative care.

V249 THE USE OF MESH IN FEMALE PELVIC SURGERY AN EDUCATIONAL VIDEO

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction and Incontinence)1 Apr 2012V249 THE USE OF MESH IN FEMALE PELVIC SURGERY AN EDUCATIONAL VIDEO Sarah Kane, Adonis Hijaz, and Firouz Daneshgari Sarah KaneSarah Kane Cleveland, OH More articles by this author , Adonis HijazAdonis Hijaz Cleveland, OH More articles by this author , and Firouz DaneshgariFirouz Daneshgari Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.305AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The July 13th, 2011 FDA warning statement on surgical mesh used for pelvic organ prolapse and stress incontinence surgery caused much anxiety for patients and for Female Pelvic Surgeons. In this video, our objectives are to show the evolution of prolapse and incontinence repair surgery. This includes showing how prolapse repair incorporating mesh has been used in the past and more recently, and also how the surgical treatment of stress incontinence has evolved to include mesh as the standard of care. We also review the FDA's warning and what it means for patients contemplating surgery. METHODS We highlight the progression of Female Pelvic Surgery from abdominal to minimally invasive surgery and the incorporation of surgical mesh. We then demonstrate the evolution of mesh from the initial midurethral slings to the vaginal mesh kits available today in a timeline, and the slings are compared to the vaginal mesh kits. Surgical treatment of pelvic organ prolapse using mesh and non-mesh techniques is then discussed, giving risks and benefits of each option. The FDA warning statement on mesh is then explained to help patients make informed decisions. RESULTS The FDA review concluded that transvaginal prolapse repair with mesh does not improve symptomatic results or quality of life when compared to the traditional sutured tissue repair, and mesh used in transvaginal prolapse repair introduces risks not present in traditional non-mesh surgery prolapse repair. They added that abdominal or robotic sacral colpopexy has a lower risk of mesh complication than transvaginal use of mesh in prolapse treatment. The review of the use of mesh for the treatment of stress incontinence is still in progress, with no final recommendations having been made for its use. CONCLUSIONS We hope that patients watching this video will have a better understanding of the use of mesh in Female Pelvic Surgery, and that this knowledge will help them make informed decisions regarding their surgical treatment. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e101 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Kane Cleveland, OH More articles by this author Adonis Hijaz Cleveland, OH More articles by this author Firouz Daneshgari Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...