- Email: [email protected]
Endometrial Preparation Prior to Essure™ Sterilization: A Provider Survey
S66
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S47–S68
study : assessment of the efficacy of the TVT or TVT-O procedure in the management of patients with recurrent urinary stress incontinence after failed previous TVT or TVT-O procedure. Design: Retrospective case series study. Median follow-up : 13.5 months (IQR :2.00-56.75). Setting: Tertiary care unit (universitary hospital). Patients: 26 patients with recurrent urinary stress incontinence after previous failed TVT or TVT-O. Patients characterisctics (median (IQR)) : Age : 56 years (49.25-67.00); body mass index : 24 kg/m2 (22.00-26.75) ; parity: 2(1.25-2.75). Intervention: Susequent TVT (n=18) or TVT-O (n=8) procedure. Measurements and Main Results: Preoperatively, patients were assessed with physical examination, uroflow, filling and voiding cystometry, urethral profilometry, and cough stress test. Satisfaction rate was assessed using semi-quantitative evaluation: very unsatisfactory unsatisfactory – satisfactory – very satisfactory. Subjective and objective efficacy of the procedure was assessed using cough stress test and ICIQ-SF questionnaire. 21 women have completed follow-up. Overall, the objective cure rate based on the cough stress test was 91% (21/23). The subjective cure rate based on ICIQ-SF findings was 42%(9/21), the improvement rate (ICIQ-SF \ 13) was 42% (9/21), and the failure rate (ICIQ-SF > 13) was 14% (3/21). Reintervention was required in 5 (19%) women because of post-operative urinary retention (2 cases) or vaginal extrusion of the sling (3 cases). Conclusion: The TVT or TVT-O procedure as a second operation could provide an overall cure rate of 91% in women with recurrent urinary stress incontinence after previous failed midurethral tape procedures. However, a high reintevention rate for complication is associated with this second procedure.
Study Objective: The aim of this study is to characterize the scheduling and utilization of endometrial preparation before EssureÔ sterilization among a nationwide sample of academic family planning providers. Design: A survey was developed using expert input and refined after pretesting. A link to the electronic survey was sent by email to all 98 directors of Ryan Residency Training Programs and Family Planning Fellowship Programs. The survey included questions regarding scheduling and utilization of hormonal contraception in different patient scenarios. Setting: Academic institutions in the United States. Intervention: Provider Survey. Measurements and Main Results: A total of 35 directors participated. Among the participants who reported performing EssureÔ sterilization and completed the survey, 91.3% (21/23) recommend hormonal contraception prior to an EssureÔ sterilization. Among those who recommend hormonal contraception, 100% recommend a minimum of 4 weeks of endometrial preparation. They recommend DepoProvera:Ô often 85.7%(18/21) and always 14.3% (3/21). Extended cycle pills are also recommended often 38.1% (8/21). The majority of participants 65.0% (13/20) believe DepoProveraÔ has a large impact on visualizing the tubal ostia. The most common time to start any hormonal endometrial preparation for postpartum patients is before hospital discharge. Among the participants who see patients desiring EssureÔ sterilization following first trimester abortion, 100% recommend starting hormonal endometrial preparation immediately post abortion for a minimum of 4-6 weeks. Conclusion: This study provides insight into choosing a method and duration of endometrial preparation prior to EssureÔ sterilization. There is a clear provider preference to recommend DepoProveraÔ prior to EssureÔ sterilization. 218
216
Open Communications 12dUrogynecology (12:59 PM d 12:15 PM)
Posterior Compartment Prolapse – Laparoscopic Supralevator Repair – 10 Year Review O’Shea RT, Seman E, Cook J, Behnia-Willison F, Lam C, Bedford N, Gibberd S, Kierse M. Flinders Endogynaecology and Urogynaecology, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia; Flinders Medical Centre, Adelaide, South Australia, Australia Study Objective: To assess the efficacy and safety of Laparoscopic Supralevator Repair in the treatment of DeLancey Level 2 posterior compartment prolapse (POPQ Assessment). Design: Prospective observational study. POPQ assessment performed preoperatively, postoperatively and on an annual basis thereafter. Setting: University Hospital (Endogynaecology, Urogynaecology) and private practice. Drs. Elvis Seman, Robert O’Shea and Jennifer Cook. Patients: 154 patients with Level 2 posterior compartment prolapse (POPQ) were treated with Laparoscopic Supralevator Repair. Patients were assessed (POPQ) preoperatively, postoperatively and annually thereafter. Intervention: Laparoscopic Supralevator Repair involved dissection into the rectovaginal septum down to the level of perineal body. Sutures were then placed between the levatores ani laterally and the posterior vaginal wall, thereby providing a ladder of support posteriorly. This procedure was then followed by a Uterosacral Colpopexy. Measurements and Main Results: POPQ assessment preoperatively, postoperatively and annually. 154 patients objective cure 97% with follow-up ranging beyond five (5) years. Conclusion: Laparoscopic Supralevator Repair for Level 2 posterior compartment vaginal prolapse has proved extremely successful. However, the procedure is technically difficult as considerable expertise with suturing is required.
217
Open Communications 13dHysteroscopy (12:05 PM d 12:10 PM)
Endometrial Preparation Prior to EssureÔ Sterilization: A Provider Survey Krishnan S, Hahn E, Kiley J, Stika C, Hammond C. Northwestern University, Chicago, Illinois
Open Communications 13dHysteroscopy (12:11 PM d 12:16 PM)
Evaluation of Pain and Other Complications in Office Hysteroscopy Lorenzo E, Jime´nez JS, Gonza´lez C, Tejerizo A´, Marqueta L, Herna´ndez JM. Gynaecology and Obstetrics, Hospital Doce de Octubre, Madrid, Spain Study Objective: To assess the complications, especially those related to pain, of outpatient hysteroscopy. Design: A retrospective study of office hysteroscopy and its complications listed in our database between April 2009 and April 2010. Setting: Universitary referral center in Madrid (Spain). Patients: Women undergoing outpatient hysteroscopy. Intervention: Hysteroscopy with saline as an irrigation medium. Measurements and Main Results: One thousand nine hundred forty-five outpatient diagnostic hysteroscopies where carried out. Of these, uterine disease was encountered in 43.03% of cases. The most frequent hysteroscopic diagnoses were: 601 polyps (71.80%), 110 myomas (13.14%), 82 endocervical polyps (9.80%) and 29 uterine anomalies (3.46%). A total of 174 (8.9%) complications were found as detailed in Table 1. Patients with vagal reaction or pain (group 1) had higher proportion of atrophic endometrium than patients who had no complication (group 2) (57.48% vs. 40.67%, p =. 0002). 23.55% of patients of group 2 had secretory endometrium whilst only 7.87% of women from group 1 had this finding (p =. 0002). On the other hand, the proportion of biopsies and polypectomies performed was higher in group 2 than in group 1 as showed in Table 2. Conclusion: Diagnostic hysteroscopy has a low incidence of complications (8.9%). The presence of atrophic endometrium is associated with an increased rate of complications related to pain, while women with secretory endometrium at are less likely to present them. Whether intervention Table 1 Hysteroscopic findings HYSTEROSCOPIC FINDING
n (%)
Polyp Myoma Endocervical polyp Uterine malformation (suspected) Endometrial neoplasm
601(71.80%) 110(13.14%) 82(9.80%) 29(3.46%) 15(1.80%)
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S47–S68
study : assessment of the efficacy of the TVT or TVT-O procedure in the management of patients with recurrent urinary stress incontinence after failed previous TVT or TVT-O procedure. Design: Retrospective case series study. Median follow-up : 13.5 months (IQR :2.00-56.75). Setting: Tertiary care unit (universitary hospital). Patients: 26 patients with recurrent urinary stress incontinence after previous failed TVT or TVT-O. Patients characterisctics (median (IQR)) : Age : 56 years (49.25-67.00); body mass index : 24 kg/m2 (22.00-26.75) ; parity: 2(1.25-2.75). Intervention: Susequent TVT (n=18) or TVT-O (n=8) procedure. Measurements and Main Results: Preoperatively, patients were assessed with physical examination, uroflow, filling and voiding cystometry, urethral profilometry, and cough stress test. Satisfaction rate was assessed using semi-quantitative evaluation: very unsatisfactory unsatisfactory – satisfactory – very satisfactory. Subjective and objective efficacy of the procedure was assessed using cough stress test and ICIQ-SF questionnaire. 21 women have completed follow-up. Overall, the objective cure rate based on the cough stress test was 91% (21/23). The subjective cure rate based on ICIQ-SF findings was 42%(9/21), the improvement rate (ICIQ-SF \ 13) was 42% (9/21), and the failure rate (ICIQ-SF > 13) was 14% (3/21). Reintervention was required in 5 (19%) women because of post-operative urinary retention (2 cases) or vaginal extrusion of the sling (3 cases). Conclusion: The TVT or TVT-O procedure as a second operation could provide an overall cure rate of 91% in women with recurrent urinary stress incontinence after previous failed midurethral tape procedures. However, a high reintevention rate for complication is associated with this second procedure.
Study Objective: The aim of this study is to characterize the scheduling and utilization of endometrial preparation before EssureÔ sterilization among a nationwide sample of academic family planning providers. Design: A survey was developed using expert input and refined after pretesting. A link to the electronic survey was sent by email to all 98 directors of Ryan Residency Training Programs and Family Planning Fellowship Programs. The survey included questions regarding scheduling and utilization of hormonal contraception in different patient scenarios. Setting: Academic institutions in the United States. Intervention: Provider Survey. Measurements and Main Results: A total of 35 directors participated. Among the participants who reported performing EssureÔ sterilization and completed the survey, 91.3% (21/23) recommend hormonal contraception prior to an EssureÔ sterilization. Among those who recommend hormonal contraception, 100% recommend a minimum of 4 weeks of endometrial preparation. They recommend DepoProvera:Ô often 85.7%(18/21) and always 14.3% (3/21). Extended cycle pills are also recommended often 38.1% (8/21). The majority of participants 65.0% (13/20) believe DepoProveraÔ has a large impact on visualizing the tubal ostia. The most common time to start any hormonal endometrial preparation for postpartum patients is before hospital discharge. Among the participants who see patients desiring EssureÔ sterilization following first trimester abortion, 100% recommend starting hormonal endometrial preparation immediately post abortion for a minimum of 4-6 weeks. Conclusion: This study provides insight into choosing a method and duration of endometrial preparation prior to EssureÔ sterilization. There is a clear provider preference to recommend DepoProveraÔ prior to EssureÔ sterilization. 218
216
Open Communications 12dUrogynecology (12:59 PM d 12:15 PM)
Posterior Compartment Prolapse – Laparoscopic Supralevator Repair – 10 Year Review O’Shea RT, Seman E, Cook J, Behnia-Willison F, Lam C, Bedford N, Gibberd S, Kierse M. Flinders Endogynaecology and Urogynaecology, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia; Flinders Medical Centre, Adelaide, South Australia, Australia Study Objective: To assess the efficacy and safety of Laparoscopic Supralevator Repair in the treatment of DeLancey Level 2 posterior compartment prolapse (POPQ Assessment). Design: Prospective observational study. POPQ assessment performed preoperatively, postoperatively and on an annual basis thereafter. Setting: University Hospital (Endogynaecology, Urogynaecology) and private practice. Drs. Elvis Seman, Robert O’Shea and Jennifer Cook. Patients: 154 patients with Level 2 posterior compartment prolapse (POPQ) were treated with Laparoscopic Supralevator Repair. Patients were assessed (POPQ) preoperatively, postoperatively and annually thereafter. Intervention: Laparoscopic Supralevator Repair involved dissection into the rectovaginal septum down to the level of perineal body. Sutures were then placed between the levatores ani laterally and the posterior vaginal wall, thereby providing a ladder of support posteriorly. This procedure was then followed by a Uterosacral Colpopexy. Measurements and Main Results: POPQ assessment preoperatively, postoperatively and annually. 154 patients objective cure 97% with follow-up ranging beyond five (5) years. Conclusion: Laparoscopic Supralevator Repair for Level 2 posterior compartment vaginal prolapse has proved extremely successful. However, the procedure is technically difficult as considerable expertise with suturing is required.
217
Open Communications 13dHysteroscopy (12:05 PM d 12:10 PM)
Endometrial Preparation Prior to EssureÔ Sterilization: A Provider Survey Krishnan S, Hahn E, Kiley J, Stika C, Hammond C. Northwestern University, Chicago, Illinois
Open Communications 13dHysteroscopy (12:11 PM d 12:16 PM)
Evaluation of Pain and Other Complications in Office Hysteroscopy Lorenzo E, Jime´nez JS, Gonza´lez C, Tejerizo A´, Marqueta L, Herna´ndez JM. Gynaecology and Obstetrics, Hospital Doce de Octubre, Madrid, Spain Study Objective: To assess the complications, especially those related to pain, of outpatient hysteroscopy. Design: A retrospective study of office hysteroscopy and its complications listed in our database between April 2009 and April 2010. Setting: Universitary referral center in Madrid (Spain). Patients: Women undergoing outpatient hysteroscopy. Intervention: Hysteroscopy with saline as an irrigation medium. Measurements and Main Results: One thousand nine hundred forty-five outpatient diagnostic hysteroscopies where carried out. Of these, uterine disease was encountered in 43.03% of cases. The most frequent hysteroscopic diagnoses were: 601 polyps (71.80%), 110 myomas (13.14%), 82 endocervical polyps (9.80%) and 29 uterine anomalies (3.46%). A total of 174 (8.9%) complications were found as detailed in Table 1. Patients with vagal reaction or pain (group 1) had higher proportion of atrophic endometrium than patients who had no complication (group 2) (57.48% vs. 40.67%, p =. 0002). 23.55% of patients of group 2 had secretory endometrium whilst only 7.87% of women from group 1 had this finding (p =. 0002). On the other hand, the proportion of biopsies and polypectomies performed was higher in group 2 than in group 1 as showed in Table 2. Conclusion: Diagnostic hysteroscopy has a low incidence of complications (8.9%). The presence of atrophic endometrium is associated with an increased rate of complications related to pain, while women with secretory endometrium at are less likely to present them. Whether intervention Table 1 Hysteroscopic findings HYSTEROSCOPIC FINDING
n (%)
Polyp Myoma Endocervical polyp Uterine malformation (suspected) Endometrial neoplasm
601(71.80%) 110(13.14%) 82(9.80%) 29(3.46%) 15(1.80%)