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Introduction and hypothesis-To determine whether consultation with pelvic floor physical therapy (PFPT) at the time of initial urogynecologic evaluation increases adherence to PFPT and to identify factors associated with PFPT attendance and completion. Methods-We performed a retrospective chart review of all patients evaluated for new urogynecology consultation at our institution in a 1-year period, abstracting data about demographics, diagnoses, and PFPT referral, attendance, and completion. Descriptive analyses compared patients who were referred to, attended, and completed PFPT, stratified by whether they saw PFPT the same day as their initial urogynecologic consultation. Logistic regression identified factors associated with PFPT attendance, completion, and referral. Results-PFPT referral was made for 35% (335/958), of whom 67% attended and 42% completed PFPT. Patients who saw PFPT the same day as their first urogynecology visit were significantly more likely to attend PFPT than those who did not (91% vs. 61%, p < 0.001), but completion rates did not differ (49% vs. 41%, p = 0.15). PFPT attendance was higher among women who saw a PFPT the same day as their initial urogynecology appointment (p <0.001) and among those aged ≥ 65 years (p = 0.015). Age ≥ 65 years and white, non-Hispanic race/ethnicity were associated with PFPT completion. Patients with a diagnosis of pelvic organ prolapse or urinary incontinence and those seen in multidisciplinary clinic were more likely to be referred to PFPT. Conclusions-PFPT consultation at the time of initial urogynecologic evaluation improves attendance of initial PFPT appointment, but does not improve completion rates.

Idiopathic overactive bladder (OAB) is a chronic condition that negatively affects quality of life, and oral medications are an important component of the OAB treatment algorithm. Recent literature has shown that anticholinergics, the most commonly prescribed oral medication for the treatment of OAB, are associated with cognitive side effects including dementia. β3-adrenoceptor agonists, the only alternative oral treatment for OAB, are similar in efficacy to anticholinergics with a more favorable side effect profile without the same cognitive effects. However, there are marked cost variations and barriers to access for OAB medications, resulting in expensive copays and medication trial requirements that ultimately limit access to β3-adrenoceptor agonists and more advanced procedural therapies. This contributes to and perpetuates health care inequality by burdening the patients with the least resources with a greater risk of dementia. When prescribing these medications, health care professionals are caught in a delicate balancing act between cost and patient safety. Through multilevel collaboration, we can help disrupt health care inequalities and provide better care for patients with OAB.

Purpose:We compared urinary tract infection (UTI) symptom resolution rates at 7–10 days in symptomatic women randomized to treatment based on standard urine culture (SUC) versus expanded quantitative urine culture (EQUC) results.Materials and Methods:Women ≥18 years old who responded “yes” to “do you feel you have a UTI?” agreed to urethral catheterization and followup. Symptoms were assessed using the validated UTI Symptom Assessment (UTISA) questionnaire. Culture method was randomized 2:1 (SUC:EQUC); antibiotics were prescribed to women with positive cultures. The primary outcome, UTI symptom resolution, was determined 7–10 days following enrollment on all participants regardless of treatment.Results:Demographic data were similar between groups. Of the SUC and EQUC groups 63% and 74% had positive cultures (p=0.10), respectively. Of participants with positive cultures 97% received antibiotics. Primary outcome data were provided by 215 of 225 participants (SUC 143 [95%], EQUC 72 [97%]). At the primary outcome assessment, 64% and 69% in the SUC and EQUC groups, respectively, reported UTI symptom resolution (p=0.46); UTISA scores improved from baseline in the EQUC arm compared to the SUC arm (p=0.04). In the subset of women predominated by non-Escherichia coli (76), there was a trend toward more symptom resolution in the EQUC arm (21%, p=0.08).Conclusions:Symptom resolution was similar for the overall population (E. coli and non-E. coli) of women treated for UTI symptoms based on SUC or EQUC. Although the sample size limits conclusions regarding the utility of EQUC in women with non-E. coli uropathogens, the detected trend indicates that this understudied clinical subset warrants further study.

Objectives Colpocleisis is a surgical treatment of pelvic organ prolapse for elderly women who are no longer sexually active. The risk calculator of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predicts perioperative complications. We aim to determine if the NSQIP calculated risk correlates with true perioperative complications in women 80 years or older undergoing colpocleisis. Methods Octogenarian women who underwent colpocleisis at our institution from 2007 to 2017 were included in this retrospective chart review. Medical comorbidities were entered into ACS NSQIP calculator, and the calculated risk was compared with actual complications. Results One hundred twenty-six octogenarians were included in the analysis. The true complication rate was higher than predicted by NSQIP (28.6% [36/126] vs 4.3% (SD, ±1.1%), which we attribute to our relatively high detection rate of urinary tract infection (32/36). Four patients (3.2%) had serious complications (pulmonary embolus, deep vein thrombosis, sepsis, and reintubation). In only 57% of cases, NSQIP risk calculation was concordant with true complication, showing significant departure from correct classification (P < 0.0001). The sensitivity and specificity of the NSQIP calculator were 66.7% and 53.3%, respectively. Multivariable analysis showed higher-than-predicted incidence of complications for patients requiring antiplatelet medication (Plavix or aspirin >81 mg vs none; odds ratio, 4.84, 95% confidence interval, 1.72–13.60; P = 0.002) and a diagnosis of hypertension (odds ratio, 4.24; 95% confidence interval, 1.31–13.72; P = 0.016). Conclusion Serious complication rates are low in octogenarians undergoing colpocleisis. The ACS NSQIP risk calculator does not strongly correlate with actual complications. Further refinement and evolvement of the database may improve its predictive value.

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