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  • 1
    Language: English
    In: The Journal of Urology, October 2017, Vol.198(4), pp.755-756
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2017.07.045 Byline: Elizabeth R. Mueller
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 2
    Article
    Article
    Language: English
    In: The Journal of Urology, April 2016, Vol.195(4), pp.941-941
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2015.11.076 Byline: Emilie K. Johnson Author Affiliation: Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Urology and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 3
    In: Obstetrics & Gynecology, 2017
    Description: OBJECTIVE:: To estimate the effect of lidocaine–prilocaine cream on patient pain at the time of office pessary removal and reinsertion. METHODS:: In this double-blind, randomized placebo-controlled trial, participants undergoing routine pessary care in a urogynecology office at a tertiary referral center were randomized to application of 4 g of either lidocaine–prilocaine or placebo cream 5 minutes before pessary change. Visual analog scale pain scores were collected from the patient at baseline, after pessary removal, and after pessary reinsertion. Physicians also recorded their estimate of patient pain at pessary removal and reinsertion. The primary outcome was the participant-reported visual analog scale pain score at the time of pessary removal and reinsertion. A sample size of 26 per group (n=52) was planned to estimate an absolute mean difference in visual analog scale pain of 2.1 cm at the time of pessary removal. An analysis of covariance was used to evaluate pain at removal and reinsertion as a function of treatment assignment controlling for baseline pain. RESULTS:: From July 2015 through February 2016, 116 women were screened and 54 were recruited: 28 in the lidocaine–prilocaine cream group and 26 in the placebo group. One patient in the lidocaine-prilocaine cream group was later withdrawn owing to vaginal erosion. The participants were all postmenopausal women, with an average age of 77.8 years. Most characteristics were similar between groups. After adjusting for baseline pain, participants randomized to the lidocaine–prilocaine group had lower pain at pessary removal when compared with those assigned to placebo (mean difference=−2.05, 95% confidence interval −3.69 to −0.41; P=.015). CONCLUSION:: Lidocaine–prilocaine cream use at the time of office pessary removal reduces patient-reported pain. Clinicians may wish to include this simple intervention to optimize patient comfort and compliance. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, NCT02380742.
    Keywords: Anesthetics, Local -- Therapeutic Use ; Lidocaine -- Therapeutic Use ; Pessaries -- Statistics & Numerical Data ; Prilocaine -- Therapeutic Use;
    ISSN: 0029-7844
    E-ISSN: 1873233X
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  • 4
    Language: English
    In: The Journal of Urology, June 2012, Vol.187(6), pp.2140-2143
    Description: We compared the proportion of women with complex repetitive discharges on urethral sphincter electromyography during filling cystometry among women with and without urinary disorders. After receiving institutional review board approval we recruited community dwelling women without urinary symptoms and women who presented for urinary incontinence treatment. Participants completed the Pelvic Floor Distress Inventory. Women who responded affirmatively to an inventory item (“Do you have difficulty emptying your bladder?” or “Do you experience a feeling of incomplete bladder emptying?”) were classified with voiding dysfunction. Women with post-void residual urine greater than 100 ml, active urinary tract infection, prolapse greater than stage II or neuromuscular disease were excluded from study. Participants underwent standardized multichannel urodynamics with continuous concentric needle electromyography of the urethral sphincter throughout filling cystometry. In the 31 controls and 56 incontinent participants mean ± SD age was 48 ± 15 years and median vaginal parity was 1 (range 0 to 2). The urodynamic diagnosis in the incontinent group included urodynamic stress incontinence in 31 (56%), detrusor overactivity with incontinence in 17 (30%) and mixed urodynamic stress incontinence with detrusor overactivity in 8 (14%). Of the women 26 (32%) met voiding dysfunction criteria with 96% reporting a feeling of incomplete bladder emptying and 53% reporting difficult bladder emptying. Controls were significantly more likely to have complex repetitive discharges than incontinent women (9 of 30 vs 2 of 56, p 〈0.002). Complex repetitive discharges occur in about a third of women without urinary symptoms.
    Keywords: Urethra ; Urinary Incontinence ; Urodynamics ; Electromyography ; Etiology ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 5
    Language: English
    In: European Urology, November 2016, Vol.70(5), pp.806-807
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.eururo.2016.05.025 Byline: Elizabeth R. Mueller Author Affiliation: Departments of Urology &Obstetrics/Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
    Keywords: Medicine
    ISSN: 0302-2838
    E-ISSN: 1873-7560
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  • 6
    In: Current Opinion in Urology, 2013, Vol.23(4), pp.317-322
    Description: PURPOSE OF REVIEW: This review summarizes the recent clinical trials that address the abdominal approach for treatment of uterine or vaginal vault prolapse following hysterectomy. RECENT FINDINGS: Open abdominal sacrocolpopexy (ASC) has improved anatomic and sexual functioning outcomes compared with the sacrospinous ligament suspension but this benefit comes with higher costs. Newer studies suggest that minimally invasive approaches to ASC that result in 1 day of hospitalization can be cost-effective. Although most studies demonstrate higher costs when using the robot during laparoscopic surgery, the costs of initial purchase and maintenance become insignificant when a single robot is used at least twice a day (500 procedures annually). Minimally invasive sacrocolpopexy appears to result in less small bowel obstruction and ileus however, intraoperative bowel injury rates are similar. During sacrocolpopexy, placing the sacral suture at the promontory may put the L5-S1 intervetebral disc at risk, while placing the suture 5 mm below the promontory would ensure the suture is at the level of S1 vertebrae. Lastly, the use of cadaveric fascia lata as an alternative to polypropylene mesh for sacrocolpopexy in patients who were followed for 5 years, results in decreased anatomic outcomes, similar subjective outcomes and surprisingly, similar mesh erosion rates. SUMMARY: One of the significant benefits of sacrocolpopexy is that it is not a procedure that has been developed for profit. As a result, the procedure has evolved based on modifications suggested by surgeons with no financial gain. Minimally invasive approaches to ASC allow for the benefits of ASC with significant reductions in patient hospitalization.
    Keywords: Laparoscopy ; Robotics ; Surgery, Computer-Assisted ; Pelvic Organ Prolapse -- Surgery ; Urologic Surgical Procedures -- Methods;
    ISSN: 0963-0643
    E-ISSN: 14736586
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  • 7
    In: Obstetrics & Gynecology, 2014, Vol.123(1), pp.5-12
    Description: OBJECTIVE:: Laparoscopic and robotic sacrocolpopexy are widely used for pelvic organ prolapse (POP) treatment. Evidence comparing outcomes and costs is lacking. We compared costs and clinically relevant outcomes in women randomized to laparoscopic sacrocolpopexy compared with robotic sacrocolpopexy. METHODS:: Participants with symptomatic stage POP II or greater, including significant apical support loss, were randomized to either laparoscopic or robotic sacrocolpopexy. We compared surgical costs (including costs for robot, initial hospitalization) and rehospitalization within 6 weeks. Secondary outcomes included postoperative pain, POP quantification, symptom severity and quality of life, and adverse events. RESULTS:: We randomized 78 women (mean age 59 years): laparoscopic (n=38) and robotic (n=40). The robotic sacrocolpopexy group had higher initial hospital costs ($19,616 compared with $11,573, P〈.001) and over 6 weeks, hospital costs remained higher for robotic sacrocolpopexy ($20,898 compared with $12,170, P〈.001). When we excluded costs of robot purchase and maintenance, we did not detect a statistical difference in initial day of surgery costs of robotic compared with laparoscopic ($12,586 compared with $11,573; P=.160) or hospital costs over 6 weeks ($13,867 compared with $12,170; P=.060). The robotic group had longer operating room times (202.8 minutes compared with 178.4 minutes, P=.030) and higher pain scores 1 week after surgery (3.5±2.1 compared with 2.6±2.2; P=.044). There were no group differences in symptom bother by Pelvic Floor Distress Inventory, POP stage, or rate of adverse events. CONCLUSION:: Costs of robotic sacrocolpopexy are higher than laparoscopic, whereas short-term outcomes and complications are similar. Primary cost differences resulted from robot maintenance and purchase costs. CLINICAL TRIAL REGISTRATION:: Clinicaltrials.gov, www.clinicaltrials.gov, NCT01124916. LEVEL OF EVIDENCE:: I
    Keywords: Medicine;
    ISSN: 0029-7844
    E-ISSN: 1873233X
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  • 8
    Language: English
    In: The Journal of Urology, April 2017, Vol.197(4), pp.e1003-e1003
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2017.02.2149 Byline: Kristin G. Baldea, Grace Delos Santos Author Affiliation: Chicago, IL Article Note: (footnote) Source of Funding: None
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 9
    Language: English
    In: The Journal of Urology, May 2013, Vol.189(5), pp.1721-1724
    Description: Despite preoperative screening and treatment for urinary tract infections, a postoperative urinary tract infection develops in approximately 1 in 5 urogynecologic patients. In this study we assess the proportion of urogynecologic patients with a positive day of surgery urine culture, the clinical consequences of a positive day of surgery culture and differences in postoperative urinary tract infection risks based on day of surgery culture. After institutional review board approval, patients undergoing urogynecologic surgery at Loyola University Medical Center were recruited for the study. Catheterized urine samples were collected in the operating room before intravenous antibiotic administration. Clinical cultures were considered positive if 1,000 colonies per ml or more bacteria were found on routine culture. For analysis we matched each woman with a positive culture with 2 women with negative culture by age within 10 years and within surgical groups (ie prolapse and/or incontinence). Data were analyzed using SPSS® version 19. Nearly a tenth (9.5%) of participants had positive day of surgery cultures. The clinical and demographic characteristics were similar in women with negative vs positive day of surgery cultures. However, women with positive day of surgery cultures were more likely to experience a postoperative urinary tract infection despite standard perioperative antibiotic administration (29.6% vs 5.6%, p = 0.005, odds ratio 7.2). Regardless of day of surgery culture status no participant experienced postoperative systemic urinary complications. Nearly a tenth of urogynecologic patients had positive day of surgery cultures. Patients with a positive day of surgery culture had an increased risk (29.6%) of postoperative urinary tract infection within 6 weeks of surgery. These findings highlight an opportunity to identify and treat patients with positive day of surgery cultures and reduce the incidence of postoperative urinary tract infections.
    Keywords: Urologic Surgical Procedures ; Gynecologic Surgical Procedures ; Urinary Tract Infections ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 10
    Language: English
    In: The Journal of Urology, 2009, Vol.181(4), pp.602-602
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
    Source: ScienceDirect Journals (Elsevier)
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