Introduction and hypothesisThe COVID-19 pandemic revolutionized the practice of medicine, requiring rapid adoption of telemedicine. However, patient satisfaction has not been well characterized for telemedicine visits for a broad range of urogynecologic conditions. Methods We performed a cross-sectional survey study following a retrospective review of all urogynecologic telemedicine visits from March 1, 2020, to March 31, 2021, at a tertiary care center. The survey queried patient satisfaction using the Likert scale. Descriptive statistics and Fisher's exact analyses were performed. Results There were 256 telemedicine visits at our institution during the study period, and 88 patients (34% unadjusted response rate) completed the survey. The average age of study participants was 55 (SD 17; 24, 84) years old. The majority of patients were white (69%), lived within the five boroughs of NYC (81%), and had higher levels of education (72% with a bachelor's or professional degree). Most visits were for urinary complaints (68%), with those patients reporting greater fulfillment of urogynecologic needs compared to patients presenting with pelvic complaints (p = 0.02). There were no significant differences in satisfaction among other demographics (p > 0.05). Altogether, high satisfaction rates were noted for scheduling (99%), technology (90%), provider interaction (96%), fulfillment of personal needs (91%), and overall satisfaction (94%). Conclusions We demonstrate high patient satisfaction for telemedicine visits in a tertiary urogynecology clinic for a variety of indications, with greater fulfillment of urogynecologic needs observed for those visits which may not necessitate an inperson exam (e.g., urinary complaint).

ClinicalTrials.gov, www.clinicaltrials.gov, NCT01994005.

BackgroundBladder pain of unknown etiology has been associated with co-morbid conditions and functional abnormalities in neighboring pelvic organs. Mechanisms underlying pain co-morbidities include cross-sensitization, which occurs predominantly via convergent neural pathways connecting distinct pelvic organs. Our previous results showed that colonic inflammation caused detrusor instability via activation of transient receptor potential vanilloid 1 (TRPV1) signaling pathways, therefore, we aimed to determine whether neurogenic bladder dysfunction can develop in the absence of TRPV1 receptors.MethodsAdult male C57BL/6 wild-type (WT) and TRPV1−/− (knockout) mice were used in this study. Colonic inflammation was induced by intracolonic trinitrobenzene sulfonic acid (TNBS). The effects of transient colitis on abdominal sensitivity and function of the urinary bladder were evaluated by cystometry, contractility and relaxation of detrusor smooth muscle (DSM) in vitro to various stimuli, gene and protein expression of voltage-gated sodium channels in bladder sensory neurons, and pelvic responses to mechanical stimulation.ResultsKnockout of TRPV1 gene did not eliminate the development of cross-sensitization between the colon and urinary bladder. However, TRPV1−/− mice had prolonged intermicturition interval and increased number of non-voiding contractions at baseline followed by reduced urodynamic responses during active colitis. Contractility of DSM was up-regulated in response to KCl in TRPV1−/− mice with inflamed colon. Application of Rho-kinase inhibitor caused relaxation of DSM in WT but not in TRPV1−/− mice during colonic inflammation. TRPV1−/− mice demonstrated blunted effects of TNBS-induced colitis on expression and function of voltage-gated sodium channels in bladder sensory neurons, and delayed development of abdominal hypersensitivity upon colon-bladder cross-talk in genetically modified animals.ConclusionsThe lack of TRPV1 receptors does not eliminate the development of cross-sensitization in the pelvis. However, the function of the urinary bladder significantly differs between WT and TRPV−/− mice especially upon development of colon-bladder cross-sensitization induced by transient colitis. Our results suggest that TRPV1 pathways may participate in the development of chronic pelvic pain co-morbidities in humans.

Asfaw TS, Hypolite J, Northington GM, Arya LA, Wein AJ, Malykhina AP. Acute colonic inflammation triggers detrusor instability via activation of TRPV1 receptors in a rat model of pelvic organ cross-sensitization. Am J Physiol Regul Integr Comp Physiol 300: R1392-R1400, 2011. First published April 6, 2011; doi:10.1152/ajpregu.00804.2010.-Chronic pelvic pain of unknown etiology is a common clinical condition and may develop as a result of cross-sensitization in the pelvis when pathological changes in one of the pelvic organs result in functional alterations in an adjacent structure. The aim of the current study was to compare transient receptor potential vanilloid 1 (TRPV1) activated pathways on detrusor contractility in vivo and in vitro using a rat model of pelvic organ cross-sensitization. Four groups of male Sprague-Dawley rats (N ϭ 56) were included in the study. Animals received intracolonic saline (control), resiniferatoxin (RTX, TRPV1 agonist, 10 Ϫ7 M), 2,4,6-trinitrobenzene sulfonic acid (TNBS, colonic irritant), or double treatment (RTX followed by TNBS). Detrusor muscle contractility was assessed under in vitro and in vivo conditions. Intracolonic RTX increased the contractility of the isolated detrusor in response to electric field stimulation (EFS) by twofold (P Յ 0.001) and enhanced the contractile response of the bladder smooth muscle to carbachol (CCh). Acute colonic inflammation reduced detrusor contractility upon application of CCh in vitro, decreased bladder capacity by 28.1% (P Յ 0.001), and reduced micturition volume by 60% (P Յ 0.001). These changes were accompanied by an increased number of nonmicturition contractions from 3.7 Ϯ 0.7 to 15 Ϯ 2.7 (N ϭ 6 in both groups, P Յ 0.001 vs. control). Desensitization of intracolonic TRPV1 receptors before the induction of acute colitis restored the response of isolated detrusor strips to CCh but not to EFS stimulation. Cystometric parameters were significantly improved in animals with double treatment and approximated the control values. Our data suggest that acute colonic inflammation triggers the occurrence of detrusor instability via activation of TRPV1-related pathways. Comparison of the results obtained under in vitro vs. in vivo conditions provides evidence that intact neural pathways are critical for the development of an overactive bladder resulting from pelvic organ cross talk. neurogenic inflammation; chronic pelvic pain; detrusor; contractility COMORBIDITY OF CLINICAL CONDITIONS characterized by chronic pelvic pain (CPP) has recently gained extra attention from physicians and scientists. Painful bladder syndrome/interstitial cystitis, irritable bowel syndrome, nonbacterial prostatitis/CPP syndrome, vulvodynia, and dysmenorrhea form a group of functional disorders with CPP of unknown etiology with the rate of concurrent diagnoses reaching up to 30 -40% (2, 37).Limited understanding of the causes, underlying mechanisms, and symptomatic complexity in patients with multidimensional pelvic pain make CPP disorders extremely difficult to cure. Cli...

Obstructive bowel symptoms are significantly associated with the presence of posterior vaginal wall prolapse, but not with the severity of prolapse.

OBJECTIVE To compare the mean voided volume and bladder sensation during filling cystometry in women with a history of recurrent UTI and controls. PATIENTS AND METHODS This was a case- control study including adult women seen in the urogynecology clinic. Cases were 49 women with at least three documented positive urine cultures >105 colonies/ml in the previous twelve months and no active infection at the time of data collection. Controls were 53 women with stress urinary incontinence and no history of recurrent urinary tract infection or co-existent urge urinary incontinence. We compared bladder diary variables and filling cystometry data in the absence of an active infection. RESULTS There was no significant difference in the median age, parity and BMI of women with a history of recurrent UTI and controls. Median number of voids per day and median number of voids per liter of fluid intake was significantly greater in women with recurrent UTI than controls (12 vs. 7 voids/day and 6 vs. 4 voids/L, P = .005 and .004 respectively). The median average voided volume was significantly lower in women with recurrent UTI than controls (155 vs. 195 mL, P = .008). On filling cystometry, median volumes of strong desire to void and maximum cystometric capacity were significantly lower in women with recurrent UTI than controls (all p < .05). CONCLUSION In the absence of an infection, premenopausal women with a history of recurrent UTI have significantly greater urinary frequency, lower average voided volume and a lower threshold of bladder sensitivity than controls.

Objectives To determine the association between the type and volume of fluid intake and bowel symptoms in women with urinary incontinence. We hypothesize that a lower volume of fluid intake would be associated with greater straining with bowel movements in women with urinary incontinence. Methods We performed a cross sectional study of 256 women presenting with complaints of urinary incontinence from 2009 to 2010. Data on fluid intake, fluid intake behavior, urinary and bowel symptoms was collected using validated questionnaires. The relationship between quartiles of total daily fluid intake and bowel symptoms was analyzed. Results The behavior of restricting fluid intake was reported by 32% women. Increasing quartiles of total daily fluid intake was significantly associated with greater bother from straining with bowel movements (p=0.04). Women with no bother from straining with bowel movements had significantly lower median daily fluid intake (2839 mL) than women with quite a bit of bother (3312 mL, p=0.01). The association between volume of fluid intake and straining with bowel movements persisted after controlling for age, body mass index, history of prolapse or incontinence surgery, and stage of prolapse (p <0.05). There was no association between caffeinated fluid intake and any bowel symptom or between the behavior of restricting fluid intake and any bowel symptom. Conclusion In women with urinary incontinence, higher volume of total fluid intake is reported by women with greater straining with bowel movements. The behavior of fluid restriction is not associated with bothersome bowel symptoms.

Pregnant women have limited knowledge about pelvic floor dysfunction despite being at increased risk for these conditions during and after their pregnancies. This is an area where patient education and empowerment during routine prenatal care could improve.