Joseph M. Novi

Exercise and urinary incontinence in women

Urinary incontinence is a common problem in women and may significantly impair their quality of life. Although women often report stress urinary incontinence during exercise, current data indicates that most types of exercise are not a risk factor for the development of urinary incontinence. However, certain extreme high-impact sports such as parachute jumping may cause pelvic organ support defects that result in stress urinary incontinence. Eating disorders also increase the risk of urinary incontinence in athletes. Overall, women should be encouraged to pursue physical activity that will benefit their general health without the risk of development of urinary incontinence later in life. Women athletes should be counseled about the increased risk of urinary incontinence with ultra high-impact sports and eating disorders. Target Audience: Obstetricians & Gynecologists, Family Practitioners Learning Objectives: After completion of this article, the reader should be able to list the most common types of urinary incontinence, to outline the risk factors for the development of urinary incontinence, and to describe the pathogenesis of exercise-associated urinary incontinence.

Postoperative voiding dysfunction following posterior colporrhaphy.

Objective The primary objective of this study was to evaluate the rate of postoperative urinary retention in patients undergoing posterior colporrhaphy. This is compared with the rate of postoperative urinary retention in patients undergoing suburethral sling placement. Methods A retrospective analysis of women treated surgically for either a symptomatic posterior compartment defect or stress urinary incontinence was performed. The preoperative, operative, and postoperative records of women who underwent a sole procedure of a posterior colporrhaphy or tension-free suburethral sling by 2 fellowship-trained urogynecologists were reviewed and compared. Results Significantly more posterior colporrhaphy patients failed their voiding trial (32.4% ± 12%) than suburethral sling patients (15% ± 17%; P = 0.030). After replacement of a Foley catheter, the total length of catheterization was longer in the posterior colporrhaphy group (3.2 ± 0.9 days) than that in the suburethral sling group (1.8 ± 0.4 days; P = 0.007). No patients in either group demonstrated long-term voiding dysfunction, and no patients required further surgical management to reverse their transient voiding dysfunction. Conclusions In this study, the rate of postoperative transient urinary retention following posterior colporrhaphy is 32.4%, which is significantly higher than the rate observed following suburethral sling placement. Although the reason for this higher rate is unclear, it may be related to postoperative pain. Although it is standard practice to assess voiding function after suburethral sling placement, the findings of our study suggest that physicians should also consider assessing postoperative voiding function following posterior colporrhaphy.

Conservative management of vesicouterine fistula after uterine rupture

We report the closure of a vesicouterine fistula with conservative management utilizing an indwelling transurethral Foley catheter. Uterine rupture occurred during a trial of vaginal birth after cesarean section, necessitating an emergency cesarean section. Upon entry into the abdomen, the base of the bladder was noted to be involved in the uterine rupture. The bladder trigone and ureteral orifices appeared normal. A primary, two-layer bladder repair was performed. A cystogram on postoperative day 14 demonstrated a vesicouterine fistula. Conservative management involving bladder drainage for 21 days with a transurethral Foley catheter was successful in closure of the fistula.Vesicouterine fistula, a documented complication of uterine rupture due to attempted vaginal birth after previous cesarean section, can spontaneously resolve with conservative management alone.

Sexual Dysfunction in Perimenopause A Review

Sexual dysfunction is a common problem for women and often impairs their quality of life. Many women are reluctant to discuss these issues with their physicians. The perimenopause presents unique changes in sexual function. At this time, women and their partners undergo numerous physiologic, psychologic, and social/cultural changes. Women should be encouraged to engage their physicians in discussions to help them maintain a satisfying sexual life during this time of change. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to describe the types of female sexual disorders, summarize a plan of treatment for the different female sexual disorders, and outline special conditions during the perimenopause which might affect sexual function.

Fecal incontinence in women: A review of evaluation and management

Fecal incontinence is a socially and psychologically distressing condition affecting a substantial number of women worldwide. It can have a major impact on the quality of life of those patients who are afflicted. Many therapeutic options exist for the treatment of fecal incontinence, but identifying affected patients remains an elusive and important first step in the evaluation process. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to explain the mechanism of fecal incontinence, to outline the workup of a patient with fecal incontinence, and to summarize the potential treatment options for fecal incontinence.

The association between post-void leakage and coital incontinence and intrinsic sphincter deficiency among women with urinary incontinence.

Objective: To identify whether an association exists between post-void urinary leakage and/or coital incontinence and the diagnosis of intrinsic sphincter deficiency (ISD) among women with urinary incontinence. Methods: Ninety women presenting to a tertiary urogynecology office with complaints of urinary incontinence were included in this retrospective chart review. All patients underwent a complete history and physical examination, including direct questioning about the symptoms of post-void leakage and coital incontinence. Multichannel urodynamic testing was evaluated for each patient and ISD was defined by a Valsalva leak point pressure of less than or equal to 60 cm H2O and/or a maximal urethral closure pressure of less than or equal to 20 cm H2O. The prevalence of ISD among those patients with post-void leakage and/or coital incontinence was evaluated. Results: The prevalence of ISD among the study population was 64%. Intrinsic sphincter deficiency was diagnosed in 45/62 patients with post-void leakage and in 13/28 patients without post-void leakage (72.6% and 46.4%, respectively, P = 0.0311). Intrinsic sphincter deficiency was present in 21/24 patients with coital incontinence and 37/66 patients without coital incontinence (87.5% and 56.1%, respectively, P = 0.0061). Patients with both symptoms were diagnosed with ISD 90% of the time, while only 41.7% of patients with neither symptom had ISD (P = 0.0014, sensitivity = 64.5%). Patients with either symptom were diagnosed with ISD 72.7% of the time, compared to 41.7% of patients with neither symptom (P = 0.0117, sensitivity = 82.8%). The positive predictive value for coital incontinence alone and ISD was 87.5%, and for both symptoms was 90%. Conclusions: The symptoms of post-void leakage and coital incontinence are associated with ISD. The strong positive predictive value of both symptoms with ISD should encourage physicians to include direct questioning about these symptoms during the history taking and treatment planning for women with urinary incontinence.

48: Long-term anatomic and symptomatic outcomes for women who have undergone abdominal sacrohysteropexy

S602 American Journal of Obstetrics & Gynecology Supplement to MARCH 2 48 Long-term anatomic and symptomatic outcomes for women who have undergone abdominal sacrohysteropexy K. Roberts, N. Book, J. Novi OB/GYN, Riverside Methodist Hospital, Columbus, OH OBJECTIVES: To describe the anatomic and symptomatic outcomes of women treated with abdominal sacrohysteropexy (ASH). MATERIALS AND METHODS: We performed a retrospective chart review with prospective physical examination and quality of life measures for women who have undergone ASH. The ASH was performed at a single institution by a board certified Urogynecologist. All patients had a piece of hand tailored Gynemesh affixed to the posterior vaginal wall and sacral promontory. Women who had completed childbearing had a second piece of Gynemesh affixed to the anterior vaginal wall, passed through a window created in the broad ligament, and affixed to the sacral promontory. For women who were uncertain or desired future childbearing, the anterior dissection was not performed. Postoperative pelvic examinations were performed by a Urogynecology fellow independently of the surgeon who performed the surgical procedures, including supine POP-Q and standing examinations. Quality of life was assessed with the Incontinence Impact Questionnaire-7 (IIQ-7), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12), and Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20). RESULTS: Sixteen patients underwent ASH between 2006 and 2012 and met inclusion criteria. Thirteen women (81.3%) were available for follow-up. At baseline, all patients had a presenting complaint of pelvic organ prolapse, 6 reported stress urinary incontinence, and 2 reported mixed urinary incontinence. At initial presentation, mean (standard deviation [SD]) BMI was 26.6 (5.7). The number of patients in prolapse stages were: apical stage 0-I: 1, apical II-III: 12; anterior 0-I: 2, anterior II-III: 11; posterior 0I: 2, posterior II-III: 11. Mean (SD) operating time was 141 (36) minutes, average (SD) estimated blood loss was 114 (48) milliliters. Mean follow-up time was 40.9 (17.7) months. Postoperatively, mean (SD) BMI was 28.1 (5.9). The number of patients in prolapse stages were: apical stage 0-I: 13, apical II-III: 0; anterior 0-I: 10, anterior II-III: 2; posterior 0-I: 13, posterior II-III: 0. All stages were statistically significantly improved from preoperative staging. Postoperatively, 2 patients had a stage II cystocele, but both were asymptomatic. One patient had anterior wall mesh erosion, which was treated successfully with estrogen cream. Three patients had attempted pregnancy. At the time of follow-up, one patient had carried to term, and delivered via uncomplicated cesarean section. Another was 12 weeks pregnant. The last was attempting to get pregnant, although HSG demonstrated lack of dye spillage from a fallopian tube. Average (SD) PISQ-12, PFDI-20, and IIQ-7 scores were 37.6 (4.7), 38.6 (43.9), and 1.1 (2.5), respectively. CONCLUSION: Our study presents optimistic anatomic and symptomatic results from ASH. At an average of 40.9 months postoperatively, none of the thirteen patients had required further evaluation for prolapse or incontinence. Two of three patients who desired childbearing were able to achieve pregnancy, and one delivered via uncomplicated cesarean section. All quality of life post-operative scores indicated a high quality of life.

Inflammatory bowel disease and interstitial cystitis: is there an association?

Purpose: To prospectively determine the prevalence of Inflammatory bowel disease (IBD) in Interstitial cystitis (IC). IC is a chronic, debilitating disease, predominantly diagnosed in women, which remains a diagnosis of exclusion with no distinctive tissue pathology. Self reported questionnaire data from IC patients revealed a prevalence of IBD that was100 times higher than that in the general population; the prevalence in the latter is 0.05 to 0.1%.