C-Clamp Technique: A Retrospective Review of a Novel Technique to Prevent Bladder Injury in Retropubic Midurethral Slings.

IMPORTANCE: Synthetic mesh midurethral slings have become the criterion-standard treatment for stress urinary incontinence with urethral hypermobility in women. Iatrogenic bladder injury is a known risk of the procedure. OBJECTIVE: Our objective was to show that a novel "C-clamp technique" can significantly reduce the risk of bladder and urethral injury at the time of bottom-up retropubic synthetic mesh midurethral sling placement. STUDY DESIGN: We conducted a retrospective review of the electronic medical records using Current Procedural Terminology coding of a single surgeon who performed synthetic mesh midurethral slings. Medical records were reviewed for demographic and clinical data for all bottom-up retropubic synthetic mesh midurethral slings placed using a novel C-clamp technique. All operative reports were reviewed for bladder and urethral injury at the time of implantation of the synthetic mesh midurethral sling using the C-clamp technique. RESULTS: Two hundred one consecutive bottom-up retropubic synthetic mesh midurethral slings were placed using the C-clamp technique from April 2012 through June 2022. The average age was 51 years (29-86 years); the average weight was 82 kg (46 -139 kg); and the average body mass index was 31 kg/m2 (15-57 kg/m2). No patients sustained a bladder or urethral injury at the time of implantation of a retropubic synthetic mesh midurethral sling using the C-clamp technique. CONCLUSION: The novel C-clamp technique shows promise in eliminating the risk of iatrogenic bladder and urethral injury at the time of implanting a bottom-up retropubic synthetic mesh midurethral sling.

Association between time of delivery and composite adverse outcomes in pregnancies complicated by diabetes.

OBJECTIVES: To compare the composite neonatal and maternal adverse outcomes among women with diabetes who labor and deliver at 37-41 weeks at distinct time shifts. METHODS: This population-based retrospective cohort study using the US Vital Statistics dataset on Period Linked Birth-Infant Death Data from 2013-2017. The study population was restricted to non-anomalous singleton live births from women with pregestational or gestational diabetes, who labored and delivered at 37 0/7 to 41 6/7 weeks of gestation. The time of delivery was categorized as the first shift (7:00-15:00), the second shift (15:00-23:00), and the third shift (23:00-7:00). The primary outcome was a composite neonatal adverse outcome; the secondary outcome was a composite maternal adverse outcome. Multivariable Poisson regression models were used to estimate the association between the time of delivery and adverse outcomes (using adjusted relative risk [aRR] and 95% CI). RESULTS: Of 19.8 million live births during the study period, 3.3% (643,610) met the study inclusion criteria. The overall rate of composite neonatal and maternal adverse outcomes were 9.62 and 3.63 per 1000 live births, respectively. Multivariable adjusted regression analysis showed that, compared to newborns delivered at the first shift, the risk of composite neonatal adverse outcome was modestly but significantly higher (aRR 1.19, 95% CI 1.12-1.27) in the third shift (23:00-7:00). There was no significant difference in the risk of composite maternal adverse outcomes between time shifts. In the sensitivity analysis stratified by the day of the week (weekday vs weekend), the results were consistent with the primary analyses. CONCLUSION: Among term pregnancies complicated by diabetes, compared with delivery at 7:00-15:00, the risk of a composite neonatal adverse outcome is marginally but significantly higher if delivery occurs at the third shift (23:00-7:00).

Overactive Bladder Symptoms After Pelvic Organ Prolapse Repair.

OBJECTIVES: This study aimed to identify the characteristics associated with overactive bladder (OAB) symptoms perioperatively in patients undergoing pelvic organ prolapse (POP) surgery with and without slings and to determine the rate of OAB symptom resolution postoperatively. METHODS: This retrospective, single-institution study involved women undergoing prolapse surgery with and without concomitant midurethral sling from 2011 to 2016. A validated questionnaire was used to determine OAB symptoms preoperatively and postoperatively. The primary outcome was rate of resolution in OAB symptoms after POP surgery with and without midurethral sling. Baseline characteristics and surgery type were presented, and univariate and multivariate logistic regression models were applied to evaluate characteristics associated with OAB symptoms at the first postoperative visit. RESULTS: The analysis included 203 patients. Among those with baseline OAB symptoms, 103 (61%) had symptom resolution, whereas 66 (39.1%) reported persistent symptoms. Among 34 patients without baseline OAB symptoms, 6% developed de novo symptoms. Older age was found to be a significant risk factor for persistence of symptoms postoperatively both on univariate (odds ratio, 0.97; 95% confidence interval, 0.94-1; P = 0.038) and multivariate logistic regression (odds ratio, 0.96, 95% confidence interval, 0.92-1; P = 0.049). The rate of medication discontinuation postoperatively was 25%. CONCLUSIONS: Approximately 61% of patients undergoing POP surgery had resolution of OAB symptoms postoperatively whether or not an incontinence procedure was performed. Older age was significantly related to persistent OAB symptoms in both univariate (P = 0.038) and multivariate (P = 0.049) models. The rate of de novo OAB symptoms was 6%.