Uduak U. Andy

Outcomes of abdominal and minimally invasive sacrocolpopexy: a retrospective cohort study.

Objective To compare perioperative and postoperative surgical outcomes between and among open and minimally invasive sacrocolpopexies (MISCs). Methods We performed a multicenter retrospective cohort study comparing abdominal sacrocolpopexy (ASC) and MISC from January 1999 to December 2010. Results A total of 1124 subjects underwent sacrocolpopexy, with 589 ASCs and 535 MISCs. Within the MISC group, 273 were laparoscopic (LSC) and 262 were robotic (RSC). Abdominal sacrocolpopexy was associated with greater overall complication rate compared with MISC (20.0% vs 12.7%; P = 0.001). After controlling for difference in length of follow-up, there was no significant difference in the rate of anatomical failure between the ASC and MISC groups. The MISC group had shorter hospitalization, less blood loss, but longer operative times compared with the ASC group. When comparing LSC to RSC, there was no difference in anatomic failures (7.7% vs 6.9%; P = 0.74). However, LSC was associated with more complications compared with RSC (18% vs 7%; P < 0.02). In addition, LSC had higher blood loss, less operative time, and shorter hospital stay compared with RSC. Conclusion Although anatomic results are similar, ASC is associated with a higher rate of complications compared with MISC.

Incidence of Unanticipated Uterine Pathology at the Time of Minimally Invasive Abdominal Sacrocolpopexy

STUDY OBJECTIVE To determine the incidence of unanticipated uterine pathologic findings in women undergoing hysterectomy concomitant with minimally invasive sacrocolpopexy. DESIGN Retrospective case series (Canadian Task Force classification III). SETTING Four institutions in the United States. PATIENTS Women undergoing laparoscopic or robotically assisted sacrocolpopexy with hysterectomy. INTERVENTIONS Concurrent hysterectomy and minimally invasive sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS We measured the incidence of clinically important uterine disease at minimally invasive sacrocolpopexy. A total of 324 women underwent concurrent hysterectomy and minimally invasive sacrocolpopexy. Their mean age was 56.1 years, and body mass index was 26.9 kg/m(2). Sixty-four percent were postmenopausal. Only 3 patients (0.92%) had abnormal uterine pathologic findings. No significant differences were noted in age, body mass index, or parity between the women with normal and abnormal uterine pathologic findings. None of the 3 women reported abnormal uterine bleeding before surgery. All lesions were premalignant and focal. No invasive carcinomas were identified. No patients required further follow-up or treatment of abnormal pathologic findings. CONCLUSION The risk of unanticipated uterine pathologic findings during minimally invasive sacrocolpopexy to treat pelvic organ prolapse is low.

Is self-reported adherence associated with clinical outcomes in women treated with anticholinergic medication for overactive bladder?

To determine the association between self‐reported adherence to anticholinergic medication and clinical outcomes in women with overactive bladder (OAB).

Shared Risk Factors for Constipation, Fecal Incontinence, and Combined Symptoms in Older U.S. Adults.

To estimate the prevalence of constipation, fecal incontinence (FI), and combined symptoms and to identify shared factors associated with bowel symptoms in older U.S. men and women

Validation of a self‐administered instrument to measure adherence to anticholinergic drugs in women with overactive bladder

To validate a self‐administered instrument, the Medication Adherence Self‐Report Inventory (MASRI) for measuring adherence to anti‐cholinergic medication for overactive bladder (OAB).

Short-Term Postoperative Functional Outcomes in Older Women Undergoing Prolapse Surgery

OBJECTIVE: To evaluate whether preoperative markers of functional status predict postoperative functional outcomes in older women undergoing surgery for pelvic organ prolapse (POP). METHODS: Prospective cohort study of women aged 60 years or older who underwent surgery for prolapse. Preoperative functional status was measured using number of functional limitations (such as difficulty walking or climbing), American Society of Anesthesiologists class, anemia, and history of recent weight loss. Our primary outcome was the number of postoperative functional limitations and secondary outcomes were failure to return to baseline functional status and length of stay after surgery. We determined the association of preoperative functional status markers with postoperative outcomes using univariable and multivariable regression. RESULTS: In 127 women, presence of a preoperative functional limitation was a significant predictor of a 0.55 (95% confidence interval [CI] 0.36–0.74) increase in the number of postoperative functional limitations after controlling for age, number of preoperative functional limitations, comorbidities, depression, surgeon, type of procedure, and complications (P<.001). History of recent weight loss and anemia increased risk for failure to return to baseline functional status after controlling for surgeon, type of surgery, and complications (relative risk 2.44, 95% CI 1.26–4.71 and relative risk 2.72, 95% CI 1.29–5.75), respectively). Preoperative markers associated with longer length of stay after surgery were American Society of Anesthesiologists class III (0.83 days, 95% CI 0.20–1.46) and history of weight loss (0.84 days, 95% CI 0.13–1.54). CONCLUSION: Preoperative markers of functional status are useful in predicting short-term postoperative functional outcomes in older women undergoing surgery for POP. LEVEL OF EVIDENCE: II

Refractory Urgency Urinary Incontinence Treatment in Women: Impact of Age on Outcomes and Complications

BACKGROUND: Women with refractory urgency urinary incontinence (ie, unresponsive to behavioral and pharmacological interventions) are treated with onabotulinumtoxinA or sacral neuromodulation. OBJECTIVE: The objective of the study was to compare treatment efficacy and adverse events in women <65 and ≥65 years old treated with onabotulinumtoxinA or sacral neuromodulation. STUDY DESIGN: This study was a planned secondary analysis of a multicenter, randomized trial that enrolled community‐dwelling women with refractory urgency urinary incontinence to onabotulinumtoxinA or sacral neuromodulation treatments. The primary outcome was a change in mean daily urgency urinary incontinence episodes on a bladder diary over 6 months. Secondary outcomes included ≥75% urgency urinary incontinence episode reduction, change in symptom severity/quality of life, treatment satisfaction, and treatment‐related adverse events. RESULTS: Both age groups experienced improvement in mean urgency urinary incontinence episodes per day following each treatment. There was no evidence that mean daily urgency urinary incontinence episode reduction differed between age groups for onabotulinumtoxinA (adjusted coefficient, –0.127, 95% confidence interval, –1.233 to 0.979; P = .821) or sacral neuromodulation (adjusted coefficient, –0.698, 95% confidence interval, –1.832 to 0.437; P = .227). Among those treated with onabotulinumtoxinA, women <65 years had 3.3‐fold greater odds of ≥75% resolution than women ≥65 years (95% confidence interval, 1.56 –7.02). Women <65 years had a greater reduction in Overactive Bladder Questionnaire Short Form symptom bother scores compared with women ≥65 years by 7.49 points (95% confidence interval, –3.23 to –11.74), regardless of treatment group. There was no difference between quality of life improvement by age. Women ≥65 years had more urinary tract infections following onabotulinumtoxinA and sacral neuromodulation (odds ratio, 1.9, 95% confidence interval, 1.2–3.3). There was no evidence of age differences in sacral neuromodulation revision/removal or catheterization following onabotulinumtoxinA treatment. CONCLUSION: Younger women experienced greater absolute continence, symptom improvement, and fewer urinary tract infections; both older and younger women had beneficial urgency urinary incontinence episode reduction, similar rates of other treatment adverse events, and improved quality of life.

Management of arterial and venous hemorrhage during sacrospinous ligament fixation: cases and review of the literature

Introduction and hypothesisSacrospinous ligament fixation (SSLF) for pelvic organ prolapse repair can incur significant intraoperative hemorrhage. Management of vascular injury is challenging because of limited visualization of the surrounding pararectal space and is not well described in the literature.MethodsWe evaluate cases of intraoperative venous and arterial hemorrhage during SSLF. Based on a review of the literature, we present a systematic approach to the treatment of venous and arterial hemorrhage associated with SSLF.ResultsVascular injury to the hypogastric and pudendal venous plexi may be controlled using directed compression and topical hemostatic agents. Vascular injury to the inferior gluteal artery, its coccygeal branch, or other arteries, may require embolization.ConclusionLife-threatening bleeding is a rare complication of transvaginal SSLF. Knowledge of surrounding pelvic vascular anatomy, treatment options, and communication with ancillary staff is essential for the treatment of sacrospinous ligament hemorrhage.

Clinical anatomy of fecal incontinence in women

Fecal incontinence is a devastating condition that has a severe impact on quality of life. This condition disproportionately affects women and its incidence is increasing with the aging United States population. Fecal continence is maintained by coordination of a functioning anal sphincter complex, intact sensation of the anorectum, rectal compliance, and the ability to consciously control defecation. Particularly important are the puborectalis sling of the levator ani muscle complex and intact innervation of the central and peripheral nervous systems. An understanding of the intricate anatomy required to maintain continence and regulate defecation will help clinicians to provide appropriate medical and surgical management and diminish the negative impact of fecal incontinence. In this article, we describe the anatomic and neural basis of fecal continence and normal defecation as well as changes that occur with fecal incontinence in women. Clin. Anat. 30:901–911, 2017.

Role of diet in fecal incontinence: a systematic review of the literature.

Introduction and hypothesisThe objective was to perform a systematic review of the literature to examine original research on the role of diet in fecal incontinence (FI) with a dual focus on dietary differences in FI and dietary treatments for FI.MethodsWe searched the PubMed and Embase databases for any peer-reviewed original research in English on the role of diet in FI.ResultsWe identified 172 unique citations. After title review and exclusion of articles not reporting original research, 9 publications were included in the final review: 4 focused on dietary differences and 5 focused on dietary treatments for FI. Limited evidence indicates that macro- and micronutrient intake does not differ significantly in those with and without FI. However, certain foods were perceived to improve or exacerbate FI symptoms and these varied and were adjusted as part of self-care practices. A high-fiber diet may reduce incontinence frequency.ConclusionsData on the pathogenesis of FI from a dietary perspective are scant. Based on the limited data, dietary differences between those with and without FI provide little insight with the exception of fiber. Further studies are needed to elucidate treatments for FI using fiber and dietary modifications.