Adonis K. Hijaz

Stem cell homing factor, CCL7, expression in mouse models of stress urinary incontinence.

Objectives Animal models of vaginal distention (VD) have demonstrated increased expression of chemokine (C-C motif) ligand 7 (CCL7) In this study, we investigated the expression of CCL7 in mice models of simulated birth trauma–induced urinary incontinence using VD and pudendal nerve transection (PNT). Methods Forty-nine mice were divided into 6 groups: VD, sham VD, PNT, sham PNT, anesthesia, and age-matched controls. The urethra, vagina, and rectum were harvested for the expression of CCL7 immediately or 24 hours after assigned procedure. Venous sampling for quantification of serum CCL7 was also performed. An analysis of variance model was used to compare the relative expression of CCL7 in each group. Results Urethral CCL7 expression in the VD group was significantly higher than control group after 24 hours (P < 0.01). There was no difference in the urethral CCL7 expression in PNT, sham PNT, sham VD, or anesthesia groups compared with the controls. No statistically significant difference was noted in the vaginal and rectal expression of CCL7 between any of the groups except for sham PNT. Statistically significant differences were noted in the serum CCL7 expression in the VD, PNT, and sham PNT (P < 0.01 in all) groups after 24 hours compared with the control group. Conclusions This study demonstrates overexpression of urethral CCL7 after VD but not PNT. This suggests that nerve injury does not contribute to the CCL7 overexpression. The overexpression of CCL7 in the serum of mice after VD suggests a translational potential where CCL7 measurement could be used as a surrogate for injury after delivery.

National Surgical Trends and Perioperative Outcomes of Midurethral Sling Placement for Stress Urinary Incontinence

OBJECTIVEnTo determine contemporary trends, patient characteristics, and outcomes for midurethral sling placement (MUS) at inpatient and ambulatory facilities from a national database.nnnMATERIALS AND METHODSnUsing the American College of Surgeons National Surgical Quality Improvement Program database, we identified 7767 women who underwent isolated MUS 2006-2012. We stratified patients by hospitalization type (outpatient vs hospitalization). Primary outcomes were 30-day complications, readmissions, and reoperations. Multivariable logistic regression was used to determine patient and surgery factors associated with adverse perioperative outcomes.nnnRESULTSnAmong the 7767 women undergoing MUS, 84.3% underwent outpatient surgery (nu2009=u20096547), with greater use of outpatient facilities over time (Pu2009<u2009.001). Overall, 3.9% of patients (nu2009=u2009300) experienced one or more postoperative complications. Complications were more likely among inpatients (7.4% vs 3.2%; odds ratio [OR] 0.48, confidence interval [CI] 0.36-0.64, Pu2009<u2009.001), with gynecologists as compared to urologists (4.4% vs 3.1%; OR 1.53, CI 1.16-2.02, Pu2009=u2009.003), and with resident participation (5.1% vs 3.7%; OR 1.32, CI 1.01-1.73, Pu2009=u2009.04). On multivariable analysis, outpatients were less likely to experience readmissions (0.9% vs 2.8%; OR 0.2, CI 0.09-0.56, Pu2009=u2009.002) or undergo reoperation (0.3% vs 3.1%; OR 0.10, CI 0.02-0.38, Pu2009=u2009.001).nnnCONCLUSIONnUse of outpatient surgical centers for MUS is increasing, with lower rates of complications, readmissions, and reoperations compared to inpatient treatment. Although there is a difference in complications by specialty and with resident involvement, overall incidence of complications is low.

ROLE OF URODYNAMICS ON CLINICAL DECISION-MAKING IN PATIENTS WITH URINARY INCONTINENCE AND VOIDING DYSFUNCTION

analysis, we used the prolapse (POPDI) and urinary (UDI) subscales of the PFDI. We used Wilcoxon ranked test and McNemar test for repeated parametric and categorical variables, respectively. RESULTS: Thirty-three women with a mean age of 79 years (65-90) were included in the analysis. The median follow-up was 9 months (3-23 months). Prior to surgery, the median POP-Q stage was 3 (range 2-4). Nearly all (91%) had some incontinence symptoms, and 80% reported symptoms of stress urinary incontinence (SUI). Preoperative urodynamic diagnoses included: urodynamic stress incontinence (USI)

Surgical trends and patient factors associated with the treatment of apical pelvic organ prolapse from a national sample

Introduction and hypothesisProlapse of the vaginal apex can be treated using multiple surgical modalities. We describe national trends and patient characteristics associated with the surgical approach and compare perioperative outcomes of abdominal versus vaginal repair of apical pelvic organ prolapse (POP).MethodsThe 2006–2012 National Surgical Quality Improvement Program Database was queried for abdominal sacrocolpopexy (ASC) and vaginal apical suspensions. Patients were stratified by whether or not concomitant hysterectomy (CH) was performed or whether or not they were post-hysterectomy (PH). Multivariate logistic regressions were adjusted for confounding variables.ResultsA total of 6,147 patients underwent apical POP repair: 33.9% (2,085) ASCs, 66.1% (4,062) vaginal suspensions. 60.0% (3,689) underwent CH. In all cohorts, older patients were less likely to have ASC (CH: OR 0.48, CI 0.28–0.83, pu2009=u20090.008 for ageu2009≥u200960; PH: OR 0.28, CI 0.18–0.43, pu2009<u20090.001). Over time, the proportion of all vaginal and abdominal repairs remained relatively stable. Use of minimally invasive ASC, however, increased over the study period (trend pu2009<u20090.001), and use of mesh for vaginal suspensions decreased (pu2009<u20090.001). ASC had a longer median operative time (PH 174 vs 95xa0min, pu2009<u20090.001; CH 192 vs 127xa0min, pu2009<u20090.001). Complication rates were the same for vaginal repairs and ASC, overall and when sub-stratified by hysterectomy status.ConclusionsNationally, most apical POP repairs are performed via a vaginal route. Older age was predictive of the vaginal route for both CH and PH groups. ASCs had longer operative times. There has been increased utilization of minimally invasive ASC and decreased use of mesh-augmented vaginal suspensions over time.

Survey of pelvic reconstructive surgeons on performance of opportunistic salpingectomy at the time of pelvic organ prolapse repair

Introduction and hypothesisOpportunistic salpingectomy (OS) at the time of benign hysterectomy has recently emerged as a potential primary preventive modality for ovarian cancer. Our objective was to determine whether the reported rate of OS at the time of prolapse surgery is similar to the rate of OS at the time of gynecologic surgery for non-prolapse indications.MethodsAn anonymous online survey was sent to the Society of Gynecologic Surgery members. Responses were divided into surgeons who did and did not perform OS at the time of prolapse repair. Differences between surgeons who did and did not perform OS were evaluated using the chi-square test. Multivariable logistic regression was used to identify which responses related to increased odds of performing OS.ResultsThere were 117xa0(33.1%) completed responses; of these, 98 (83.8%) reported performing OS at the time of prolapse repair, which was similar to the reported rate of OS at the time of hysterectomy for non-prolapse indications, 82.1%. After multivariable logistic regression, performance of salpingectomy at the time of hysterectomy for a non-prolapse indication (aOR: 17.9, 95% CI: 3.11–42.01), use of a laparoscopic or robotic surgical approach (aOR 14.1, 95% CI: 1.81–32.21) and completion of an FPMRS fellowship (aOR: 3.47, 95% CI: 1.20–10.02) were associated with a higher likelihood of performing OS at the time of prolapse repair.ConclusionsOS at the time prolapse repair is performed more frequently with concomitant hysterectomy compared with OS at the time of post-hysterectomy prolapse repair and is similar to rates of OS performed at the time of hysterectomy for non-prolapse indications.

A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics in the Diagnosis of Stress Urinary Incontinence

Purpose: The cough stress test is a common and accepted tool to evaluate stress urinary incontinence but there is no agreement on how the test should be performed. We assessed the diagnostic ability of different cough stress tests performed when varying patient position and bladder volume using urodynamic stress urinary incontinence as the gold standard. The 24‐hour pad test was also evaluated. Materials and Methods: We recruited women who presented to specialty outpatient clinics with the complaint of urinary incontinence and who were recommended to undergo urodynamic testing. A total of 140 patients were randomized to 4 cough stress test groups, including group 1—a comfortably full bladder, group 2—an empty bladder, group 3— a bladder infused with 200 cc saline and group 4—a bladder filled to half functional capacity. The sequence of standing and sitting was randomly assigned. The groups were compared by 1‐way ANOVA or the generalized Fisher exact test. The &kgr; statistic was used to evaluate agreement between the sitting and standing positions. The 95% CIs of sensitivity and specificity were calculated using the Wilson method. ROC analysis was done to evaluate the performance of the 24‐hour pad test. Results: The cough stress test performed with a bladder filled to half functional capacity was the best performing test with 83% sensitivity and 90% specificity. There was no statistically significant evidence that the sensitivity or specificity of 1 cough stress test differed from that of the others. The pad test had no significant predictive ability to diagnose urodynamic stress urinary incontinence (AUC 0.60, p = 0.08). Conclusions: Cough stress tests were accurate to diagnose urodynamic stress urinary incontinence. The 24‐hour pad test was not predictive of urodynamic stress urinary incontinence and not helpful when used in conjunction with the cough stress test.

A genetic female mouse model with congenital genitourinary anomalies and adult stages of urinary incontinence

To characterize the urinary incontinence observed in adult Gli2+/−; Gli3Δ699/+ female mice and identify the defects underlying the condition.