Momoe T. Hyakutake

Bilateral Sacrospinous Vault Fixation With Tailored Synthetic Mesh Arms: Clinical Outcomes at One Year

OBJECTIVES Bilateral sacrospinous fixation with tailored mesh arms (bSSVF) uses polypropylene mesh to suspend the vault to the sacrospinous ligaments bilaterally with minimal tension, recreating nulliparous midline anatomy. It can be used with uterine conservation. Our primary objective was to determine objective cure rate at one year following bSSVF compared with a control group undergoing abdominal sacrocolpopexy (ASC). Secondary objectives were to compare symptoms, quality of life, sexual function, pain, and global satisfaction before and after surgery and between bSSVF and ASC groups at one year. METHODS This prospective cohort study enrolled patients with symptomatic prolapse who chose to undergo bSSVF or ASC. Baseline demographics were obtained. Prolapse quantification, validated symptom questionnaire scores, and McGill pain scores were obtained at baseline, six weeks, and one-year postoperatively. Global satisfaction was recorded. The primary outcome measure was the difference in cure rate (vault stage ≤ 1) between groups. RESULTS Fifty patients were recruited: 30 underwent bSSVF and 17 ASC. Forty-three patients were available for one-year follow-up. Baseline data were similar. There was no difference in vault stage between bSSVF and ASC groups at one year. Five women who underwent bSSVF had cervical elongation, and four of these were classified as POP recurrence. Women who underwent bSSVF had more anterior recurrences but fewer postoperative complications, shorter hospital stay, and less use of narcotics than controls. Questionnaire scores were similar at one year. All respondents felt subjective improvement after either surgical procedure. CONCLUSIONS Objective and subjective cure rates are comparable after bSSVF and ASC. Hysteropexy may cause cervical elongation that merits further research.

Pregnancy-Associated Pelvic Floor Health Knowledge and Reduction of Symptoms: The PREPARED Randomized Controlled Trial

OBJECTIVES Pregnancy and childbirth can lead to pelvic floor disorders, yet this topic is not routine in antenatal education. We aimed to determine the impact of a pregnancy workshop on womens postpartum pelvic floor health knowledge, performance of pelvic floor muscle exercises (PFME), symptoms, condition-specific quality of life, mode of delivery, and satisfaction. METHODS This was a RCT. Pregnant primiparous women in a tertiary care centre received a pelvic floor health workshop intervention versus routine prenatal care. Thirty-six participants/group were needed to detect a significant knowledge difference (power = 0.80, α = 0.05). Participants completed questionnaires at recruitment and six weeks postpartum. Main outcome measures were: difference between groups in knowledge scores; PFME-specific knowledge and practice; pelvic symptoms and condition-specific quality of life; and mode of and satisfaction with delivery. RESULTS Fifty women were recruited per group; 40 attended the workshop. Women were Caucasian (72%), college educated (96%), mean age 33.2. Mean demographics did not differ. Postpartum data were available for 37 women per group. The intervention group scored higher on a pelvic floor knowledge questionnaire (mean score 31.2/39 vs. 29.3/39, P = 0.02, 95% CI 0.3, 3.6). 58.3% of intervention participants reported daily performance of PFME compared with 22.9% of controls (P = 0.002) and rated higher confidence in correct performance (P = 0.004). The intervention group reported fewer bowel symptoms (P = 0.046). There were no differences in urinary or prolapse symptoms, mode of delivery, complications, or satisfaction. CONCLUSION A pelvic floor health workshop improves postpartum knowledge, performance of PFME, and bowel-specific quality of life.

Urogynecology digest : Presented by Momoe Hyakutake.

This was a double blind randomized trial with two parallel treatment arms comparing the treatment of uncomplicated urinary tract infection with ibuprofen, 400 mg three times a day for 3 days, versus a single dose of fosfomycin (3 g). The aim of this study was to compare the number of courses of antibiotics treatment over a 28-day period and symptomatic burden over the first 7 days between the two groups. The symptom burden was measured as area under the curve of the sum of daily symptom scores. Symptom scores included dysuria, frequency/urgency of micturition, and low abdominal pain. A total of 1,184 women with suspected urinary tract infection were screened. Of the 779 eligible women, 494 were randomized to either the ibuprofen group or the fosfomycin group. Two hundred and twenty-two women completed the study in the ibuprofen group and 224 in the fosfomycin group. Results demonstrate a significant reduction in the number of courses of antibiotics treatment in the ibuprofen group compared with the fosfomycin group; 94 courses vs 283 respectively, with a rate reduction of 66.5 % (95 % CI 58.8 % to 74.4 %; P<0.001). However, the symptom burden was significantly greater in the ibuprofen group than in the fosfomycin group, with an area under the curve ratio of 140 %. There were also more cases of pyelonephritis in the ibuprofen group (5 vs 1), in addition to one drug-related hospital admission for gastrointestinal hemorrhage. Uncomplicated urinary tract infections are common and antibiotics are recommended as the first-line treatment. However, increasing resistance rates, especially seen in Escherichia coli, the main causative agent in urinary tract infections, is a serious health concern. This study succeeds in showing that antibiotic use can be decreased, with initial symptomatic treatment using ibuprofen. In fact, 67% of women in the ibuprofen group recovered without antibiotics. This is a higher rate than has been seen for placebo groups in other trials. Unfortunately, this comes at the cost of a higher symptom burden and more cases of pyelonephritis. The rate of pyelonephritis in the ibuprofen group was 2.1 %, which is comparatively higher than that seen in other studies of placebo-treated patients (0.4 % to 2.6 %). It is unclear from this study if this is due to the lack of treatment with antibiotics or an effect of ibuprofen on the urogenital system. Based on this study, the authors cannot recommend the use of ibuprofen as an initial treatment for symptomatic uncomplicated urinary tract infections. Future studies are needed to identify patients for whom initial ibuprofen treatment would be sufficient.