Is de novo stress incontinence after sacrocolpopexy related to anatomical changes and surgical approach?

INTRODUCTION AND HYPOTHESIS: The objective was to investigate the relationship between new onset postoperative stress urinary incontinence (SUI) after sacrocolpopexy (SCP) and anatomical change/surgical approach. METHODS: We analyzed a retrospective cohort of patients with negative preoperative testing for SUI who underwent SCP from 2005 to 2012. Our primary outcome was new onset postoperative SUI. Logistic regression was used to examine the relationship among anatomical change, defined as ΔAa, ΔBa, ΔC, and ΔTVL, and surgical approach, categorized as abdominal (ASCP) for open cases and minimally invasive (MISCP) for laparoscopic and robot-assisted cases, and postoperative SUI. RESULTS: Of 795 cases, 33 ASCP (43%) and 44 MISCP (57%) met the inclusion criteria for analysis. New onset SUI was demonstrated by 15 patients (45%) of the ASCP group and 7 patients (15%) of the MISCP group (p = 0.005). New onset SUI was significantly associated with route of SCP and ΔAa (p = 0.006 and p = 0.033 respectively). Controlling for ΔAa, the odds of new onset SUI were 4.4 times higher in the ASCP group compared with the MISCP group (OR 4.37, 95% CI 1.42, 13.48). Controlling for route of SCP, the odds of new onset SUI were 2.2 times higher with moderate ΔAa compared with low ΔAa (OR 2.16 95% CI 1.07, 4.38). The odds of new onset SUI was 4.7 times higher in those with high ΔAa than in those with low ΔAa (OR 4.67 95% CI 1.14, 19.22). ΔBa, ΔC, and ΔTVL were not associated with new onset SUI. CONCLUSIONS: Greater reduction in point Aa and abdominal surgical route are risk factors for new onset postoperative SUI after SCP.

Erosion of pelvicol used in sacrocolpopexy.

INTRODUCTION: Biologic graft materials are used more frequently in pelvic reconstructive surgeries. We describe here the complete process of removal of such a biologic graft in the office. CASE: We report a case of a 69-year-old woman with pig dermal graft erosion 1 year after placement. The patient presented with complaints of vaginal discharge. Upon examination, the graft material was seen eroding through the vaginal apex. The pig tissue was removed whole and intact in the office without complications. CONCLUSION: Transvaginal removal of pig tissue in the office relieved the patient's symptoms.

A case of silicone mesh extrusion into the bladder associated with robotic sacrocolpopexy.

BACKGROUND: Over the past several years, the daVinci robot has been used in gynecologic surgery as a new surgical approach. The literature is being slowly populated with pros and cons of this technology. CASE: We report a 60-year-old woman with a history of pelvic organ prolapse who had a robotic sacrocolpopexy. She presented with mesh extrusion into her vagina, which was removed by exploratory laparotomy. Two years later, she presented with mesh erosion into her bladder, which was removed. CONCLUSION: This case report provides an example of significant mesh complication associated with robotic sacrocolpopexy 4 years after surgery and then again 2 years later.

Transvaginal sling release with intraoperative ultrasound guidance.

INTRODUCTION: Visualization of a midurethral sling may be challenging intraoperatively, especially if the sling is deep, well healed, not in the usual location, or made of materials that are not colored. CASE: We present the case of a 71-year-old woman presenting with a history of incomplete bladder emptying and debilitating voiding dysfunction documented by uroflowmetry and postvoid residual after a tension-free vaginal tape placement. Medications in addition to attempts to dilate her urethra failed to provide her with adequate relief. Intraoperative 3-dimensional ultrasound guidance was used to transect the sling that was otherwise unable to be localized with examination alone. CONCLUSIONS: Surgical transection of a tension-free vaginal tape can be safely performed under the guidance of ultrasound. At her 12-month follow-up visit, the patient did not have urinary incontinence or voiding dysfunction.

Metastatic cancer in sigmoid neovagina: a case report.

UNLABELLED: We report a case of a 30-year-old woman with congenital anal cloaca who presented with vaginal bleeding and urinary retention from sigmoid neovagina. She was found to have metastatic mucinous producing adenocarcinoma in the neovagina. BACKGROUND: Malignancy of neovagina is rare. SUMMARY: We report a case of metastatic colorectal cancer after creation of a neovagina and urethra using sigmoid colon.

Predictors of successful salpingo-oophorectomy at the time of vaginal hysterectomy.

STUDY OBJECTIVE: To determine prognostic factors related to successful salpingo-oophorectomy in menopausal women at the time of vaginal hysterectomy. DESIGN: Retrospective cohort study (Canadian Task Force Classification II-2). SETTING: Tertiary care center. PATIENTS: A total of 309 postmenopausal ≥60 years old with pelvic floor disorders. INTERVENTIONS: Vaginal hysterectomy with attempted prophylactic salpingo-oophorectomy. MEASUREMENTS: Factors associated with ability to achieve vaginal salpingo-oophorectomy. MAIN RESULTS: 203 (65.7%) achieved successful removal of 1 or both ovaries, and 106 (34.3%) were not amenable to removal. Younger age and shorter cervical length were predictors of salpingo-oophorectomy. Cervical elongation of ≥7 cm, exteriorized cervical/uterine prolapse, and anterior vaginal wall prolapse beyond the hymen were associated with lower likelihood of achieving salpingo-oophorectomy. CONCLUSIONS: Patient age and cervical length are independent factors that influence the success of accomplishing salpingo-oophorectomy at the time of vaginal hysterectomy.

Percutaneous nerve evaluation in women: lessons learned.

OBJECTIVES: : The primary aim of this study was to identify patient characteristics potentially affecting response to office-based percutaneous nerve evaluation (PNE). Secondarily, we aimed to identify appropriate candidates to undergo office-based PNE. METHODS: : A retrospective chart review was conducted from 2000 to 2011 of female patients who underwent office-based PNE. Data were separated into 3 groups based on outcome: success, equivocal, and failure. Data examined included patient demographics, voiding dysfunction diagnosis, comorbidities, evidence of previous pelvic nerve injury, systemic hormonal status, and neurological insult of such varieties as stroke and Parkinson disease. All data were analyzed using χ analysis and analysis of variance. P < 0.05 was considered statistically significant. RESULTS: : One hundred twelve women underwent office-based PNE. Seventy-four patients (66.1%) had a successful outcome, 15 (13.4%) had an equivocal outcome, and 23 patients (20.5%) failed PNE trial. Neurological insult was the only factor of significance identified in those patients with an equivocal or unsuccessful trial of office-based PNE. After categorizing body mass index according to the World Health Organization's 2011 guidelines, no significance was found for body mass index between successful outcomes, equivocal outcomes, and failures. CONCLUSIONS: : Our cohort demonstrates that those patients who had an equivocal or failed outcome of office-based PNE were more likely to have a neurological insult. Patients with neurological insult who are considered appropriate candidates for neuromodulation trial should undergo staged implantation with quadruple tined lead in the operating room to provide these patients with the greatest opportunity for successful outcome.