A Modern Comparison of Urodynamic Findings in Diabetic Versus Nondiabetic Women.

OBJECTIVES: Few contemporary studies exist regarding urodynamic (UDS) findings in patients with diabetes mellitus (DM), and data are conflicting. Our aim was to compare UDS findings in women with and without DM. METHODS: Data from female patients in a prospectively maintained UDS database (2010-2014) were reviewed. Studies were performed according to International Continence Society standards. Clinical data, presenting symptoms, and UDS findings were compared in women with and without DM, controlling for demographic and pertinent variables. RESULTS: There were 384 patients who met the inclusion criteria, of whom 88 (26%) had DM. Symptoms at presentation were not statistically different in women with and without DM. Women with DM had larger bladder capacity (mean, 493 mL vs 409 mL; P = 0.005) and had more detrusor underactivity (30% vs 18%, P = 0.042) when compared with nondiabetic women. Diabetic women were more frequently diagnosed as having impaired sensation, or lack of desire to void, at 75% of capacity (17% vs 5%, P = 0.001). In women with diabetes, a serum hemoglobin A1c level of at least 7.5% was associated with delayed first sensation and first urge. Diagnosis of DM of more than 10 years was associated with greater volume at first urge, and maximal capacity, lower detrusor pressures, and higher postvoid residual. CONCLUSIONS: In this contemporary series, women with DM demonstrated similar presenting complaints to women without DM but had significantly altered UDS findings. Among diabetic female patients, diabetes control and duration of diabetes seem to impact bladder sensation and contractility. Urodynamics may be helpful in diabetic female patients to diagnose underlying concealed bladder dysfunction before initiation of treatment.

Safety and Efficacy of Retropubic Mid-urethral Sling Placement in Women Who Void With Valsalva.

OBJECTIVE: To compare outcomes after retropubic sling (RPS) in women with and without Valsalva voiding. METHODS: Women who underwent RPS for stress incontinence from 2010 to 2014 were identified and their baseline characteristics were examined. Valsalva voiding was defined as abdominal straining throughout voiding on preoperative urodynamics. Sub-analysis of those with Valsalva included a subset with detrusor underactivity on urodynamics. Follow-up was at 1, 3, 6, and 12 months. Primary outcomes were rates of subjective success, revisions, complications, and voiding dysfunction. Secondary measures were Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7) score, post-void residual, and pad use. RESULTS: Subjects (n = 141) analyzed included 75 Valsalva voiders (VV) and 66 non-Valsalva voiders. At baseline, there were no differences in age, race, comorbidity, post-void residual, pad use, UDI-6, or capacity. Postoperatively, there were no differences in rates of passing initial void trial, need for clean intermittent catheterization, revisions, complications, or voiding dysfunction. No differences in pad use, UDI-6, or IIQ-7 were seen at 6 or 12 months. Within VV, no differences between patients with and without detrusor underactivity were seen for any primary or secondary outcomes (all P > .05). CONCLUSION: In patients who void with Valsalva, RPS appears to be safe and effective. Between VV and non-Valsalva voiders, there were no differences in rates of subjective success, revisions, or complications, even in patients with Valsalva voiding without appreciable detrusor contraction.

Laparoendoscopic single-site surgery for benign ovarian cystectomies.

BACKGROUND: Single-port laparoscopy (LESS) utilizes a single, multichannel port in an attempt to decrease postoperative pain, while enhancing cosmesis and minimizing the potential risks and morbidities associated with the multiple ports used in conventional laparoscopy. METHODS: We performed a retrospective study examining three tertiary care referral centers. From September 2009 until March 2013, 31 patients with ovarian cystic lesions were treated using the LESS technique. A control group of 57 patients who underwent conventional laparoscopic ovarian cystectomy was included for comparison. RESULTS: All patients underwent a technically successful cystectomy. There were no statistically significant differences in the mean operative time or estimated blood loss between the two groups. Narcotic use during the recovery period was reported in less patients in the LESS group than in the laparoscopic group (p = 0.05). CONCLUSIONS: The LESS technique can be used to safely perform cystectomies on women with benign ovarian cysts. Additional investigation is needed to evaluate the safety, cost-effectiveness and long-term outcomes of this new approach.

Laparoscopic single-site linear salpingostomy for the management of heterotopic pregnancy: a case report.

BACKGROUND: The laparoscopic management of tubal pregnancy component of a heterotopic pregnancy was conducted via multiport approach. In this report we describe a new technique using a single port approach with long-term follow-up. CASE: A 27-year-old woman, G4P1031, presented with a heterotopic pregnancy after 2 years of infertility treatment. She underwent multiple surgeries to excise left ovarian cysts, lysis of adhesions, and recanalization of the right fallopian tube. During this time she also experienced a left-sided ectopic pregnancy and was treated with a traditional operative laparoscopy. Upon diagnosis of a heterotopic pregnancy, the decision was made to perform a laparoendoscopic single-site (LESS) procedure for treatment of a right ectopic pregnancy via a salpingostomy to preserve her potential for future spontaneous conception. A linear salpingostomy procedure was performed without complications, and the patient was able to carry her intrauterine pregnancy to term. CONCLUSION: The LESS procedure is effective in resolving an ectopic pregnancy without affecting a coexisting intrauterine pregnancy, and preserving the potential for future spontaneous pregnancies. This approach should be considered for eligible patients with a heterotopic pregnancy who desire preservation of tubal function. (J Reprod Med 2014;