Periurethral Lidocaine Does Not Decrease Pain After Urodynamic Testing in Women: A Double-Blinded Randomized Control Trial.

OBJECTIVE: Urodynamic testing of women is a common procedure to evaluate lower urinary tract symptoms but may cause discomfort. The objective of our study was to determine the effect of externally applied periurethral 2% lidocaine gel on pain scores after complex urodynamic testing in women. METHODS: This prospective, double-blinded, placebo-controlled randomized trial compared 2% lidocaine gel to water-based lubricant applied to the periurethral area before urodynamic testing in women. Discomfort was measured using a visual analog pain scale (VAS) ranging from 0 to 100. The primary outcome was the difference in VAS from baseline to 4 to 6 hours after urodynamic testing. Secondary outcomes included: VAS difference from baseline to immediately postprocedure and 24 hours after urodynamic testing; VAS scores: at baseline, immediately postprocedure, after 4-6 hours, and after 24 hours; urodynamic testing results; and any adverse events. Sixty-four women per group were needed to provide a power of 80% to detect a 10-mm difference on a 100-point VAS. RESULTS: From January 2018 to March 2019, 134 subjects were randomized, 6 subjects were excluded, which resulted in 64 subjects in both the water-based lubricant group and 2% lidocaine gel group. There was no difference in baseline demographics. There was no significant difference in the change in VAS from baseline to 4 to 6 hours after UDT (0, 0 P = 0.88). No difference in secondary outcomes was noted. CONCLUSIONS: Topically applied 2% lidocaine gel does not decrease pain compared with water-based lubricant. For most women, complex urodynamic testing is not associated with any significant pain.Clinical Trial Registration:www.ClinicalTrials.gov,-NCT03390790, "Lidocaine for Pain After Urodynamic Testing".

Intrapartum risk factors for postpartum urinary retention: a case-control study.

INTRODUCTION: Urinary voiding dysfunction is a common postpartum condition. Increased knowledge of risk factors for postpartum urinary retention could improve early identification of women at risk and lead to enhanced postpartum surveillance. We sought to identify intrapartum factors that contribute to postpartum urinary retention. METHODS: This retrospective case-control study compared subjects who developed postpartum urinary retention requiring indwelling catheterization after vaginal delivery to a control group who did not require catheterization. The control group was randomly selected in a 1:4 ratio. Continuous data were analyzed using a two-sample t-test and Mann-Whitney U test. Categorical data were analyzed using Fisher's exact test and two proportions test. Logistic regression was performed to identify variables independently associated with increased risk for development of postpartum urinary retention. RESULTS: A total of 5802 women who delivered vaginally met eligibility criteria with 38 women (0.65%) experiencing postpartum urinary retention. Logistic regression revealed that nulliparity, ≥ 2nd-degree obstetrical laceration, and intermittent catheterization during labor were independently associated with increased risk for postpartum urinary retention. CONCLUSION: No single factor predicted development of postpartum urinary retention; however, a higher index of suspicion after vaginal delivery is warranted for nulliparous women, ≥ 2nd-degree obstetrical laceration, and if intermittent catheterization during labor was required.

Prevalence of symptomatic urinary incontinence and pelvic organ prolapse among women in rural Nepal.

INTRODUCTION AND HYPOTHESIS: Although pelvic floor disorders (PFDs) are a significant public health issue in higher income countries, less is known about these disorders and associated risk factors in low income countries. We aimed to determine prevalence and associated risk factors for stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) in reproductive age women in Sarlahi District in rural Nepal. METHODS: We conducted a community-based cross-sectional survey of parous, reproductive age women in rural Nepal and screened for pelvic floor disorders using validated screening questions for PFDs. Overall frequency of self-reported symptoms for SUI, UUI, and POP was estimated and compared across demographic and pregnancy history information. RESULTS: Of 14,469 women available for analysis, the mean (SD, range) age was 33.5 (8.2, 13-52) years, and median (range) number of pregnancies was 4 (1-15). The prevalence of SUI was 24.1% (95% CI: 23.3-24.8), of UUI was 13.5% (95% CI: 13.0-14.1), and of POP was 8.0% (95% CI: 7.5-8.4). Bivariate analysis identified the risk of PFD increased incrementally with age and number of vaginal deliveries; these covariates were highly correlated. Multivariable logistic regression revealed age, vaginal deliveries, and previous pelvic surgeries were independently associated with PFD. CONCLUSIONS: PFDs are common in a community of parous, reproductive age women in rural Nepal. Risk factors for these conditions are similar to risk factors found in higher income countries.

Perineal hernia repair using permanent suture and mesh: a video case presentation.

INTRODUCTION: Perineal hernias are an uncommon cause of pelvic bulge symptoms in women with no established ideal surgical approach. We present the case of a posterior perineal hernia repaired robotically using permanent sutures and mesh. METHODS: A 67-year-old woman with a posterior perineal hernia and stage III uterovaginal prolapse presented to our office and underwent minimally invasive robotics-assisted abdominal surgery. Her levator plate defect was closed primarily using permanent sutures and reinforced using polypropylene mesh. A concomitant supracervical hysterectomy and sacrocolpopexy were performed. RESULTS: Robotics-assisted transabdominal perineal hernia repair offered excellent intra-operative visualization and complete delineation of the defect. CONCLUSIONS: Robotics-assisted abdominal primary repair of the perineal hernia and overlying mesh placement offered a safe and effective repair of this rare disorder.

Change in cost after 5 years of experience with robotic-assisted hysterectomy for the treatment of endometrial cancer.

Health care costs are an important consideration in the decision of hysterectomy routes and robotic surgery is often critiqued for its high cost. We sought to compare the cost of robotic-assisted hysterectomies performed after initial acquisition of the robotic surgical system to cases performed after 5 years of experience. The first 20 patients at a community teaching hospital who underwent robotic-assisted hysterectomy for endometrial cancer by a single gynecologic oncology surgeon were designated Group 1 and 20 patients undergoing robotic hysterectomies 5 years later for the same indication were designated Group 2. Direct hospital costs were divided into operative and non-operative costs. Mean operating room cost and cost of anesthesia per minute for Group 1 were adjusted to Group 2 mean costs. Supply costs were adjusted using the 2015 Consumer Price Index. Baseline characteristics of the groups were comparable. After 5 years of experience, there was a 15.5% [95% CI (-$2865, -$407), p = 0.01] reduction in mean total costs (Group 1 = $10,543, Group 2 = $8907) and a 14.3% [95% CI (-$2378, -$390), p ≤ 0.01] reduction in mean operative costs (Group 1 = $9688, Group 2 = $8304). Significant reductions in procedure time, operating room time, operating room cost, and cost of anesthesia were seen from Group 1 to Group 2. There were no differences in mean non-operative costs, estimated blood loss, cost of supplies or surgeon cost. Experience with robotic-assisted hysterectomies is associated with reduction in costs, which is primarily a result of reduced operative times. This is an important factor when considering costs related to robotic surgery.