Mesh Exposure and Associated Risk Factors in Women Undergoing Transvaginal Prolapse Repair with Mesh

Objective. To determine frequency, rate, and risk factors associated with mesh exposure in women undergoing transvaginal prolapse repair with polypropylene mesh. Methods. Retrospective chart review was performed for all women who underwent Prolift Pelvic Floor Repair System (Gynecare, Somerville, NJ) between September 2005 and September 2008. Multivariable logistic regression was performed to identify risk factors for mesh exposure. Results. 201 women underwent Prolift. Mesh exposure occurred in 12% (24/201). Median time to mesh exposure was 62 days (range: 10–372). When mesh was placed in the anterior compartment, the frequency of mesh exposure was higher than that when mesh was placed in the posterior compartment (8.7% versus 2.9%, P=0.04). Independent risk factors for mesh exposure were diabetes (AOR = 7.7, 95% CI 1.6–37.6; P=0.01) and surgeon (AOR = 7.3, 95% CI 1.9–28.6; P=0.004). Conclusion. Women with diabetes have a 7-fold increased risk for mesh exposure after transvaginal prolapse repair using Prolift. The variable rate of mesh exposure amongst surgeons may be related to technique. The anterior vaginal wall may be at higher risk of mesh exposure as compared to the posterior vaginal wall

Risk Factors for Fecal and Urinary Incontinence After Childbirth: The Childbirth and Pelvic Symptoms Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73402/1/j.1572-0241.2007.01364.x.pd

Risk factors for mesh/suture erosion following sacral colpopexy

To identify risks for mesh/suture erosions following sacrocolpopexy (ASC)

The impact of fecal and urinary incontinence on quality of life 6 months after childbirth

The objective of the study was to investigate the impact of postpartum fecal incontinence (FI) and urinary incontinence (UI) on quality of life (QOL)

Enhancing Participation of Older Women in Surgical Trials

Older participants are often excluded from clinical trials, precluding a representative sample

A multicentered comparison of measurements obtained with microtip and external water pressure transducers

This study compared simultaneous intravesical pressure readings obtained with catheter-mounted microtip transducers and external water pressure transducer catheters during filling cystometry. Women undergoing multichannel urodynamic testing were randomly assigned to one of three groups: two microtip catheters, two external water pressure transducer catheters, or one of each type. Intravesical pressure was measured simultaneously for each transducer combination in each subject for minimal and maximal Valsalva effort and minimal, moderate, and maximal cough effort at two sequential bladder volumes (150 and 300 ml). Paired t tests were used to compare the means of the intravesical pressure obtained by the two types of catheters. The largest mean differences were observed when comparing microtip and water pressure transducers. Correlations of maximum pressure were consistently high between two microtip transducers and two water pressure transducers but lower for the microtip–water combination. Excellent reproducibility was demonstrated with transducers of similar types for intravesical pressures recorded during Valsalva and cough in women without prolapse. However, considerable variability was seen in pressures recorded by different transducers, particularly dependent on the water catheter manufacturer, indicating that intravesical pressure recordings from microtip and water-based systems are not interchangeable.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45850/1/192_2005_Article_27.pd

30-Day unanticipated healthcare encounters after prolapse surgery: impact of same day discharge

© 2019 Elsevier Inc. Background: Same-day discharge is becoming increasingly common in gynecologic surgery; however, data are limited for frequency, setting, and severity of unanticipated healthcare visits for women who are discharged on the day of surgery after major prolapse repair. Objective: The purpose of this study was to evaluate whether discharge on the day of surgery is associated with increased 30-day unanticipated healthcare encounters after major pelvic organ prolapse surgery compared with discharge on or after postoperative day 1. Study Design: This is a retrospective analysis of women who underwent pelvic organ prolapse surgery by 8 female pelvic medicine and reconstructive surgery surgeons from January 2016 to October 2017. Unanticipated healthcare encounter was a composite variable of any visit to the office, emergency department, or hospital readmission. Number of visits, visit diagnoses, and complication severity (Clavien-Dindo classification) were compared by day of discharge with the use of χ2 tests. Multivariable analyses were performed. Results: Of 405 women, 258 (63.7%) were discharged on the day of surgery, and 147 (36.3%) were discharged on postoperative day 1 or later. Mean age was 66±11 years, body mass index was 27.9±4.8 kg/m2. Most had stage III prolapse (n=273; 67.4%). Procedures included laparoscopic or robotic sacrocolpopexy, (n=163; 40.2%), vaginal apical suspensions (n=115; 28.4%), obliterative (n=105; 25.9%), and concomitant hysterectomy (n=229; 56.5%). There was no increase in the number of women with at least 1 unanticipated healthcare encounter within 30 days of surgery, based on discharge on the day of surgery compared with postoperative day 1 (24.0% vs 26.5%; P=.572). The majority of visits occurred in the office (17.8% vs 19.0%; P=.760). There was no increase in 30-day readmissions (3.5% vs 4.8%; P=.527). The most common visit diagnosis was pain and accounted for 31.5% of all visits, followed by urologic and gastrointestinal symptoms. Diagnoses and complication severity did not vary by day of discharge, except that women who were discharged on the day of surgery were more likely to have a superficial wound separation (11.3% vs 0%; P=.011) and less likely to experience grade II complications (7.4% vs 15.6%, P=.009). Few women had \u3e1 unscheduled visit, and rates were similar between the 2 groups (6.2% vs 6.8%; P=.810). On multivariable regression, younger women (adjusted odds ratio, 1.03; 95% confidence interval, 1.001–1.05), those with lower body mass index (adjusted odds ratio, 1.07; 95% confidence interval, 1.13–1.01), and higher initial postanesthesia recovery unit pain scores (adjusted odds ratio, 1.11; 95% confidence interval, 1.02–1.21) were more likely to have an unanticipated healthcare encounter. Pain complaints were evaluated most often in the office compared with the emergency department (41.1% vs 13.0%); medical complications such as cardiac (15.6% vs 0%) and respiratory (6.5% vs 0%) were more likely to be evaluated in the emergency department. Higher grade complications (II/III) were more likely to visit the emergence department (78.2% vs 27.1%; P\u3c.0001). Conclusion: Same-day discharge after prolapse surgery did not result in an increase in 30-day unanticipated healthcare encounters