Route of Hysterectomy at the Time of Sacrocolpopexy: A Multicenter Retrospective Cohort Study.

OBJECTIVES: This study aimed to compare the incidence of mesh exposure based on route of hysterectomy at the time of minimally invasive sacrocolpopexy. Secondary outcomes included perioperative outcomes and prolapse recurrence. METHODS: This was a multicenter, retrospective cohort study. Patients who underwent sacrocolpopexy between 2007 and 2017 were stratified by hysterectomy approach: total vaginal hysterectomy (TVH), total laparoscopic or robotic hysterectomy (TLH), and laparoscopic or robotic supracervical hysterectomy (LSH). Total vaginal hysterectomy was subdivided into vaginal and laparoscopic mesh attachment to the cuff. Statistical analyses were performed, with P < 0.05 denoting statistical significance. RESULTS: Seven institutions participated, and 502 minimally invasive sacrocolpopexies with concomitant hysterectomy were performed by 23 surgeons: 263 TVH, 128 TLH, and 111 LSH. The median follow-up interval was 10 months, and this was significantly different between the groups (months): TVH, 11 (3-13); TLH, 2 (2-9); and LSH, 12 (5-24; P < 0.01). The overall incidence of vaginal mesh exposure was 4.0% (20/502). There were no significant differences in vaginal mesh exposure based on hysterectomy route: TVH, 5.7% (15/263); TLH, 1.6% (2/128); and LSH, 2.7% (3/111; P = 0.11). Within the TVH group, there was no significant difference in vaginal mesh exposure comparing vaginal and laparoscopic mesh attachment: 1.9% (1/52) versus 6.6% (14/211; P = 0.48). Laparoscopic supracervical hysterectomy demonstrated a significantly higher incidence of recurrence compared with TVH and TLH: 10.8% (12/111) versus 3.4% (9/263) and 2.3% (3/128; P < 0.01). CONCLUSIONS: The incidence of sacrocolpopexy mesh exposure was not significantly different based on route of hysterectomy or mode of mesh attachment to the vagina. There was a significant increase in prolapse recurrence with supracervical hysterectomy.

Long-term Fecal Incontinence, Recurrence, Satisfaction, and Regret After the Transobturator Postanal Sling Procedure.

OBJECTIVES: The objective of this study was to assess long-term outcomes after the transobturator postanal sling (TOPAS) procedure for the treatment of fecal incontinence. Long-term recurrence, satisfaction and regret after transobturator postanal sling procedure support the ongoing use of this procedure for patients with fecal incontinence. METHODS: Both a retrospective review of medical records and a prospective telephone survey were conducted. For the retrospective review of medical records, all patients who underwent the TOPAS procedure at our institution were eligible. Medical records were reviewed to assess for symptom resolution, retreatment, and complications. For the prospective telephone survey, patients who were conversant in English and had a valid contact information were eligible and were asked to complete questions on satisfaction, the Patient Global Impression of Improvement, the Wexner Symptom Severity Score, the Fecal Incontinence Qualify of Life Scale, and the modified Decision Regret Scale. RESULTS: A total of 134 patients met the inclusion criteria for the retrospective medical record review. Patients were followed in clinic for a median of 24.0 months (interquartile range, 6.0-53.0). Overall, 75.4% reported improvement in fecal incontinence. There were 37 (27.6%) who required subsequent treatment for fecal incontinence. There were 67 patients eligible for the prospective telephone survey, of whom 46 (68.7%) agreed to participate. Median time between surgery and the telephone survey was 63.5 months (interquartile range, 36.0-98.0). Among these participants, 54.3% were satisfied and 60.9% would recommend the procedure to someone else. No adverse events were identified with long-term follow-up. CONCLUSIONS: Our findings suggest that the TOPAS procedure remains a safe and effective therapy for the treatment of fecal incontinence with favorable long-term outcomes.

Inpatient prenatal yoga sessions for women with high-risk pregnancies: A feasibility study.

BACKGROUND: Antenatal hospitalization for pregnancy complications can result in significant stress for pregnant women and their families. Prenatal yoga has been investigated in the outpatient setting as a method to alleviate stress. This study was designed to investigate the feasibility of incorporating prenatal yoga into the inpatient environment for women hospitalized with pregnancy complications. STUDY DESIGN: High-risk women were recruited from the inpatient antepartum service at Tufts Medical Center (Boston, MA; March 2016 to February 2017) to evaluate the feasibility of an inpatient prenatal yoga program. The thirty-minute session was led by a certified instructor in a room adjacent to Labor and Delivery. Participants and antepartum nurses completed study questionnaires addressing logistics such as class duration and frequency. Perceived benefits of yoga were also explored. RESULTS: Thirty-nine women were found eligible for this study and were consented for participation. Of these, fifteen (38%) participated in at least one yoga session. Responses to the to the post-class questionnaire by study participants indicated that the thirty minutes allocated for the yoga class was appropriate. Of the eight participants who responded to the discharge questionnaire, all indicated that the class was helpful with regards to stress reduction. Completed questionnaires by the antepartum nursing staff (n = 14) unanimously indicated that the yoga session was helpful for the patients and was not disruptive to medical care. CONCLUSION(S): Prenatal yoga is a technique that has been currently limited to the outpatient setting. This study provides a foundation for continued investigation of inpatient prenatal yoga for women hospitalized with pregnancy complications.