Surgical repair of pelvic organ prolapse in elderly patients.

PURPOSE OF REVIEW: Epidemiologic data suggests that our population greater than 65 years of age will nearly double. In addition, the incidence of women undergoing surgery for pelvic organ prolapse will rise. Chronologic age does not preclude a woman from undergoing a reconstructive procedure, yet the preoperative assessment should be approached most judiciously with great care to insure patient is maximally medically prepared for surgery. RECENT FINDINGS: Surgical procedures in this review include: the abdominal sacral colpopexy, anterior repair, posterior repair, sacrospinous ligament fixation, uterosacral suspension, and iliococcygeus fixation. The advent of robotic surgery has decreased the perioperative morbidity of several of these procedures. However, the risk of more severe complications does appear higher following robotic procedures, when compared with vaginal procedures. SUMMARY: Intuitively, one would surmise that there is a point where vaginal surgery should be considered as the primary procedure based on age, risk and durability of the surgery - unfortunately that age is not clear. Thus, the proper selection of prevalence of organ prolapse surgery can only be done after careful discussion with the patient and including the patient in the selection process as much as possible.

Managing Diabetes in Pregnancy Using Cell Phone/Internet Technology.

In Brief For pregnant women with diabetes, using cell phone/Internet technology to track and report self-monitoring of blood glucose results improves compliance and satisfaction compared to using the more traditional methods of log books, telephone calls, and voicemail messages.

Central compartment and apical defect repair using synthetic mesh.

Pelvic organ prolapse is an increasingly common condition for women that has been challenging to treat due to high recurrence rates after surgical repair. The introduction of mesh-augmented prolapse repairs as a means to achieve more robust repairs had great initial promise. As more data emerge on outcomes and novel mesh complications, the when and where of mesh augmentation has become much less clear. This article reviews the relevant literature on the use of mesh in central and apical repairs. This includes a detailed look at the available data for vaginal mesh kits and several recent trials comparing mesh kits to traditional repairs. The article ends with a discussion of the recent U.S. Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh in pelvic organ prolapse and the authors' views of how practice may change in this new environment.

Assessment of internet-based information regarding pelvic organ prolapse and urinary incontinence.

OBJECTIVE: This study aimed to establish descriptive data on the content, accuracy, and relevance of Internet-based information regarding pelvic organ prolapse and urinary incontinence. METHODS: Using the search terms, urinary incontinence, uterine prolapse, dropped uterus, cystocele, and dropped bladder, the first 20 Web sites that appeared in each of 3 highly used search engines were identified. Two experienced reviewers independently evaluated each site for specific content, relevance, and accuracy. RESULTS: A total of 220 individual sites were identified: government-, university-, and/or society-sponsored sites represented 14.1% of the identified sites. Private parties, community groups, or unknown sponsors represented 73.2% of the sites. Industry represented 12.7% of the sites. The year the site was created was displayed in 45.9% of the sites, although 66.4% of the sites contained a year of update. Overall, 45% of the sites were rated as mostly/completely relevant to the search term and 44% of the sites were rated as mostly/completely accurate. Government-, university-, and/or society-sponsored sites were significantly more likely to be rated mostly/completely relevant and mostly/completely accurate compared with all other site sponsors with P = 0.05 and P = 0.0003, respectively. CONCLUSIONS: Government, university, and/or medical societies sponsor a minority of Web sites compared with other sponsors but provide more comprehensive content that is more relevant and accurate to the topics of pelvic organ prolapse and urinary incontinence.

Defining an at-risk population for obstetric anal sphincter laceration.

OBJECTIVE: The purpose of this study was to calculate the number of cesarean deliveries needed to prevent 1 case of obstetric anal sphincter laceration associated with operative vaginal delivery in an at-risk cohort. STUDY DESIGN: An institutional, computerized database was used to analyze women with obstructed labor who could have been managed by either operative vaginal or cesarean delivery from September 2006 to March 2008. Women with 1 or more of the following diagnoses comprised the cohort: cephalopelvic disproportion (CPD), arrest of descent, maternal exhaustion, and fetal distress. RESULTS: Fifty (23.9%) out of a total of 209 women managed by operative vaginal delivery experienced an anal sphincter laceration compared to none of 254 women in the cesarean delivery group (P < .0001). The ARR therefore was 23.9% (95% confidence interval, 18.1-29.7) and the NNT was 4.2 (95% confidence interval, 3.4-5.5). CONCLUSION: Five cesarean deliveries are needed to prevent 1 anal sphincter laceration associated with operative vaginal delivery in this cohort.