Trends in Surgical Exposure and Experience in Female Pelvic Medicine and Reconstructive Surgery Fellowship Programs.

OBJECTIVES: This study aimed to characterize variations in female pelvic medicine and reconstructive surgery (FPMRS) fellows' surgical experiences, concurrence with Accreditation Council for Graduate Medical Education (ACGME) proposed procedural volume guidelines, and to explore how these factors affect self-assessed preparedness to practice independently upon graduation. METHODS: An electronic survey was sent to 166 fellows enrolled in ACGME-approved FPMRS fellowship programs during the 2017-2018 academic year. The survey included questions on demographics, program specifics, desires for future practice, case volume, and self-assessed ability to independently perform selected procedures. RESULTS: A total of 99 fellows responded, yielding a 59.6% (99/166) response rate. Procedures assessed as "core" urogynecologic surgeries were midurethral sling, sacral nerve stimulator placement, abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, extraperitoneal colpopexy, intraperitoneal colpopexy, anterior colporrhaphy, posterior colporrhaphy, colpocleisis, rectovaginal fistula repair, vesicovaginal fistula repair, and urethral diverticulectomy. The percentage of third-year respondents meeting proposed ACGME guidelines varied from 56.3% (18/32; sling procedures) to 96.9% (31/32; intraperitoneal colpopexy and rectovaginal fistula repair). Although 67.7% (67/99) of all respondents reported that they did not expect to feel qualified to perform at least one of these procedures independently upon graduation from fellowship, 99.0% (98/99) predicted that they would be adequately trained overall to practice independently upon graduation. CONCLUSIONS: Surgical experience varied among FMPRS surgical fellows. Case volume was somewhat but not completely associated with self-perceived ability to practice a procedure independently.

Transdermal light neuromodulation: Optogenetics in the murine urinary tract.

BACKGROUND: Optogenetics is a biologic technique that uses light to control living neurons, which have been genetically modified to express light-sensitive ion-channels. OBJECTIVES: Using an adenovirus to modify the sciatic nerves of mice, we aim to demonstrate peripheral neuromodulation of bladder pain using transdermal light. STUDY DESIGN: This pilot study is divided into: A) Confirmation and Application and B) Behavioral Step. A) Six mice were injected with AAV6-hSyn-ChR2(H134R)-eYFP virus into their sciatic nerves. This encoded an excitatory opsin, enabling light-inducible stimulation. At 4-6 weeks after injection, we induced foot pain responses with an activating blue 475 nm wavelength of light. B) Two optogenetically primed mice and two control mice underwent anesthesia and capsaicin was instilled into their bladders via catheter. The catheters were removed and the mice awoke in a chamber that exposed them to either blue 475 nm light or no light. Groin licking was scored in a binary fashion by two blinded observers. RESULTS: A) All six mice exhibited pain response to 475 nm blue light either by licking of foot or avoidance of light. B) The optogenetically primed mice had a 48% reduction in bladder pain behavior when exposed to blue 475 nm light whereas the control mice had a 18% reduction. CONCLUSION: To our knowledge this is the first demonstration of the application of optogenetics to modulate sensation in the lower urinary tract. It suggests that the process of priming peripheral nerves for optogenetic modulation is possible and can be used to study bladder pain response in mice.