Our nomenclature system provides a simple way to describe the locations of parathyroid adenomas. Type E adenomas were associated with a higher rate of outpatient surgery and type F adenomas with a longer operative time. Biochemical cure rates were comparable for all locations of single adenomas.

Objective The primary objective of this study was to describe patient compliance with pelvic floor physical therapy (PFPT) for high-tone pelvic floor disorders (HTPFD) and to compare patients who are compliant with prescribed therapy to those who are not. The secondary objective is to describe second-line treatments offered for HTPFD for returning patients. Methods This is a retrospective cohort study of women with a HTPFD who were prescribed PFPT at a tertiary care referral center. Patients were excluded if they had a primary diagnosis of urinary incontinence, had undergone prior PFPT, or if PFPT was part of preoperative planning. Noncompliance with PFPT was defined as not being formally discharged from therapy by the treating therapist. Results Data on PFPT compliance were available for 662 patients (87.3%). A total of 128 patients (19.4%) were fully compliant. Noncompliant patients were more likely to smoke and to have mental health disease compared with compliant patients (18% vs 8.7%, P = 0.01, and 50.4% vs 37.5%, P = 0.009, respectively). A total of 285 patients (43.1%) returned to their prescribing provider. Noncompliant patients were less likely to return to their provider: 63.4% versus 29.7%, P = <0.0001. Of the patients who returned, 183 (64.2%) were offered second-line treatment. Conclusions Only 1 in 5 patients referred to PFPT for management of a high-tone pelvic floor disorder is compliant with the recommended therapy. Patients who are noncompliant are less likely to return to their prescribing provider, and less than half of referred patients return. Sixty percent of patients who return are offered second-line treatment.

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For treating nonneurogenic overactive bladder, female pelvic medicine and urogenital reconstruction guidelines given by the American Urological Association and Society of Urodynamics recommend that onabotulinumtoxinA (botoxA) may be used as third-line therapy following a failure of both first-line lifestyle and behavioral changes and second-line cholinergic or β-agonist therapy. Wide variations on the acceptable number of injections per treatment episode (as much as 1 injection to 40) have been promulgated for botoxA. Few studies have been performed to assess patient-centered outcomes for repeated injection. As the goal of treatment using botoxA is to improve patient quality of life, this study aimed to assess the effect of the injection paradigm on patient perceptions of the treatment. In addition, the study sought comparisons of the patient-perceived efficacy of treatment, the duration of the procedure, and any adverse events. The authors hypothesized that receiving fewer injections will result in a patient experience with significantly less pain and a shorter procedure time than those receiving more injections.This study used a multicenter single-blind, randomized controlled trial format. It enrolled women undergoing treatment of refractory idiopathic overactive bladder via intradetrusor botoxA. For the experimental arm, participants received a 100-unit dose of botoxA in 10 mL of sodium chloride as 5 injections of 2 mL each, and participants in the control arm received 20 injections of 0.5 mL each. Participants were masked to their treatment allocation.Primary outcomes of the study were perceived overall pain on a 10-point visual analog scale (VAS) and duration of injection procedure. Secondary outcomes included a 6-week postprocedure Global Response Assessment (GRA) score measuring subjective treatment efficacy, as collected via follow-up phone call (integer scale of −3 to +3). A total of 60 patients were recruited at 2 study sites.The median VAS pain score was not significantly different between groups. However, there was a significant difference in duration of procedure, with a median of 76 seconds for 5-injection participants and 176 seconds for 20-injection participants, meaning that the procedure was almost 2 minutes shorter with the 5-injection approach. The GRA score of efficacy was not significantly different between groups, but the study did not assess additional traditional methods of measuring efficacy of treatment with botoxA such as pad counts or bladder diaries.Strengths of this study include the following: single-blind, randomized controlled design and a well-defined study population consisting of women with urgency urinary incontinence or idiopathic overactive bladder. The generalizability of the study is facilitated by its multisite nature. Furthermore, the authors' choice to utilize subjective outcome measures contributed to the strength of this patient-focused outcomes study.Limitations of the study include the inability to determine whether masking patients to their treatment assignment tr...