- Email: [email protected]
Postoperative Pain Management in Robotic Versus Laparoscopic Hysterectomy
S30
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S1–S35
Table 1 Characteristics of Subjects with Cyclic Pelvic Pain Age at GEA
Interval to Hyst.*
Prior BTL
Type of GEA
Uterine Weight (g)
Operative Findings
Endometrial Pathology
26 29 34 34 35 38 39 39 42 46
5.3 9.11 17.1 31.2 13.8 58.5 45.7 40.7 9.0 29.8
Yes Yes Yes Yes Yes Yes No No No Yes
Balloon Balloon Balloon Unknown Balloon Balloon Balloon Balloon Balloon Balloon
152 130 120 84 47 537 N/A 218 238 103
Secretory Proliferative Secretory Secretory Proliferative Secretory Basalis only Secretory Secretory Inactive
47
32.2
Yes
Balloon
135
Unremarkable Unremarkable Unremarkable Hematometra Hematosalpinx Unremarkable Unremarkable Unremarkable Unremarkable Hematometra, Hematosalpinx Unremarkable
N/A
*months
Table 2 Characteristics According to Indication for Surgery
Age at GEA Parity BMI Interval to Hyst.* Prior BTL Type of GEA Balloon Hydrothermablation Path. Findings Uterine Weight (g) Hematometra Hydrosalpinx Adenomyosis Leiomyoma Endometriosis
Bleeding (n = 64)
Cyclic Pelvic Pain (n = 11)
40.0 5.8 2.5 1.1 31.8 8.3 18.4 16.2 42 (66%)
37.7 6.5 2.4 1.2 25.8 3.3U 26.6 17.2 8 (73%)
22 (34%) 36 (56%)
10 (91%)U 0[bold]U[bold]
133 77.5 0 2 (3.1%) 31 (48%) 33 (52%) 1 (1.6%)
176 139 2 (18%)U 2 (18%)U 4 (36%) 7 (64%) 0
*months, Up\0.05.
Statistically significant differences included lower BMI in subjects with cyclic pelvic pain, findings of hematometra or hydrosalpinx, and type of ablation. Conclusion: The incidence of PATSS remains unclear. We demonstrate an incidence of pathologic confirmation of 2.3% (n = 3) of subjects. However, hematometra/hydrosalpinx may resolve outside the menstrual phase, and the true incidence of PATSS is likely higher. Though larger studies are needed to verify these findings, our study demonstrates that lower BMI and use of intrauterine balloon may be associated with post-ablation cyclic pelvic pain.
88
Open Communications 6dPain Issues (3:03 PM d 3:08 PM)
Abdominal Wall Endometriosis: A 10-Year Experience at a Large Academic Institution Ecker AM, Donnellan NM, Shepherd JP, Bodur S, Lee TTM. MageeWomens Hospital of UPMC, Pittsburgh, Pennyslvania Study Objective: To review the clinical presentation, patient characteristics, pathologic findings, and time lapse from surgery to presentation for excised cases of abdominal wall endometriosis.
Design: Retrospective chart review of pathologic-confirmed cases. Setting: Large urban tertiary-care academic hospital. Patients: Forty-two women who underwent excision of pathologically confirmed abdominal wall endometriosis at Magee Womens Hospital between 2001 and 2011. Intervention: Excision of abdominal wall endometriosis, 37 via open approach and 5 via a combined laparoscopic and open approach. Measurements and Main Results: Of the 42 patients, 66.7% presented with complaints of abdominal pain, 61.9% with a mass/lump, 16.7% with dysmenorrhea, 14.3% with pelvic pain, and 11.9% with dyspareunia. 4.8% were incidentally found at time of an unrelated surgery. Four cases had not had any prior surgery. The prevalence of tissue planes affected included: 19% skin, 100% adipose, 66.7% fascia, 11.9% rectus muscle, and 16.7% peritoneum. Multiparous women were at higher risk of deeper involvement (p = 0.009) and obese women appeared to be at higher risk for peritoneal involvement (p = 0.029). Time from initial surgery to presentation ranged from 1-31 years (median 8.0; interquartile range 5.25-12) and time from most recent relevant surgery ranged from 1-23 years (median 4.0; interquartile range 3-7). Parous women presented at a younger age (35.1 vs 39.5, p = 0.009), and were more likely to not have had prior exploratory laparotomy (p = 0.042). Unfortunately, we were unable to demonstrate a statistically significant correlation between increasing numbers of open abdominal surgeries and time to presentation or depth of involvement. Conclusion: In women presenting with a mass or pain at a prior abdominal incision, abdominal wall endometriosis should be considered in the differential diagnosis. A thorough excision ensuring complete removal of all affected tissue should be performed for diagnosis as well as definitive therapy.
89
Open Communications 6dPain Issues (3:09 PM d 3:14 PM)
Postoperative Pain Management in Robotic Versus Laparoscopic Hysterectomy Gyang A, Carugno J, Hoover F, Taylor K, Lamvu G. Advanced Gynecology, Minimally Invasive Surgery, Florida Hospital, Orlando, Florida Study Objective: 1. To describe post operative pain patterns in patients undergoing robotic total hysterectomy (RTH)or laparoscopic total hysterectomy (LTH) in terms of postoperative pain scores, pain scores at discharge and serious adverse events related to pain (extended stay due to pain, re-admission due to pain, outpatient or ER evaluation due to pain). 2. To determine if a specific postoperative pain regimen is most beneficial in decreasing postoperative pain at discharge and pain related adverse events.
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S1–S35 Design: A retrospective cohort analysis of 1290 sequential cases of minimally invasive hysterectomy over a 3 year period. Setting: Urban hospital that serves as a tertiary referral center for minimally invasive gynecologic surgery. Patients: 1290 women who underwent a robotic or laparoscopic hysterectomy over a 3 year period from January 2008 to December 2011. Intervention: Robotic or laparoscopic hysterectomy, and postoperative pain management. Measurements and Main Results: Demographic characteristics for the study group showed significant differences between the RTH and LTH groups in age (LTH 44.5yrs, SD 8.32 vs RTH 48.6 yrs, SD 10.7, p = 0.000) and BMI (LTH 29.3, SD 6.61 vs. RTH 28.8, SD 6.8, p0.262). In this study cohort the 2 hr post operative pain scores (using VAS) were generally low (LTH mean VAS = 4.3, SD = 3.2 vs RTH mean VAS = 4.4, SD 3.18, p = 0.681). At discharge pain scores were also similar between the two groups (LTH mean VAS = 2.2, SD = 2.0 vs. RTH mean VAS = 2.1, SD = 1.92, p = 0.555). The most common pain regimen used was injectable opioids with 86.5% of patients recieving this type of pain control. Injectable Toradol was used intraoperatively in 26.4% of patients and was more likely to be used in the LTH group (78.9% received IV Toradol in LTH group vs 21.1% in the RTH group, p = 0.000). Conclusion: Patients who receive IV opioids or oral NSAIDs postoperatively are less likely to present with pain as an adverse event following RTH or LTH.
90
Open Communications 7dUrogynecology (2:15 PM d 2:20 PM)
Two-Year Experience with ElevateÒ Anterior and Apical (EAA) with InteProÒ LiteÔ in the Surgical Treatment of Pelvic Organ Prolapse Stanford EJ,1 Moore RD,2 Roovers J-PRW,3 VanDrie D,4 Lukban JC,5 Giudice T,6 Bataller E,7 Sutherland SE.8 1Urogynecology, Auburn Regional Medical Center, Auburn, Washington; 2Atlanta Medical Research Institute, Atlanta, Georgia; 3Academic Medical Center University of Amsterdam, Amsterdam, Netherlands; 4Grand Rapids Women’s Health, Grand Rapids, Michigan; 5Eastern Virginia Medical School, Norfolk, Virginia; 6South Carolina OB/GYN, Columbia, South Carolina; 7Hospital Clinic i Provincial de Barcelona, Barceona, Spain; 8 Metro Urology Centers for Female Urology, Woodbury, Minnesota Study Objective: To assess EAA (American Medical Systems, Minnesota, USA) performance in the repair of pelvic organ prolapse (POP). Design: Prospective, multi-center study. Setting: Ten US and 6 EU sites. Patients: Of 142 enrolled subjects (age 63.9 9.8 years) with anterior vaginal prolapse and/or apical descent R Stage II of which 124 (87.3%) completed two-year follow-up. Intervention: Transvaginal synthetic polypropylene mesh insertion with no external needle passes. Measurements and Main Results: Two definitions for treatment success: 1) objective anatomic success defined as % Stage I POP-Q during follow-up using the Last Observation Carried Forward (LFCF) method or surgical revision for recurrence (concomitant Elevate Apical and Posterior (EAP) were excluded from the apical efficacy analysis); 2) subjective cure defined as the absence of bulge symptoms (negative response to Pelvic Floor Distress Inventory (PFDI) questions: ‘Do you usually have a sensation of bulging or protrusion from the vaginal area?’ (Q4) and ‘Do you usually have a bulge or something falling out that you can see or feel in the vaginal area?’ (Q5)). Exact binomial method was used to calculate 95% confidence interval (CI). Statistical significance was assessed at p\ 0.05. Anterior objective success rate was 81.6% (102/125, 95% CI 73.788.0%). Of the 23 subjects considered failure, none complained of bulging on the PFDI. Apical success rate was 95.9% (71/74, 95% CI 88.6-99.2%). Of the 3 subjects who presented with apical anatomic failure only 1 complained of bulge symptoms. Related adverse events reported at >2% were: mesh exposure (8; 5.6%), UTI (8; 5.6%),
S31
Dyspareunia (7; 4.9%), de novo SUI (6; 4.2%), transient buttock pain (5; 3.5%), new prolapse (5, 3.5%), urinary retention (5; 3.5%), granuloma formation (4; 2.8%), hematoma (3; 2.1%) and urinary urgency (3, 2.1%). Conclusion: EAA yields objective and subjective improvement with few complications at 24-months.
91
Open Communications 7dUrogynecology (2:21 PM d 2:26 PM)
Cosmetic Vulvar Surgery and Perception of Vulvar Appearance Yurteri-Kaplan LA,1 Antosh DD,1 Sokol AI,1 Park AJ,1 Gutman RE,1 Kingsberg SA,2 Iglesia CB.1 1Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, District of Columbia; 2 Department of Reproductive Biology and Psychiatry, Division of Behavioral Medicine in Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, Ohio Study Objective: Cosmetic vulvar surgery has been popularized as more women who believe their vulvas to be abnormal seek ‘corrective’ surgery. Primary aim: to determine if women age 18 to 44 years (Group 1) are less likely to perceive their vulva as normal compared to women age 45 to 72 years (Group 2). Secondary aim: to determine if age impacts interest in cosmetic vulvar surgery. Design: This IRB approved cross-sectional survey was conducted during July - September 2011. Women completed 24-items. Data was collected on demographics, perceptions of vulvas, grooming patterns, and sources of educational information. Participants were asked to identify which vulva appeared ‘‘normal’’ from 4 pairs of photographs. Setting: Washington Hospital Center, Georgetown University, and a community fair. Patients: Women ages 18 to 72. Measurements and Main Results: 516 women were approached; 121 declined, leaving 395 women, response rate 77%. Participants were grouped in two age categories: Group 1 (n = 207)and Group 2 (n = 147). A significantly larger percentage in Group 1 worked in health care (93% vs. 69%, p\0.01), were single (47% vs. 22%, p\.01), and sexually active (84% vs. 70%, p\ 0.01). There was no difference in how often women looked at their vulva or in the perception that they had a normal vulva (Group 1: 91% vs. Group 2: 93%, p = 0.76). The two groups were similarly satisfied with the appearance of their vulva (81% vs. 82%, p = 0.71). A higher percentage of women in Group 2 would consider cosmetic surgery versus Group 1 (15% vs. 8%, p = 0.05). Conclusion: Women’s age does not impact perception of a normal vulva. The majority of women, approximately 90%, perceived their vulva to be normal and were satisfied with their appearance. Despite this, older women are more interested in cosmetic vulvar surgery even though they are less sexually active.
92
Open Communications 7dUrogynecology (2:27 PM d 2:32 PM)
The Use of Biologic Graft for Posterior Colporrhaphy in Women with Poor Rectovaginal Fascia Gross CK, Aimee SL, Aguilar V, Davila GW. Urogynecology, Cleveland Clinic Florida, Weston, Florida Study Objective: Does the use of a biologic graft for posterior vaginal repair in women with deficient rectovaginal fascia improve outcomes. Design: We conducted a retrospective review of all grafted posterior colporraphies performed at a single institution from 2007 to 2011. Patients: All patients with 6 months or greater follow up were included. These cases were then matched based on age, BMI, severity of prolapse to a control group of patients undergoing traditional native tissue repair during the same time period. Primary outcome was surgical failure defined as posterior POP-Q stage 2 or greater. Secondary outcomes included anatomic and functional outcomes.
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S1–S35
Table 1 Characteristics of Subjects with Cyclic Pelvic Pain Age at GEA
Interval to Hyst.*
Prior BTL
Type of GEA
Uterine Weight (g)
Operative Findings
Endometrial Pathology
26 29 34 34 35 38 39 39 42 46
5.3 9.11 17.1 31.2 13.8 58.5 45.7 40.7 9.0 29.8
Yes Yes Yes Yes Yes Yes No No No Yes
Balloon Balloon Balloon Unknown Balloon Balloon Balloon Balloon Balloon Balloon
152 130 120 84 47 537 N/A 218 238 103
Secretory Proliferative Secretory Secretory Proliferative Secretory Basalis only Secretory Secretory Inactive
47
32.2
Yes
Balloon
135
Unremarkable Unremarkable Unremarkable Hematometra Hematosalpinx Unremarkable Unremarkable Unremarkable Unremarkable Hematometra, Hematosalpinx Unremarkable
N/A
*months
Table 2 Characteristics According to Indication for Surgery
Age at GEA Parity BMI Interval to Hyst.* Prior BTL Type of GEA Balloon Hydrothermablation Path. Findings Uterine Weight (g) Hematometra Hydrosalpinx Adenomyosis Leiomyoma Endometriosis
Bleeding (n = 64)
Cyclic Pelvic Pain (n = 11)
40.0 5.8 2.5 1.1 31.8 8.3 18.4 16.2 42 (66%)
37.7 6.5 2.4 1.2 25.8 3.3U 26.6 17.2 8 (73%)
22 (34%) 36 (56%)
10 (91%)U 0[bold]U[bold]
133 77.5 0 2 (3.1%) 31 (48%) 33 (52%) 1 (1.6%)
176 139 2 (18%)U 2 (18%)U 4 (36%) 7 (64%) 0
*months, Up\0.05.
Statistically significant differences included lower BMI in subjects with cyclic pelvic pain, findings of hematometra or hydrosalpinx, and type of ablation. Conclusion: The incidence of PATSS remains unclear. We demonstrate an incidence of pathologic confirmation of 2.3% (n = 3) of subjects. However, hematometra/hydrosalpinx may resolve outside the menstrual phase, and the true incidence of PATSS is likely higher. Though larger studies are needed to verify these findings, our study demonstrates that lower BMI and use of intrauterine balloon may be associated with post-ablation cyclic pelvic pain.
88
Open Communications 6dPain Issues (3:03 PM d 3:08 PM)
Abdominal Wall Endometriosis: A 10-Year Experience at a Large Academic Institution Ecker AM, Donnellan NM, Shepherd JP, Bodur S, Lee TTM. MageeWomens Hospital of UPMC, Pittsburgh, Pennyslvania Study Objective: To review the clinical presentation, patient characteristics, pathologic findings, and time lapse from surgery to presentation for excised cases of abdominal wall endometriosis.
Design: Retrospective chart review of pathologic-confirmed cases. Setting: Large urban tertiary-care academic hospital. Patients: Forty-two women who underwent excision of pathologically confirmed abdominal wall endometriosis at Magee Womens Hospital between 2001 and 2011. Intervention: Excision of abdominal wall endometriosis, 37 via open approach and 5 via a combined laparoscopic and open approach. Measurements and Main Results: Of the 42 patients, 66.7% presented with complaints of abdominal pain, 61.9% with a mass/lump, 16.7% with dysmenorrhea, 14.3% with pelvic pain, and 11.9% with dyspareunia. 4.8% were incidentally found at time of an unrelated surgery. Four cases had not had any prior surgery. The prevalence of tissue planes affected included: 19% skin, 100% adipose, 66.7% fascia, 11.9% rectus muscle, and 16.7% peritoneum. Multiparous women were at higher risk of deeper involvement (p = 0.009) and obese women appeared to be at higher risk for peritoneal involvement (p = 0.029). Time from initial surgery to presentation ranged from 1-31 years (median 8.0; interquartile range 5.25-12) and time from most recent relevant surgery ranged from 1-23 years (median 4.0; interquartile range 3-7). Parous women presented at a younger age (35.1 vs 39.5, p = 0.009), and were more likely to not have had prior exploratory laparotomy (p = 0.042). Unfortunately, we were unable to demonstrate a statistically significant correlation between increasing numbers of open abdominal surgeries and time to presentation or depth of involvement. Conclusion: In women presenting with a mass or pain at a prior abdominal incision, abdominal wall endometriosis should be considered in the differential diagnosis. A thorough excision ensuring complete removal of all affected tissue should be performed for diagnosis as well as definitive therapy.
89
Open Communications 6dPain Issues (3:09 PM d 3:14 PM)
Postoperative Pain Management in Robotic Versus Laparoscopic Hysterectomy Gyang A, Carugno J, Hoover F, Taylor K, Lamvu G. Advanced Gynecology, Minimally Invasive Surgery, Florida Hospital, Orlando, Florida Study Objective: 1. To describe post operative pain patterns in patients undergoing robotic total hysterectomy (RTH)or laparoscopic total hysterectomy (LTH) in terms of postoperative pain scores, pain scores at discharge and serious adverse events related to pain (extended stay due to pain, re-admission due to pain, outpatient or ER evaluation due to pain). 2. To determine if a specific postoperative pain regimen is most beneficial in decreasing postoperative pain at discharge and pain related adverse events.
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S1–S35 Design: A retrospective cohort analysis of 1290 sequential cases of minimally invasive hysterectomy over a 3 year period. Setting: Urban hospital that serves as a tertiary referral center for minimally invasive gynecologic surgery. Patients: 1290 women who underwent a robotic or laparoscopic hysterectomy over a 3 year period from January 2008 to December 2011. Intervention: Robotic or laparoscopic hysterectomy, and postoperative pain management. Measurements and Main Results: Demographic characteristics for the study group showed significant differences between the RTH and LTH groups in age (LTH 44.5yrs, SD 8.32 vs RTH 48.6 yrs, SD 10.7, p = 0.000) and BMI (LTH 29.3, SD 6.61 vs. RTH 28.8, SD 6.8, p0.262). In this study cohort the 2 hr post operative pain scores (using VAS) were generally low (LTH mean VAS = 4.3, SD = 3.2 vs RTH mean VAS = 4.4, SD 3.18, p = 0.681). At discharge pain scores were also similar between the two groups (LTH mean VAS = 2.2, SD = 2.0 vs. RTH mean VAS = 2.1, SD = 1.92, p = 0.555). The most common pain regimen used was injectable opioids with 86.5% of patients recieving this type of pain control. Injectable Toradol was used intraoperatively in 26.4% of patients and was more likely to be used in the LTH group (78.9% received IV Toradol in LTH group vs 21.1% in the RTH group, p = 0.000). Conclusion: Patients who receive IV opioids or oral NSAIDs postoperatively are less likely to present with pain as an adverse event following RTH or LTH.
90
Open Communications 7dUrogynecology (2:15 PM d 2:20 PM)
Two-Year Experience with ElevateÒ Anterior and Apical (EAA) with InteProÒ LiteÔ in the Surgical Treatment of Pelvic Organ Prolapse Stanford EJ,1 Moore RD,2 Roovers J-PRW,3 VanDrie D,4 Lukban JC,5 Giudice T,6 Bataller E,7 Sutherland SE.8 1Urogynecology, Auburn Regional Medical Center, Auburn, Washington; 2Atlanta Medical Research Institute, Atlanta, Georgia; 3Academic Medical Center University of Amsterdam, Amsterdam, Netherlands; 4Grand Rapids Women’s Health, Grand Rapids, Michigan; 5Eastern Virginia Medical School, Norfolk, Virginia; 6South Carolina OB/GYN, Columbia, South Carolina; 7Hospital Clinic i Provincial de Barcelona, Barceona, Spain; 8 Metro Urology Centers for Female Urology, Woodbury, Minnesota Study Objective: To assess EAA (American Medical Systems, Minnesota, USA) performance in the repair of pelvic organ prolapse (POP). Design: Prospective, multi-center study. Setting: Ten US and 6 EU sites. Patients: Of 142 enrolled subjects (age 63.9 9.8 years) with anterior vaginal prolapse and/or apical descent R Stage II of which 124 (87.3%) completed two-year follow-up. Intervention: Transvaginal synthetic polypropylene mesh insertion with no external needle passes. Measurements and Main Results: Two definitions for treatment success: 1) objective anatomic success defined as % Stage I POP-Q during follow-up using the Last Observation Carried Forward (LFCF) method or surgical revision for recurrence (concomitant Elevate Apical and Posterior (EAP) were excluded from the apical efficacy analysis); 2) subjective cure defined as the absence of bulge symptoms (negative response to Pelvic Floor Distress Inventory (PFDI) questions: ‘Do you usually have a sensation of bulging or protrusion from the vaginal area?’ (Q4) and ‘Do you usually have a bulge or something falling out that you can see or feel in the vaginal area?’ (Q5)). Exact binomial method was used to calculate 95% confidence interval (CI). Statistical significance was assessed at p\ 0.05. Anterior objective success rate was 81.6% (102/125, 95% CI 73.788.0%). Of the 23 subjects considered failure, none complained of bulging on the PFDI. Apical success rate was 95.9% (71/74, 95% CI 88.6-99.2%). Of the 3 subjects who presented with apical anatomic failure only 1 complained of bulge symptoms. Related adverse events reported at >2% were: mesh exposure (8; 5.6%), UTI (8; 5.6%),
S31
Dyspareunia (7; 4.9%), de novo SUI (6; 4.2%), transient buttock pain (5; 3.5%), new prolapse (5, 3.5%), urinary retention (5; 3.5%), granuloma formation (4; 2.8%), hematoma (3; 2.1%) and urinary urgency (3, 2.1%). Conclusion: EAA yields objective and subjective improvement with few complications at 24-months.
91
Open Communications 7dUrogynecology (2:21 PM d 2:26 PM)
Cosmetic Vulvar Surgery and Perception of Vulvar Appearance Yurteri-Kaplan LA,1 Antosh DD,1 Sokol AI,1 Park AJ,1 Gutman RE,1 Kingsberg SA,2 Iglesia CB.1 1Section of Female Pelvic Medicine and Reconstructive Surgery, Medstar Washington Hospital Center/Georgetown University School of Medicine, Washington, District of Columbia; 2 Department of Reproductive Biology and Psychiatry, Division of Behavioral Medicine in Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, Ohio Study Objective: Cosmetic vulvar surgery has been popularized as more women who believe their vulvas to be abnormal seek ‘corrective’ surgery. Primary aim: to determine if women age 18 to 44 years (Group 1) are less likely to perceive their vulva as normal compared to women age 45 to 72 years (Group 2). Secondary aim: to determine if age impacts interest in cosmetic vulvar surgery. Design: This IRB approved cross-sectional survey was conducted during July - September 2011. Women completed 24-items. Data was collected on demographics, perceptions of vulvas, grooming patterns, and sources of educational information. Participants were asked to identify which vulva appeared ‘‘normal’’ from 4 pairs of photographs. Setting: Washington Hospital Center, Georgetown University, and a community fair. Patients: Women ages 18 to 72. Measurements and Main Results: 516 women were approached; 121 declined, leaving 395 women, response rate 77%. Participants were grouped in two age categories: Group 1 (n = 207)and Group 2 (n = 147). A significantly larger percentage in Group 1 worked in health care (93% vs. 69%, p\0.01), were single (47% vs. 22%, p\.01), and sexually active (84% vs. 70%, p\ 0.01). There was no difference in how often women looked at their vulva or in the perception that they had a normal vulva (Group 1: 91% vs. Group 2: 93%, p = 0.76). The two groups were similarly satisfied with the appearance of their vulva (81% vs. 82%, p = 0.71). A higher percentage of women in Group 2 would consider cosmetic surgery versus Group 1 (15% vs. 8%, p = 0.05). Conclusion: Women’s age does not impact perception of a normal vulva. The majority of women, approximately 90%, perceived their vulva to be normal and were satisfied with their appearance. Despite this, older women are more interested in cosmetic vulvar surgery even though they are less sexually active.
92
Open Communications 7dUrogynecology (2:27 PM d 2:32 PM)
The Use of Biologic Graft for Posterior Colporrhaphy in Women with Poor Rectovaginal Fascia Gross CK, Aimee SL, Aguilar V, Davila GW. Urogynecology, Cleveland Clinic Florida, Weston, Florida Study Objective: Does the use of a biologic graft for posterior vaginal repair in women with deficient rectovaginal fascia improve outcomes. Design: We conducted a retrospective review of all grafted posterior colporraphies performed at a single institution from 2007 to 2011. Patients: All patients with 6 months or greater follow up were included. These cases were then matched based on age, BMI, severity of prolapse to a control group of patients undergoing traditional native tissue repair during the same time period. Primary outcome was surgical failure defined as posterior POP-Q stage 2 or greater. Secondary outcomes included anatomic and functional outcomes.