Objective To assess the factors that may predispose patients to the development of vaginal vault prolapse and enterocele, and to determine the success of sacrocolpopexy in correcting prolapse. Design A retrospective study of women with vault prolapse undergoing sacrocolpopexy over a 10 year period between 1983 and 1993, with analysis of postoperative complications and success. Setting St. George's Hospital in London, a university teaching hospital, and private practice. Subjects Forty‐one women, presenting with symptomatic vault prolapse, who desired preservation of sexual function. Interventions Forty‐one patients underwent 43 sacrocolpopexies. Of these, 39 were performed by the senior author. All but four were reviewed in the clinic within the last year. Main outcome measures Pre‐ and post‐operative data and any interim prolapse or incontinence surgery were recorded. Success was assessed subjectively and by clinical examination for recurrence of prolapse, associated post‐operative complications, subsequent voiding difficulties, and incidence of incontinence. Results Failure was denned as a symptomatic enterocele or evidence of a third degree enterocele on examination. The 41 patients were followed for a mean time of 21.2 months. The cure rate of vault prolapse was 88 %. The most common complications were stress incontinence, urinary tract infection, and persistent vaginal discharge. Using the unpaired t‐est and χ2 analysis, there was no significant difference between failures or successes in terms of weight, parity, age, previous surgery, pulmonary history, or difficulties with defaecation, although the number of patients studied was small. Conclusions Sacrocolpopexy is a successful operation for the correction of prolapse. Complications include the development of genuine stress incontinence, detrusor instability, voiding difficulty, and mesh infection.

Prophylactic closure of the patent ductus arteriosus has been recommended as a means of decreasing the morbidity of the very low birth weight neonate. This study was undertaken in order to determine potential risk factors involved in the development of the silent ductus, its impact upon both the early cardiorespiratory symptomatology and the subsequent morbidity of the premature neonate, and finally the potential benefit to be derived from prophylactic closure in this presymptomatic stage. Infants with birth weights of 1000 g or less were studied on days 2-3 of life echocardiographically, clinically, and with determination of plasma dilator prostaglandin levels. On entry to the study, those infants with early evidence of silent left-to-right patent ductus arteriosus (PDA) shunting were randomized to receive either prophylactic indomethacin or placebo therapy. Those infants with no evidence of ductal shunting were not treated at all. Infants with silent PDAs had elevated levels of the dilator prostaglandin metabolite 6-keto PGF1 alpha on admission, although they had no echocardiographic abnormalities. No other risk factors for PDA development could be identified. Silent PDA infants had an increased incidence of subsequent symptomatic PDAs, and overall morbidity and mortality when compared with those with no evidence of PDA (silent or symptomatic). Prophylactic ductal closure decreased the incidence of subsequent PDA development, but had no effect on overall morbidity and/or mortality.

Purpose: We aimed to understand the reasons patients choose to pursue thirdline overactive bladder (OAB) therapy. Materials and Methods: We conducted a mixed methods study that included patient interviews and survey data. Eligible patients were diagnosed by symptoms, had tried behavioral modifications, and OAB medications enrolled from October 2018 to August 2019. In addition to interviews, patients completed 4 surveys: the Pelvic Floor Distress Inventory, Overactive Bladder Questionnaire Short Form, Life Orientation TestdRevised, and a patient confidence in the health care system survey. Qualitative interview data were analyzed thematically. Logistic regression and chi-square analysis was used to analyze survey data. Results: A total of 69 patients were consented, 4 withdrew, and 51 completed both interview and survey data. Overall 55% of patients were Caucasian, 45% were African American, and their average age was 71 (SD[10.4); 75% intended to pursue third-line OAB therapy and 31 (61%) expressed interest in a specific third-line therapy. Major interview themes included a desire for a better quality of life, embarrassment with accidents, and problems with medication. Themes leading patients away from third-line OAB treatment included concern about invasiveness and side effects of treatments, and restrictions to accessing care. Conclusions: Most patients desired to progress to third-line OAB therapy, were motivated by embarrassment, but were concerned about treatment side effects. We found that economic burden of OAB treatment is associated with patient interest in and decision to receive third-line therapies to include onabotuli-numtoxinA and percutaneous tibial nerve stimulation. Improved quality of life, medication frustration, and concerns about side effects of further therapy are themes patients identified when patients considered third-line overactive bladder therapy.

A number of medical specialties have recently developed their own specialty-specific charters. This proliferation of charters is representative of an unease about medical professionalism that has arisen not just from increasing medical specialization, but also from evolving needs as physicians progress through their careers. The development of such specialty-specific definitions of professionalism is undesirable: all specialties should adhere to the same basic principles. These charters and "definitions" should be incorporated into a formal developmental model, derived from needs assessments from the level of medical school through the level of specialization. Such a model would provide physicians with more concrete guidance regarding professional behavior at each stage of their careers, address unmet needs in neglected areas such as mid- and late career, and help alleviate the tension associated with expressing these ideas. Incorporating concepts derived from more classic models of development may create opportunities to address the teaching of values and identify barriers to success.