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Objectives (1) To systematically collect and organize into clinical categories all outcomes reported in trials for abnormal uterine bleeding (AUB); (2) to rank the importance of outcomes for patient decision making; and (3) to improve future comparisons of effects in trials of AUB interventions. Study Design and Setting Systematic review of English-language randomized controlled trials of AUB treatments in MEDLINE from 1950 to June 2008. All outcomes and definitions were extracted and organized into major outcome categories by an expert group. Each outcome was ranked “critically important,” “important,” or “not important” for informing patients’ choices. Results One hundred thirteen articles from 79 trials met the criteria. One hundred fourteen different outcomes were identified, only 15 (13%) of which were ranked as critically important and 29 (25%) as important. Outcomes were grouped into eight categories: (1) bleeding; (2) quality of life; (3) pain; (4) sexual health; (5) patient satisfaction; (6) bulk-related complaints; (7) need for subsequent surgical treatment; and (8) adverse events. Conclusion To improve the quality, consistency, and utility of future AUB trials, we recommend assessing a limited number of clinical outcomes for bleeding, disease-specific quality of life, pain, sexual health, and bulk-related symptoms both before and after treatment and reporting satisfaction and adverse events. Further development of validated patient-based outcome measures and the standardization of outcome reporting are needed.

Overall, the existing evidence is limited to guide decisions regarding whether to use graft materials in transvaginal prolapse surgery. Adequately powered randomized trials evaluating anatomic and symptomatic efficacy as well as adverse events are needed.

Purpose-To examine the association of urinary incontinence by diabetes status and race and evaluate beliefs and help-seeking around incontinence in a population-based cohort of women with and without diabetes.Materials and Methods-We performed a cross-sectional analysis of 2,270 middle-aged and older racially/ethnically diverse women in Diabetes RRISK. Incontinence, help-seeking behavior, and beliefs were assessed by self-report questionnaires and in-person interviews. Incontinence characteristics of diabetics and non-diabetics were compared using univariate analysis and multivariate models.Results-Women with diabetes reported weekly incontinence significantly more than women without diabetes (Weekly: 35.4% vs. 25.7%, respectively, p <0.001). Race prevalence patterns were similar (white and Latina women with the most prevalent incontinence and African-American and Asian women with the least) among women with and without diabetes. Less than 50% of women with diabetes discussed their incontinence with a doctor (42.2% vs. 55.5% (of women without diabetes) p <0.003). Women with diabetes were more likely than women without diabetes to report believing that incontinence is a rare condition (17% vs. 6%, respectively, p<0.001).Conclusions-Incontinence is highly prevalent among women with diabetes. Race prevalence patterns are similar among women with and without diabetes. Understanding help-seeking behaviors are important to ensure appropriate care for patients. Physicians should be alert for urinary incontinence because it is often unrecognized and thereby under-treated among women with diabetes.

The aim of this study was to evaluate the effectiveness of a McCall culdeplasty in maintaining support of the post-hysterectomy vaginal cuff in women undergoing surgery for uterine prolapse. A retrospective chart review was performed on all patients who had a vaginal hysterectomy and McCall culdeplasty for uterine prolapse without prolapse of the posterior vaginal fornix. Patients were examined pre- and postoperatively using the International Continence Society (ICS) staging system. Data were analyzed using repeated measures analysis of variance (ANOVA) for correlation between preoperative point D and the two postoperative point C measurements. Of the 43 patients studied, 39 (90%) had stage 0 prolapse and 3 (7%) had stage I prolapse of the vaginal cuff 1 year postoperatively. In patients who have hysterectomies for uterine prolapse with good support of the posterior vaginal fornix, the McCall culdeplasty is a highly successful procedure in maintaining proper anatomic support of the vaginal cuff.