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IMPORTANCE: The impact of preoperative pain on outcomes can guide counseling. OBJECTIVE: The objective of this study was to compare outcomes after vaginal reconstructive surgery and pelvic muscle training between women with and without preoperative pain. STUDY DESIGN: This is a secondary analysis of the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, which randomized patients to a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (pelvic floor muscle training vs usual care). Preoperative pain was defined as a response of "5" or greater on the pain scale or answering "moderately" or "quite a bit" on the Pelvic Floor Distress Inventory question "Do you usually experience pain in the lower abdomen or genital area?" RESULTS: The OPTIMAL trial included 109 women with preoperative pain and 259 without pain. Although women with pain had worse pain scores and pelvic floor symptoms at baseline and postoperatively, they had greater improvement on pain scores (-2.3 ± 2.4 vs -0.2 ± 1.4, P < 0.001), as well as Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire scores. Among women with pain who underwent a sacrospinous ligament fixation, those who received pelvic floor muscle training had a greater reduction in pain compared with those in the usual care group (-3.0 ± 2.3 vs -1.3 ± 2.1, P = 0.008). Persistent or worsening pain was present at 24 months in 5 (16%) women with preoperative pain. CONCLUSIONS: Women with preoperative pain experience significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery. Pelvic floor muscle training perioperatively may be beneficial for select patients.

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IMPORTANCE: The relative cost per improvement in quality of life can help guide decisions about adding a midurethral sling at the time of prolapse surgery. OBJECTIVE: This study aimed to assess the cost-effectiveness of prophylactic midurethral slings placed at the time of prolapse surgery to reduce de novo urinary incontinence based on a randomized controlled trial. STUDY DESIGN: Costs and effectiveness were collected as part of a planned secondary analysis from the Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) trial, where 337 women without symptomatic stress urinary incontinence were randomly assigned to a midurethral sling or sham incisions during vaginal prolapse surgery. Within-trial cost-effectiveness analysis was performed from the societal perspective. Effectiveness was measured in quality-adjusted life-years (QALYs) and de novo urinary incontinence. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. RESULTS: Within-trial societal costs were higher for the sling group than for the control group ($18,170 [95% confidence interval (CI), $16,420-$19,920] vs $15,700 [95% CI, $14,110-$17300], P = 0.041). The changes in QALY were 0.04 (95% CI, 0.02-0.06) versus 0.03 (95% CI, 0.02-0.05; P = 0.54). The incremental cost-effectiveness ratio for prophylactic sling was $309,620/QALY. This is above the generally accepted range of willingness-to-pay thresholds of $50,000 to $150,000/QALY. At 1 year, urinary incontinence was more common in the control group, and the cost to prevent 1 case was $91. The probability that prophylactic sling is cost-effective is 24%. CONCLUSIONS: Prophylactic sling placed during vaginal prolapse surgery reduced the rate of de novo urinary incontinence, but was not cost-effective.

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OBJECTIVE: To assess the cost effectiveness of performing routine concurrent apical support procedures at the time of hysterectomy for benign indications. METHODS: We developed a Markov decision model from the health care sector perspective to compare concurrent apical support (ie, McCall culdoplasty) at the time of hysterectomy for benign indications compared with hysterectomy alone. We modeled Markov transitions between asymptomatic, prolapse without treatment, and treated prolapse states for 3 years. Our primary outcome was incremental cost-effectiveness ratio, defined as the difference between groups in mean cost (2019 U.S. dollars) divided by the difference in mean quality-adjusted life-years (QALYs). Model parameter estimates were taken from the published medical literature. Cost estimates were obtained from Medicare reimbursement rates and the literature. One-way, two-way, and probabilistic sensitivity analyses were performed. RESULTS: We assumed a base-case scenario of 13% posthysterectomy prolapse after hysterectomy alone and 2.1% after concurrent apical support, 5.8% and 0.9% undergoing subsequent surgical treatment for prolapse, respectively. Concurrent apical support at the time of hysterectomy had higher costs ($1,667 vs $1,423) but was more effective (2.34 vs 2.31 QALYs) than hysterectomy alone. Concurrent apical support was cost effective with an incremental cost-effectiveness ratio of $11,988/QALY, compared with general willingness-to-pay ranges of $50,000-150,000/QALY. In sensitivity analyses, concurrent apical support remained cost effective as long as the rate of posthysterectomy prolapse after concurrent apical support remained less than 8.7%. Monte Carlo simulation showed that concurrent apical support was cost effective in more than 60% of the simulated iterations. CONCLUSION: Apical support at the time of hysterectomy for benign indications is cost effective compared with hysterectomy alone from the health care sector perspective at 3 years. Our results suggest that encouraging concurrent apical support procedures at time of hysterectomy is a cost-effective strategy in preventing posthysterectomy vaginal prolapse.

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OBJECTIVE: To evaluate objective and subjective outcomes of patients who underwent sacrocolpopexy using autologous rectus fascia to provide more data regarding non-mesh alternatives in pelvic organ prolapse surgery. DESIGN: Ambispective cohort study with retrospective and prospective data. SETTING: A single academic medical centre. POPULATION: Women who underwent abdominal sacrocolpopexy using autologous rectus fascia between January 2010 and December 2019. METHODS: Patients were recruited for a follow-up visit, including completing the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse Quantification (POP-Q) examination. Demographic and clinical characteristics were collected. MAIN OUTCOME MEASURES: Composite failure, anatomic failure, symptomatic failure and retreatment. RESULTS: During the study period, 132 women underwent sacrocolpopexy using autologous rectus fascia. The median follow-up time was 2.2 years. Survival analysis showed that composite failure was 0.8% (95% CI 0.1%-5.9%) at 12 months, 3.5% (95% CI 1.1%-10.7%) at 2 years, 13.2% (95% CI 7.0%-24.3%) at 3 years and 28.3% (95% CI 17.0%-44.8%) at 5 years. The anatomic failure rate was 0% at 12 months, 1.4% (95% CI 0.2%-9.2%) at 2 years, 3.1% (95% CI 0.8%-12.0%) at 3 years and 6.8% (95% CI 2.0%-22.0%) at 5 years. The symptomatic failure rate was 0% at 12 months, 1.3% (95% CI 0.2%-9.0%) at 2 years, 2.9% (95% CI 0.7%-11.3%) at 3 years and 13.1% (95% CI 5.3%-30.3%) at 5 years. The retreatment rate was 0.8% (95% CI 0.1%-5.9%) at 12 months and 2 years, 9.4% (95% CI 4.2%-20.3%) at 3 years and 13.0% (95% CI 6.0%-27.2%) at 5 years. CONCLUSION: Autologous rectus fascia sacrocolpopexy may be considered a safe and effective alternative for patients who wish to avoid synthetic mesh. TWEETABLE ABSTRACT: Sacrocolpopexy using autologous rectus fascia is a safe and effective alternative to synthetic mesh.

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BACKGROUND: Vaginal epithelial abnormalities (VEA) are a common complication associated with pessary use. The objective of this study was to determine if there is a host pro-inflammatory response associated with pessary use and VEA. METHODS: Patients wearing pessaries for at least two weeks for the management of pelvic organ prolapse and/or urinary incontinence were screened for eligibility. Vaginal swabs were collected from women with VEA (cases) and without VEA (controls). Cases were matched to controls in a 1:3 ratio. Cytokine analysis of the collected samples was performed using multiplex analysis to determine the concentrations of interleukin (IL)6, interferon alpha 2 (IFNα2), tumor necrosis factor alpha (TNFα) and IL1ß. A cross-sectional analysis was performed, comparing vaginal cytokine concentrations in women with and without VEA. RESULTS: We enrolled 211 patients in this analysis: 50 cases and 161 controls. The median concentrations (pg/mL) of the four cytokines for cases and controls respectively were; IL6: 6.7 (IQR <2.9 [the lower limit of detection, LLD]-14.2) and < 2.9 (LLD) (IQR <2.9 [LLD]-5.5), IFNα2: 8.2 (IQR 6.1-13.9) and 7.9 (IQR 3.9-13.6), TNFα: 15.2 (IQR 6.1-30.4) and 4.68 (IQR <2.3 [LLD]-16.3), IL1ß 195.7 (IQR 54.5-388.6) and 38.5 (IQR 6.7-154.9). The differences in median cytokine levels were statistically higher in cases for IL6, TNFα, and IL1ß (all p < 0.001) compared to controls. Older age (OR: 1.062, 95% CI, 1.015-1.112), lower BMI (OR: 0.910, 95% CI, 0.839-0.986) and presence of VEA at last check (OR: 5.377, 95% CI, 2.049-14.108) were associated with higher odds of having VEA on multivariate analysis. CONCLUSION: Pro-inflammatory cytokines, specifically IL6, TNFα, and IL1ß, are elevated in pessary-wearing patients who have VEA. Additional prospective studies are needed to assess baseline vaginal inflammatory profiles before and after pessary placement to understand VEA formation in pessary patients.

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BACKGROUND: Pelvic pain is a debilitating condition that is common among women with pelvic floor disorders. Limited information is known about the impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery. OBJECTIVE: This study aimed to compare the outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain. STUDY DESIGN: Baseline and postoperative data were analyzed from the "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial." The multicenter trial involved women with anterior prolapse without symptoms of stress incontinence randomized to receive either a midurethral sling or sham incisions during a vaginal reconstructive surgery. Participants completed the visual analog scale adapted for suprapubic pain and Pelvic Floor Distress Inventory at baseline, 3 months, and 12 months. Preoperative pelvic pain was defined as a response of "5" or greater on pain on the visual analog scale or answering "moderately" or "quite a bit" on the Pelvic Floor Distress Inventory question, "Do you usually experience pain in the lower abdomen or genital area?" Outcomes and complication rates were compared between women with and without pelvic pain. RESULTS: The "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial" participants included 112 women with pelvic pain (58 had a midurethral sling and 54 had sham incisions) and 212 women without pelvic pain (105 had a midurethral sling and 107 had sham incisions). Women who had a midurethral sling and pelvic pain were younger than women without pelvic pain (60.3±12.1 vs 65.1±8.6; P=.004). Women who had sham incisions and pelvic pain were more likely of Hispanic ethnicity than women without pelvic pain (27.8% vs 9.4%; P=.002). Patient improvement based on the Patient Global Impression of Improvement scale did not differ between arms. Women with pelvic pain had greater improvement on the visual analog scale pain scores after a surgical procedure at 3 months (-3.1±2.9 vs -0.4±1.6; P<.001) and at 12 months (-3.4±3.0 vs -0.6±1.6; P<.001) than women without pain, although their pain scores remained higher than those without preoperative pelvic pain at all time points (P<.001 for all). Similar improvements were found on the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. The differences observed were not affected by whether women were in the midurethral sling or sham arm of the trial. Postoperative urinary tract infection and incomplete bladder emptying did not differ between the groups. CONCLUSION: Women with preoperative pelvic pain experienced significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery and had similar subjective improvement postoperatively compared with women without preoperative pelvic pain. Reassuringly, the performance of a midurethral sling did not have an impact on the results.

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OBJECTIVES: To evaluate the association between pessary use more than 1 year and change in prolapse severity. METHODS: This is a secondary analysis of a previously published randomized controlled trial of women undergoing office management of pessaries for management of symptomatic pelvic organ prolapse and incontinence. Primary outcome was change in pelvic organ prolapse quantification measurement genital hiatus (GH). Secondary outcomes included change in prolapse stage, type of pessary, size of pessary, number of pessary changes, and duration of use. Baseline data were collected from the earliest documented examination within the hospital record before pessary placement and compared with their final study visit. Demographics were analyzed using descriptive statistics. Student t test and Mann-Whitney tests were used for categorical comparisons. Pearson and Spearman correlation coefficients were used to evaluate change over time. RESULTS: The cohort was 132 predominantly non-Hispanic White (75%) women with symptomatic prolapse >stage 2 (70.5%). All were postmenopausal. Median duration of pessary use was 39.5 months (interquartile range, 17-64.5 months). Genital hiatus (P = 0.014) and prolapse stage (P = 0.001) decreased as duration of pessary use increased. Those with baseline stages ≥3 had a significant decrease in GH as duration of pessary use increased compared with stages <3 (-0.5 cm vs 0 cm, P < 0.001). There was no difference in change in GH when comparing women with baseline GH less than 3 to 3 cm or greater. CONCLUSIONS: Pessary use by women with pelvic organ prolapse causes a change in vaginal anatomy over time as seen by decreasing stage and point GH.

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OBJECTIVE: To determine the relationship between age at first delivery and subsequent risk of pelvic organ prolapse. STUDY DESIGN: We performed a retrospective cross-sectional study using the National Health and Nutrition Examination Survey data from 2005 to 2012. Our primary outcome was self-reported prolapse. Survival analyses and Cox proportional hazard models were used to estimate parous women's risks of reporting prolapse in terms of time since first delivery, adjusting for parity, body mass index, prior hysterectomy, ethnicity, and education. We performed subgroup analyses on women with at least 1 vaginal delivery and those with only cesarean deliveries. RESULTS: The survey-weighted prevalence of prolapse was 2.82%. A total of 6203 women, 79% of all parous women surveyed, reported age at first delivery. Kaplan-Meier curves were different for women based on age at first delivery (P = 0.034). For each year increase in age at first delivery, there was a 6% increase in the rate of developing prolapse (adjusted hazard ratio, 1.06; 95% confidence interval, 1.01-1.11; P = 0.011). Compared with a woman who was 20 years at her first delivery, someone who was 30 years had 1.79 times the risk, while at 40 years the risk was 3.21 times. Among women with at least 1 vaginal delivery, the same relationship was found (adjusted hazard ratio, 1.06; 95% confidence interval, 1.01-1.12; P = 0.019). However, this was not significant for women with only cesarean deliveries (P = 0.367). CONCLUSIONS: Older age at the time of first delivery was associated with a higher risk of subsequent prolapse. These results should be interpreted with caution given the limitations of cross-sectional survey data.

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INTRODUCTION AND HYPOTHESIS: Risk factors can be used to determine what patients will develop delayed postoperative urinary retention after female pelvic reconstructive surgery. METHODS: A case-control study was performed including all female pelvic reconstructive surgeries necessitating a voiding trial. All patients passed their previous voiding trial. Cases had an acute encounter for urinary retention. Controls did not have acute postoperative urinary retention. Cases and controls were stratified based on procedure. Demographics, medical/surgical histories, voiding symptoms, urodynamic testing, and intraoperative data were collected. Cases were matched to controls in a 1:3 ratio. Mann-Whitney U and chi-square tests were used for univariate analyses; logistic regression was used to determine predictors of delayed postoperative urinary retention (DPOUR). RESULTS: A total of 1219 patients underwent pelvic reconstructive surgery that met eligibility; 51 cases of DPOUR (4.3%) were identified and matched with 153 controls without postoperative urinary retention. Of the procedures performed, 41.2% had prolapse surgery, 10.3% had incontinence surgery, and 48.5% had both prolapse and incontinence surgery. There were no differences between cases and controls in age, race, prior surgery, medical comorbidities, prolapse stage ≥ 3, voiding symptoms, and surgical characteristics. Cases had a lower BMI than controls (p < 0.001). There was no difference in preoperative urodynamic variables. Cases had lower percent voided volume on their last voiding trial than controls (90.2% ± 28.6% vs. 110.7% ± 39.5%, respectively; p = 0.001); however, clinically we consider a voided volume of two-thirds or greater of the instilled volume to be a normal result. CONCLUSIONS: DPOUR is an uncommon postoperative event. Demographic and clinical factors and urodynamic findings were unable to predict DPOUR. Percent voided volume on voiding trial was greater in controls.

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OBJECTIVE: The aim of the study was to compare perioperative morbidity of stress urinary incontinence surgery using data from a nationwide cohort. METHODS: This is a retrospective cohort study of the American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2016. Stress urinary incontinence surgery was defined using current procedural terminology (CPT) for abdominal retropubic colposuspension (CPT 51840, 51841), laparoscopic retropubic colposuspension (CPT 51990, 51992), and suburethral sling (CPT 57288). Patients were excluded if they underwent any concomitant surgery except for cystoscopy (CPT 52000). Surgical approach and perioperative morbidity were examined using suburethral sling as the referent population. Patient characteristics, operative data, and 30-day postoperative events were collected. RESULTS: Overall, 19,093 women underwent a stress urinary incontinence surgery: 317 abdominal retropubic colposuspension, 357 laparoscopic retropubic colposuspension, and 18,419 suburethral sling. Patients undergoing abdominal retropubic suspension had more inpatient procedures compared with suburethral sling and laparoscopic retropubic colposuspension (65% vs 10.4% and 17.6%, P < 0.001) and longer length of stay (1.6 ± 2.9 vs 0.3 ± 2.7 and 0.3 ± 0.6, respectively, P < 0.001). Abdominal retropubic colposuspension had the longest odds ratio time compared with suburethral sling (72.0 ± 64.6 vs 38.1 ± 34.2 minutes, P < 0.001). Composite morbidity was significantly higher for abdominal retropubic colposuspension compared with suburethral sling and laparoscopic retropubic colposuspension (7.9% vs 3.4% and 2.0%, P < 0.001). After adjusting for comorbidities, composite morbidity was higher for abdominal retropubic suspension (P = 0.007) compared with suburethral sling. CONCLUSIONS: Compared with suburethral sling, laparoscopic retropubic colposuspension had the lowest 30-day comorbidity and abdominal retropubic colposuspension had the highest 30-day comorbidity.

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OBJECTIVES: We aim to describe the volume and cost of female pelvic reconstructive surgeries across the United States and evaluate the relationship between volume and cost of inpatient care for these surgeries. METHODS: Medicare Severity Diagnosis Related Group was used to identify admissions for female pelvic reconstructive procedures and aggregated at the state and census region levels using the 2016 Inpatient Medicare Provider Utilization and Payment Data. Total hospital charges were converted to cost using the cost-to-charge ratios for each state. For context and comparison with another benign gynecologic procedure, we replicated the analysis for benign uterine and adnexal surgeries. RESULTS: We identified 2133 patients admitted for female pelvic reconstructive procedures. Across all states, the average cost was US $11,857, and the average number of procedures per 100,000 Medicare beneficiaries was 4.4. The Northeast had the lowest cost, and the West had the highest. The regression model showed that, for each additional admission per 100,000 Medicare beneficiaries, the cost of inpatient care decreased (US $549, P = 0.04). In comparison, we identified 8340 admissions for benign uterine and adnexal surgeries and found a minimal, nonsignificant decrease in cost for each additional admission. CONCLUSIONS: There are variations in the volume and cost of admissions for female pelvic reconstructive surgeries across the United States. We identified that an inverse association between volume and cost for female pelvic reconstructive surgery was not seen in benign uterine and adnexal surgeries.

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OBJECTIVE: To evaluate the influence of pessary visit intervals on development of vaginal epithelial abnormalities. METHODS: We conducted a randomized, noninferiority trial of office-based pessary care. Eligible participants were adult women wearing a ring, Gellhorn, or incontinence dish pessary to treat pelvic organ prolapse or incontinence or both. Patients were randomized 1:1 to routine pessary care (office visits every 12 weeks, "routine" arm) or to extended pessary care (office visits every 24 weeks, "extended" arm). The primary study outcome was rate of vaginal epithelial abnormalities (epithelial break or erosion) at the final study visit (48 weeks). The predetermined noninferiority margin was 7.5%. RESULTS: From January 2015 through June 2017, inclusive, 448 patients were screened and 130 were randomized, 64 to the routine arm and 66 to the extended arm. Baseline characteristics of the study arms were similar with the exception of pessary type, with ring pessary more common in the routine arm and Gellhorn pessary more common in the extended arm (P=.02). The rate of epithelial abnormalities at the final study visit (48 weeks) was 7.4% in the routine arm and 1.7% in the extended arm (difference, -5.7 percentage points; 95% CI -7.4 to -4), which met the criterion for noninferiority. Rates of all types of epithelial abnormalities did not differ between arms at any time point. Increasing duration of pessary use (P=.003) and history of prior epithelial abnormalities were associated with development of epithelial abnormalities (P=.01). Other than epithelial abnormalities, no adverse events related to pessary use occurred in either arm. CONCLUSION: In women who receive office-based pessary care and are using a ring, Gellhorn, or incontinence dish pessary, routine follow-up every 24 weeks is noninferior to every 12 weeks based on incidence of vaginal epithelial abnormalities. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02371083.

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OBJECTIVES: This study aims to identify risk factors for elevated preoperative postvoid residual (PVR) and persistently elevated postoperative PVR and to evaluate the resolution rate of elevated PVR urine volume in patients undergoing reconstructive surgery for pelvic organ prolapse (POP). METHODS: This was a retrospective cohort study comparing 50 women with elevated preoperative PVR (≥100 mL) and 50 women with normal PVR (<100 mL). Preoperative demographic, physical examination, urodynamic data, type of surgery performed, and postoperative trial of void data were collected. Variables were evaluated for association with elevated PVR using Student t test or Mann-Whitney U test, and χ or Fisher exact test. RESULTS: The elevated PVR cohort was older (65.5 ± 13.3 vs 60.6 ± 10.1 years, P = 0.04). The cohorts did not differ by body mass index, parity, number of cesarean deliveries, prior hysterectomy, incontinence, prolapse surgery, menopausal status, hormone replacement therapy, history of recurrent urinary tract infections, diabetes mellitus, or maximum bladder capacity. Most patients had preoperative anterior prolapse stage 2 or 3. Complaints of incontinence, incomplete bladder emptying, and overactive bladder did not differ between groups. Performed Surgical procedures, cystoscopy findings, and rate of postoperative trial of void failures did not differ between groups. One patient per cohort learned clean intermittent self-catheterization for persistently elevated PVR. CONCLUSIONS: All women undergoing surgery for POP had postoperative resolution of elevated PVR. Patients with nonneurogenic-elevated PVR can be reassured that bladder emptying will improve after surgical repair of POP.

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INTRODUCTION AND HYPOTHESIS: The Pelvic Organ Quantification (POP-Q) system is a standardized technique used for staging POP. This study aimed to examine POP-Q use in peer-reviewed publications. METHODS: Nine journals representative of urogynecology were reviewed for articles describing POP staging from January to December 2012 and 2015. Review articles, editorials, letters and articles with or without retractions in manuscript form were excluded. The primary outcome was frequency of POP-Q use. Secondary outcomes were POP-Q use by journal specialty, specialty of primary author, country of origin, and an anatomic definition of failure. Data were evaluated using chi-square tests. Results yielding p < 0.05 were deemed statistically significant. RESULTS: Two hundred and nineteen articles were reviewed. POP-Q was used in 88.4% in 2012 and 80% in 2015(not significant; p = 0.296). Urologists used the POP-Q least frequently, although its use was greater in 2015 (63.6%) than in 2012 (50%). In 2012, a definition for anatomic failure was present in 27% of articles; 23% of authors in the 2012 time frame reported using the POP-Q, and 17.8% used a specific POP-Q point. Between 2012 and 2015, the use of a specific point significantly decreased (17.8 vs. 7.8%, p = 0.033). CONCLUSION: POP-Q is the most common staging system used in published articles across studied subgroups. When used as an outcome measure, a greater number of authors use the recommended staging system rather than specific points.

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INTRODUCTION AND HYPOTHESIS: Hospital readmission is increasingly used as a measure of quality care. Our objective was to evaluate the rate of readmission and associated factors in women undergoing suburethral sling placement in the USA. METHODS: This is a cohort study of suburethral sling procedures performed in the USA from 2012 to 2014 using the American College of Surgeons' National Surgical Quality Improvement Program database. The database was queried for suburethral sling procedures. Records were excluded if concomitant surgery had been performed. Patient and surgical characteristics were evaluated for association with readmission using Chi-squared test for categorical variables and Student's t test for continuous variables. All results yielding p < 0.05 were deemed statistically significant. RESULTS: A total of 7,117 suburethral sling procedures were identified. There were 83 (1.16%) hospital readmissions. Those who were readmitted tended to be older (p = 0.011), non-Hispanic (p = 0.04), smokers (p < 0.001), and have an American Society of Anesthesiologists Physical Status Classification System score of 3 or 4 (p = 0.001). A history of bleeding disorder (p < 0.001), congestive heart failure (p < 0.001), or chronic obstructive pulmonary disease (p < 0.001) was associated with readmission. Fifty-four (0.75%) patients underwent reoperation within 30 days of suburethral sling placement. The most common reoperation procedure was sling excision (20 patients). The most common complication was urinary tract infection, which occurred in 189 patients (2.7%). CONCLUSIONS: Suburethral sling placement is a safe procedure with a low rate of readmissions, reoperations, and complications. Consistent with other types of surgery, infection is the most common post-operative complication.

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OBJECTIVE: To evaluate the relationship between perioperative use of transdermal scopolamine and the rate of urinary retention after stress urinary incontinence and pelvic organ prolapse procedures in women. METHODS: This is a retrospective, cohort study; the primary outcome is the rate of acute postoperative urinary retention. Study candidates were adult female patients who underwent pelvic reconstructive surgery at a tertiary care center. Subjects were excluded if preoperative postvoid residual urine volume was greater than 150 mL, preoperative urodynamic testing was not performed, or if a postoperative trial of void was not performed. Subjects were grouped based on preoperative use of transdermal scopolamine. Patients were selected consecutively until 138 subjects per group was reached. Differences in rates of acute postoperative urinary retention were evaluated using a chi-square test. Group demographics were evaluated using t tests and χ tests. RESULTS: Two hundred seventy-six subjects were included in the analysis, 138 received a transdermal scopolamine patch in the perioperative period and 138 did not. The overall rate of acute postoperative urinary retention was 25.3%. There was no significant difference in the rate of acute postoperative urinary retention between the study groups (scopolamine, 26.8%; no scopolamine, 23.9%; P = 0.580). Demographics of the 2 groups were compared; patients who received scopolamine patch were younger (P = 0.001), received a greater amount of intravenous fluids (P = 0.007), and underwent a greater percentage of incontinence procedures (P = 0.048). Otherwise, there were no differences between the groups. CONCLUSIONS: Transdermal scopolamine is not a risk factor for acute postoperative urinary retention after pelvic reconstructive procedures.

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STUDY OBJECTIVE: To examine the rate of abstract publication from the Society of Gynecologic Surgeons Annual Scientific Meeting (SGSASM), 2004 to 2012. STUDY DESIGN: This is a retrospective study in which all abstracts presented at the SGSASM from 2004 to 2012 were reviewed. Information was collected on oral (O), oral poster (OP), and poster (P) presentations. To evaluate for publication, all abstracts were searched for in the US National Library of Medicine's PubMed database. Chi-square tests were used to evaluate whether there were differences in distribution of published studies by first author location and affiliation and number of abstract authors. DESIGN CLASSIFICATION: Canadian Task Force III. MEASUREMENTS AND MAIN RESULTS: In total, 867 abstracts were reviewed, including all O, OP, and P presentations. Video and tips and tricks presentations were excluded. Overall rate of publication for all abstracts from 2004 to 2012 was 55.7%, comprising 82.4% for O presentations, 60.9% for OP presentations, and 41.4% for P presentations. There was no significant difference in location for published abstracts (p = .878), although published abstracts had a significantly greater number of authors (p < .001). Abstracts presented by authors from university programs were more likely to be published (p < .001). For all presentation types, the mean number of citations for published abstracts was different for the 9-year period (O, OP, and P: p < .001), with an overall decline toward the end of the assessment period. CONCLUSION: Over a 9-year period (2004-2012), the rate of abstract publication at the SGSASM was 55.7%, which is similar to other academic meetings. The comparability of this publication rate shows that the abstract selection committee is able to select high-quality research with limited information provided in abstract submissions.

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OBJECTIVE: The objective of the study was to evaluate the differences in vaginal culture, microscopy, and Gram stain between postmenopausal women who wear pessaries and those who do not to explain pessary-related, bothersome vaginal discharge. STUDY DESIGN: Postmenopausal women not using exogenous estrogen who had either been wearing a pessary for at least 3 months or who were undergoing their first pessary fittings were approached for enrollment. Symptoms were assessed, and vaginal fluid was collected for culture, microscopy, and Gram stain. A cross-sectional analysis was performed, comparing the new and return pessary wearers. The new pessary users were also sampled at 2 weeks, 3 months, and 6 months after fitting. RESULTS: Women who wore pessaries were more likely to be bothered by discharge (30.0% vs 2.1%, P < .001). They were also more likely to show microscopic evidence of vaginal inflammation and vaginitis. Prospective data showed that these changes developed during the first 2 weeks of pessary use. Aerobic and anaerobic organisms were nearly identical in women with and without bothersome vaginal discharge in the cross-sectional analysis and at all time points in the prospective analysis. CONCLUSION: Pessary-related, bothersome vaginal discharge develops early and may be due to an inflammatory process in the vagina.

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