- Email: [email protected]
Hysteroscopic Correction of Uterine Malformations Improves the Uterine Receptivity and Implantation Rate in Infertile Cases with Recurrent Implantation Failure
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 185
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:21 AM – GROUP A
Reproductive Outcomes After Hysteroscopic Septoplasty and Comparison of Different Surgical Techniques: A Retrospective Cohort Study uven C,1 Sahin C,1 Akdemir A,1 Ergenoglu AM,1 Yeniel AO,1 Simsek D,1 G€ Sendag F.2 1Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey; 2Obstetrics and Gynecology, Acibadem University Faculty of Medicine, Istanbul, Atakent, Turkey Study Objective: The aim of the study was to evaluate pregnancy outcomes after hysteroscopic septoplasty and to compare the beneficial effects of different hysteroscopic techniques. Design: Retrospective design. Setting: Ege University School of Medicine Department of Obstetrics and Gynecology. Patients: Hospital records of 122 patients who underwent hysteroscopic septoplasty were retrospectively reviewed. Intervention: Hysteroscopic septoplasty was performed in all cases with either monopolar electrode or cold scissors. Measurements and Main Results: All patients’ pregnancy outcomes were followed-up by using registry system and telephone interviews. Ninety-four pregnancies (79 live births, 15 abortion) occurred. Sixty-six women had at least one live birth. Hysteroscopic septoplasty was performed in 72 and 50 patients using resectoscope and cold scissors with 5mm hysteroscope, respectively. Fourty-two (58%) and twenty-four patients (48%) in the resectoscope and cold scissors group, respectively, had live birth but the difference was not statistically significant. Hysteroscopic septoplasty is a safe and effective method with high pregnancy rate. There is no significant difference in live birth rates whether using resectoscope or scissors. Conclusion: Infertile patients should be offered the option of hysteroscopic septoplasty unless they have a history of adverse reproductive outcomes. 186
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:32 AM – GROUP B
Fertility and Pregnancy Outcomes Following Lapascopic Myomectomy Kozachenko IF, Adamyan LV, Smolnikova VY, Porotikova IE, Begieva GA, Stepanian AA. Operative Gynecology Department, Russian Scientific Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russian Federation Study Objective: To assess post-operative fertility rates and pregnancy outcomes of patients who had a Laparoscopic myomectomy (LM) from 2012 to 2014. Design: Retrospective case series. Setting: Department of operative gynecology of The Research Center for Obstetrics, Gynecology and Perinatology. Patients: 437 patients that underwent LM. Intervention: We reviewed the medical records of 437 patients that underwent LM. Routine postoperative care involved obtaining follow up on their fertility and pregnancy outcomes. Measurements and Main Results: 437 women with mean age of 40.55 +/-2.24 years and mean BMI of 24.53+/-4.9 kg/m2. Patients had a mean of 3.34 +/- 2.9 fibroids removed (range 1-21), with the average mass of the fibroids being 331.23 +/- 310.36 grams. 354 of 437 patients (81%) provided fertility and pregnancy outcome data. Follow-up from time of surgery to most recent charted data ranged from 10 months to 7.9 years. Of the 354 women, 212 (59.9%) actively tried for pregnancy after surgery. 73.2% of the 212 achieved a total of 155 pregnancies – 123 full term, 26 preterm, 16 spontaneous abortions and 2 termination. 90.4% of these patients underwent cesarean section. A subset of 104 women had pre-existing infertility. 25 of these patients underwent intrauterine
S81
insemination (IUI), while 79 underwent in vitro fertilization (IVF). After surgery, 60% of these patients achieved 62 total pregnancies. Of the 354 cases, there was one placenta accreta and no uterine ruptures. Conclusion: The fertility rate after laparoscopic myomectomy for all women attempting to conceive (73.2%) and for those with known infertility who continued to try for pregnancy (60%) was similar. There was a low incidence of major complications associated with the presence of uterine scarring in pregnancies conceived after laparoscopic myomectomy in both women with and without a diagnosis of fertility. 187
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:39 AM – GROUP B
Why We Fail. Single Dose Methotrexate Failure – Comparing Patients Receiving Second Dose with Those Selected for Surgical Intervention Schwartz M, Wu C, Fridman D, Rotenberg O, Arabkhazaeli M, Scott C, Levie M. Montefiore Medical Center, Bronx, New York Study Objective: To compare patients selected for surgery with those receiving second dose of methotrexate amongst patients who failed single-dose methotrexate for treatment of ectopic pregnancy (EP). Design: A retrospective cohort, descriptive study. Setting: Inner city academic medical center. Patients: Patients treated with methotrexate for suspected EP from January 1998 to January 2014. Intervention: Review of medical records. Measurements and Main Results: 396 patients with EP were treated with single-dose methotrexate – 114 (28.8%) failed single-dose methotrexate therapy. Group 1 (n=57) received a second dose of methotrexate; Group 2 (n=57) underwent surgery. There were no significant differences with regards to demographics, prior history, or initial clinical presentation. Group 1 had lower initial levels of hcg (24662354 vs 58547734, p=0.002), and lower proportion of patients with adnexal mass (68.4% vs 89.5%, p=0.005) or fetal pole (12.2% vs 33.3%, p=0.007). Other parameters (size of mass, presence of free fluid) did not demonstrate statistical significance. The main reason for administration of a second dose methotrexate was inappropriate decline of hcg (86.0%). 8.8% received additional methotrexate due to an increase in size of adnexal mass despite adequate hcg dynamic and there was no information on indication in 5.3%. 17.5% patients from Group 1 ultimately required surgery, while the others had successful resolution of EP. The main reason for surgical intervention in Group 2 was worsening abdominal pain (57.9%). Other causes were – de-novo ectopic fetal pole (12.3%), inadequate decline in hcg (8.8%), increase in size of adnexal mass (5.3%), increase in free fluid (3.5%), and in 12.3% no reason was identified. Conclusion: In our setting, single-dose methotrexate therapy failed in 28.8% patients – half received a second dose and the other half went directly to surgery. Patients who were selected for surgery had a more advanced gestation at initial presentation. Decision of intervention in cases of failed single-dose methotrexate was mostly clinical. 188
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:46 AM – GROUP B
Hysteroscopic Correction of Uterine Malformations Improves the Uterine Receptivity and Implantation Rate in Infertile Cases with Recurrent Implantation Failure Mounir MS, Elkalaa LE, Deif R, Soliman EM, Anwar AK. Obstetrics/ Gynecology and Infertility, Al Madina for Woman, Alexandria, Sidi Gaber, Egypt Study Objective: To increase the endometrial receptivity that increases implantation rate in infertile women suffering from recurrent ICSI failure with variation in the endometrial shape, thickness and subendometrial blood flow without any other cause of implantation failure.
S82
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Design: Retrospective observational study. Setting: 2D and 3D vaginal ultrasound of the endometrium with DOPPLER study to assess the pattern of the endometium (triple line, thickness and subendometrial blood flow). Hysteroscopic metroplasty of dysmorphic cavity to reach the normal parameters. Patients: 376 women ages between 22 to 38 suffering from recurrent implantation failure and uterine dysmorphia. Intervention: 2D and 3D vaginal ultrasound of the endometrium with DOPPLER study to assess the pattern of the endometium (triple line, thickness and subendometrial blood flow). Hysteroscopic metroplasty of dysmorphic cavity to reach the normal parameters. Measurements and Main Results: The endometrial cavity characterized by dysmorphia with variation in the widest dimensions between the two ostea less than 20MM and midcavitary narrowing less than 12MM and abnormal high subendometrial blood flow with RI more than 0.6. After hysteroscopic correction of the dimension resulted in increase the dimensions of the cavity and better subendometrial blood flow and successful embryo implantation and even spontaneous pregnancy of 223 cases and had full term babies, 72 cases had succsseful implantation after ICSI/ET and 61 had fullterm babies, 31 cases had abortion due to infections and thrombophilias, 22 cases are pregnant now 10 by ICSI and 12 spontaneously under follow up, 27 cases have been lost. Conclusion: Hysterscopic correction of uterine dysmorphias associated with recurrent implantation failure due to weak, narrow and insufficient blood supply of the cavity significantly increase the implantation rate and take home baby rate. 189
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:53 AM – GROUP B
Comparing Patients with Ectopic Pregnancy Who Fail Methotrexate Therapy with Those Selected for Immediate Surgical Intervention Wu C, Fridman D, Rotenberg O, Scott C, Levie M. Montefiore Medical Center, Bronx, New York Study Objective: To compare patients with ectopic pregnancy (EP) who fail methotrexate therapy with those who were selected for immediate surgical intervention. Design: A retrospective cohort, descriptive study. Setting: Inner city academic medical center. Patients: Patients presenting to the medical center who were treated surgically for suspected EP from January 1998 to January 2014. Intervention: Review of medical records. Measurements and Main Results: 508 patients were treated surgically for EP. 437 were selected for immediate surgical intervention (group 1), and 70 underwent surgery after failure of medical management (group 2). There was no significant difference in demographic and prior history between groups. Complaint of pain was prevalent in both groups, but group 1 reported it more frequently (89.2% vs 75.0%, p\0.001). Comparing sonographic findings on the day when decision for intervention was made (surgery or initial administration of methotrexate) patients had similar prevalence of adnexal mass (85.2% vs 80.3%, p=0.29). However, the larger adnexal masses (36.420.0 mm vs 20.116.9 mm, p\0.001), more pelvic free fluid (84.4% vs 39.4%, p\0.001), and/or definite ectopic structures (yolk sac or higher, 32.6%, p\0.001) were more prevalent in group 1. Level of serum hcg was highly variable and was significantly higher in group 1 (1024316837 vs 45895190 p=0.005). Conclusion: Comparing patients with ectopic pregnancy selected for immediate surgical intervention to those with surgical intervention following failure of medical management there was no difference in demographic parameters, or prior history. The difference was evident during clinical evaluation (pain), sonographic (presence and volume of free fluid, size of the adnexal mass and presence of definite ectopic structures) and laboratory findings (level of hcg).
190
Open Communications 16 - Surgical Trends / Techniques (12:10 PM - 1:10 PM) 12:10 PM – GROUP A
Correlation Between Severity of Urinary Symptoms and Clinical and Image-Based Indexes of Interstitial Cystitis in a Prospective Cohort of Patients with and without Interstitial Cystitis Marcu I, Gavard J, Rockefeller NF, Vazirabadi G, Miller C, Nieto R, Yeung P, Holloran-Schwartz MB, Steele A, Leong FC, McLennan MT, Campian EC. Obstetrics, Gynecology and Women’s Health, St. Louis University, St. Louis, Missouri Study Objective: To examine the correlation between severity of urinary symptoms and clinical suspicion indexes of interstitial cystitis (IC) as well as cystoscopic findings after cystoscopy with hydrodistension (CwHD). Design: Prospective interventional cohort study with blinded image review. Setting: Participants were recruited from an academic urogynecologic and minimally invasive gynecologic practice. Patients: All participants in the study are patients scheduled to have routine gynecologic or urogynecologic procedures involving cystoscopy. 224 of the 269 women initially enrolled in this study are included in this interim analysis. All 224 participants had complete data sets and met all criteria. Intervention: Patients scheduled for cystoscopy or cystoscopy with hydrodistension were all consented for CwHD. Participants completed questionnaires including the IC Problem Index (ICPI). Originally scheduled procedure (cystoscopy vs CwHD) and treating physician expectancy of IC served as clinical suspicion indexes. A panel of three urogynecologists evaluated de-identified picture sets. Measurements and Main Results: Associations were assessed by c2 tests using SPSS v23.0 for Windows. P\0.05 denoted statistical significance. There is significant correlation between ICPI bladder burning/pain/discomfort component and suspicion indexes (initially scheduled procedure P\0.001, and physician expectancy P\0.001) and diagnosis (physician diagnosis P\0.001, image review diagnosis P\0.05). There was a statistically significant relationship between several ICPI component scores as well as overall ICPI score and clinical suspicion indexes. The correlation of ICPI component other than pain with indexes of diagnosis was weaker by comparison. We found no statistically significant association between overall ICPI score and image-based diagnosis. Conclusion: Severity of pain is highly correlated with clinical suspicion and image-based diagnosis, indicating a relationship between the ICPI pain component and glomerulations. However, ICPI as a whole correlated poorly with cystoscopic findings. These findings can inform the debate regarding the clinical significance of severity of individual symptoms and cystoscopic findings in diagnosis.
191
Open Communications 16 - Surgical Trends / Techniques (12:10 PM - 1:10 PM) 12:17 PM – GROUP A
Can CDC Guidelines on Opioid Use Be Applied to Patients with Chronic Pelvic Pain? Wiseman DM. International Adhesions Society, Dallas, Texas Study Objective: To compare the harms and benefits of opioid use in patients with chronic pelvic pain with those postulated by the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Design: Patient reports of their use of opioid analgesics. Opioid usage was stratified by duration (>3 months, \3 months) and dose (larger or smaller than a daily dose equivalent to 90mg of morphine - 90mgME). Setting: Internet survey of visitors to ten patient advocacy groups. Patients: 2214 women (F) and 133 men (M) with at least one of 14 conditions related to chronic pelvic pain. Intervention: N/A
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:21 AM – GROUP A
Reproductive Outcomes After Hysteroscopic Septoplasty and Comparison of Different Surgical Techniques: A Retrospective Cohort Study uven C,1 Sahin C,1 Akdemir A,1 Ergenoglu AM,1 Yeniel AO,1 Simsek D,1 G€ Sendag F.2 1Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey; 2Obstetrics and Gynecology, Acibadem University Faculty of Medicine, Istanbul, Atakent, Turkey Study Objective: The aim of the study was to evaluate pregnancy outcomes after hysteroscopic septoplasty and to compare the beneficial effects of different hysteroscopic techniques. Design: Retrospective design. Setting: Ege University School of Medicine Department of Obstetrics and Gynecology. Patients: Hospital records of 122 patients who underwent hysteroscopic septoplasty were retrospectively reviewed. Intervention: Hysteroscopic septoplasty was performed in all cases with either monopolar electrode or cold scissors. Measurements and Main Results: All patients’ pregnancy outcomes were followed-up by using registry system and telephone interviews. Ninety-four pregnancies (79 live births, 15 abortion) occurred. Sixty-six women had at least one live birth. Hysteroscopic septoplasty was performed in 72 and 50 patients using resectoscope and cold scissors with 5mm hysteroscope, respectively. Fourty-two (58%) and twenty-four patients (48%) in the resectoscope and cold scissors group, respectively, had live birth but the difference was not statistically significant. Hysteroscopic septoplasty is a safe and effective method with high pregnancy rate. There is no significant difference in live birth rates whether using resectoscope or scissors. Conclusion: Infertile patients should be offered the option of hysteroscopic septoplasty unless they have a history of adverse reproductive outcomes. 186
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:32 AM – GROUP B
Fertility and Pregnancy Outcomes Following Lapascopic Myomectomy Kozachenko IF, Adamyan LV, Smolnikova VY, Porotikova IE, Begieva GA, Stepanian AA. Operative Gynecology Department, Russian Scientific Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russian Federation Study Objective: To assess post-operative fertility rates and pregnancy outcomes of patients who had a Laparoscopic myomectomy (LM) from 2012 to 2014. Design: Retrospective case series. Setting: Department of operative gynecology of The Research Center for Obstetrics, Gynecology and Perinatology. Patients: 437 patients that underwent LM. Intervention: We reviewed the medical records of 437 patients that underwent LM. Routine postoperative care involved obtaining follow up on their fertility and pregnancy outcomes. Measurements and Main Results: 437 women with mean age of 40.55 +/-2.24 years and mean BMI of 24.53+/-4.9 kg/m2. Patients had a mean of 3.34 +/- 2.9 fibroids removed (range 1-21), with the average mass of the fibroids being 331.23 +/- 310.36 grams. 354 of 437 patients (81%) provided fertility and pregnancy outcome data. Follow-up from time of surgery to most recent charted data ranged from 10 months to 7.9 years. Of the 354 women, 212 (59.9%) actively tried for pregnancy after surgery. 73.2% of the 212 achieved a total of 155 pregnancies – 123 full term, 26 preterm, 16 spontaneous abortions and 2 termination. 90.4% of these patients underwent cesarean section. A subset of 104 women had pre-existing infertility. 25 of these patients underwent intrauterine
S81
insemination (IUI), while 79 underwent in vitro fertilization (IVF). After surgery, 60% of these patients achieved 62 total pregnancies. Of the 354 cases, there was one placenta accreta and no uterine ruptures. Conclusion: The fertility rate after laparoscopic myomectomy for all women attempting to conceive (73.2%) and for those with known infertility who continued to try for pregnancy (60%) was similar. There was a low incidence of major complications associated with the presence of uterine scarring in pregnancies conceived after laparoscopic myomectomy in both women with and without a diagnosis of fertility. 187
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:39 AM – GROUP B
Why We Fail. Single Dose Methotrexate Failure – Comparing Patients Receiving Second Dose with Those Selected for Surgical Intervention Schwartz M, Wu C, Fridman D, Rotenberg O, Arabkhazaeli M, Scott C, Levie M. Montefiore Medical Center, Bronx, New York Study Objective: To compare patients selected for surgery with those receiving second dose of methotrexate amongst patients who failed single-dose methotrexate for treatment of ectopic pregnancy (EP). Design: A retrospective cohort, descriptive study. Setting: Inner city academic medical center. Patients: Patients treated with methotrexate for suspected EP from January 1998 to January 2014. Intervention: Review of medical records. Measurements and Main Results: 396 patients with EP were treated with single-dose methotrexate – 114 (28.8%) failed single-dose methotrexate therapy. Group 1 (n=57) received a second dose of methotrexate; Group 2 (n=57) underwent surgery. There were no significant differences with regards to demographics, prior history, or initial clinical presentation. Group 1 had lower initial levels of hcg (24662354 vs 58547734, p=0.002), and lower proportion of patients with adnexal mass (68.4% vs 89.5%, p=0.005) or fetal pole (12.2% vs 33.3%, p=0.007). Other parameters (size of mass, presence of free fluid) did not demonstrate statistical significance. The main reason for administration of a second dose methotrexate was inappropriate decline of hcg (86.0%). 8.8% received additional methotrexate due to an increase in size of adnexal mass despite adequate hcg dynamic and there was no information on indication in 5.3%. 17.5% patients from Group 1 ultimately required surgery, while the others had successful resolution of EP. The main reason for surgical intervention in Group 2 was worsening abdominal pain (57.9%). Other causes were – de-novo ectopic fetal pole (12.3%), inadequate decline in hcg (8.8%), increase in size of adnexal mass (5.3%), increase in free fluid (3.5%), and in 12.3% no reason was identified. Conclusion: In our setting, single-dose methotrexate therapy failed in 28.8% patients – half received a second dose and the other half went directly to surgery. Patients who were selected for surgery had a more advanced gestation at initial presentation. Decision of intervention in cases of failed single-dose methotrexate was mostly clinical. 188
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:46 AM – GROUP B
Hysteroscopic Correction of Uterine Malformations Improves the Uterine Receptivity and Implantation Rate in Infertile Cases with Recurrent Implantation Failure Mounir MS, Elkalaa LE, Deif R, Soliman EM, Anwar AK. Obstetrics/ Gynecology and Infertility, Al Madina for Woman, Alexandria, Sidi Gaber, Egypt Study Objective: To increase the endometrial receptivity that increases implantation rate in infertile women suffering from recurrent ICSI failure with variation in the endometrial shape, thickness and subendometrial blood flow without any other cause of implantation failure.
S82
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252
Design: Retrospective observational study. Setting: 2D and 3D vaginal ultrasound of the endometrium with DOPPLER study to assess the pattern of the endometium (triple line, thickness and subendometrial blood flow). Hysteroscopic metroplasty of dysmorphic cavity to reach the normal parameters. Patients: 376 women ages between 22 to 38 suffering from recurrent implantation failure and uterine dysmorphia. Intervention: 2D and 3D vaginal ultrasound of the endometrium with DOPPLER study to assess the pattern of the endometium (triple line, thickness and subendometrial blood flow). Hysteroscopic metroplasty of dysmorphic cavity to reach the normal parameters. Measurements and Main Results: The endometrial cavity characterized by dysmorphia with variation in the widest dimensions between the two ostea less than 20MM and midcavitary narrowing less than 12MM and abnormal high subendometrial blood flow with RI more than 0.6. After hysteroscopic correction of the dimension resulted in increase the dimensions of the cavity and better subendometrial blood flow and successful embryo implantation and even spontaneous pregnancy of 223 cases and had full term babies, 72 cases had succsseful implantation after ICSI/ET and 61 had fullterm babies, 31 cases had abortion due to infections and thrombophilias, 22 cases are pregnant now 10 by ICSI and 12 spontaneously under follow up, 27 cases have been lost. Conclusion: Hysterscopic correction of uterine dysmorphias associated with recurrent implantation failure due to weak, narrow and insufficient blood supply of the cavity significantly increase the implantation rate and take home baby rate. 189
Open Communications 15 - Reproductive Issues (11:00 AM - 12:00 PM) 11:53 AM – GROUP B
Comparing Patients with Ectopic Pregnancy Who Fail Methotrexate Therapy with Those Selected for Immediate Surgical Intervention Wu C, Fridman D, Rotenberg O, Scott C, Levie M. Montefiore Medical Center, Bronx, New York Study Objective: To compare patients with ectopic pregnancy (EP) who fail methotrexate therapy with those who were selected for immediate surgical intervention. Design: A retrospective cohort, descriptive study. Setting: Inner city academic medical center. Patients: Patients presenting to the medical center who were treated surgically for suspected EP from January 1998 to January 2014. Intervention: Review of medical records. Measurements and Main Results: 508 patients were treated surgically for EP. 437 were selected for immediate surgical intervention (group 1), and 70 underwent surgery after failure of medical management (group 2). There was no significant difference in demographic and prior history between groups. Complaint of pain was prevalent in both groups, but group 1 reported it more frequently (89.2% vs 75.0%, p\0.001). Comparing sonographic findings on the day when decision for intervention was made (surgery or initial administration of methotrexate) patients had similar prevalence of adnexal mass (85.2% vs 80.3%, p=0.29). However, the larger adnexal masses (36.420.0 mm vs 20.116.9 mm, p\0.001), more pelvic free fluid (84.4% vs 39.4%, p\0.001), and/or definite ectopic structures (yolk sac or higher, 32.6%, p\0.001) were more prevalent in group 1. Level of serum hcg was highly variable and was significantly higher in group 1 (1024316837 vs 45895190 p=0.005). Conclusion: Comparing patients with ectopic pregnancy selected for immediate surgical intervention to those with surgical intervention following failure of medical management there was no difference in demographic parameters, or prior history. The difference was evident during clinical evaluation (pain), sonographic (presence and volume of free fluid, size of the adnexal mass and presence of definite ectopic structures) and laboratory findings (level of hcg).
190
Open Communications 16 - Surgical Trends / Techniques (12:10 PM - 1:10 PM) 12:10 PM – GROUP A
Correlation Between Severity of Urinary Symptoms and Clinical and Image-Based Indexes of Interstitial Cystitis in a Prospective Cohort of Patients with and without Interstitial Cystitis Marcu I, Gavard J, Rockefeller NF, Vazirabadi G, Miller C, Nieto R, Yeung P, Holloran-Schwartz MB, Steele A, Leong FC, McLennan MT, Campian EC. Obstetrics, Gynecology and Women’s Health, St. Louis University, St. Louis, Missouri Study Objective: To examine the correlation between severity of urinary symptoms and clinical suspicion indexes of interstitial cystitis (IC) as well as cystoscopic findings after cystoscopy with hydrodistension (CwHD). Design: Prospective interventional cohort study with blinded image review. Setting: Participants were recruited from an academic urogynecologic and minimally invasive gynecologic practice. Patients: All participants in the study are patients scheduled to have routine gynecologic or urogynecologic procedures involving cystoscopy. 224 of the 269 women initially enrolled in this study are included in this interim analysis. All 224 participants had complete data sets and met all criteria. Intervention: Patients scheduled for cystoscopy or cystoscopy with hydrodistension were all consented for CwHD. Participants completed questionnaires including the IC Problem Index (ICPI). Originally scheduled procedure (cystoscopy vs CwHD) and treating physician expectancy of IC served as clinical suspicion indexes. A panel of three urogynecologists evaluated de-identified picture sets. Measurements and Main Results: Associations were assessed by c2 tests using SPSS v23.0 for Windows. P\0.05 denoted statistical significance. There is significant correlation between ICPI bladder burning/pain/discomfort component and suspicion indexes (initially scheduled procedure P\0.001, and physician expectancy P\0.001) and diagnosis (physician diagnosis P\0.001, image review diagnosis P\0.05). There was a statistically significant relationship between several ICPI component scores as well as overall ICPI score and clinical suspicion indexes. The correlation of ICPI component other than pain with indexes of diagnosis was weaker by comparison. We found no statistically significant association between overall ICPI score and image-based diagnosis. Conclusion: Severity of pain is highly correlated with clinical suspicion and image-based diagnosis, indicating a relationship between the ICPI pain component and glomerulations. However, ICPI as a whole correlated poorly with cystoscopic findings. These findings can inform the debate regarding the clinical significance of severity of individual symptoms and cystoscopic findings in diagnosis.
191
Open Communications 16 - Surgical Trends / Techniques (12:10 PM - 1:10 PM) 12:17 PM – GROUP A
Can CDC Guidelines on Opioid Use Be Applied to Patients with Chronic Pelvic Pain? Wiseman DM. International Adhesions Society, Dallas, Texas Study Objective: To compare the harms and benefits of opioid use in patients with chronic pelvic pain with those postulated by the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Design: Patient reports of their use of opioid analgesics. Opioid usage was stratified by duration (>3 months, \3 months) and dose (larger or smaller than a daily dose equivalent to 90mg of morphine - 90mgME). Setting: Internet survey of visitors to ten patient advocacy groups. Patients: 2214 women (F) and 133 men (M) with at least one of 14 conditions related to chronic pelvic pain. Intervention: N/A