Dara Shalom

The prevalence of microscopic hematuria in a cohort of women with pelvic organ prolapse.

Introduction and hypothesisIn 2012, the American Urological Association (AUA) revised its guidelines for microscopic hematuria (MH). We hypothesize that the prevalence of MH is greater in women with pelvic organ prolapse than in the general population.MethodsAll patients presenting to an outpatient urogynecological center with prolapse between January 2008 and December 2011 were reviewed. Exclusion criteria included: pregnancy, presence of gross hematuria, menses, or urological pathology. MH was defined as ≥3 red blood cells per high power field on one urinalysis specimen with a negative urine culture, and the prevalence of MH was calculated. Statistical analysis was performed.ResultsOne thousand and forty women with pelvic organ prolapse were included in the analysis. Mean age was 64.1xa0years (range 20 to 96) and mean parity was 2.7 (range 0 to 12). Two hundred and nine out of 1,040 met the criteria for MH. No cases of urological malignancy were diagnosed in patients who underwent further workup. One hundred and ninety-seven patients with MH (93.4xa0%) had cystoceles on examination.ConclusionsThis is the largest study to investigate MH in women with prolapse based on the new guidelines. The prevalence of MH was 20.1xa0% in our study population. Cystoscopy, renal function testing, and CT urography are now recommended after one positive urinalysis, regardless of gender or the presence of prolapse. Owing to the low incidence of urological malignancy detected as well as the increased prevalence of MH found in women with prolapse, specific guidelines for the management of MH in this population are needed.

Sacral nerve stimulation reduces elevated urinary nerve growth factor levels in women with symptomatic detrusor overactivity

OBJECTIVESnTo investigate changes in urinary nerve growth factor (uNGF) in women with symptomatic detrusor overactivity (DO) following peripheral nerve evaluation (PNE) for sacral neuromodulation vs controls.nnnSTUDY DESIGNnThere were 23 subjects with overactive bladder symptoms and DO who failed management with anticholinergics and 22 controls consented to participate in this prospective pilot study. Urine specimens were collected from controls at baseline for evaluation of uNGF and creatinine. Subjects were evaluated at baseline and 5 days after a trial of sacral nerve stimulation referred to as a PNE. Each visit included urine collection for uNGF and, Incontinence Quality of Life Questionnaire, Urinary Distress Inventory Questionnaire, postvoid residual volume, and a 3-day voiding diary. uNGF levels were measured by enzyme-linked immunosorbent assay and expressed as uNGF pg/creatinine mg.nnnRESULTSnSubjects with DO had significantly higher baseline uNGFxa0levels (corrected for creatinine) compared with controls (19.82 pg/mg vs 7.88 pg/mg, P < .002). Seventeen DO subjects underwent PNE and were evaluated at the end of the testing period. There was a significant improvement in quality of life scores for subjects after PNE compared with baseline (Urinary Distress Inventory Questionnaire: 7.0 vs 13.7, P < .001; Incontinence Quality of Life Questionnaire: 87.3 vs 52.8, P < .0001). Concordantly, uNGF levels significantly decreased from 17.23 pg/mg to 9.24 pg/mg (P < .02) after PNE.nnnCONCLUSIONnuNGF levels decrease with symptomatic response in DO subjects undergoing PNE. DO subjects had significantly higher uNGF at baseline vs controls, and uNGF levels significantly decreased after only 5 days of sacral nerve stimulation. These findings support a larger study to validate the use of uNGF as an objective tool to assess therapeutic outcome in patients undergoing PNE for sacral neuromodulation.

Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse

Introduction and hypothesisThe aim of this study was to investigate factors associated with long-term pessary use in patients with advanced pelvic organ prolapse (POP).MethodsThis was a retrospective chart review of patients with POP of stage ≥2 managed with a pessary. Patients were excluded if the date of fitting or follow-up was unavailable. Long-term use was defined as more than 1xa0year. Patient demographics, pessary fitting, and follow-up visit dates were collected. The primary end point was the duration of use and the prognostic impact of pessary type. Secondary objectives addressed other influencing factors including age, estrogen use, and prolapse stage. The data were analyzed using SPSS version 21.ResultsThe final analysis included 311 patients. The mean (±u2009standard deviation, SD) duration of pessary use was 7.0u2009±u20090.72xa0years (median 5.7xa0years). Long-term use was found in 76xa0% (164) of these patients. Factors associated with longer use were age >65xa0years (pu2009=u20090.004) and estrogen use (pu2009=u20090.048). The estimated mean (±u2009SD) durations of use of the Gellhorn, open ring, ring with support, cube and donut pessaries were 10.5u2009±u20090.7xa0years, 3.4u2009±u20090.6xa0years, 1.8u2009±u20090.2xa0years, 1.8u2009±u20090.3xa0years and 1.7u2009±u20090.5xa0years, respectively. The Gellhorn pessary was associated with significantly longer use than other pessary types (10.5u2009±u20090.7, pu2009<u20090.0000001); this finding was independent of age, prolapse stage, hysterectomy, and vaginal estrogen use.ConclusionsIn this retrospective analysis, the duration of use was longest with the Gellhorn pessary. Older age and vaginal estrogen use were associated with longer pessary use.

Quality of life after treatment with midurethral sling and concomitant prolapse repair in patients with mixed versus stress urinary incontinence

To compare quality of life in patients with mixed urinary incontinence (MUI) to stress urinary incontinence (SUI) after treatment with a retropubic midurethral sling and concomitant prolapse repair.

Comparison of strength of sacrocolpopexy mesh attachment using barbed and nonbarbed sutures

Introduction and hypothesisWe aimed to assess the pull-out strength of barbed and nonbarbed sutures used in sacrocolpopexy mesh fixation. We hypothesized there are no differences in the force needed to dislodge mesh from tissue using barbed and nonbarbed sutures of similar size.MethodsUsing the rectus fascia of three unembalmed cadavers, a 6xa0×xa03xa0cm strip of polypropylene mesh was anchored to the fascia with sutures. The barbed sutures investigated were 2-0xa0V-Loc 180 (nine trials) and 3-0 bidirectional Quill™ SRS PDO (five trials). The nonbarbed sutures included 2-0 PDS (nine trials), CV-2 GORE-TEX (nine trials) and 2-0 Prolene (nine trials). The free-end of the mesh was anchored to a pulley system fixed to a tensiometer to measure the peak force applied at the moment of mesh dislodgement (termed the pull-out force). The pull-out force was recorded. Continuous variables are presented as medians and interquartile ranges (IQR). Analysis of variance was used to compare the forces across the suture types.ResultsThe highest pull-out force observed was with GORE-TEX (median 65.14xa0N, IQR 53.37–68.77xa0N) followed by Prolene (median 58.98xa0N, IQR 54.64–62.59xa0N), V-Loc (median 55.23xa0N, IQR 51.60–58.57xa0N), PDS (53.96xa0N, IQR 51.60–57.88xa0N), and Quill (44.44xa0N, IQR 17.27–47.38xa0N). All 2-0 and CV-2 caliber sutures had greater pull-out forces than 3-0 Quill sutures (pxa0<xa00.01). No significant differences in pull-out forces were observed between 2-0 and CV-2 caliber sutures (pxa0>xa00.05). In 35 of the 41 trials (85%), the mesh sheared from the tissue.ConclusionCV-2 ad 2-0 barbed and nonbarbed sutures had similar pull-out forces in an assessment of mesh fixation strength.

19: Randomized controlled trial of two voiding trials after midurethral sling with or without colporrhaphy

Introduction and hypothesis nTo compare the force of the stream (FOS) voiding trial with the standard voiding trial (SVT) after outpatient midurethral sling (MUS) whether or not colporrhaphy was performed.