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The Current Landscape of PARP Inhibitors in Ovarian Cancer
AbstractPurpose of ReviewThe aim of this study is to discuss the background of PARP inhibitors and to provide an overview of the utility of these drugs for treatment of epithelial ovarian cancer.Recent FindingsNumerous phase I –III trials are presented within the manuscript that outline the safety and efficacy of several PARP inhibitors in women with primary and recurrent ovarian cancer. There are now three FDA-approved PARP inhibitors for use in ovarian cancer patients in the USA: olaparib, niraparib, and rucaparib. Th ese drugs have activity both alone and in combination with other agents, including chemotherapy and ta...
Source: Current Obstetrics and Gynecology Reports - March 1, 2018 Category: OBGYN Source Type: research

Apical Suspension During Prolapse Repair: When Is It indicated?
AbstractPurpose of ReviewThe criteria for choosing to perform an apical suspension at the time of prolapse repair are not always clear. The aim of this article is to review the evidence regarding the role of apical suspension at the time of prolapse repair.Recent FindingsSeveral studies have shown that defects in apical vaginal support contribute significantly to both anterior and posterior prolapse. Furthermore, there is evidence that apical suspension at the time of anterior and, to a lesser extent, posterior prolapse repair may decrease the risk of recurrence requiring treatment in the future. Despite this evidence, con...
Source: Current Obstetrics and Gynecology Reports - March 1, 2018 Category: OBGYN Source Type: research

Enhanced Recovery After Minimally Invasive Surgery (ERA mi S) for Gynecology
AbstractPurpose of ReviewEnhanced Recovery After Surgery (ERAS) programs are mechanisms for achieving multimodal, evidence-based reductions in surgical stress and value-based improvements in perioperative care. Implementation of these programs has been shown to significantly decrease narcotics utilization, perioperative morbidity, length of stay (LOS), and cost of care. This review summarizes the origins and penetrance of ERAS programs into the field of gynecology to date. It presents the rationale and basic construct for an ERAS program customized for gynecologic minimally invasive surgery (MIS), with special focus on pat...
Source: Current Obstetrics and Gynecology Reports - February 22, 2018 Category: OBGYN Source Type: research

Immune Checkpoint Inhibition in the Treatment of Gynecologic Cancer
AbstractPurpose of ReviewThe purpose of this review is to update readers on recent advancements in the use of immune checkpoint inhibitors for the treatment of ovarian, uterine, and cervical cancers.Recent FindingsImmunotherapy has emerged as a novel therapeutic paradigm in the treatment of gynecologic malignancies. Currently, immune checkpoint inhibitors are approved for use across five solid malignancies, with recent approval of pembrolizumab in patients with MMR-deficient, recurrent, solid tumors in a disease site agnostic fashion. Phase 3 clinical trials are being conducted in the gynecologic cancer arena to determine ...
Source: Current Obstetrics and Gynecology Reports - February 14, 2018 Category: OBGYN Source Type: research

Updates in Sentinel Lymph Node Mapping in Gynecologic Cancer
AbstractPurpose of ReviewThe aim of this study is to review the indications, techniques, and outcomes of sentinel lymph node (SLN) mapping in endometrial, cervical, and vulvar cancers.Recent FindingsIn endometrial cancer, the prospective FIRES trial showed that the negative predictive value of SLN mapping was 99.6%. Furthermore, multi-institutional retrospective studies comparing SLN mapping to traditional lymphadenectomy have found comparable survival between the two techniques, in both type 1 and type 2 endometrial cancer. In cervical cancer, randomized data from the SENTICOL-2 study has demonstrated significant reductio...
Source: Current Obstetrics and Gynecology Reports - February 6, 2018 Category: OBGYN Source Type: research

Apical Suspension During Prolapse Repair: When Is It indicated?
AbstractPurpose of ReviewThe criteria for choosing to perform an apical suspension at the time of prolapse repair are not always clear. The aim of this article is to review the evidence regarding the role of apical suspension at the time of prolapse repair.Recent FindingsSeveral studies have shown that defects in apical vaginal support contribute significantly to both anterior and posterior prolapse. Furthermore, there is evidence that apical suspension at the time of anterior and, to a lesser extent, posterior prolapse repair may decrease the risk of recurrence requiring treatment in the future. Despite this evidence, con...
Source: Current Obstetrics and Gynecology Reports - February 2, 2018 Category: OBGYN Source Type: research

Cognitive Impairment and Pelvic Floor Disorders
AbstractPurpose of ReviewCognitive impairment and pelvic floor disorders (PFDs) more frequently affect older women. We aimed to review recent literature on challenges of providing treatment for women with pelvic floor disorders and cognitive impairment, including risks to those with cognitive impairment, challenges in treatment, and non-pharmacologic treatment options.Recent FindingsPrevalence of cognitive impairment in women seeking PFD treatment ranges between 4.3 and 29.3%. Women with cognitive impairment and urgency incontinence are at risk of cognitive changes from antimuscarinics, and polypharmacy in treatment of inc...
Source: Current Obstetrics and Gynecology Reports - December 1, 2017 Category: OBGYN Source Type: research

Uterine Sarcoma: Modern Treatment Paradigms
AbstractPurpose of ReviewThe purpose of this review is to inform readers of the most current management strategies for women with uterine sarcoma.Recent FindingsSurgery is the standard of care in the management of all soft-tissue sarcomas, including uterine sarcoma. However, there are malignancies that can be challenging to diagnose preoperatively and can mimic the appearance of benign uterine leiomyomas. Because of aggressive tumor biology and relative chemotherapy and radiotherapy resistance, efficacious therapies to achieve prolonged survival or cure in those with both early- and advanced-stage uterine sarcomas have bee...
Source: Current Obstetrics and Gynecology Reports - December 1, 2017 Category: OBGYN Source Type: research

Postpartum LARC: Best Practices, Policy and Public Health Implications
AbstractPurpose of ReviewTo review current literature highlighting effective strategies and policies in implementation of postpartum long-acting reversible contraception (LARC) as well as outcomes of postpartum LARC use.Recent FindingsThe use of postpartum LARC is highly desired by patients, effective at reducing rates of unintended and short interval pregnancies, and has demonstrated significant health care savings. Despite these positive outcomes associated with postpartum LARC use, availability of immediate postpartum LARC is limited in the majority of US hospitals. Barriers to the provision of postpartum LARC include l...
Source: Current Obstetrics and Gynecology Reports - November 3, 2017 Category: OBGYN Source Type: research

Urogynecologic Care of the Transgender Patient
AbstractPurpose of ReviewThis paper aims to review the current data that exist on the urogynecologic needs of the transgender patient and to relay important clinical pearls that may be useful to assist providers in caring for this patient population.Recent FindingsIn one study, 7.5% of transgender women who had undergone vaginoplasty surgery had a stage 2 or greater prolapse; 3.8% required surgery to repair their prolapse; 47% reported voiding dysfunction; 25 and 17% reported urinary urgency and urge incontinence, respectively; and 23% had stress incontinence. In a large cohort of patients who had undergone vaginoplasty, t...
Source: Current Obstetrics and Gynecology Reports - October 25, 2017 Category: OBGYN Source Type: research

Uterine Sarcoma: Modern Treatment Paradigms
AbstractPurpose of ReviewThe purpose of this review is to inform readers of the most current management strategies for women with uterine sarcoma.Recent FindingsSurgery is the standard of care in the management of all soft-tissue sarcomas, including uterine sarcoma. However, there are malignancies that can be challenging to diagnose preoperatively and can mimic the appearance of benign uterine leiomyomas. Because of aggressive tumor biology and relative chemotherapy and radiotherapy resistance, efficacious therapies to achieve prolonged survival or cure in those with both early- and advanced-stage uterine sarcomas have bee...
Source: Current Obstetrics and Gynecology Reports - October 25, 2017 Category: OBGYN Source Type: research

Urodynamic Testing: Choosing Between Simple Versus Complex
AbstractPurpose of ReviewThe purpose of the review is to explore the utility of urodynamic testing and guide readers on how to choose the best between simple and complex urodynamic testing.Recent FindingsThe literature discussed includes clinical scenarios in which urodynamic testing is usually not necessary, when a simple urodynamic assessment provides sufficient clinical information and when complex testing is particularly helpful in clinical decision-making.SummaryThe evaluation of a straightforward incontinent woman usually does not require urodynamic testing when planning initial behavioral or pharmacologic therapy. T...
Source: Current Obstetrics and Gynecology Reports - October 19, 2017 Category: OBGYN Source Type: research

Preventable Surgical Harm in Gynecologic Oncology: Optimizing Quality and Patient Safety
AbstractPurpose of ReviewPreventable medical adverse events are a leading cause of death in the USA. The most common adverse events include medication errors, perioperative complications, venous thromboembolism, infection, and readmission. Patients requiring care with a gynecologic oncologist are at increased risk for all of these adverse events, which are both clinically undesirable and now also represent targets for reduced hospital reimbursement. The goal of this review is to identify areas of preventable harm that occur in the perioperative period on a gynecologic oncology service and identify mechanisms to minimize ha...
Source: Current Obstetrics and Gynecology Reports - October 9, 2017 Category: OBGYN Source Type: research

Recurrent Urinary Tract Infection in Women
AbstractPurpose of ReviewThe purpose of this review is to discuss the pathophysiology, diagnosis, treatment, and prevention of recurrent urinary tract infection (UTI) in the setting of antimicrobial stewardship.Recent FindingsAlthough recurrent UTI was traditionally thought to occur by repeated ascension of uropathogenic colonizers, newer evidence suggests that a subset of bacteria becomes internalized within uroepithelial cells forming quiescent intracellular reservoirs. These quiescent reservoirs do not elicit an immune response and persist after treatment of acute infection. In time, epithelial turnover results in relea...
Source: Current Obstetrics and Gynecology Reports - October 6, 2017 Category: OBGYN Source Type: research

Cognitive Impairment and Pelvic Floor Disorders
AbstractPurpose of ReviewCognitive impairment and pelvic floor disorders (PFDs) more frequently affect older women. We aimed to review recent literature on challenges of providing treatment for women with pelvic floor disorders and cognitive impairment, including risks to those with cognitive impairment, challenges in treatment, and non-pharmacologic treatment options.Recent FindingsPrevalence of cognitive impairment in women seeking PFD treatment ranges between 4.3 and 29.3%. Women with cognitive impairment and urgency incontinence are at risk of cognitive changes from antimuscarinics, and polypharmacy in treatment of inc...
Source: Current Obstetrics and Gynecology Reports - September 5, 2017 Category: OBGYN Source Type: research