Accidental Bowel Leakage/Fecal Incontinence
This article reviews the evidence-based update for the management of fecal incontinence. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Isuzu Meyer, Holly E. Richter Source Type: research
Telemedicine in Urogynecology
Telemedicine, which provides safe, equitable, patient-centered care, has gained significant momentum in recent years. Success using telemedicine has been seen across diverse groups of patients for a variety of diagnoses, including older adults and gynecology patients. In response to the coronavirus disease 2019 pandemic, federal and local governments have issued provisions to improve reimbursement and accessibility to telemedicine. In urogynecology, virtual care is growing in popularity, along with a growing body of literature in support of this method of providing care. Providers should use clinical judgment and existing ...
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Miriam C. Toaff, Cara L. Grimes Source Type: research
Recurrent Urinary Tract Infections
This article addresses the diagnosis, treatment, and prevention of recurrent urinary tract infections, including pharmacologic and nonpharmacologic interventions. Most notably, increased interest in the urinary microbiome is leading to improved understanding of virulent and commensal bacteria in the genitourinary tract. Understanding the causative factors of recurrent urinary tract infections will lead to improved detection, treatment, and prevention. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Julie Peck, Jonathan P. Shepherd Source Type: research
Update in Transvaginal Grafts
This article is a narrative review of newer mesh and graft products including lightweight polypropylene mesh products, biological grafts, hybrid grafts, and tissue engineered grafts. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Visha Tailor, Alex Digesu, Steven Edward Swift Source Type: research
Urinary Tract Injury During Gynecologic Surgery
Lower urinary tract (LUT) injuries may occur during gynecologic surgery due to the close proximity of pelvic organs and vary by procedure, surgical indication, and route. Prevention of LUT injury should be a primary goal of gynecologic surgery. LUT injuries are more common in patients with aberrant anatomy, during difficult procedures, and with surgeons with less experience. Immediate recognition and management of LUT injuries is optimal, although delayed postoperative diagnoses may be unavoidable. Surgical management is based on the size and location of injury and should be performed by an experienced surgeon with thoroug...
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Ushma J. Patel, Christine A. Heisler Source Type: research
Female Pelvic Fistulae
Female pelvic fistulae are a pathologic connection between the urinary or gastrointestinal tract and the genital tract. Although this condition has been present for millennia, successful surgical treatments have only been described for the past few hundred years. In developed nations, the most common cause of genitourinary fistulae is benign gynecologic surgery, but worldwide it is obstetric trauma. Fistulae management is rooted in surgical intervention with the highest probability of success associated with the first repair. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Tasha Serna-Gallegos, Peter C. Jeppson Source Type: research
Recognition and Management of Pelvic Floor Disorders in Pregnancy and the Postpartum Period
Often considered a condition of aging women, pelvic floor disorders may initially present in pregnancy and postpartum, having a negative impact on quality of life during this important time in a woman ’s life. This review outlines the clinical approach to implementing pelvic health into obstetric care through education and promotion of pelvic health in pregnancy, screening for pelvic floor disorders routinely, and providing support through resources, treatment, and referrals if pelvic floor dis orders develop during pregnancy and postpartum. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Annetta M. Madsen, Lisa C. Hickman, Katie Propst Source Type: research
Painful Bladder Syndrome/Interstitial Cystitis and High Tone Pelvic Floor Dysfunction
This article provides an overview of 2 conditions that defy straightforward characterization and treatment: interstitial cystitis/painful bladder syndrome often coexists with high tone pelvic floor dysfunction. These conditions are common in gynecologic patients who present with chronic pelvic pain and are often misdiagnosed due to their syndromic nature and amorphous definitions. Clinicians should maintain a high level of suspicion for these processes in patients with chronic pelvic pain or recurrent urinary tract infection symptoms. Optimal treatment uses a multimodal approach to alleviate symptoms. (Source: Obstetrics a...
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Catherine Chandler Moody, Tola B. Fashokun Source Type: research
Urethral Masses
Urethral and periurethral masses in women include both benign and malignant entities that can be difficult to clinically differentiate. Primary urethral carcinoma is rare and the optimal treatment modality may vary depending on the stage at presentation. Because cancer-free survival is poor, clinicians shouldhave a high index of suspicion when evaluating a urethral mass. Some benign-appearing urethral masses may be safely observed. Surgical resection is an effective option that should be used based on patient preference and symptoms, and for suspicious lesions. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Emily C. Serrell, Sarah E. McAchran Source Type: research
Female Pelvic Medicine and Reconstructive Surgery: Where Are We in 2021?
The field of urogynecology, or female pelvic medicine and reconstructive surgery (FPMRS), has expanded tremendously in the last decade. While the American Urogynecologic Society was founded in 1979, it was more than 30 years later, in 2012, that FPMRS was first officially recognized as a subspecialty by the Accreditation Council for Graduate Medical Education (ACGME). Following a 3-year fellowship, FPMRS-trained subspecialists in OB/GYN complete both written and oral board examinations through the American Board of Obstetrics and Gynecology. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Heidi Wendell Brown, Rebecca Glenn Rogers Tags: Preface Source Type: research
Aiding the Increasing Numbers of Women with Pelvic Floor Disorders
This issue of the Obstetrics and Gynecology Clinics of North America, edited by Heidi Brown, MD and Rebecca Rogers, MD, is an update on advances in the field of urogynecology, or female pelvic medicine and reconstructive surgery (FPMRS). The readers have become aware of the expansion in knowledge since the Obstetrics and Gynecology Clinics of North America issue was published in 2016 before the field became a recognized subspecialty. Newer surgical and nonsurgical treatments are presented about conditions that affect the pelvic floor, including the supporting muscles and connective tissues. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: William F. Rayburn Tags: Foreword Source Type: research
Ultrasonographic Imaging of the Pelvic Floor
This article discusses various pelvic floor ultrasonographic modalities and the clinical applications of ultrasonography of the pelvic floor. Ultrasonography provides a detailed anatomic assessment of the muscles and surrounding organs of the pelvic floor. Different anatomic variabilities and pathologic conditions, such as prolapse, fecal incontinence, urinary symptoms, vaginal wall cysts, synthetic implanted material, and pelvic pain, are assessed with pelvic floor ultrasonography. This imaging modality is an important adjunct to the evaluation and diagnosis of pelvic floor disorders. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Trang X. Pham, Lieschen H. Quiroz Source Type: research
Sexual Function After Pelvic Reconstructive Surgery
Improvement in sexual function is an important goal for many women undergoing surgery for pelvic organ prolapse, and patient counseling regarding changes in sexual function and activity is necessary prior to pelvic reconstructive surgery. Based on validated questionnaires, sexual function either remains unchanged or improves after pelvic reconstructive surgery for prolapse, while dyspareunia prevalence is reduced. De novo dyspareunia ranges from 0% to 9% after various types of prolapse surgery, with the exception of posterior repair. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Danielle D. Antosh, Nadia N. Megahed Source Type: research
Defecatory Dysfunction
Normal defecation is a complex and coordinated physiologic process that involves the rectum, anus, anal sphincter complex, and pelvic floor muscles. Any alteration of this process can be considered defecatory dysfunction, a term that covers a broad range of disorders, including slow-transit constipation, functional constipation, and functional or anatomic outlet obstruction. Evaluation should include history, physical, and consideration of additional testing such as colonoscopy, colonic transit studies, defecography, and/or anorectal manometry. Depending on the etiology, management options can include conservative measures...
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Erin C. Crosby, Katherine E. Husk Source Type: research
Urinary Incontinence in Older Women
Urinary incontinence is a prevalent pelvic floor disorder among women of all ages. However, in many older women, especially those who have multiple chronic conditions it may be a geriatric syndrome because of its shared characteristics of physical function impairments, cognitive decline, and mobility disability. The geriatric incontinence syndrome may represent a poorly characterized phenotype of UI among older women which in many ways reflects unhealthy aging. In this article, we explore the evidence behind these concepts together with potentiel impact on the diagnosis and management of UI in this group. (Source: Obstetri...
Source: Obstetrics and Gynecology Clinics - August 18, 2021 Category: OBGYN Authors: Candace Parker-Autry, George A. Kuchel Source Type: research
