S. A. Shobeiri

Age effects on pelvic floor symptoms in a cohort of nulliparous patients.

Objectives This study aimed to investigate the effects of age on pelvic floor symptoms (PFSs) in nulliparous women. Methods Eighty community-dwelling nulliparous women, aged 21 to 70 years, were recruited. Pelvic floor support was assessed with pelvic organ prolapse quantification system. Participants completed the Pelvic Floor Distress Inventory 20 and Pelvic Floor Impact Questionnaire 7. Sexual function was assessed with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 and health status with the Short-Form Health Survey. The correlation between age and questionnaire scores was evaluated using Pearson coefficient. Logistic regression assessed predictors associated with PFS. Results Participants had a median age of 47 years, average body mass index of 28.3 kg/m2, and most were white; 52.5% were healthy and 30% were postmenopausal. The most common stage of prolapse was stage I. Age was associated with slightly higher Pelvic Floor Distress Inventory-20 scores (r = 0.41, P = 0.002), corresponding to more bothersome PFS, and lower Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 scores, corresponding to worsening sexual function with advancing age (r = −0.41, P = 0.0012). There was no association between age and overall Pelvic Floor Impact Questionnaire scores (P = 0.12). For symptomatic patients, logistic regression showed age to be associated with increased odds of having PFS [odds ratio (OR), 1.881; 95% confidence interval (CI), 1.216–2.91]. Menopausal status was not associated with increased odds of reporting symptoms (OR, 3.05; 95% CI, 0.80–11.62). When age and age by menopause were incorporated in the model, age remained a significant predictor of having PFS (OR, 1.78; 95% CI, 1.13–2.78). Conclusions In this population of community-dwelling nulliparous women, age was associated with worsening sexual function and slightly increased odds of reporting symptoms of pelvic floor disorders.

An ultrasound approach to the posterior compartment and anorectal dysfunction

Introduction and hypothesisPatients with anorectal dysfunction are common and can be quite challenging to diagnose. The common underlying causes for such conditions are usually anatomical in nature, which may be difficult to fully evaluate by clinical examination alone. The aim of this video was to demonstrate how multicompartmental ultrasound imaging can be utilized clinically in the evaluation of patients with anorectal dysfunction.MethodsPertinent ultrasound findings of the common anatomical causes of defecatory dysfunction were discussed in this video.ResultsDifferent ultrasound techniques were shown.ConclusionIn conclusion, multicompartmental ultrasound imaging is an easy, cost-efficient, and valuable tool in the evaluation of patients with anorectal dysfunction.

Statistical justifications for interrater reliability of levator ani deficiency (LAD) assessment by 3D endovaginal ultrasonography: response to critique

Tester 1 vs tester 2 0.891 0.825 0.874 0.930 0.889 0.887 Tester 1 vs tester 3 0.882 0.839 0.831 0.891 0.903 0.881 Tester 1 vs tester 4 0.714 0.712 0.638 0.740 0.821 0.797 Tester 2 vs tester 3 0.857 0.857 0.885 0.873 0.890 0.862 Tester 2 vs tester 4 0.670 0.715 0.678 0.752 0.803 0.816 Tester 3 vs tester 4 0.708 0.705 0.639 0.674 0.791 0.865

Training community gynecologists to perform intraoperative cystoscopy: a competency-based training experience.

Objective This study aimed to pilot a cystoscopy training program for community gynecologists that is validated by posttraining examination. Methods Twenty-eight gynecologists were trained to perform cystoscopy using a competency-based training approach. Baseline information included years in practice and number of incontinence procedures and/or cystoscopies performed per month. Three 5-hour workshops were administered that included applied practice. After learners individually trained until they felt comfortable with their skills on a model, they were individually tested on a cadaver. Performance was evaluated with 2 instruments, namely, a task-specific checklist and a global rating scale based on the objective structured assessment of technical skill model. Failure was defined as inability to independently complete elements of the task-specific checklist for cystoscopic examination. Likert-type self-report scales were used during pretesting and posttesting, assessing confidence to perform component tasks for diagnostic cystoscopy. Results Twenty-four of 28 trainees successfully performed a systematic cadaveric bladder examination during the primary posttest. After debriefing, the 4 trainees who initially failed successfully performed cystoscopy during a second trial. Median age was 51 years and median time in practice was 19.5 years. All participants reported high confidence in identifying ureteral injury at the course’s conclusion. Conclusions A task-specific training program can successfully improve the confidence and skill of community gynecologists to perform intraoperative diagnostic cystoscopy. Professionals may not be able to define when they have received enough instruction in terms of hands-on training with models, before acquisition of technical skills. Formal evaluation of technical skills is recommended after training to ensure competence.