Obstetrics & Gynaecology - Journal articles
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Item Beyond the numbers: Impact of obesity on obstetric anal sphincter injury (OASI) outcomes in women(John Wiley and Sons Inc, 2025) Rotem, Reut; Galvin, Daniel; McCormack, Kate; O'Sullivan, Orfhlaith E.; Hayes-Ryan, DeirdreObjective: To compare the risk profiles, anatomical, and functional outcomes between obese and non-obese women who experienced obstetric anal sphincter injury (OASI). Methods: A retrospective electronic database study was conducted at Cork University Maternity Hospital (CUMH). Women with missing data/repairs conducted outside CUMH were excluded. Participants were categorized into obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) groups. Primary measure was a composite adverse outcome assessed 6 months post-delivery, including one or more of the following: resting pressure <40 mmHg, squeezing pressure <100 mmHg, defects in the internal and/or external anal sphincter. Statistical analyses were performed using SPSS version 28. Results: Among the 349 women included in the study, 285 (81.7%) had a BMI <30 kg/m2 and 64 (18.3%) had a BMI ≥30 kg/m2. Gestational diabetes was significantly higher in obese women. No significant differences were observed in newborn weight or mode of delivery. The majority of tears were classified as grade 3B in both groups. Attendance rates at the OASI clinic did not differ between the groups. Among those attending, no statistical differences were noted in manometry results, which were reduced in both groups. Rates of internal anal sphincter defects were lower in the obese group (7.0% vs 15.6%, P = 0.15) and external anal sphincter defects were significantly lower in obese women (0% vs 9.1%, P = 0.04). No difference was found in the rates of composite adverse outcomes between the groups. Conclusion: Functional outcomes and manometry results did not differ, but non-obese women had higher rates of anatomical defects in OASI, requiring further study. © 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.Item The future of patient education: A study on AI-driven responses to urinary incontinence inquiries(John Wiley and Sons Inc, 2024) Rotem, Reut; Zamstein, Omri; Rottenstreich, Misgav; O'Sullivan, Orfhlaith E.; O'Reilly, Barry A.; Weintraub, Adi Y.OBJECTIVE: To evaluate the effectiveness of ChatGPT in providing insights into common urinary incontinence concerns within urogynecology. By analyzing the model's responses against established benchmarks of accuracy, completeness, and safety, the study aimed to quantify its usefulness for informing patients and aiding healthcare providers. METHODS: An expert-driven questionnaire was developed, inviting urogynecologists worldwide to assess ChatGPT's answers to 10 carefully selected questions on urinary incontinence (UI). These assessments focused on the accuracy of the responses, their comprehensiveness, and whether they raised any safety issues. Subsequent statistical analyses determined the average consensus among experts and identified the proportion of responses receiving favorable evaluations (a score of 4 or higher). RESULTS: Of 50 urogynecologists that were approached worldwide, 37 responded, offering insights into ChatGPT's responses on UI. The overall feedback averaged a score of 4.0, indicating a positive acceptance. Accuracy scores averaged 3.9 with 71% rated favorably, whereas comprehensiveness scored slightly higher at 4 with 74% favorable ratings. Safety assessments also averaged 4 with 74% favorable responses. CONCLUSION: This investigation underlines ChatGPT's favorable performance across the evaluated domains of accuracy, comprehensiveness, and safety within the context of UI queries. However, despite this broadly positive reception, the study also signals a clear avenue for improvement, particularly in the precision of the provided information. Refining ChatGPT's accuracy and ensuring the delivery of more pinpointed responses are essential steps forward, aiming to bolster its utility as a comprehensive educational resource for patients and a supportive tool for healthcare practitioners. © 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.Item Precision in practice: The critical role of mesh and procedure type specification in urogynecological surgeries and research(Springer Nature, 2024) Rotem, Reut; Galvin, Daniel; Daykan, Yair; Al-Shukaili, Sumaiya; O’Reilly, Barry A.; O'Sullivan, Orfhlaith E.Recently, the debate surrounding the use of mesh in urogynecological procedures has intensified, leading to FDA warnings and heightened safety concerns. This clinical opinion emphasizes the vital need to specify mesh types in these procedures, drawing attention to the risk profiles and clinical outcomes associated with various meshes and the procedures that utilize them. A significant issue identified in contemporary literature is the tendency to group diverse mesh types under the same umbrella, disregarding their unique characteristics and applications. We describe the range of mesh types, their application routes, and associated complications, highlighting the risks of this nonspecific approach to patient safety and informed decision making. We critically examine the generalization of mesh terminology in clinical and research dialogues. Concluding with specific recommendations for health care providers and researchers, the paper advocates for a more nuanced understanding and communication in the field, ultimately aiming to improve patient care and safety in urogynecological practice. © The Author(s) 2024.Item Novel endoscopic management of a late complication following TVT insertion for stress urinary incontinence(International Scientific Information, Inc., 2013) O'Sullivan, Orfhlaith E.; Martyn, Fiona; O'Connor, Rory; Jaffery, SyedBackground: Since 1995 over 1 million tension free vaginal slings have been utilized to treat stress incontinence. The 10 year success rates range from 84-93%. Complication rates are low by comparision. Bladder perforation occurring during the time of surgery and is managed effectively if diagnosed and treated intraoperatively. However bladder erosion occuring post-operatively predominantly occur within the first 2 years. The risk of erosion increases with body mass index and previous vaginal surgery. Case Report: We report the case of a bladder erosion occurring 5 years following the original surgery. The symptoms included recurrent urinary tract infections, frequency and haematuria. A novel technique was employed using the transurethral approach to initially disintegrate the calculus and then using an endoshears to excise the mesh below the level of the epithelium. Continence was maintained postoperatively. Conclusions: This approach provides a safe alternative to both the transvaginal and transabdominal approach to excising intravesical mesh. © Am J Case Rep, 2013.Item Preserving essential skills: The future of vaginal hysterectomy training in urogynaecology(John Wiley and Sons Inc, 2025) Rotem, Reut; Carey, Michael O.; McCarthy, Claire M.; O'Reilly, Barry A.; Daykan, Yair; O'Sullivan, Orfhlaith E.Objectives: This study aimed to evaluate the training and self-assessed proficiency of surgeons in the surgical management of pelvic organ prolapse (POP). We focused on the factors that influence decision-making, the surgical techniques employed, the training received, and the management of complications. Design: A cross-sectional survey. Setting: An electronic questionnaire. Population: European Urogynaecological Association (EUGA) and International Urogynecological Association (IUGA) members. Methods: A total of 33 questions evaluating surgeon preference regarding vaginal surgeries. Main Outcome Measures: Demographics, surgical selection, proficiency and technique, and training methods. Results: There were 471 respondents, of which 273 (58%) dedicated more than 50% of their week to urogynaecology. 250 (53%) had completed a fellowship, with 215 (86%) of those fellowships being in urogynaecology and pelvic floor reconstruction. A preference for hysterectomy in cases of uterine descent was noted by 297 (63%) respondents, influenced mainly by patient preference, age, and prolapse anatomical score. A total of 443 (94%) were proficient in vaginal hysterectomy, with two-thirds performing 30 or fewer procedures annually; 212 (45%) reporting a decrease in the number of procedures over the last decade. Additionally, 373 (79%) respondents believed that 10–30 cases were needed to achieve and maintain proficiency. Conclusion: Vaginal hysterectomy remains a key component in uterine prolapse repair. However, with the rise of uterine-sparing prolapse repairs, the decision-making process may be influenced by multiple factors, including surgical training. Emphasis should be placed on training and maintaining proficiency in both traditional and novel techniques. © 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.