<strong>Objectives:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Urinary tract injuries ...<strong>Objectives:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">% </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre- and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Across all three PGY levels, statistically significant improvements were observed in knowledge, surgical skills, and confidence after didactic and cadaver education (p = 0.001, p < 0.02, and p = 0.009 respectively). The largest increases in confidence occurred in residents’ ability to describe and perform cystotomy repairs. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room. The cadaver surgical skills curriculum was an effective training module and remains an important component of skills training in conjunction with simulation and traditional didactic sessions</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>展开更多
Objective To describe whether or not there are gender differences in lower urinary tract symptoms(LUTS)prevalence and risk factors in community-dwelling older Chinese Americans.Methods We performed a secondary analysi...Objective To describe whether or not there are gender differences in lower urinary tract symptoms(LUTS)prevalence and risk factors in community-dwelling older Chinese Americans.Methods We performed a secondary analysis of a prospective cross-sectional population-based survey of Chinese Americans aged 60 years and older between January 2011 and December 2013 in English,Mandarin,Cantonese,Taishanese,or Teochew.A clinical review of systems was used to assess LUTS,which included urinary frequency,urgency,burning and/or pain,blood in urine,and urinary incontinence.Results Of the total 3157 people queried,42%were men and 58%were women.More men reported LUTS compared to women(32.9%vs.28.6%,p=0.01).In a multivariable analysis,female gender(adjusted odds ratio[aOR]0.60,95%confidence interval[CI]0.49-0.73),being married(aOR 0.79,95%CI 0.65-0.97),and smoking(aOR 0.66,95%CI 0.49-0.88)were found to be protective,while traditional Chinese medicine use(aOR 1.51,95%CI 1.28-1.78),heart disease(aOR 1.54,95%CI 1.24-1.91),and anxiety(aOR 1.69,95%CI 1.25-2.28)were most strongly associated with increased odds of LUTS.When examining genders separately,being married was found to be protective only in women.Meanwhile,unique factors found in men were hypertension,heart disease,and practice of Tai Chi.Conclusion In this large population-based study,LUTS were more prevalent in older Chinese American men than women.We also found gender-specific factors that influenced the odds of reporting LUTS;however,traditional Chinese medicine use was the only factor that was shared by both genders.Future longitudinal investigations are needed to elucidate these underlying mechanisms to provide evidence-based and culture-specific guidelines for this rapidly growing population.展开更多
BACKGROUND Vaginal stones are rare with current literature limited to case reports.Vaginal stones are classified as primary or secondary stones.Primary stones form in the vagina when there is urinary stasis.Secondary ...BACKGROUND Vaginal stones are rare with current literature limited to case reports.Vaginal stones are classified as primary or secondary stones.Primary stones form in the vagina when there is urinary stasis.Secondary stones form in the presence of a vaginal foreign body that acts as a nidus for the deposition of urinary salts.Foreign bodies,such as surgical mesh,make vaginal stone formation more likely,particularly in patients with urinary incontinence and conditions that predispose them to urinary calculi formation.CASE SUMMARY A 71-year-old female with a history of sacrocolpopexy,hyperaldosteronism,and urgency urinary incontinence presented with vaginal stone accumulation overlying two areas of vaginal sacrocolpopexy mesh exposure.The vaginal stones were initially removed to permit examination,but the stones reaccumulated at the site of the exposed mesh,later requiring definitive surgical management.CONCLUSION Patients with vaginal mesh exposure and conditions that predispose them to kidney stones are not ideal candidates for expectant management of mesh exposure,particularly if they have coexisting urinary incontinence.These individuals should be counseled about possible vaginal stone accumulation,and surgical management should be considered.展开更多
This study was undertaken to determine the complication rates of abdominal sacral suspensions (ASC) using polypropylene mesh and to compare the erosion rates in women who underwent ASC at the time of supracervical hys...This study was undertaken to determine the complication rates of abdominal sacral suspensions (ASC) using polypropylene mesh and to compare the erosion rates in women who underwent ASC at the time of supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) versus ASC in women who had previously undergone TAH. Study design: A retrospective analysis of patients from the urogynecology practice at North Shore University Hospital, who underwent ASC with polypropylene mesh between March 1997 and July 2004. Office and hospital charts were reviewed for patient demographics, preoperative history and physical examinations, intraoperative and postoperative findings, and complications. Women were stratified into 3 groups: group I: SCH with ASC; group Ⅱ : TAH with ASC; and group Ⅲ : ASC alone in women with a history of prior TAH. Results: A total of 121 patients were analyzed and comprised group I, 30.6% (n = 37); group Ⅱ , 40.5% (n = 49); and group Ⅲ , 28.9% (n = 35). Four patients (3.3% ) had mesh erosions develop. There were no significant differences in age, weight, parity, menopause status, estrogen therapy, previous surgery, or degree of preoperative prolapse between the patients with and without erosions. All the erosions occurred in group Ⅱ (8.2% , 95% CI 2.3% - 19.6% , P = .0389). The intraoperative complication rate was 2.5% and included a cystotomy (n = 2) and a small bowel laceration (n = 1). Immediate postoperative complications included partial SBO/Ileus (3.5% ), febrile morbidity (9.6% ), and autologous blood transfusions (1.7% ). Long term complications included persistent vaginal discharge (4.7% ), vaginal bleeding (1.6% ), dysparuenia (6.3% ), and recurrent prolapse (2.5% ). There were no significant differences in short or long term complications among the 3 groups (P > .05). Conclusion: ASC with polypropylene mesh is a safe surgical procedure for vaginal vault prolapse with low complication rates. Mesh erosion occurred in 8.2% of patients who underwent TAH with concurrent ASC. Patients having ASC at the time of TAH had a 7- fold increased risk for mesh erosion compared with patients who underwent SCH with ASC.展开更多
Objective: The purpose of this study was to determine the relationship between nocturia and obstructive sleep apnea (OSA),and the effect of continuous positive airways pressure (CPAP)- therapy on nocturic frequency. S...Objective: The purpose of this study was to determine the relationship between nocturia and obstructive sleep apnea (OSA),and the effect of continuous positive airways pressure (CPAP)- therapy on nocturic frequency. Study design: This was a retrospective review of sleep studies including patients with and without evidence of OSA, before and during CPAP treatment(where relevant). Chi-squared tests compared nocturia prevalence according to sleep diagnosis, logistic regression determined predictors of nocturia, and regression analyses determined predictors of nocturic frequency. Results: In 196 eligible studies, predictors of nocturia included increasing age and diabetes mellitus; nocturia was equally likely to occur in patients with and without OSA. In patients with OSA and nocturia,nocturic frequency was related to age, diabetes, and severity of OSA (P < .001). Patients with OSA and nocturia who were treated with CPAP demonstrated a significant decrease in nocturic frequency (P < .001). Conclusion: OSA severity predicts nocturic frequency. The role of testing in the triage of patients with nocturia remains to be determined.展开更多
文摘<strong>Objectives:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">% </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre- and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Across all three PGY levels, statistically significant improvements were observed in knowledge, surgical skills, and confidence after didactic and cadaver education (p = 0.001, p < 0.02, and p = 0.009 respectively). The largest increases in confidence occurred in residents’ ability to describe and perform cystotomy repairs. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room. The cadaver surgical skills curriculum was an effective training module and remains an important component of skills training in conjunction with simulation and traditional didactic sessions</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>
基金Data collection for the Population Study of Chinese Elderly(PINE,R01AG042318,PI:XinQi Dong)was supported by the National Institute on Aging.The funding agent had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Objective To describe whether or not there are gender differences in lower urinary tract symptoms(LUTS)prevalence and risk factors in community-dwelling older Chinese Americans.Methods We performed a secondary analysis of a prospective cross-sectional population-based survey of Chinese Americans aged 60 years and older between January 2011 and December 2013 in English,Mandarin,Cantonese,Taishanese,or Teochew.A clinical review of systems was used to assess LUTS,which included urinary frequency,urgency,burning and/or pain,blood in urine,and urinary incontinence.Results Of the total 3157 people queried,42%were men and 58%were women.More men reported LUTS compared to women(32.9%vs.28.6%,p=0.01).In a multivariable analysis,female gender(adjusted odds ratio[aOR]0.60,95%confidence interval[CI]0.49-0.73),being married(aOR 0.79,95%CI 0.65-0.97),and smoking(aOR 0.66,95%CI 0.49-0.88)were found to be protective,while traditional Chinese medicine use(aOR 1.51,95%CI 1.28-1.78),heart disease(aOR 1.54,95%CI 1.24-1.91),and anxiety(aOR 1.69,95%CI 1.25-2.28)were most strongly associated with increased odds of LUTS.When examining genders separately,being married was found to be protective only in women.Meanwhile,unique factors found in men were hypertension,heart disease,and practice of Tai Chi.Conclusion In this large population-based study,LUTS were more prevalent in older Chinese American men than women.We also found gender-specific factors that influenced the odds of reporting LUTS;however,traditional Chinese medicine use was the only factor that was shared by both genders.Future longitudinal investigations are needed to elucidate these underlying mechanisms to provide evidence-based and culture-specific guidelines for this rapidly growing population.
文摘BACKGROUND Vaginal stones are rare with current literature limited to case reports.Vaginal stones are classified as primary or secondary stones.Primary stones form in the vagina when there is urinary stasis.Secondary stones form in the presence of a vaginal foreign body that acts as a nidus for the deposition of urinary salts.Foreign bodies,such as surgical mesh,make vaginal stone formation more likely,particularly in patients with urinary incontinence and conditions that predispose them to urinary calculi formation.CASE SUMMARY A 71-year-old female with a history of sacrocolpopexy,hyperaldosteronism,and urgency urinary incontinence presented with vaginal stone accumulation overlying two areas of vaginal sacrocolpopexy mesh exposure.The vaginal stones were initially removed to permit examination,but the stones reaccumulated at the site of the exposed mesh,later requiring definitive surgical management.CONCLUSION Patients with vaginal mesh exposure and conditions that predispose them to kidney stones are not ideal candidates for expectant management of mesh exposure,particularly if they have coexisting urinary incontinence.These individuals should be counseled about possible vaginal stone accumulation,and surgical management should be considered.
文摘This study was undertaken to determine the complication rates of abdominal sacral suspensions (ASC) using polypropylene mesh and to compare the erosion rates in women who underwent ASC at the time of supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) versus ASC in women who had previously undergone TAH. Study design: A retrospective analysis of patients from the urogynecology practice at North Shore University Hospital, who underwent ASC with polypropylene mesh between March 1997 and July 2004. Office and hospital charts were reviewed for patient demographics, preoperative history and physical examinations, intraoperative and postoperative findings, and complications. Women were stratified into 3 groups: group I: SCH with ASC; group Ⅱ : TAH with ASC; and group Ⅲ : ASC alone in women with a history of prior TAH. Results: A total of 121 patients were analyzed and comprised group I, 30.6% (n = 37); group Ⅱ , 40.5% (n = 49); and group Ⅲ , 28.9% (n = 35). Four patients (3.3% ) had mesh erosions develop. There were no significant differences in age, weight, parity, menopause status, estrogen therapy, previous surgery, or degree of preoperative prolapse between the patients with and without erosions. All the erosions occurred in group Ⅱ (8.2% , 95% CI 2.3% - 19.6% , P = .0389). The intraoperative complication rate was 2.5% and included a cystotomy (n = 2) and a small bowel laceration (n = 1). Immediate postoperative complications included partial SBO/Ileus (3.5% ), febrile morbidity (9.6% ), and autologous blood transfusions (1.7% ). Long term complications included persistent vaginal discharge (4.7% ), vaginal bleeding (1.6% ), dysparuenia (6.3% ), and recurrent prolapse (2.5% ). There were no significant differences in short or long term complications among the 3 groups (P > .05). Conclusion: ASC with polypropylene mesh is a safe surgical procedure for vaginal vault prolapse with low complication rates. Mesh erosion occurred in 8.2% of patients who underwent TAH with concurrent ASC. Patients having ASC at the time of TAH had a 7- fold increased risk for mesh erosion compared with patients who underwent SCH with ASC.
文摘Objective: The purpose of this study was to determine the relationship between nocturia and obstructive sleep apnea (OSA),and the effect of continuous positive airways pressure (CPAP)- therapy on nocturic frequency. Study design: This was a retrospective review of sleep studies including patients with and without evidence of OSA, before and during CPAP treatment(where relevant). Chi-squared tests compared nocturia prevalence according to sleep diagnosis, logistic regression determined predictors of nocturia, and regression analyses determined predictors of nocturic frequency. Results: In 196 eligible studies, predictors of nocturia included increasing age and diabetes mellitus; nocturia was equally likely to occur in patients with and without OSA. In patients with OSA and nocturia,nocturic frequency was related to age, diabetes, and severity of OSA (P < .001). Patients with OSA and nocturia who were treated with CPAP demonstrated a significant decrease in nocturic frequency (P < .001). Conclusion: OSA severity predicts nocturic frequency. The role of testing in the triage of patients with nocturia remains to be determined.
