Urology

Clinical situations that typically result in litigation and the variation in jury verdicts and awards across the nation.

A postmenopausal woman is more likely to develop a urinary tract infection if she has recently had intercourse. Although sexual intercourse is a known risk factor for UTI in younger women, this is the first study to examine postmenopausal women. Using daily diaries, women recorded episodes of vaginal intercourse. Dr. Elya Prystowsky and colleagues from the University of Washington explored the relationship between intercourse and the development of symptoms of culture-proven urinary tract infections. After controlling for diabetes, the risk for UTI was increased 3.4-fold in the 48 hours following intercourse.

Although traditional drugs work for most patients, potential side effects turn some patients off. Examining the evidence, two experts argue for trying approaches like magnetic and electrical stimulation, acupuncture, or Botox.

What's holding you back? Cost? Worries about managing pain or complications? An expert debunks common excuses for not doing more office-based procedures and explains why you need both U/S and diagnostic hysteroscopy-and the rewards you can reap from taking your practice in this direction.

Routine urinalysis shows RBCs, but your patient has no symptoms. Is treatment necessary? This four-point plan will help you more quickly get to that answer.

Now that the device has been available in the United States for several years, there are more clinical data to look at. Here's a brief review of the literature on its indications, benefits, contraindications, and complications.

Adding Burch colposuspension to abdominal sacrocolpopexy for the treatment of pelvic-organ prolapse approximately halves the incidence of postoperative stress urinary incontinence (SUI) in women who do not have SUI preoperatively and does so without increasing other lower urinary tract symptoms, according to the results of a randomized controlled trial.

What do you tell a pregnant patient with a previous third- orfourth-degree tear, for whom another vaginal delivery raises therisk of further injury? Can some women safely have a trial oflabor? Diagnose occult tears with ultrasound, advise theseexperts-and use it to assess the anal sphincters of allincontinent women.

Faced with a challenging, unusual presentation, accuratedocumentation that spells out the clinician's rationale forcare-or absence of care-takes on even greatersignificance.

The risk of accidents with laparoscopic surgery could be reduced ifhospitals used fault-detection devices currently on the market.

Can the right graft materials improve the success rates for vaginal repair surgery? Drawing upon the latest research, experts weigh the pros and cons of synthetic and biologic surgical graft materials, citing pore size as arguably the key factor in reducing complications.

Risk management in obstetrics and gynecology

Women with uterine fibroids equal to or larger than 16 weeks in size can be safely and effectively managed with abdominal myomectomy.

Aromatase inhibitors have surpassed tamoxifen in treatment of recurrent breast cancer. Will the same be true for early disease? An expert examines the evidence from ongoing clinical trials.

While nurse-led conservative treatment of postnatal urinary and fecal incontinence may help in the short-term, the benefits do not persist in about 75% of women when followed for 6 years.

Routine episiotomies—performed on more than 1 million pregnant women each year in the United States—have no benefits, cause more complications, and should be stopped immediately, according to the authors of a systematic review of the medical research.

In a previous article, we reviewed coding changes for vaginal colpopexy. This article looks at a related code introduced in CPT 2005 and how to report multiple services provided during the same surgery.

Evidently not, according to a large, Danish, population-based, case–control study.

The 4th Current Issues Update yesterday offered late breaking news in five specialty areas: urogynecology, STD treatment guidelines, reproductive medicine, gynecologic oncology, and maternal-fetal medicine.

American College of Obstetricians and Gynecologists (ACOG) Junior Fellows stumped the Professors at ACM's 5th Scientific Session. ACOG's annual brainteaser that pits senior residents against a panel of professors left the profs guessing on three of four test cases.

Each year CPT introduces new codes and makes revisions to existingcodes to better reflect current medical practices. CPT 2005 is nodifferent. This month, we'll look at changes in coding for vaginalcolpopexy. The 2005 CPT codes reflect the expansion and improvementof surgical techniques in the area of female reconstructive surgery

The airline industry didn't wait for validation before they employed simulation in their credentialing program, and surgeons shouldn't either.

Abdominal sacral colpopexy is still the "gold standard" for this complicated problem. But early results with two minimally invasive procedures show promise for safely managing prolapse.

Early diagnosis of m?llerian anomalies is important because they can have a significant impact on a woman?s reproductive potential. Sonographic clues lead the way to prompt and precise classification.

The pathogenic triad of vascular stasis, hypercoagulability, and vascular injury remains the prime initiator of thrombosis, and gynecologic surgery is associated with all three.