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The Use of Intraoperative Cystoscopy for Detection of Lower Urinary Tract Injury
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S1−S97 experienced burnout were more likely to be in their second year (p=0.003), spend less time per week doing scholarly activities (p=0.048), and are less satisfied with their fellowship experience (p<0.001). Participants who experienced anxiety, depression, or extreme fatigue had more co-fellows in their program (p=0.031), worked more hours per week on average (P=0.020), and were more often required to practice obstetrics in their fellowship (p=0.022). Conclusion: Burnout symptoms are common in obstetrics and gynecology residency programs, and our study demonstrates that FMIGS trainees experience similar concerns. Our findings suggest widespread prevalence of this serious issue and lack of access to emotional and psychologic support programs. We hope that this study will prompt increased attention to this important topic by both individual fellowship programs and AAGL to increase access to resources and promote physician wellness for fellows experiencing burnout and depression. Open Communications 9: Basic Science/Research/Education (3:05 PM − 4:05 PM) 3:40 PM Long-Term Bleeding Status And Hysteroscopic Cavity Access Results Following Water Vapor Endometrial Ablation for Heavy Menstrual Bleeding (HMB) In Subjects Who Have Large Cavities, Uterine Myoma and/or Intratubal Contraceptive Inserts Levine DJ,1,* Harris M2. 1Gynecology Minimally Invasive Surgery, Mercy Clinical Minimally Invasive Gynecology, St. Louis, MO; 2Clinical Research, MomDoc Women’s Health Research, Scottsdale, AZ *Corresponding author. Study Objective: To assess long-term menstrual status and hysteroscopic uterine cavity access a mean 4 years after water vapor endometrial ablation in a subset of patients traditionally not indicated for endometrial ablation treatment. Design: Prospective, multicenter, observational. Setting: Eight private practice and outpatient locations in North and Central America. Patients or Participants: 29 women with large uterine cavities (10-12 cm uterine cavity lengths), non-cavity obstructing myoma up to 4 cm in diameter and/or intratubal contraceptive inserts underwent water vapor endometrial ablation for HMB. Three women had both large cavities and myomas. These 29 women completed 3-year follow-up as part of the AEGEA Pivotal Clinical Trial (NCT01979861). All patients consented to a diagnostic hysteroscopy a mean 4 years from the ablation procedure. Self-reported menstrual status was captured prior to diagnostic hysteroscopy. The degree of hysteroscopic access was judged by an Independent Reviewer blinded to subject history and procedural details. Interventions: Diagnostic hysteroscopy. Measurements and Main Results: At a mean 4 years post ablation, 93% (27/29) of subjects reported a return to normal, light or no menstrual bleeding. Cavity access was achieved in in 90% (26/29) of subjects. Cornua / ostia were visualized in 88% (23/26) of subjects with cavity access. Conclusion: Water vapor endometrial ablation provides enduring reduction in menses and permits long-term cavity access in subjects with longer cavities (up to 12cm), uterine myoma and/or intratubal contraceptive inserts, each of which has been traditionally excluded from endometrial ablation treatment. Open Communications 9: Basic Science/Research/Education (3:05 PM − 4:05 PM) 3:47 PM Should BMI Rather than Age Guide the Decision for Endometrial Sampling in Premenopausal Women with AUB? Helou CM,* Harvey LFB. Minimally Invasive Gynecology, Vanderbilt University Medical Center, Nashville, TN *Corresponding author.
S45 Study Objective: Screening guidelines for endometrial hyperplasia/ malignancy are based on a patient population predating the current obesity epidemic. With the rise in obesity and related malignancies, the objective of this study is to evaluate various risk factors for endometrial hyperplasia/malignancy in premenopausal women with AUB or oligomenorrhea. Specifically the study aims to elucidate whether obesity or age confers higher risk of disease in the premenopausal population. Design: Retrospective cohort study. Setting: Large urban academic center. Patients or Participants: Premenopausal women undergoing endometrial sampling for AUB or oligomenorrhea. Interventions: Endometrial sampling via office biopsy or dilation and curettage. Measurements and Main Results: A cohort of women (N = 7001) ages 18-51 who underwent endometrial sampling for AUB or oligomenorrhea were identified from a large deidentified database of clinical records from approximately 1990 to 2019 unique to our institution. A preliminary convenience sample (N= 250) was analyzed and a total of 13 cases (5.6%) of hyperplasia or malignancy were noted. Mean age was found to be 42.6 overall in this sample and 45.9 in those with disease. Mean BMI of the sample was found to be 31.8 overall and 40.7 in those with disease. Logistic regression was performed and revealed that BMI (coefficient = 0.096, p = 0.001) was a significant predictor of malignancy/hyperplasia in this population while age (coefficient = 0.018, p = 0.102) was not. Conclusion: While both age and obesity are risk factors for endometrial hyperplasia and malignancy in the postmenopausal population, obesity appears to be a risk factor for disease in the premenopausal while age does not. Our study suggests that BMI may be a more important risk factor to prompt screening. Further study of risk factors for endometrial malignancy in a contemporary demographic setting is needed. Open Communications 9: Basic Science/Research/Education (3:05 PM − 4:05 PM) 3:54 PM The Use of Intraoperative Cystoscopy for Detection of Lower Urinary Tract Injury Pickett C,1,* Yoder K,1 Andrews N2. 1Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM; 2University of New Mexico, Albuquerque, NM *Corresponding author. Video Objective: To review the use of cystoscopy by OB/GYN generalists for detection of lower urinary tract injury during hysterectomy. This includes the basic steps to diagnostic cystoscopy, the relevant anatomy, indications and limitations. Setting: Cystoscopy is routinely used in prolapse and incontinence repair procedures due to the relatively high risk of bladder or ureteral injury during these surgeries. While some recommend the routine use of intra-operative cystoscopy as a part of laparoscopic hysterectomy to detect bladder or ureteral injury, this is still not routine practice among OB/GYNs generalists. Whether this is due to decreased familiarity with the technique, or it’s limitations in sensitivity for detection of ureteral injury, remains unclear. To achieve the above objectives, this video reviews the details of the equipment involved, relevant anatomy, role of the bladder survey and visualization of ureteral jetting. Tips for detecting jetting and restoring normal anatomy are discussed. A brief review of the literature is used to outline indications for cystoscopy in general gynecology as well as its limitations. Interventions: NA Conclusion: Intra-operative cystoscopy is a useful tool for the general gynecologist. Simple steps can be taken to make it straightforward and diagnostic. However, it’s also important to realize the limitations of cystoscopy, particularly in the detection of non-obstructive ureteral injury.
S45 Study Objective: Screening guidelines for endometrial hyperplasia/ malignancy are based on a patient population predating the current obesity epidemic. With the rise in obesity and related malignancies, the objective of this study is to evaluate various risk factors for endometrial hyperplasia/malignancy in premenopausal women with AUB or oligomenorrhea. Specifically the study aims to elucidate whether obesity or age confers higher risk of disease in the premenopausal population. Design: Retrospective cohort study. Setting: Large urban academic center. Patients or Participants: Premenopausal women undergoing endometrial sampling for AUB or oligomenorrhea. Interventions: Endometrial sampling via office biopsy or dilation and curettage. Measurements and Main Results: A cohort of women (N = 7001) ages 18-51 who underwent endometrial sampling for AUB or oligomenorrhea were identified from a large deidentified database of clinical records from approximately 1990 to 2019 unique to our institution. A preliminary convenience sample (N= 250) was analyzed and a total of 13 cases (5.6%) of hyperplasia or malignancy were noted. Mean age was found to be 42.6 overall in this sample and 45.9 in those with disease. Mean BMI of the sample was found to be 31.8 overall and 40.7 in those with disease. Logistic regression was performed and revealed that BMI (coefficient = 0.096, p = 0.001) was a significant predictor of malignancy/hyperplasia in this population while age (coefficient = 0.018, p = 0.102) was not. Conclusion: While both age and obesity are risk factors for endometrial hyperplasia and malignancy in the postmenopausal population, obesity appears to be a risk factor for disease in the premenopausal while age does not. Our study suggests that BMI may be a more important risk factor to prompt screening. Further study of risk factors for endometrial malignancy in a contemporary demographic setting is needed. Open Communications 9: Basic Science/Research/Education (3:05 PM − 4:05 PM) 3:54 PM The Use of Intraoperative Cystoscopy for Detection of Lower Urinary Tract Injury Pickett C,1,* Yoder K,1 Andrews N2. 1Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM; 2University of New Mexico, Albuquerque, NM *Corresponding author. Video Objective: To review the use of cystoscopy by OB/GYN generalists for detection of lower urinary tract injury during hysterectomy. This includes the basic steps to diagnostic cystoscopy, the relevant anatomy, indications and limitations. Setting: Cystoscopy is routinely used in prolapse and incontinence repair procedures due to the relatively high risk of bladder or ureteral injury during these surgeries. While some recommend the routine use of intra-operative cystoscopy as a part of laparoscopic hysterectomy to detect bladder or ureteral injury, this is still not routine practice among OB/GYNs generalists. Whether this is due to decreased familiarity with the technique, or it’s limitations in sensitivity for detection of ureteral injury, remains unclear. To achieve the above objectives, this video reviews the details of the equipment involved, relevant anatomy, role of the bladder survey and visualization of ureteral jetting. Tips for detecting jetting and restoring normal anatomy are discussed. A brief review of the literature is used to outline indications for cystoscopy in general gynecology as well as its limitations. Interventions: NA Conclusion: Intra-operative cystoscopy is a useful tool for the general gynecologist. Simple steps can be taken to make it straightforward and diagnostic. However, it’s also important to realize the limitations of cystoscopy, particularly in the detection of non-obstructive ureteral injury.