Howard B. Goldstein

Hydrodistention of the bladder for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC)

The purpose of this study is to determine whether a transvaginal trigonal block immediately preceding cystoscopy with hydrodistention yields an additional therapeutic benefit compared to cystoscopy with hydrodistention alone for the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC).

Surgical Outcomes of Paravaginal Repair After Robotic Sacrocolpopexy

STUDY OBJECTIVE To evaluate surgical outcomes of robotic sacrocolpopexy with and without paravaginal repair for pelvic organ prolapse (POP). DESIGN A retrospective cohort study with a 3-month postoperative follow-up (Canadian Task Force classification II-3). SETTING An academic-affiliated community hospital with a practice comprised of 3 surgeons board certified in female pelvic medicine and reconstructive surgery. PATIENTS Patients undergoing robotic sacrocolpopexy for POP from April 2013 through November 2014. INTERVENTIONS Robotic paravaginal repair (RPVR) after robotic sacrocolpopexy. The decision to perform a paravaginal repair was at the discretion of the surgeon. MEASUREMENTS AND MAIN RESULTS One hundred fifty-six patients underwent a robotic sacrocolpopexy. Twenty-four patients were excluded because of a lack of a 3-month postoperative follow-up. Nine patients underwent concomitant vaginal paravaginal repair and were also excluded. Outcomes were defined by comparing preoperative characteristics with those at the 3-month follow-up. Of the 123 patients in this cohort, 21 patients underwent a concomitant RPVR, and 102 did not. All Pelvic Organ Prolapse Questionnaire (POP-Q) points improved within groups (p < .001) except for the total vaginal length (TVL) in the RPVR group (p = .940). The Patient Global Impression of Improvement (PGI-I) did not differ between groups (1.2 vs 1.5, p = .128). Subgroup analysis was performed on patients with preoperative anterior wall prolapse of stage 3 or greater. Baseline characteristics and perioperative data were not remarkably different from the main cohort. All POP-Q points improved within groups (p < .001) except for the TVL in the RPVR group (p = .572). The PGI-I did not differ between groups (1.2 vs 1.3, p = .378). CONCLUSION In both groups, anatomic markers substantially improved within each group. There were significant differences in postoperative POP-Q findings, which may have been influenced by the fact that patients undergoing RPVR usually had worse baseline prolapse. This selection bias creates difficulty with interpretation. Although in this study RPVR did not change subjective outcomes, further study is necessary to control for the severity of prolapse.

Surgical Outcomes of Paravaginal Repair Following Robotic Sacrocolpopexy

Study Objective: To determine if peritoneal washings of the abdominopelvic cavity during laparoscopic myomectomy can detect leiomyoma cells after power morcellation. Design: Pilot prospective cohort study. Setting: University of North Carolina Hospitals, an academic, tertiary referral center. Patients: Patients undergoing laparoscopic or robotic myomectomy for suspected benign leiomyoma by members of the Minimally Invasive Gynecologic Surgery division, September 2014-January 2015. Intervention: Washings of the peritoneal cavity were collected at three times during surgery: (1) the beginning of the procedure once the peritoneal cavity has been accessed laparoscopically, (2) after the myoma has been excised and myometrial incision closed, and (3) following uncontained power morcellation. Measurements and Main Results: Ten patients were recruited. The median age was 36 years and the median BMI was 25 kg/m2. The median morcellation time was 18.5 minutes (range 2–36). In all cases, pathology was consistent with benign leiomyomata. The median specimen weight was 301 grams (range 50–935). Cytologic evaluation using ThinPrep (Hologic, Bedford MA) with Papanicolaou staining did not detect any smooth muscle cells. Cell block histology, however, detected spindle cells on four post-morcellation samples (time 3). Two of these four samples also had spindle cells detected on the post-myomectomy closure samples (time 2). Desmin and smooth muscle actin immunostaining performed on these four samples were positive, confirming the presence of smooth muscle cells in the samples after morcellation. Conclusion: Collecting peritoneal washings is a simple method that could potentially detect leiomyoma cells after power morcellation. Performing cell blocks seems to be necessary to detect the smooth muscle cells as ThinPrep cytology failed to identify smooth muscle cells when present. A quantitative measure of tissue dissemination would allow future researchers test comparative safety of new morcellation methods.