Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision ...Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision of care,outcomes,or patient population.We aimed to elucidate potential differences in demographics,outcomes,and minimally invasive surgery utilization for SCP performed by urology and gynecology.Methods:In our retrospective analysis,sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006–2020.Pearson’s chi-square test was performed to test trends in the utilization of MIS in five-year blocks.Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index.Univariate analysis was performed using Student’s t-test and Pearson’s chi-square to compare operative parameters,frailty,demographics,and outcomes.Results:We identified 8944 sacrocolpopexies.Gynecology performed 81%of cases while urology performed the remaining 19%(p<0.001).Between the specialties,there were no significant differences in outcomes,minor or major complications,or 30-day reoperations/hospital readmissions/mortality.However,urologists tended to care for patients who were older(65 vs.61 years,p<0.001)and frailer by both frailty indices(p<0.001).Conclusion:Case distributions have remained stable,with gynecologists four-fold more sacrocolpopexies,in keeping with the larger number of practicing gynecologists vs.urologists.There was no difference in 30-day outcomes between both specialties.However,urologists operated on older,more frail patients.展开更多
AIM:To explore the impact of fecal incontinence (FI) on quality of life (QOL) of patients attending urogynecology and colorectal clinics (CCs).METHODS:Cross-sectional study of 154 patients (27 male) with FI,who attend...AIM:To explore the impact of fecal incontinence (FI) on quality of life (QOL) of patients attending urogynecology and colorectal clinics (CCs).METHODS:Cross-sectional study of 154 patients (27 male) with FI,who attended the clinics at a regional hospital in North Queensland,Australia in 2003 and 2004,and completed the Fecal Incontinence Quality of Life Scale (FIQL:1=very affected;4=not affected).RESULTS:More than 22% of patients had their QOL affected severely by FI.Patients reported that they had not previously been asked about FI by a medical practitioner nor did they voluntarily disclose its presence.The median FIQL scores for all participants were:lifestyle=3.24;coping=2.23;depression=2.42;and embarrassment=2.33.Increasing frequency of soiling had a negative effect on all four FIQL scales (P < 0.001) as did the quantity of soiling (P < 0.01).Female CC patients had poorer FIQL scores than urogynecology clinic patients for lifestyle (P=0.015),coping (P=0.004) and embarrassment (P=0.009),but not depression (P=0.062),despite having experienced FI for a shorter period.CONCLUSION:Failure to seek treatment for FI degrades the quality of patients' lives over time.FI assessment tools should incorporate the quantity of fecal loss.展开更多
Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual ...Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual function of women before and after surgical treatment for urinary incontinence. Method: The sample consisted of 38 women with urinary incontinence and surgical treatment (Burch or Sling procedure). The Female Sexual Function Index (FSFI) was used to evaluate sexual dysfunction before and after surgical treatment. Results: The mean age of the women in the study was 48 ± 8.8 years, and 58% were 50 years old or younger. By analyzing FSFI, it was observed that the majority of subjects had an overall index of sexual dysfunction (score < 26 points) before surgery. The desire and arousal domains improved significantly after surgery for all women included in the study. It was also observed that women with higher levels of education had more positive results related to desire. Conclusions: In our sample, in general, sexual function improved after surgical treatment of urinary incontinence, regardless of technique used, particularly in the discounter and pain domain. There was a substantial improvement of the sexual function among women who had presented with cystocele. Desire and arousal improved significantly after surgery, very likely due to the improvement of self-esteem after surgery.展开更多
BACKGROUND Skin closure techniques during minimally-invasive gynecologic surgery is largely based on surgeon preference.The optimum technique would theoretically be safe,rapid,inexpensive,and result in good cosmetic a...BACKGROUND Skin closure techniques during minimally-invasive gynecologic surgery is largely based on surgeon preference.The optimum technique would theoretically be safe,rapid,inexpensive,and result in good cosmetic appearance.Cyanoacrylate tissue adhesive(Dermabond)may be a comparable and safe option for port site closure as compared with subcuticular suture.In this randomized clinical trial,we hypothesized that operative time for skin closure would be less than subcuticular suture during robotic urogynecologic procedures.AIM To compare skin closure during robotic urogynecologic surgeries for tissue adhesives and subcuticular suture.METHODS Fifty female subjects>18 years of age undergoing robotic urogynecologic procedures were randomized to have port site closure with either cyanoacrylate tissue adhesive(n=25)or subcuticular suture(n=25).All procedures and postoperative evaluations were performed by the same board certified Female Pelvic Medicine and Reconstructive Surgeon.Incisional closure time was recorded.Each subject was followed for 12-wk postoperatively.Incision cosmesis was evaluated using the Stony Brook Scar Evaluation Scale.RESULTS A total of 47 subjects(cyanoacrylate group,n=23;suture group,n=24)completed the 12-wk postoperative evaluation.Closure time was significantly less(P<0.0005)using cyanoacrylate tissue adhesive(5.4±2.0 min)than subcuticular suture(24.9±5.6 min).Cosmesis scores were significantly higher in the cyanoacrylate tissue adhesive group than subcuticular suture(P=0.025).No differences were found between bleeding,infection,or dehiscence(P=1.00,P=0.609,P=0.234,respectively).No statistical demographical differences existed between the two study arms.CONCLUSION Our study supported our original hypothesis that cyanoacrylate tissue adhesive for port site closure during robotic urogynecolgic procedures uses less time than with subcuticular suture.Our study also supports that tissue adhesive is comparable to cosmetic outcome while not jeopardizing rates of bleeding,infection,or dehiscence.展开更多
Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few d...Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).展开更多
Pelvic organ prolapse （POP） is non-fatal conditions which can markedly affect a patient’s quality of life. Multiple recently developed pelvic reconstructive surgeries have led to a recent expansion in China. In thi...Pelvic organ prolapse （POP） is non-fatal conditions which can markedly affect a patient’s quality of life. Multiple recently developed pelvic reconstructive surgeries have led to a recent expansion in China. In this study, we would like to discuss various aspects of the evaluation and management of POP and raise the question of what is sufficient evidence for the adoption of innovative treatments for POP.展开更多
文摘Introduction:With the aging population,more females will suffer from pelvic organ prolapse.Both urologists and gynecologists perform sacrocolpopexy,but there is no comparative study analyzing differences in provision of care,outcomes,or patient population.We aimed to elucidate potential differences in demographics,outcomes,and minimally invasive surgery utilization for SCP performed by urology and gynecology.Methods:In our retrospective analysis,sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006–2020.Pearson’s chi-square test was performed to test trends in the utilization of MIS in five-year blocks.Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index.Univariate analysis was performed using Student’s t-test and Pearson’s chi-square to compare operative parameters,frailty,demographics,and outcomes.Results:We identified 8944 sacrocolpopexies.Gynecology performed 81%of cases while urology performed the remaining 19%(p<0.001).Between the specialties,there were no significant differences in outcomes,minor or major complications,or 30-day reoperations/hospital readmissions/mortality.However,urologists tended to care for patients who were older(65 vs.61 years,p<0.001)and frailer by both frailty indices(p<0.001).Conclusion:Case distributions have remained stable,with gynecologists four-fold more sacrocolpopexies,in keeping with the larger number of practicing gynecologists vs.urologists.There was no difference in 30-day outcomes between both specialties.However,urologists operated on older,more frail patients.
基金Supported by A James Cook University Program Grant (2003) and A Cancer Council Queensland scholarship
文摘AIM:To explore the impact of fecal incontinence (FI) on quality of life (QOL) of patients attending urogynecology and colorectal clinics (CCs).METHODS:Cross-sectional study of 154 patients (27 male) with FI,who attended the clinics at a regional hospital in North Queensland,Australia in 2003 and 2004,and completed the Fecal Incontinence Quality of Life Scale (FIQL:1=very affected;4=not affected).RESULTS:More than 22% of patients had their QOL affected severely by FI.Patients reported that they had not previously been asked about FI by a medical practitioner nor did they voluntarily disclose its presence.The median FIQL scores for all participants were:lifestyle=3.24;coping=2.23;depression=2.42;and embarrassment=2.33.Increasing frequency of soiling had a negative effect on all four FIQL scales (P < 0.001) as did the quantity of soiling (P < 0.01).Female CC patients had poorer FIQL scores than urogynecology clinic patients for lifestyle (P=0.015),coping (P=0.004) and embarrassment (P=0.009),but not depression (P=0.062),despite having experienced FI for a shorter period.CONCLUSION:Failure to seek treatment for FI degrades the quality of patients' lives over time.FI assessment tools should incorporate the quantity of fecal loss.
文摘Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual function of women before and after surgical treatment for urinary incontinence. Method: The sample consisted of 38 women with urinary incontinence and surgical treatment (Burch or Sling procedure). The Female Sexual Function Index (FSFI) was used to evaluate sexual dysfunction before and after surgical treatment. Results: The mean age of the women in the study was 48 ± 8.8 years, and 58% were 50 years old or younger. By analyzing FSFI, it was observed that the majority of subjects had an overall index of sexual dysfunction (score < 26 points) before surgery. The desire and arousal domains improved significantly after surgery for all women included in the study. It was also observed that women with higher levels of education had more positive results related to desire. Conclusions: In our sample, in general, sexual function improved after surgical treatment of urinary incontinence, regardless of technique used, particularly in the discounter and pain domain. There was a substantial improvement of the sexual function among women who had presented with cystocele. Desire and arousal improved significantly after surgery, very likely due to the improvement of self-esteem after surgery.
基金This study was reviewed and approved by Ascension St John Hospital Institutional Review Board,reference number 1165375.
文摘BACKGROUND Skin closure techniques during minimally-invasive gynecologic surgery is largely based on surgeon preference.The optimum technique would theoretically be safe,rapid,inexpensive,and result in good cosmetic appearance.Cyanoacrylate tissue adhesive(Dermabond)may be a comparable and safe option for port site closure as compared with subcuticular suture.In this randomized clinical trial,we hypothesized that operative time for skin closure would be less than subcuticular suture during robotic urogynecologic procedures.AIM To compare skin closure during robotic urogynecologic surgeries for tissue adhesives and subcuticular suture.METHODS Fifty female subjects>18 years of age undergoing robotic urogynecologic procedures were randomized to have port site closure with either cyanoacrylate tissue adhesive(n=25)or subcuticular suture(n=25).All procedures and postoperative evaluations were performed by the same board certified Female Pelvic Medicine and Reconstructive Surgeon.Incisional closure time was recorded.Each subject was followed for 12-wk postoperatively.Incision cosmesis was evaluated using the Stony Brook Scar Evaluation Scale.RESULTS A total of 47 subjects(cyanoacrylate group,n=23;suture group,n=24)completed the 12-wk postoperative evaluation.Closure time was significantly less(P<0.0005)using cyanoacrylate tissue adhesive(5.4±2.0 min)than subcuticular suture(24.9±5.6 min).Cosmesis scores were significantly higher in the cyanoacrylate tissue adhesive group than subcuticular suture(P=0.025).No differences were found between bleeding,infection,or dehiscence(P=1.00,P=0.609,P=0.234,respectively).No statistical demographical differences existed between the two study arms.CONCLUSION Our study supported our original hypothesis that cyanoacrylate tissue adhesive for port site closure during robotic urogynecolgic procedures uses less time than with subcuticular suture.Our study also supports that tissue adhesive is comparable to cosmetic outcome while not jeopardizing rates of bleeding,infection,or dehiscence.
文摘Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).
文摘Pelvic organ prolapse （POP） is non-fatal conditions which can markedly affect a patient’s quality of life. Multiple recently developed pelvic reconstructive surgeries have led to a recent expansion in China. In this study, we would like to discuss various aspects of the evaluation and management of POP and raise the question of what is sufficient evidence for the adoption of innovative treatments for POP.
