Objectives: This study aimed to compare the incidence of mesh exposure based on route of hysterectomy at the time of minimally invasive sacrocolpopexy. Secondary outcomes included perioperative outcomes and prolapse recurrence.Methods: This was a multicenter, retrospective cohort study. Patients who underwent sacrocolpopexy between 2007 and 2017 were stratified by hysterectomy approach: total vaginal hysterectomy (TVH), total laparoscopic or robotic hysterectomy (TLH), and laparoscopic or robotic supracervical hysterectomy (LSH). Total vaginal hysterectomy was subdivided into vaginal and laparoscopic mesh attachment to the cuff. Statistical analyses were performed, with P < 0.05 denoting statistical significance.Results: Seven institutions participated, and 502 minimally invasive sacrocolpopexies with concomitant hysterectomy were performed by 23 surgeons: 263 TVH, 128 TLH, and 111 LSH. The median follow-up interval was 10 months, and this was significantly different between the groups (months): TVH, 11 (3-13); TLH, 2 (2-9); and LSH, 12 (5-24; P < 0.01). The overall incidence of vaginal mesh exposure was 4.0% (20/502). There were no significant differences in vaginal mesh exposure based on hysterectomy route: TVH, 5.7% (15/263); TLH, 1.6% (2/128); and LSH, 2.7% (3/111; P = 0.11). Within the TVH group, there was no significant difference in vaginal mesh exposure comparing vaginal and laparoscopic mesh attachment: 1.9% (1/52) versus 6.6% (14/211; P = 0.48). Laparoscopic supracervical hysterectomy demonstrated a significantly higher incidence of recurrence compared with TVH and TLH: 10.8% (12/111) versus 3.4% (9/263) and 2.3% (3/128; P < 0.01). Conclusions:The incidence of sacrocolpopexy mesh exposure was not significantly different based on route of hysterectomy or mode of mesh attachment to the vagina. There was a significant increase in prolapse recurrence with supracervical hysterectomy.

Context Fatigue is a prevalent, debilitating and often disruptive symptom for cancer patients. Yet, it remains inadequately understood and managed, especially among late middle- aged and older patients with advanced disease. Few studies have explored fatigue qualitatively and almost none have focused on patients’ attributions for this subjective and multidimensional symptom. Objectives Our objectives were to: 1) examine the attributions patients 55 or older with advanced cancer made for their fatigue and how they arrived at these attributions; and 2) understand how patients’ attributions affect how they contend with fatigue, including communication with health care providers. Methods We conducted qualitative in-depth interviews with 35 patients 55 years of age or older on their experiences with fatigue. Patients had a variety of cancers and were at stages IV or late III of the disease. Interviews were thematically coded and analyzed. Results Two main themes emerged: 1) Cancer-related treatment was the master and often the sole attribution patients made for their fatigue. Patients making this attribution expressed certainty about its accuracy and seemed less distressed about the symptom. 2) Multiple causes of fatigue, typically a combination of cancer, treatment and non-threatening causes (e.g., older age, overexertion, or anemia), were also offered by some. Patients seemed to resist identifying disease severity as a cause and appeared motivated to normalize and minimize the symptom, thus decreasing its threatening impact. Conclusion Patients’ causal attributions for fatigue had a profound effect on their physical and psychological well-being, their communication with providers, and their integration of the symptom into their lives.

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Objectives To evaluate the effect of bilateral pudendal nerve blockade on immediate postoperative bladder emptying after midurethral sling. Methods We performed a double-blinded, randomized, placebo-controlled trial of women undergoing a midurethral sling procedure between October 2017 and February of 2019. Women older than 18 years were eligible if they were undergoing a midurethral sling with no concomitant procedures and had no preoperative urinary retention. Participant demographics and medical conditions that may affect bladder emptying were recorded preoperatively. Participants were randomized to a bilateral pudendal injection of either bupivacaine or normal saline. After induction of anesthesia, the pudendal injection was administered before any incisions. No other local anesthesia was used. The primary outcome was the rate of passing a standardized void trial. Secondary outcomes included perioperative pain scores, analgesia use, and complications. Results Ninety-one participants were enrolled in the study. One patient had a delayed void trial on postoperative day 1, leaving 90 participants for the final analysis. Demographic and perioperative characteristics were similar between the groups. Adjusted logistic regression showed that the administration of a bupivacaine pudendal block led to a higher rate of void trial failure (43% vs 20%, odds ratio = 0.32, P = 0.02 adjusted for age, body mass index, and comorbidities). Postoperative pain scores and analgesia use were similar between the groups. Postoperative complications, including urinary tract infection, mesh erosion, pelvic hematoma, or urinary retention within 6 weeks were similar between the groups. Conclusions Our prospective trial demonstrates that a bilateral pudendal blockade before midurethral sling procedure worsens postoperative bladder emptying.

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ObjectiveThe aims of the study were to construct uroflowmetry nomograms, evaluate uroflowmetry flow rate patterns, and graphically illustrate overlaid uroflowmetry curves in nulliparous female adult volunteers.MethodsWe performed a prospective cross-sectional study evaluating uroflowmetry curve and flow rate patterns on a cohort of nulliparous female adult volunteers. Primary outcome was construction of uroflowmetry maximum and average flow rate nomograms. Secondary outcomes included evaluation of uroflowmetry flow rate patterns and graphical illustrations of overlaid uroflowmetry curves. Uroflowmetry printouts were overlaid and used to create a model of uroflow patterns, and nomogram curves were analyzed in 5 groups based on voided volumes.ResultsWe enrolled 164 participants and 158 had voided volumes between 50 mL and 800 mL. Participants' mean age and body mass index were 25 years and 23, respectively. Maximum and average flow rate nomograms were created, and analysis of uroflow parameters was performed. Median voided volume was 241 mL (149–431 mL), the median maximum flow was 29 mL/s (20–38 mL/s), and the median average flow was 15 mL/s (10–19 mL/s). Participants were divided into 5 groups based on voided volumes. The nomogram patterns for each voided volume group were visually different from typical nomogram patterns.ConclusionsUroflowmetry curves and flow rates vary significantly according to voided volume. Our study suggests that in normal healthy nulliparous female adults there is likely a broader range of normal flow rates and uroflowmetry curves than what has been previously reported. Further research is needed to investigate the accuracy of these finding.

ImportanceThere is limited literature reporting perioperative outcomes among colpocleisis types.ObjectivesThis study aimed to describe perioperative outcomes after colpocleisis at a single institution.Study DesignPatients who underwent colpocleisis at our academic medical center between August 2009 and January 2019 were included. A retrospective chart review was performed. Descriptive and comparative statistics were generated.ResultsA total of 367 of 409 eligible cases were included. Median follow-up was 44 weeks. There were no major complications or mortalities. Le Fort and posthysterectomy colpocleises were faster than transvaginal hysterectomy (TVH) with colpocleisis (95 and 98 minutes, respectively, vs 123 minutes; P = 0.00) with decreased estimated blood loss (100 and 100 mL, respectively, vs 200 mL; P = 0.000). Urinary tract infection and postoperative incomplete bladder emptying occurred in 22.6% and 13.4% of all patients, respectively, with no difference among the colpocleisis groups (P = 0.83 and P = 0.90). Patients who underwent concomitant sling were not at increased risk of postoperative incomplete bladder emptying (14.7% for Le Fort and 17.2% for total colpocleisis). Prolapse recurred after 0 Le Fort (0%), 6 posthysterectomy (3.7%), and 0 TVH with colpocleisis procedures (0%) (P = 0.02).ConclusionsColpocleisis is a safe procedure with a relatively low complication rate. Le Fort, posthysterectomy, and TVH with colpocleisis have similarly favorable safety profiles and very low overall recurrence rates. Concomitant TVH at the time of colpocleisis is associated with increased operative time and increased blood loss. Concomitant sling procedure at the time of colpocleisis does not increase the risk of short-term incomplete bladder emptying.

Objective The objective of this study was to determine if in-person interpreters improve patient satisfaction scores compared with phone interpreters for urogynecology office visits in limited English proficient (LEP) patients. Methods Portuguese and Spanish LEP subjects were randomized to phone or in-person interpreter, and a 14-item questionnaire was administered with 3 subscales assessing the primary outcome of patient satisfaction with the interpreter, physician, and nursing. Subject demographics, English proficiency, overall health status, and yearly household income were recorded. Sample size calculations indicated that a mean difference of 12 in satisfaction scores could be detected with 44 subjects per arm. Analysis was conducted using descriptive statistics, and comparisons between the intervention versus control group were analyzed using Fisher exact test, Wilcoxon rank sum test, and linear regression. Results We enrolled and randomized 106 subjects, and 82 subjects completed the study. There was a statistically significant difference in subject satisfaction between randomization groups, favoring in-person interpreters. In the as-treated analysis, the median satisfaction score for the phone interpreter group was 92.9 and 100 for in-person interpreter group (P < 0.001). Linear regression adjusted for English proficiency showed that there was a difference between median scores of 7.14 (P = 0.002). Conclusions Portuguese and Spanish LEP patients experienced higher satisfaction scores for urogynecology office visits when in-person interpreters are used compared with a phone interpreter. Although we found a statistically significant difference between these groups, the clinical significance of our finding is less clear. This topic should continue to be investigated for the field of urogynecology and further studies are needed.