Brittany Star Hampton

Epidemiology of Pelvic Floor Dysfunction

The epidemiology of female pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, anal incontinence, and interstitial cystitis/painful bladder syndrome is reviewed. The natural history, prevalence, incidence, remission, risk factors, and potential areas for prevention are considered.

Imaging Pelvic Floor Disorders: Trend Toward Comprehensive MRI

OBJECTIVE The purpose of this article is to review the relevant anatomy and sonographic, fluoroscopic, and MRI options for evaluating patients with pelvic floor disorders. CONCLUSION Disorders of the pelvic floor are a heterogeneous and complex group of problems. Imaging can help elucidate the presence and extent of pelvic floor abnormalities. MRI is particularly well suited for global pelvic floor assessment including pelvic organ prolapse, defecatory function, and pelvic floor support structure integrity.

Magnetic resonance imaging of pelvic organ prolapse: comparing pubococcygeal and midpubic lines with clinical staging

Introduction and hypothesisThe aim of the study was to determine which magnetic resonance imaging (MRI) reference line for staging pelvic organ prolapse, the pubococcygeal line (PCL) vs. the midpubic line (MPL), has the highest agreement with clinical staging.MethodsA retrospective study of women with pelvic floor complaints who underwent dynamic pelvic MRI from January 2004 to April 2007 was conducted. Two radiologists staged descent on MRI for each pelvic compartment (anterior, apical, posterior) by consensus, using PCL and MPL reference lines. Agreement between MRI and clinical staging was estimated using weighted kappas.ResultsTwenty women were included. Agreement between clinical and PCL staging was fair in the anterior (κ = 0.29) and poor in the apical (κ = 0.03) and posterior (κ = 0.08) compartments. Agreement between clinical and MPL staging was fair in the anterior (κ = 0.37), apical (κ = 0.31), and posterior (κ = 0.25) compartments.ConclusionsThe MPL has higher agreement with clinical staging than the PCL. However, neither reference line has good agreement with clinical staging.

Pelvic arterial embolization in the setting of acute hemorrhage as a result of the anterior Prolift® procedure

Acute hemorrhage following pelvic reconstructive surgery is a complication requiring immediate evaluation and treatment. Therapeutic options include fluid resuscitation, tamponade techniques, exploratory surgical intervention, and, more recently, pelvic vessel embolization. New approaches to pelvic organ prolapse have been evolving rapidly with little reported on safety and efficacy. We present a 77-year-old female who had a life-threatening acute pelvic hemorrhage from an anterior Prolift® procedure successfully treated with pelvic artery embolization.

The impact of multichannel urodynamics upon treatment recommendations for female urinary incontinence.

The aim of this study was to evaluate whether multichannel urodynamic testing changes a physician’s treatment recommendations when managing women with urinary incontinence. In this prospective reader study, four fellowship-trained urogynecologists reviewed 39 abstracted cases of urinary incontinence on two occasions: first without and subsequently with urodynamic data. Treatment recommendations were made for each case after each review. The probability of urodynamic data modifying treatment recommendations was estimated for each reader and for the population of readers using a random effects logistic regression to account for reader variability. The overall probability that urodynamic data would change treatment was 26.9% (95% confidence interval (CI), 18.6%, 37.2%) for medical treatments and 45.5% (95% CI, 37.8%, 53.4%) for surgical treatments. Reader-to-reader differences accounted for 3% and <1% of the total variance for medical and surgical treatments, respectively. Multichannel urodynamic evaluations are significantly associated with changes in medical and surgical treatment recommendations in a referral population.

Pyometra necessitating hysterectomy after colpocleisis in an extremely elderly patient.

As the number of women more than the age 65 increases, so will the need for treatment of pelvic organ prolapse and the comorbidities that come with surgical treatment of an aging population gain significance. Colpocleisis is an option for women failing or refusing conservative prolapse management and not desiring sexual function. The advantages of colpocleisis are decreased operative time, low complication rate, and ability to use local or regional anesthesia. We report a case of a 95-year-old woman whose procidentia was treated with colpocleisis. Endometrial evaluation with dilation and curettage was performed at the time of colpocleisis. Postoperative course was complicated by pyometra necessitating total abdominal hysterectomy and bilateral salpingoopherectomy, leading to further complications including deep vein thrombosis, anemia, atrial fibrillation, and pleural effusions. Preoperative versus intraoperative endometrial evaluation may decrease the risk of developing pyometra after colpocleisis and, therefore, diminish the possibility of multiple complications.

Perceptions of Operating Room Learning Experiences During the Obstetrics and Gynecology Clerkship

BACKGROUND There is little published describing curriculum development for the medical student in the operating room (OR). PURPOSE Explore student and faculty perceptions of learning experiences in the OR during the Obstetrics and Gynecology (Ob/Gyn) clerkship as a prelude to defining OR-specific learning objectives and curriculum. METHODS Fourth year students and Obstetrics and Gynecology faculty participated in structured, audiotaped focus groups aimed at defining OR educational objectives and curriculum content. Review of audiotapes identified emergent themes used to categorize perceived learning experiences. RESULTS Two focus groups including 13 students and 1 focus group including 5 faculty were conducted. Four dominant categories of OR learning were identified: (1) development of a foundation of clinical knowledge; (2) surgical technique and skill acquisition; (3) personal insight into career choice; and (4) surgical culture and OR functioning. CONCLUSIONS Students and faculty were aligned regarding general categories of key OR learning experiences, building an experiential framework for developing OR-specific learning objectives and curricular components.

Improving medical student knowledge of female pelvic floor dysfunction and anatomy: a randomized trial

OBJECTIVE The objective of the study was to estimate the effect of an interactive computer trainer on improving medical student knowledge and attitudes regarding female pelvic anatomy (PA) and pelvic floor dysfunction (PFD). STUDY DESIGN Forty-three students were randomized to the trainer and usual teaching vs usual teaching alone. Pre- and postintervention knowledge and attitude questionnaires were completed. Between-group pre- and postintervention scores were analyzed. Multiple linear regression was used to estimate trainer effect on scores, adjusting for confounders. RESULTS There was no difference in baseline scores between groups (P > .05). The trainer group had significantly higher postintervention knowledge (mean score, 15.6 +/- 1.9 vs 12.6 +/- 2.5; P = .007) and attitude (mean score, 19.2 +/- 2.8 vs 15.8 +/- 3.2; P = .001) scores compared with the usual teaching group. On multiple linear regression, the trainer group had significantly higher postintervention knowledge and attitude scores, after adjusting for year of medical education and prior clerkships. CONCLUSION An interactive computer trainer to teach female PA and PFD improves medical student knowledge and attitudes.

To the point: medical education, technology, and the millennial learner

&NA; This article, from the “To The Point” series that was prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, provides an overview of the characteristics of millennials and describes how medical educators can customize and reframe their curricula and teaching methods to maximize millennial learning. A literature search was performed to identify articles on generational learning. We summarize the importance of understanding the attitudes, ideas, and priorities of millennials to tailor educational methods to stimulate and enhance learning. Where relevant, a special focus on the obstetrics and gynecology curriculum is highlighted.

Epidemiologic profile of women presenting to the National Hospital of Niamey, Niger for vaginal fistula repair.

To describe the epidemiologic profile of women with vaginal fistulas presenting to the surgical mission trips of the International Organization for Women and Development (IOWD) at the National Hospital of Niamey, Niger.