No abstract

UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.

Dilation and evacuation (D&E) is the recommended surgical procedure for uterine evacuation in the second trimester. Despite its established safety record, it is not routinely available in most countries around the world. In this paper, we describe the multi-phase capacity-building project we undertook to introduce D&E in Brazil. First, we invited a highly motivated obstetrician-gynecologist and abortion provider to complete an observership at an established D&E site in the United States. We then organized a month-long clinical training for two experienced gynecologists in Brazil, followed by ongoing remote mentorship. Almost all patients we approached during the training opted for D&E, and all expressed satisfaction with their experience. Despite the restrictive legal setting and prevailing abortion stigma in Brazil, our training was well-received, and we did not experience any overt resistance from hospital staff. We learned that obtaining institutional support is essential; and that presenting scientific evidence during dedicated didactic times was an important strategy to obtain buy-in from other local healthcare providers. An important challenge we encountered was low case volume given the restrictive legal setting. We addressed this by partnering with nearby hospitals and non-profit organizations for patient referrals. We also rescheduled, adapted and optimized this project for implementation in the midst of the COVID-19 pandemic. Despite the challenges we faced, this project led to the successful introduction of D&E up to 16–18 weeks at two sites in Brazil. In the future, we plan additional training to increase capacity for D&E at more advanced gestational ages.

indicate that general urologists may be referring mesh complications onto FPMRS providers, indicating that societal and FDA recommendations are perhaps not being adhered to.

experienced UUI resolution in the successes, and 10 (17.2%) in the failures (P .001). Among successes, a significant interaction (p<.001) was detected between the baseline and postoperative urodynamic parameters, including Qmax, corrected Qmax, postvoid residual (PVR), voiding volume, voiding efficiency(VE), and bladder outlet obstruction index (BOOI). Significantly increased PdetQmax was also observed after surgery (P .015). A significant interaction (P .034) is detected from the baseline to 6 months between successes and failures for BOOI.CONCLUSIONS: Suburethral sling has a durable long-term effect in our study. There is a trend suggesting that the decreased Qmax, corrected Qmax and VE are associated with surgical success, while increased Pdet. Qmax, BOOI, and PVR are also associated with success. Slight obstruction makes efficacious sling surgery. The increased outlet resistance is essential for achieving dryness.