Purpose:Although minimally invasive (robotic or laparoscopic) abdominal sacrocolpopexy (MISC) has become the new gold standard for durable pelvic organ prolapse repair after the vaginal mesh controversy, current literature is limited. Our objective was to study reoperation for mesh complications after MISC.Materials and Methods:All women undergoing MISC in California from January 2012 to December 2018 were identified from Office of Statewide Health Planning and Development data sets using appropriate ICD-9/10 (International Classification of Diseases 9th/10th Revision) and CPT® (Current Procedural Terminology) codes. Univariate and multivariable analyses were performed to assess associations between patient demographics, surgical details and our primary outcomes: rates of reoperation for a mesh complication.Results:Of 12,189 women undergoing MISC 8,398 (68.9%) had concomitant hysterectomy. Total hysterectomy (TH) and supracervical hysterectomy (SCH) were performed in 5,027 (41.2%) and 3,371 (27.6%) cases, respectively. Reoperation rates for mesh complications were lower after SCH vs TH (overall: 0.7%, mean followup time 1,111 days vs 3.1%, mean followup time 1,095 days, p <0.001; subcohort with at least 4 years of followup: 2.1% vs 8.9%, p <0.001). Additionally, mesh complication rates were higher even if TH was performed remotely, as compared to concomitant SCH (5.2% vs 0.7%, p <0.001). The increased risk for reoperation due to mesh complications after TH was preserved on multivariable analysis (OR 4.20, 95% CI 2.72‒6.50, p <0.001).Conclusions:Concomitant TH at time of MISC is associated with a significantly higher rate of mesh complication as compared to SCH. The increased risk of a mesh complication associated with TH is present even if the TH was performed prior to the MISC.

Purpose of review Recurrent urinary tract infections (rUTIs) represent a large burden on the healthcare system. Recent guidelines from the AUA/CUA/SUFU and advancements in the field reflect a paradigm shift for clinician and patients, steering away from empiric antibiotic therapy towards judicious antibiotic use. Recent findings Antibiotic stewardship, including increasing awareness of the collateral damage of antibiotics and the risks of bacterial resistance are a major focus of the new guidelines. Accurate diagnosis of rUTIs is imperative. Urine cultures are necessary to document rUTI and should be obtained prior to any treatment. First line treatment options (trimethoprim–sulfamethoxazole, nitrofurantoin, and fosfomycin) should be used whenever possible. Asymptomatic bacteriuria should not be treated in these patients with rUTI. Although antibiotic prophylaxis methods are effective, nonantibiotic regimens show promise. Summary The management of rUTIs has evolved significantly with the goal of antibiotic stewardship. It is increasingly important to ensure the accuracy of diagnosis with a positive urine culture in the setting of cystitis symptoms, and standardize treatment with first-line therapies to minimize antibiotic side effects.

cervical preservation. Of note, actual mesh complication rate in this cohort is likely higher as conservatively managed mesh problems were not included. Additionally, mesh complications from a concomitant sling placement might have contaminated the results. However, one should bear in mind that surgeon experience and technique are critically important. In 1 study, mesh erosion rate after TH during sacrocolpopexy varied tremendously between 2 centers (1% vs 37%; reference 8 in article). Finally, one should also take the other risks associated with retaining the cervix after sacrocolpopexy into account. More prospective studies with longer-term outcomes are needed.

anatomical reconstructed images, all patients were cleared to undergo donor nephrectomy based on the additional information that was provided from the virtual models. In the patient with the perihilar mass, the 3D imaging delineated the mass as arising from the renal parenchyma. This patient underwent robotic donor nephrectomy with ex-vivo excision of the mass (pathology: lipid-poor renal angiomyolipoma), with successful subsequent renal transplantation. All 63 patients underwent uneventful laparoscopic or robotic donor nephrectomy.CONCLUSIONS: Virtual 3D anatomical modeling with IRISä allows surgeons to perform donor nephrectomy in patients that may otherwise be excluded from renal donation. This technology offers preoperative interpretation of renal anatomy, provides confidence in the setting of complex vasculature, and facilitates planned procedural completion.

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