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Interstitial cystitis is a clinical condition occurring predominantly in women and is characterized by urinary frequency, urgency, and pain. Patient symptoms have the potential to significantly affect quality of life, posing a challenge to some to perform activities of daily living. This article comprehensively reviews the literature on the epidemiology, etiology, evaluation, and treatment of interstitial cystitis, and considers commonly associated pelvic floor dysfunction.

Pelvic organ prolapse (POP) is a debilitating condition of unknown aetiology affecting > 50% of women over 40 years of age. In POP patients, the vaginal walls are weakened allowing descent of pelvic organs through the vagina. We sought to determine if sphingosine-1-phosphate (S1P) signalling, which regulates smooth muscle contractility and apoptosis via the RhoA/Rho-kinase (ROK) pathway, is altered in the vagina of women with POP. Utilising anterior vaginal wall specimens, we provide novel demonstration of the S1P pathway in this organ. Additionally, comparing specimens from women having pelvic reconstructive surgery for POP and control subjects, we reveal increases in mRNA expression of the three major mammalian S1P receptors (S1P1-S1P3), and RhoA and the ROK isoforms: ROKα and ROKβ in POP patients, which correlates with a decrease in elastic fibre assembly pathway constituents. Taken together, our data suggest the S1P/ROK pathway as a novel area for future POP research and potential therapeutic development.

A higher preoperative anterior stage prolapse, combined anterior and posterior compartment repairs, and retropubic sling procedures appear to be associated with PUR.

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OBJECTIVES:To evaluate factors associated with the development of vesicovaginal fistula following a cystotomy during benign hysterectomy at two large university settings. MATERIALS AND METHODSCharts from all hysterectomies performed for benign indications at Grady Memorial Hospital and the University of Mississippi Medical Center between January 1, 2000 and December 31, 2008 were reviewed. Demographic and operative data were abstracted. Cystotomies were scored using the American Association for the Surgery of Trauma (AAST) grading system for iatrogenic bladder injuries. Cases were patients who developed a vesicovaginal fistula (VVF) following cystotomy while patients who had a bladder injury without development of a VVF served as the controls. The Fisher's exact test was used to analyze categorical variables while the Student's t-test was used for continuous variables. Odds ratios with 95% confidence intervals were calculated for risk factors. RESULTS:During the study period, 5786 hysterectomies were performed for benign indications at the two study centers. Of these, 59% were abdominal, 34% vaginal and 7% were laparoscopic assisted hysterectomies. A total of 90 (1.6%) cystotomies occurred. Vesicovaginal fistulas developed in seven (7.8%) patients. No significant differences in age, parity, weight or ethnicity were identified between those developing a VVF and those who did not. No significant differences in the rate of tobacco use, hypertension, diabetes, prior Cesarean delivery, prior sexually transmitted infections, pelvic adhesive disease or prior pelvic surgeries were seen. The route or indication for hysterectomy did not differ between the groups. The mean uterine weight and operative blood loss did not differ between the groups, however, patients who developed a VVF were more likely to have a uterus that weighed more than 250 g (83% vs 36%, P ϭ 0.03) and a trend towards an operative blood loss of greater than 1000 mL (67% vs 27%, P ϭ 0.06). Patients who developed a VVF had longer operative time (317 Ϯ 82 vs 206 Ϯ 10 minutes, P ϭ 0.02) and were more likely to have an associated ureteral injury (29% vs 1%, P ϭ 0.02). An AAST Grade V bladder injury (OR: 30.80, 95% CI: 4.50 -210.79) and one layer repair of the bladder (OR: 7.20, 95% CI: 1.05-49.32) were associated with VVF formation. CONCLUSION:Patients with an AAST Grade V bladder injury or those whose bladder is repaired in a single layer are at increased risk for developing a vesicovaginal fistula following a cystotomy during a hysterectomy performed for benign indications. OBJECTIVES:To systematically review and synthesize published literature on sacral neuromodulation for the treatment of urinary urgency, frequency and urge urinary incontinence. MATERIALS AND METHODS: Vanderbilt University's Evidence-basedPractice Center was contracted by the Agency for Healthcare Research and Quality to review the literature on the Management of Overactive Bladder, including sacral neuromodulation. Literature published in English from January 1966 to October 2008 and ind...

The aim of the study was to determine whether an easy-toread patient education card given at the preoperative visit can increase patient recall of the planned surgery.Methods: This was a randomized controlled trial. Patients scheduled to undergo pelvic reconstructive surgery were recruited during their preoperative visits. All participants received standard surgical counseling, whereas the intervention group also received a 4 Â 6 inch card highlighting the anticipated procedure. The primary outcome was correct recall of the planned surgery as measured by a preoperative questionnaire. Secondary outcomes were correct recall of the surgery postoperatively and patient satisfaction with the information provided.Results: One hundred twenty-eight patients were enrolled with 64 participants in each arm. One hundred twenty-seven participants were analyzed because 1 patient was lost to follow-up. No difference was found between patient demographics, including types of surgical procedures performed. There was a statistically significant improvement in preoperative recall: 30 of 63 participants (47.6%) in the intervention group answered all questions correctly versus 18 of 64 patients (28.6%) patients in the standard counseling group (P = 0.021). There was no difference in the postoperative scores between the 2 groups: 48.3% (28 of 58) and 52.5% (32 of 61) of the participants answered all questions correctly in the intervention and standard counseling only groups, respectively (P = 0.648). There was no difference in satisfaction scores, with a median score of 20 out of 20 for either group (interquartile range = 19-20). Conclusions:A concise and easy-to-use education card enhanced patient preoperative recall of the proposed surgery. This difference was not sustained postoperatively. High satisfaction with the information provided was reported regardless of counseling method.