Assessing Vaginal Surgical Skills Using Video Motion Analysis

OBJECTIVE: To demonstrate the feasibility of using video motion analysis to quantitate a key step of vaginal hysterectomy and define measurable differences between novice and experienced surgical trainees during vaginal hysterectomy. METHODS: Analyses focused on clamping, transecting, and suturing the left uterosacral ligament. Using a cutoff of 25, trainees were grouped as experienced (n=14) and novice (n=9) based on the total number of vaginal hysterectomies performed by each trainee. Contrasting-groups analysis was used to determine cutoff values that separated novices from experts. RESULTS: Novice trainees took longer (112 seconds compared with 84 seconds) and had greater cumulative translational motion (92 cm compared with 49 cm, P=.05) while performing the task. Experienced trainees placed the Heaney clamp closer to a right angle to the vertical axis (experienced 96° compared with novice 109°, P=.03) while passing the needle through the uterosacral ligament. Trainees move from novice to experts when the steps occur in 112 or fewer seconds, cumulative translational motion is at or less than 75 cm, and the angle between the clamp to bladder retractor is at or below 105°. CONCLUSION: Video motion analysis is a feasible technique to quantify and compare surgical skills objectively during vaginal surgery. There are measurable differences between novice and more experienced surgical trainees performing vaginal hysterectomy that can be quantified using motion analysis

A new outcome measure for LUTS: Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index‐29 (LURN SI‐29) questionnaire

AimsTo develop a representative, self‐report assessment of lower urinary tract symptoms (LUTS) for men and women, the symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index‐29 (LURN SI‐29).MethodsWomen and men seeking treatment for LUTS at one of six academic medical centers in the US were assessed at baseline, 3‐month and 12‐month intervals. Twelve‐month data on 78 LURN SI‐29 items were analyzed among 353 women and 420 men using exploratory factor analysis (EFA), with factor structure confirmed using confirmatory factor analysis (CFA). Internal consistency, reliability, and validity of the five developed scales were evaluated by assessing correlations with the American Urological Association Symptom Index (AUA‐SI), the genitourinary pain index (GUPI), and the Pelvic Floor Distress Inventory‐20 (PFDI‐20), and by examining expected sex differences in scores.ResultsEFA results (n = 150 women; 150 men) produced an interpretable eight‐factor solution, with three of the factors comprised of dichotomous items addressing LUTS‐associated sensations. The remaining five factors, confirmed with CFA in an independent sample of 473 participants, produced five scales: incontinence, urgency, voiding difficulty, bladder pain, and nocturia. Subscales and total LURN SI‐29 scores were correlated as expected with AUA‐SI, GUPI, and PFDI‐20. LURN SI‐29 scores also performed as expected in differentiating men from women based upon clinically expected differences, with men reporting more voiding difficulties and nocturia, and women reporting more urgency and incontinence.ConclusionsThe LURN SI‐29 questionnaire has the potential to improve research and clinical outcome measurement for both men and women with LUTS.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150585/1/nau24067.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150585/2/nau24067_am.pd

Does trocar-guided tension-free vaginal mesh (Prolift™) repair provoke prolapse of the unaffected compartments?

Contains fulltext : 88857.pdf (publisher's version ) (Closed access)INTRODUCTION AND HYPOTHESIS: The objective of this study was to assess the effect of the tension-free vaginal mesh (Prolift) procedure on the non-treated and initially unaffected vaginal compartments. METHODS: This prospective observational cohort study involved 150 patients who underwent a Prolift procedure. Pelvic organ prolapse (POP) quantification and evaluation of prolapse symptoms with validated questionnaires was performed pre-operatively and 6 and 12 months postoperatively. Primary outcome was the rate of POP stage > or = II in the non-treated vaginal compartments. RESULTS: Twenty-three percent of all patients developed a de novo POP stage > or = II in the untreated compartment. This occurred in 46% and 25% of patients after an isolated anterior and isolated posterior Prolift, respectively. CONCLUSION: Tension-free vaginal mesh treatment of one vaginal compartment seems to provoke the development of vaginal prolapse in initially unaffected vaginal compartments, particularly after an isolated anterior Prolift procedure.1 maart 201

Midline fascial plication under continuous digital transrectal control: which factors determine anatomic outcome?

Contains fulltext : 88897.pdf (publisher's version ) (Closed access)INTRODUCTION AND HYPOTHESIS: The aim of the study was to report anatomic and functional outcome of midline fascial plication under continuous digital transrectal control and to identify predictors of anatomic failure. METHODS: Prospective observational cohort. Anatomic success defined as POP-Q stage or= II underwent midline fascial plication under continuous digital transrectal control. Median follow-up was 14 months (12-35 months), and anatomic success was 80.3% (95% CI 75-86). Independent predictors of failure were posterior compartment POP stage >or= III [OR 8.7 (95% CI 2.7-28.1)] and prior colposuspension [OR 5.6 (95% CI 1.1-27.8)]. Sixty-three percent of patients bothered by obstructed defaecation experienced relief after surgery. CONCLUSIONS: Anatomic and functional outcomes were good. Risk factors for anatomic failure were initial size of posterior POP (stage >or= III) and prior colposuspension.1 juni 201

Controlling anal incontinence in women by performing anal exercises with biofeedback or loperamide (CAPABLe) trial: Design and methods

The goals of this trial are to determine the efficacy and safety of two treatments for women experiencing fecal incontinence. First, we aim to compare the use of loperamide to placebo and second, to compare the use of anal sphincter exercises with biofeedback to usual care. The primary outcome is the change from baseline in the St. Mark's (Vaizey) Score 24 weeks after treatment initiation. As a Pelvic Floor Disorders Network (PFDN) trial, subjects are enrolling from eight PFDN clinical centers across the United States. A centralized data coordinating center supervises data collection and analysis. These two first-line treatments for fecal incontinence are being investigated simultaneously using a two-by-two randomized factorial design: a medication intervention (loperamide versus placebo) and a pelvic floor strength and sensory training intervention (anal sphincter exercises with manometry-assisted biofeedback versus usual care using an educational pamphlet). Interventionists providing the anal sphincter exercise training with biofeedback have received standardized training and assessment. Symptom severity, diary, standardized anorectal manometry and health-related quality of life outcomes are assessed using validated instruments administered by researchers masked to randomized interventions. Cost effectiveness analyses will be performed using prospectively collected data on care costs and resource utilization. This article describes the rationale and design of this randomized trial, focusing on specific research concepts of interest to researchers in the field of female pelvic floor disorders and all other providers who care for patients with fecal incontinence

A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth

© 2018, The International Urogynecological Association. Introduction and hypothesis: Anal incontinence following childbirth is prevalent and has a significant impact upon quality of life (QoL). Currently, there is no standard assessment for women after childbirth to identify these symptoms. This systematic review aimed to identify non-invasive modalities used to identify women with anal incontinence following childbirth and assess response and reporting rates of anal incontinence for these modalities. Methods: Ovid Medline, Allied and Complementary Medicine Database (AMED), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Collaboration, EMBASE and Web of Science databases were searched for studies using non-invasive modalities published from January 1966 to May 2018 to identify women with anal incontinence following childbirth. Study data including type of modality, response rates and reported prevalence of anal incontinence were extracted and critically appraised. Results: One hundred and nine studies were included from 1602 screened articles. Three types of non-invasive modalities were identified: validated questionnaires/symptom scales (n = 36 studies using 15 different instruments), non-validated questionnaires (n = 50 studies) and patient interviews (n = 23 studies). Mean response rates were 92% up to 6 weeks after childbirth. Non-personalised assessment modalities (validated and non-validated questionnaires) were associated with reporting of higher rates of anal incontinence compared with patient interview at all periods of follow-up after childbirth, which was statistically significant between 6 weeks and 1 year after childbirth (p < 0.05). Conclusions: This systematic review confirms that questionnaires can be used effectively after childbirth to identify women with anal incontinence. Given the methodological limitations associated with non-validated questionnaires, assessing all women following childbirth for pelvic-floor symptomatology, including anal incontinence, using validated questionnaires should be considered