Adam Gafni-Kane

Enhanced interpretability of the PFDI‐20 with establishment of reference scores among women in the general population

To enhance the interpretability of the PFDI‐20 by establishing a score distribution for women in the general population and to determine whether scores correspond with urinary and anal incontinence (UI and AI).

Foreign-body granuloma after injection of calcium hydroxylapatite for type III stress urinary incontinence.

BACKGROUND: Foreign-body granuloma is a potential complication of periurethral injection of calcium hydroxylapatite for the treatment of type III stress urinary incontinence. CASES: We present two cases of foreign-body granuloma formation after periurethral injection of calcium hydroxylapatite for type III stress urinary incontinence. Excision of the lesion resulted in cessation of pain in a symptomatic patient; however, it led to the resumption of stress urinary incontinence in both cases. CONCLUSION: Foreign-body granuloma is not the normative response to periurethral bulking with calcium hydroxylapatite. However, granuloma should be considered when a periurethral mass is encountered after injection of calcium hydroxylapatite for type III stress urinary incontinence.

Extrasphincteric perianal fistulae after sacrospinous fixation for apical prolapse.

BACKGROUND: Delayed extrasphincteric perianal fistulae may be encountered after sacrospinous vaginal vault suspension or hysteropexy with permanent sutures. CASES: We report two cases of extrasphincteric perianal fistulae: one after a sacrospinous vaginal vault suspension and one after a sacropsinous hysteropexy. Reproduction of the vaginal dissection performed to place the sacrospinous fixation sutures failed to expose the sutures, and the fistulae persisted. Perianal fistulotomy and fistulectomy, however, resulted in identification and excision of the sutures. CONCLUSION: Perianal fistulotomy or fistulectomy offers the most successful approach to identifying the inciting sutures.

An automatic female pelvic medicine and reconstructive surgery registry and complications manager developed in an electronic medical record.

Objectives The aim of this study is to incorporate a structured clinical documentation system (SCDS) into the electronic medical record (EMR), allowing for automatic flow of clinical data into an enterprise data warehouse (EDW) and clinical registry. Methods The SCDS programming was developed within inpatient and ambulatory EMR domains, allowing routine documentation in these settings to trigger data flow into an EDW. An extensive set of clinical outcomes was included, focusing on data points likely to exist in the forthcoming American Urogynecologic Society Pelvic Floor Disorders Registry. An electronic complications manager was developed to link immediate and/or delayed complications to the index surgery, allowing for accurate morbidity tracking. Results All aspects of EMR documentation were successfully reconfigured for charting in both inpatient and office settings. Clinicians transitioned to clinical documentation such that no additional data entry beyond routine charting was required, and this resulted in data flow into the EDW. Physician feedback led to the refinement of SCDS entry fields. Conclusions This SCDS system allows for automatic flow of a comprehensive data set from our EMR into an EDW and registry. It also provides the ability to systematically track complications and longitudinal clinical outcomes. Integrated systems may eliminate barriers associated with free-standing registries including those relating to cost, maintenance, data integrity, and consistent clinician participation. In addition, it should improve ascertainment of a complete patient population in comparison to voluntary registries.

Factors influencing women's participation in urogynecology research in the UK and USA†‡

To explore factors influencing willingness to participate in urogynecology trials and explore associations between demographics, quality of life score (ICIQ‐SF), and willingness to participate.

Predictive modeling and threshold scores for care seeking among women with urinary incontinence: The short forms of the Pelvic Floor Distress Inventory and Urogenital Distress Inventory

To further the interpretability of the Pelvic Floor Distress Inventory (PFDI‐20) and Urogenital Distress Inventory (UDI‐6) by (i) evaluating the ability of these measures to distinguish between women with urinary incontinence who do and do not seek care, (ii) defining PFDI‐20 and UDI‐6 threshold scores above which women with urinary incontinence seek care, and (iii) developing a predictive model for incontinence care seeking.

Postoperative pain and perceptions of recuperation after suture‐ and mesh‐based apical sacrospinous ligament suspension

To compare the incidence of postoperative pain after suture‐ or mesh‐based sacrospinous ligament suspension (SSLS).

Impact of endometriosis on IVF outcomes

Endometriosis, a disease of reproductive-age women, is defined by the identification of aberrant growth of endometrial glands or stroma in sites outside of the uterine cavity. Endometriosis is a spectrum of disease spanning from minimal disease (stage I; <5 mm of peritoneal implants) to severe disease (stage IV; ovarian endometriomas and pelvic adhesions). Often, women with endometriosis require IVF to conceive. However, to date, there is a lack of large, randomized controlled trials that assess the efficacy of IVF in the treatment of infertility in women with endometriosis. Whether endometriosis is culpable in depressing the natural fecundity of affected women remains controversial. Similarly debated are the adverse effects of endometriosis on the success of IVF. This review examines the purported means by which endometriosis may render a women either subfertile or infertile. These associations include: embryotoxicity, altered endometrial receptivity, dysfunctional implantation, poorer oocyte quality and...