Division of Urogynecology and Reconstructive Pelvic Surgery

The Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Iowa includes Drs. Catherine Bradley and Rene Genadry (urogynecologists) and Diane Elas, ARNP (nurse practitioner with advanced clinical training). University of Iowa Urogynecology clinics focus on the outpatient evaluation and management of female pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, and other urinary and defecatory disorders. Outpatient diagnostic testing is available, including urodynamic tests and cystourethroscopy. We offer a wide spectrum of clinical care for pelvic floor disorders, including nonsurgical (e.g. pessaries and behavioral therapies) and surgical therapies. Clinic-based procedures (such as transurethral bulking injections and intra-detrusor botulinum toxin injections) are offered, as well as outpatient and inpatient surgeries. Special clinical initiatives include our minimally-invasive surgery program for urinary incontinence and prolapse, including outpatient slings and robotic hysterectomy and sacrocolpopexy

Vaginal mesh vs native tissue repairs for prolapse: FDA update and recent evidence

In 2010, 300,000 surgeries were performed in the U.S. for pelvic organ prolapse (POP), and 100,000 of those involved the placement of surgical mesh. The use of mesh in abdominal surgeries for POP has been described for over 50 years, but the first surgical mesh product specifically for POP was approved by the FDA in 2002. Over the last decade, transvaginal mesh POP surgeries have become more common, and mesh “kits” have been approved and are increasingly used for transvaginal POP repair, but clinical trial evidence of their safety and effectiveness has lagged behind rapid adoption into practice

Division of Urogynecology and Reconstructive Pelvic Surgery

The Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Iowa focuses on the outpatient evaluation and management of female pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, and other urinary and defecatory disorders. Outpatient diagnostic testing is available, including urodynamic tests and cystourethroscopy. We offer a wide spectrum of clinical care for pelvic floor disorders, including nonsurgical (e.g. pessaries and behavioral therapies) and surgical therapies. Clinic-based procedures (such as transurethral bulking injections and intra-detrusor botulinum toxin injections) are offered, as well as outpatient and inpatient surgeries. Special clinical initiatives include our minimally-invasive surgery program for urinary incontinence and prolapse, including outpatient slings and robotic hysterectomy and sacrocolpopexy

Leadership for Learning Improvement in Urban Schools

Examines urban school leaders' efforts to improve the quality of teaching and learning by supporting progress for diverse students, sharing leadership work, and aligning resources. Analyzes school environments and coordination of various leadership roles

Vaginal cancer in patient presenting with advanced pelvic organ prolapse: case report and literature review

Background: Vaginal cancer presenting concurrently with stage 4 uterovaginal prolapse is a rare occurrence, representing less than 1% of all gynecologic malignancies. Case: We review the case of an 82-year-old woman who presented for care of prolapse. Examination demonstrated complete uterovaginal prolapse and a vaginal ulcer, later confirmed to be vaginal cancer. Conclusion: The management of these complicated patients is limited by a lack of data available to guide treatment. This case and the literature review highlight the need for a multi-disciplinary approach to treatment and a high level of clinical suspicion for diagnosis of these very challenging cases

Coenzyme Q10 deficiencies: pathways in yeast and humans.

Coenzyme Q (ubiquinone or CoQ) is an essential lipid that plays a role in mitochondrial respiratory electron transport and serves as an important antioxidant. In human and yeast cells, CoQ synthesis derives from aromatic ring precursors and the isoprene biosynthetic pathway. Saccharomyces cerevisiae coq mutants provide a powerful model for our understanding of CoQ biosynthesis. This review focusses on the biosynthesis of CoQ in yeast and the relevance of this model to CoQ biosynthesis in human cells. The COQ1-COQ11 yeast genes are required for efficient biosynthesis of yeast CoQ. Expression of human homologs of yeast COQ1-COQ10 genes restore CoQ biosynthesis in the corresponding yeast coq mutants, indicating profound functional conservation. Thus, yeast provides a simple yet effective model to investigate and define the function and possible pathology of human COQ (yeast or human gene involved in CoQ biosynthesis) gene polymorphisms and mutations. Biosynthesis of CoQ in yeast and human cells depends on high molecular mass multisubunit complexes consisting of several of the COQ gene products, as well as CoQ itself and CoQ intermediates. The CoQ synthome in yeast or Complex Q in human cells, is essential for de novo biosynthesis of CoQ. Although some human CoQ deficiencies respond to dietary supplementation with CoQ, in general the uptake and assimilation of this very hydrophobic lipid is inefficient. Simple natural products may serve as alternate ring precursors in CoQ biosynthesis in both yeast and human cells, and these compounds may act to enhance biosynthesis of CoQ or may bypass certain deficient steps in the CoQ biosynthetic pathway

Persistent postoperative granulation tissue following vaginal prolapse repair

To report rates and risk factors for persistent postoperative granulation tissue (GT) in women undergoing reconstructive vaginal prolapse surgery

Hormonal contraceptive use increases serum 25-hydroxyvitamin D concentrations in active, young women [abstract]

Abstract only availableMany studies have shown that the estrogen in oral hormonal contraceptives (HC) increases serum 25-hydroxyvitamin D 25(OH)D concentrations in women. As a hormone that regulates gene transcription estrogen is known to increase Vitamin-D binding protein concentrations, and therefore 25(OH)D concentrations in the blood. Furthermore, Vitamin D is a major regulator of bone metabolism and its status within the blood influences circulating levels of bone turnover markers. The objective of this study was to determine the effects of HC use on serum 25OHD concentrations and biochemical markers of bone turnover in active young females. Thirty-nine young (age 18-33 years), active (≥5 h of aerobic exercise per week) women participated (HC users, n=16; Non-users, n=23). Of the HC users, 9 were taking monophasic HC; 7 were taking triphasic HC. Fasting serum samples were taken during the early follicular phase (d2-5 of the menstrual cycle) and were analyzed for 25OHD and biochemical bone markers [bone alkaline phosphatase (BAP), N-telopeptide of collagen cross-links (NTx), parathyroid hormone (PTH) and osteocalcin (OC)] using radioimmuno assay and ELISA, respectively. Serum 25OHD was significantly greater (p=.007) and BAP significantly lower (p=.002) in HC users compared with nonusers. No differences were found between groups for NTx, PTH or osteocalcin. Serum concentrations of BAP and Vitamin D were negatively correlated (r= -.453; p=.004). We conclude that HC use is associated with increased serum 25OHD concentrations and lower circulating BAP in young active females

Factors associated with long-term pessary use

Vaginal pessary is a well-established pelvic organ prolapse (POP) treatment, but little evidence about long-term use is available. Our aim was to report the duration of use and investigate predictors of long-term pessary use for POP. We hypothesized that younger, healthier women and women who experienced complications would have shorter duration of use

Identifying barriers to accessing information and treatment for obstetric fistula in Niamey, Niger

Objective: To identify barriers to accessing information and treatment regarding obstetric fistula (OF) unique to Niger encountered by women referred to the National Referral Fistula Center. Method: A questionnaire was administered at the National Referral Fistula Center to 29 women with OF. Qualitative and quantitative statistics were computed. Results: The average individual was 30.4 years old, illiterate and from a rural area. 76.0% had antenatal care, the average labor time was 3.04 days, and 88.0% had a physician-assisted delivery. Barriers to information included rural dwelling, lack of education, lack of understanding of cause despite contact with health care workers, lack of knowledgeable resources to seek advice from or lack of ability/interest, not given specific information about availability of treatment, and not utilizing available resources to disseminate information. Barriers to treatment included lack of information regarding condition and treatment, traditional healer utilization, inability to access adequate care for condition, delay for childbirth recovery, permission needed to seek treatment, cost, timely treatment unavailable, and lack of social support. Conclusion: Improving efficiency of getting women to the hospital at time of delivery, prompt referrals for OF, and using cell phones for disseminating information or accessing transport may benefit women with OF in Niger