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Obliterative Lefort Colpocleisis in a Large Group of Elderly Women
Obliterative LeFort Colpocleisis in a Large Group of Elderly Women Salomon Zebede, MD, Aimee L. Smith, MD, Leon N. Plowright, MD, Aparna Hegde, MD, Vivian C. Aguilar, MD, and G. Willy Davila, MD OBJECTIVE: To report on anatomical and functional satisfaction. Associated morbidity and mortality related outcomes, patient satisfaction, and associated morbidity to the procedure are low. Colpocleisis remains an and mortality in patients undergoing LeFort colpocleisis. excellent surgical option for the elderly patient with METHODS: This was a retrospective case series of advanced pelvic organ prolapse. LeFort colpocleisis performed from January 2000 to (Obstet Gynecol 2013;121:279–84) October 2011. Data obtained from a urogynecologic DOI: http://10.1097/AOG.0b013e31827d8fdb database included demographics, comorbidities, medi- LEVEL OF EVIDENCE: III cations, and urinary and bowel symptoms. Prolapse was quantified using the pelvic organ prolapse quantification y 2050, the elderly will represent the largest section (POP-Q) examination. Operative characteristics were Bof the population and pelvic floor dysfunction is recorded. All patients underwent pelvic examination projected to affect 58.2 million women in the United and POP-Q assessment at follow-up visits. Patients also States. We thus can expect to see a increase in the were asked about urinary and bowel symptoms as well as demand for urogynecologic services in this popula- overall satisfaction. All intraoperative and postoperative tion.1,2 Most women older than age 65 years are surgical complications were recorded. afflicted with at least one chronic medical condition, RESULTS: Three hundred twenty-five patients under- and, with the rate of comorbid conditions increasing went LeFort colpocleisis. -
Urology Services in the ASC
Urology Services in the ASC Brad D. Lerner, MD, FACS, CASC Medical Director Summit ASC President of Chesapeake Urology Associates Chief of Urology Union Memorial Hospital Urologic Consultant NFL Baltimore Ravens Learning Objectives: Describe the numerous basic and advanced urology cases/lines of service that can be provided in an ASC setting Discuss various opportunities regarding clinical, operational and financial aspects of urology lines of service in an ASC setting Why Offer Urology Services in Your ASC? Majority of urologic surgical services are already outpatient Many urologic procedures are high volume, short duration and low cost Increasing emphasis on movement of site of service for surgical cases from hospitals and insurance carriers to ASCs There are still some case types where patients are traditionally admitted or placed in extended recovery status that can be converted to strictly outpatient status and would be suitable for an ASC Potential core of fee-for-service case types (microsurgery, aesthetics, prosthetics, etc.) Increasing Population of Those Aged 65 and Over As of 2018, it was estimated that there were 51 million persons aged 65 and over (15.63% of total population) By 2030, it is expected that there will be 72.1 million persons aged 65 and over National ASC Statistics - 2017 Urology cases represented 6% of total case mix for ASCs Urology cases were 4th in median net revenue per case (approximately $2,400) – behind Orthopedics, ENT and Podiatry Urology comprised 3% of single specialty ASCs (5th behind -
Curriculum Vitae
CURRICULUM VITAE G. WILLY DAVILA, M.D. GUILLERMO H. DAVILA, M.D., FACOG, FPMRS Medical Director, Women and Children’s Services Holy Cross Medical Group Center for Urogynecology and Pelvic Floor Medicine Dorothy Mangurian Comprehensive Women’s Center Holy Cross Health Fort Lauderdale, Florida, USA Academic positions: Affiliate Professor, Florida Atlantic University School of Medicine Clinical Associate Professor, University of South Florida, Dept. of Obstetrics and Gynecology Address: Holy Cross HealthPlex Dorothy Mangurian Comprehensive Women’s Center 1000 NE 56th Street Fort Lauderdale, Florida 33334 Phone (954) 229-8660 FAX (954) 229-8659 Email: [email protected] Education 1976-1979 University of Texas at El Paso, Texas B.S. Biology 1976-1977 University of Bolivia Medical School, La Paz, Bolivia no degree 1979-1983 University of Texas Medical School, Houston, Texas M.D. Residency 1983-1987 University of Colorado Health Sciences Center, Denver, Colorado Obstetrics and Gynecology Postgraduate Training 1989 Gynecological Urology Clinical Preceptorship: Long Beach Memorial Hospital, University of California, Irvine Donald Ostergard, M.D., Director Previous Positions: 1999-2017 Chairman, Department of Gynecology, Cleveland Clinic Florida 1999-2018 Head, Section of Urogynecology and Reconstructive Pelvic Surgery Cleveland Clinic Florida Director, The Pelvic Floor Center at Cleveland Clinic Florida A National Association for Continence (NAFC) Center of Excellence in Pelvic Floor Care Director, Clinical Fellowship program - Urogynecology and Reconstructive Pelvic Surgery (2000-2007) 2015-2016 Clinical Director, Global Patient Services (Weston) Cleveland Clinic Foundation, International Center 2013-2016 Center Director, Obstetrics and Gynecology and Women’s Health Institute (Weston) Cleveland Clinic Foundation 1992-1999 Director, Colorado Gynecology and Continence Center, P.C. -
Colpocleisis (Closing the Vagina to Treat Prolapse)
Colpocleisis (Closing the vagina to treat prolapse) Patient Information Leaflet About this leaflet The information provided in this leaflet should be used as a guide. There may be some variation in how each gynaecologist performs the procedure, the care procedures on the ward immediately after your operation and the advice given to you when you get home. You should ask your gynaecologist about any concerns that you may have. You should take your time to read this leaflet. A page is provided at the end of the leaflet for you to write down any questions you may have. It is your right to know about your planned operation/procedure, why it has been recommended, what the alternatives are and what the risks and benefits are. These should be covered in this leaflet. You may also wish to ask about your gynaecologist’s personal experience and results of treating your condition. Benefits and risks The success and the risks of most operations carried out to treat prolapse and incontinence have been poorly studied and so it is often not possible to define them clearly. In this leaflet risks may be referred to as common, rare etc. or an approximate level of risk may be given. Further information about risk is explained in a leaflet published by the Royal College of Obstetricians and Gynaecologists “Understanding how risk is discussed in healthcare”. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pi- understanding-risk.pdf The following table is taken from that leaflet British Society of Urogynaecology (BSUG) database In order to better understand the success and risks of surgery for prolapse and incontinence the British Society of Urogynaecology has established a national database. -
Complications of Urinary Diversion
Complications of Urinary Diversion Jennifer L. Dodson, M.D. Department of Urology Johns Hopkins University Types of Diversion Conduit Diversions Ileal conduit Colon conduit Continent Diversions Continent catheterizable reservoir Continent rectal pouch 1 Overview of Complications Mechanical Stoma problems Bowel obstruction Ureteral obstruction Reservoir perforation Metabolic Altered absorption Altered bone metabolism Growth delay Stones Cancer Conduit Diversions Ileal Conduit: Technically simplest Segment of choice Colon Conduit: Transverse or sigmoid Used when ileum not appropriate (eg: concomitant colon resection, abdominal radiation, short bowel syndrome, IBD) Early complications (< 30 days): 20-56% Late complications : 28-81% Risks: abdominal radiation abdominal surgery poor nutrition chronic steroids Farnham & Cookson, World J Urol, 2004 2 Complications of Ileal Conduit Campbell’s Urology, 8th Edition, 2002 Conduit: Bowel Complications Paralytic ileus 18-20% Conservative management vs NGT Consider TPN Bowel obstruction 5-10% Causes: Adhesions, internal hernia Evaluation: CT scan, Upper GI series Anastomotic leak 1-5 % Risk factors: bowel ischemia, radiation, steroids, IBD, technical error Prevention: Pre-operative bowel prep Attention to technical detail Stapled small-bowel Anastomosis (Campbell’s Blood supply, tension-free anastomosis, Urology, 8th Ed, 2004) realignment of mesentery Farnham & Cookson, World J Urol, 2004 3 Conduit Complications Conduit necrosis: Acute ischemia to bowel -
Diagnosis and Management of Urinary Incontinence in Childhood
Committee 9 Diagnosis and Management of Urinary Incontinence in Childhood Chairman S. TEKGUL (Turkey) Members R. JM NIJMAN (The Netherlands), P. H OEBEKE (Belgium), D. CANNING (USA), W.BOWER (Hong-Kong), A. VON GONTARD (Germany) 701 CONTENTS E. NEUROGENIC DETRUSOR A. INTRODUCTION SPHINCTER DYSFUNCTION B. EVALUATION IN CHILDREN F. SURGICAL MANAGEMENT WHO WET C. NOCTURNAL ENURESIS G. PSYCHOLOGICAL ASPECTS OF URINARY INCONTINENCE AND ENURESIS IN CHILDREN D. DAY AND NIGHTTIME INCONTINENCE 702 Diagnosis and Management of Urinary Incontinence in Childhood S. TEKGUL, R. JM NIJMAN, P. HOEBEKE, D. CANNING, W.BOWER, A. VON GONTARD In newborns the bladder has been traditionally described as “uninhibited”, and it has been assumed A. INTRODUCTION that micturition occurs automatically by a simple spinal cord reflex, with little or no mediation by the higher neural centres. However, studies have indicated that In this chapter the diagnostic and treatment modalities even in full-term foetuses and newborns, micturition of urinary incontinence in childhood will be discussed. is modulated by higher centres and the previous notion In order to understand the pathophysiology of the that voiding is spontaneous and mediated by a simple most frequently encountered problems in children the spinal reflex is an oversimplification [3]. Foetal normal development of bladder and sphincter control micturition seems to be a behavioural state-dependent will be discussed. event: intrauterine micturition is not randomly distributed between sleep and arousal, but occurs The underlying pathophysiology will be outlined and almost exclusively while the foetus is awake [3]. the specific investigations for children will be discussed. For general information on epidemiology and During the last trimester the intra-uterine urine urodynamic investigations the respective chapters production is much higher than in the postnatal period are to be consulted. -
Overview of Surgical Techniques in Gender-Affirming Genital Surgery
208 Review Article Overview of surgical techniques in gender-affirming genital surgery Mang L. Chen1, Polina Reyblat2, Melissa M. Poh2, Amanda C. Chi2 1GU Recon, Los Angeles, CA, USA; 2Southern California Permanente Medical Group, Los Angeles, CA, USA Contributions: (I) Conception and design: ML Chen, AC Chi; (II) Administrative support: None; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: None; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Amanda C. Chi. 6041 Cadillac Ave, Los Angeles, CA 90034, USA. Email: [email protected]. Abstract: Gender related genitourinary surgeries are vitally important in the management of gender dysphoria. Vaginoplasty, metoidioplasty, phalloplasty and their associated surgeries help patients achieve their main goal of aligning their body and mind. These surgeries warrant careful adherence to reconstructive surgical principles as many patients can require corrective surgeries from complications that arise. Peri- operative assessment, the surgical techniques employed for vaginoplasty, phalloplasty, metoidioplasty, and their associated procedures are described. The general reconstructive principles for managing complications including urethroplasty to correct urethral bulging, vaginl stenosis, clitoroplasty and labiaplasty after primary vaginoplasty, and urethroplasty for strictures and fistulas, neophallus and neoscrotal reconstruction after phalloplasty are outlined as well. Keywords: Transgender; vaginoplasty; phalloplasty; metoidioplasty Submitted May 30, 2019. Accepted for publication Jun 20, 2019. doi: 10.21037/tau.2019.06.19 View this article at: http://dx.doi.org/10.21037/tau.2019.06.19 Introduction the rectum and the lower urinary tract, formation of perineogenital complex for patients who desire a functional The rise in social awareness of gender dysphoria has led vaginal canal, labiaplasty, and clitoroplasty. -
EAU Guidelines on Urinary Incontinence in Adults
EAU Guidelines on Urinary Incontinence in Adults F.C . Burkhard (Chair), J.L.H.R. Bosch, F. Cruz, G.E. Lemack, A.K. Nambiar, N. Thiruchelvam, A. Tubaro Guidelines Associates: D. Ambühl, D.A. Bedretdinova, F. Farag, R. Lombardo, M.P. Schneider © European Association of Urology 2018 TABLE OF CONTENTS PAGE 1. INTRODUCTION 8 1.1 Aim and objectives 8 1.1.1 The elderly 8 1.2 Panel composition 8 1.3 Available publications 8 1.4 Publication history 9 1.4.1 Summary of changes. 9 2. METHODS 11 2.1 Introduction 11 2.2 Review 11 2.3 Future goals 11 3. DIAGNOSTIC EVALUATION 11 3.1 History and physical examination 11 3.2 Patient questionnaires 12 3.2.1 Questions 12 3.2.2 Evidence 12 3.2.3 Summary of evidence and recommendations for patient questionnaires 13 3.3 Voiding diaries 14 3.3.1 Question 14 3.3.2 Evidence 14 3.3.3 Summary of evidence and recommendations for voiding diaries 14 3.4 Urinalysis and urinary tract infection 14 3.4.1 Question 14 3.4.2 Evidence 14 3.4.3 Summary of evidence and recommendations for urinalysis 15 3.5 Post-void residual volume 15 3.5.1 Question 15 3.5.2 Evidence 15 3.5.3 Summary of evidence and recommendations for post-void residual 15 3.6 Urodynamics 15 3.6.1 Question 16 3.6.2 Evidence 16 3.6.2.1 Variability 16 3.6.2.2 Diagnostic accuracy 16 3.6.2.3 Question 16 3.6.2.4 Evidence 16 3.6.2.5 Question 16 3.6.2.6 Evidence 16 3.6.2.7 Question 17 3.6.2.8 Evidence 17 3.6.2.9 Question 17 3.6.2.10 Evidence 17 3.6.3 Summary of evidence and recommendations for urodynamics 17 3.6.4 Research priority 18 3.7 Pad testing 18 3.7.1 Questions 18 3.7.2 Evidence 18 3.7.3 Summary of evidence and recommendations for pad testing 18 3.7.4 Research priority 18 3.8 Imaging 18 3.8.1 Questions 19 3.8.2 Evidence 19 3.8.3 Summary of evidence and recommendations for imaging 19 3.8.4 Research priority 19 2 URINARY INCONTINENCE IN ADULTS - LIMITED UPDATE MARCH 2018 4. -
OBGYN-Study-Guide-1.Pdf
OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test. -
Invasive Treatments for Urinary Incontinence
Cigna Medical Coverage Policy Effective Date .......................... 12/15/2013 Subject Invasive Treatments for Next Review Date .................... 12/15/2014 Coverage Policy Number ................. 0365 Urinary Incontinence Table of Contents Hyperlink to Related Coverage Policies Coverage Policy .................................................. 1 Biofeedback General Background ........................................... 2 Botulinum Therapy Coding/Billing Information ................................. 15 Electrical Stimulators References ........................................................ 16 Extracorporeal Electromagnetic Stimulation for Urinary Incontinence Injectable Bulking Agents for Urinary Conditions and Fecal Incontinence Physical Therapy Sacral Nerve Stimulation for Urinary Voiding Dysfunction and Fecal Incontinence INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna companies. Coverage Policies are intended to provide guidance in interpreting certain standard Cigna benefit plans. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion related to a topic addressed in a Coverage Policy. In the event of a conflict, a customer’s benefit plan document -
UNMH Obstetrics and Gynecology Clinical Privileges Name
UNMH Obstetrics and Gynecology Clinical Privileges Name:____________________________ Effective Dates: From __________ To ___________ All new applicants must meet the following requirements as approved by the UNMH Board of Trustees, effective April 28, 2017: Initial Privileges (initial appointment) Renewal of Privileges (reappointment) Expansion of Privileges (modification) INSTRUCTIONS: Applicant: Check off the “requested” box for each privilege requested. Applicants have the burden of producing information deemed adequate by the Hospital for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Department Chair: Check the appropriate box for recommendation on the last page of this form. If recommended with conditions or not recommended, provide condition or explanation. OTHER REQUIREMENTS: 1. Note that privileges granted may only be exercised at UNM Hospitals and clinics that have the appropriate equipment, license, beds, staff, and other support required to provide the services defined in this document. Site-specific services may be defined in hospital or department policy. 2. This document defines qualifications to exercise clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet. --------------------------------------------------------------------------------------------------------------------------------------- -
Urological Care of the Spinal Cord–Injured Patient
WJ350312_323-331.qxd 4/22/08 4:52 AM Page 323 J Wound Ostomy Continence Nurs. 2008;35(3):323-331. Published by Lippincott Williams & Wilkins CONTINENCE CARE CE Urological Care of the Spinal Cord–Injured Patient Nancy Fonte Spinal cord injury (SCI) is a catastrophic occurrence affecting the (47.5%). Falls are the second most frequent cause of SCI lives of 11,000 people in the United States every year. Urologic (22%), and violence, primarily from gunshot wounds, ac- complications account for much of the morbidity associated with count for 13% of all these injuries. Recently, the propor- SCI and as much as 15% of the associated mortality. Spinal tion of sports-related injuries has declined to 8.9%. The cord–injured patients are required to digest a plethora of self- majority of all those injured are men (79%), and the aver- management information during the emotionally and psycho- age age at the time of injury is 37.6 years.2 logically distressing period immediately following their injury. As a vital resource in the SCI patients’ recovery process, it is crucial ■ Continence Physiology for the WOC nurse to have knowledge of the specialized needs of this population. This article reviews the effects of SCI on blad- The term continence denotes the ability to store urine der function, discusses potential complications of the neurogenic until an acceptable opportunity for urination occurs. bladder, and provides an overview of management options to Normal bladder function involves a cycle of filling, stor- assist the patient in adaptation and restoration of quality of life.