Kyle Wohlrab

Management of Laparoscopic Bladder Injuries

Injuries to the urinary system have been reported in up to 8% of minimally invasive gynecologic surgeries. Intraoperative recognition of a bladder injury allows for immediate repair and decreased postoperative morbidity rates. Although laparoscopic repair of such injuries requires advanced surgical skills, it affords the patient the benefits of minimally invasive surgery. In addition, laparoscopic visualization of the intravesical anatomy may help to delineate the relationship of the ureters to the bladder injury, thus avoiding further complication. This article will review the techniques and devices used to facilitate laparoscopic cystotomy repair.

The association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures

OBJECTIVE The objective of the study was to estimate the association between regional anesthesia and acute postoperative urinary retention in women undergoing outpatient midurethral sling procedures. STUDY DESIGN We performed a retrospective cohort study of women undergoing outpatient midurethral sling procedures. Exposure was defined as the type of anesthesia, categorized as regional (spinal or combined spinal/epidural) or nonregional (general endotracheal, monitored anesthesia care with sedation, or local). The outcome, acute postoperative urinary retention, was defined as a failed voiding trial prior to discharge. RESULTS A total of 131 women met our inclusion criteria. Forty-two women (32%) had regional anesthesia and 89 (68%) women had non-regional anesthesia. Overall, 48 women (36.6%) had acute postoperative urinary retention. Women who had regional anesthesia had an increased odds (adjusted odds ratio, 4.4; 95% confidence interval, 1.9-10.2) of acute postoperative urinary retention compared with women receiving nonregional anesthesia. CONCLUSION Regional anesthesia is a risk factor for acute postoperative urinary retention following outpatient midurethral slings.

Impact of Route of Delivery on Continence and Sexual Function

Urinary and fecal incontinence have been linked to pregnancy and childbirth. This article reviews the rates of pelvic floor dysfunction following vaginal delivery and cesarean section as cited in short-term and long-term follow-up studies.

Effects of Repetition and Inactivity on Laparoscopic Skills Training

STUDY OBJECTIVE To describe the impact of task repetition and time between practice sessions on time to complete a surgical task using a high-fidelity laparoscopic simulator. DESIGN An Institutional Review Board-approved retrospective cohort study of 33 obstetrics/gynecology residents with unlimited access to a high-fidelity laparoscopic simulator over a period of 12 months. Canadian Task Force design classification II-2. SETTING Academic medical center and obstetrics/gynecology residency training program. PARTICIPANTS Obstetrics/gynecology residents. INTERVENTIONS Participation in a high-fidelity laparoscopic training exercise. MEASUREMENTS Residents completed a standardized peg transfer exercise with data collected on the time to completion of the exercise, number of the attempt, and interval since the last day of practice. Data were analyzed using Spearman correlation coefficients and mixed-effects linear regression. MAIN RESULTS A total of 33 residents participated during the 12-month period, completing 484 peg transfer exercises (mean, 16.2 per resident). Each repetition was correlated with a mean decrease in time to completion of 2.28 seconds (p < .0001). This correlation was most dramatic in the first 9 completed exercises, in which each repetition correlated with a decrease in time to complete of 7.98 seconds (p ≤ .0001). The lapse in practice preceding the exercise correlated with a negligible change in time to completion of 0.003 second (SD, 0.06; p = .90). CONCLUSION The number of previous completed exercises was significantly correlated with decreased time to completion of this standardized exercise. Lapses in practice did not correlate with slower times to completion, suggesting that repetitive exposure to a simple surgical task has a greater impact on efficiency than lapse in practice.

Vesicovaginal fistula: an unexpected consequence of changing sexual practices?

Vesicovaginal fistula (VVF) is commonly associated with obstetric trauma, but in developed nations it is typically iatrogenic. To date, there have been no published reports of VVF resulting from consensual sexual activity with sex toys. A 19-year-old gravida 0 presented with leakage of clear urine from the vagina following repetitive use of a sex toy with her female partner. The fistula was repaired in the operating room using a vaginal approach and a layered closure. This is the first case report of a VVF caused by consensual sex toy use between same-sex partners. As sex toy use increases, counselling providers will need to be aware of possible adverse sequelae.