Abstract:
BACKGROUND:Sacral neuromodulation is an effective therapy for overactive bladder, urinary retention, and fecal incontinence. Infection after sacral neurostimulation is costly and burdensome. Determining optimal perioperative management strategies to reduce the risk of infection is important to reduce this burden. OBJECTIVE:We sought to identify risk factors associated with sacral neurostimulator infection requiring explantation, to estimate the incidence of infection requiring explantation, and identify associated microbial pathogens. STUDY DESIGN:This is a multicenter retrospective case-control study of sacral neuromodulation procedures completed from Jan. 1, 2004, through Dec. 31, 2014. We identified all sacral neuromodulation implantable pulse generator implants as well as explants due to infection at 8 participating institutions. Cases were patients who required implantable pulse generator explantation for infection during the review period. Cases were included if age ≥18 years old, follow-up data were available ≥30 days after implantable pulse generator implant, and the implant was performed at the institution performing the explant. Two controls were matched to each case. These controls were the patients who had an implantable pulse generator implanted by the same surgeon immediately preceding and immediately following the identified case who met inclusion criteria. Controls were included if age ≥18 years old, no infection after implantable pulse generator implant, follow-up data were available ≥180 days after implant, and no explant for any reason <180 days from implant. Controls may have had an explant for reasons other than infection at >180 days after implant. Fisher exact test (for categorical variables) and Student t test (for continuous variables) were used to test the strength of the association between infection and patient and surgery characteristics. Significant variables were then considered in a multivariable logistic regression model to determine risk factors independently associated with infection. RESULTS:Over a 10-year period at 8 academic institutions, 1930 sacral neuromodulator implants were performed by 17 surgeons. In all, 38 cases requiring device explant for infection and 72 corresponding controls were identified. The incidence of infection requiring explant was 1.97%. Hematoma formation (13% cases, 0% controls; P = .004) and pocket depth of ≥3 cm (21% cases, 0% controls; P = .031) were independently associated with an increased risk of infection requiring explant. On multivariable regression analysis controlling for significant variables, both hematoma formation (P = .006) and pocket depth ≥3 cm (P = .020, odds ratio 3.26; 95% confidence interval, 1.20-8.89) remained significantly associated with infection requiring explant. Of the 38 cases requiring explant, 32 had cultures collected and 24 had positive cultures. All 5 cases with a hematoma had a positive culture (100%). Of the 4 cases with a pocket depth ≥3 cm, 2 had positive cultures, 1 had negative cultures, and 1 had a missing culture result. The most common organism identified was methicillin-resistant Staphylococcus aureus (38%). CONCLUSION:Infection after sacral neuromodulation requiring device explant is low. The most common infectious pathogen identified was methicillin-resistant S aureus. Demographic and health characteristics did not predict risk of explant due to infection, however, having a postoperative hematoma or a deep pocket ≥3 cm significantly increased the risk of explant due to infection. These findings highlight the importance of meticulous hemostasis as well as ensuring the pocket depth is <3 cm at the time of device implant.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Myer ENB,Petrikovets A,Slocum PD,Lee TG,Carter-Brooks CM,Noor N,Carlos DM,Wu E,Van Eck K,Fashokun TB,Yurteri-Kaplan L,Chen CCGdoi
10.1016/j.ajog.2018.04.005subject
Has Abstractpub_date
2018-07-01 00:00:00pages
78.e1-78.e9issue
1eissn
0002-9378issn
1097-6868pii
S0002-9378(18)30282-5journal_volume
219pub_type
杂志文章,多中心研究abstract:OBJECTIVE:Our purpose was to determine, in the murine model, whether human ovarian cancer cells injected intraperitoneally are subject to osmotic lysis by peritoneal lavage with sterile water, thereby decreasing the establishment of peritoneal implants. STUDY DESIGN:Preliminary experiments on six nude mice determined ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70095-9
更新日期:1996-12-01 00:00:00
abstract:BACKGROUND:Umbilical cord arterial blood gas values are used to diagnose fetal acidemia; however, arterial cord blood specimens are frequently not available. OBJECTIVE:We sought to assess whether umbilical cord venous blood gas values can be used to reliably predict fetal acidemia. STUDY DESIGN:This is an observation...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2017.05.047
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:The prototype of surgical treatment for vulvar vestibulitis has been the Woodruff vulvoplasty. A simpler surgery could be less morbid, technically easier, and equally effective. STUDY DESIGN:Twelve patients underwent vestibular revision, nine with local anesthesia. They were followed up for between 6 months ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(96)70200-4
更新日期:1996-06-01 00:00:00
abstract::Herein is the first reported case of bartholinitis complicated by toxic shock-like syndrome. Streptococcal exotoxin is implicated in this case of nonmenstrual toxic shock-like syndrome, which is an increasingly recognized manifestation of streptococcal infection. Further surveillance, investigation, and reporting of s...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90163-4
更新日期:1989-05-01 00:00:00
abstract:OBJECTIVE:This study was undertaken to determine whether laser thermocoagulation for twin-twin transfusion syndrome (TTTS) causes increased cell-free fetal DNA levels in maternal plasma, potentially as a result of placental injury. STUDY DESIGN:We enrolled 34 patients with twin pregnancies complicated by severe TTTS w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2004.07.019
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to assess the reliability and validity of an objective structured assessment of technical skills (OSATS) for repair of fourth-degree obstetric lacerations on a surgical model. STUDY DESIGN:Three blinded judges reviewed recordings of 20 junior and 20 senior obstetrics-gynecolog...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.07.054
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:Cervical ripening of an unfavorable cervix can be achieved by placement of a transcervical catheter. Advantages of this method include both lower cost and lower risk of tachysystole than other methods. Despite widespread use with varying degrees of applied tension, an unanswered question is whether there is ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2016.09.082
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the effect of discordant fetal growth on subsequent perinatal and neonatal outcome for different degrees of birth weight discordance in preterm twin gestations. STUDY DESIGN:One hundred twenty-two live born twin sets delivered between 25 and 34 completed weeks' gest...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90027-6
更新日期:1995-03-01 00:00:00
abstract::To clarify whether there is a variation of dopamine effect throughout the normal menstrual cycle, 24 studies were performed during the follicular, periovulatory, and luteal phase in seven ovulatory women. The subjects were studied for 24 hours after receiving two different dopamine agonists, 2.5 mg of bromocriptine in...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90672-1
更新日期:1986-02-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the effect of early oral bowel stimulation with osmotic laxatives on gastrointestinal function, postoperative nausea and vomiting (PONV) and pain in patients who undergo fast-track abdominal hysterectomy. STUDY DESIGN:This was a double-blind, placebo-controlled stud...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2006.10.902
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine whether any association exists between preeclampsia and circulating platelet activating factor levels. STUDY DESIGN:We performed a cross-sectional observational study of circulating platelet activating factor concentrations in nonpregnant women, normotensive pregnant wo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.108894
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVES:This study details the incidence, by gestational age and birth weight, of specific neonatal morbidities in singleton neonates without major congenital anomalies. STUDY DESIGN:Data were prospectively collected on all deliveries at five tertiary centers in the United States during the years 1983 through 1986....
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91551-k
更新日期:1992-06-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to investigate whether knowledge of human papillomavirus (HPV) deoxyribonucleic acid test results increases sensitivity of guided cytology screening for the detection of cervical intraepithelial neoplasia (CIN)-2 or higher-grade cervical lesions. STUDY DESIGN:This was a prospec...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/j.ajog.2011.06.101
更新日期:2011-12-01 00:00:00
abstract::Previous series that described fetuses with choroid plexus cysts have been too small to determine whether there is an association with trisomy 18 sufficiently high to warrant amniocentesis. To address this issue, we studied the incidence of choroid plexus cysts and other ultrasonographic abnormalities in 26 consecutiv...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)91304-u
更新日期:1990-04-01 00:00:00
abstract::The aim of this paper was to study the influence of prostaglandins compounds on the pregnant human uterus in situ. Recordings of uterine motility were made on 14 pregnant women by measuring the amniotic pressure. PGE1 alpha and PGF2 alpha were administered intravenously as single injections. It was found that PGF2 ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(70)90042-6
更新日期:1970-02-15 00:00:00
abstract::Pulmonary beta-adrenergic receptors, which mediate the actions of endogenous catecholamines, increase before birth, an important step in pulmonary maturation. This increase, which occurs primarily in the alveoli, may be hastened by corticosteroids. However, because the lung is composed of more than 40 cell types, we a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90863-3
更新日期:1990-01-01 00:00:00
abstract::Recombinant human-activated protein C (rhAPC) has been suggested to treat sepsis. We present the case of a 19-year-old pregnant patient at the 18th week of gestation with septic shock syndrome that originated from urinary tract infection and was successfully treated with rhAPC. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.04.046
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to analyze records of uterine electrical activity made from the abdominal surface of pregnant and laboring rats to examine whether similar quantitative information can be extracted as from direct recording from the uterine muscle. STUDY DESIGN:Electrical activity during pregnancy (...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70498-3
更新日期:1998-04-01 00:00:00
abstract::Although generally safe, combined oral contraceptives (COCs) are associated with risks, including an estimated 2-fold increased relative risk of cardiovascular events. For most women taking COCs for contraception, absolute cardiovascular risks are very low, and the overall risks of COCs are outweighed by the risks of ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2012.01.037
更新日期:2013-01-01 00:00:00
abstract::An improved statistical method for assessing the efficacy of intrauterine contraception is presented. This method, called the log-rank method, is based on a daily life table, which yields the best estimates of the cumulative net termination probabilities. It provides a sensitive chi-square test statistic to detect dif...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(77)90632-9
更新日期:1977-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the effectiveness of a human immunodeficiency virus (HIV) rapid testing (RT) program. STUDY DESIGN:From April 13, 2004, to April 13, 2005, pregnant women at 2 high-risk maternity hospitals with no or incomplete HIV testing results (negative tests at <34 weeks, none t...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajog.2007.09.005
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:Our aim was to understand how vaginal eversion after hysterectomy differs from other forms of prolapse. STUDY DESIGN:The role of individual structures involved in vaginal support was studied by pelvic dissection of 61 cadavers. Serial cross sections from 13 additional cadavers were examined. RESULTS:The upp...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(92)91562-o
更新日期:1992-06-01 00:00:00
abstract:BACKGROUND:Precocious cervical ripening, as defined by cervical shortening on transvaginal sonography, has prompted a broad evaluation of secondary strategies (such as cerclage, vaginal progesterone, or a cervical pessary) to prevent preterm delivery. However, there is still a lack of direct comparisons between individ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2015.12.007
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine the efficacy of combination intravaginal misoprostol and intracervical Foley catheter for prelabor cervical ripening. STUDY DESIGN:A prospective, randomized controlled trial was conducted. Women who were undergoing labor induction, with a singleton gestation >or=28 ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/s0002-9378(03)00842-1
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Antecedents of chronic pelvic pain are not well characterized, but pelvic organ visceral sensitivity is a hallmark of these disorders. Recent studies have identified that some dysmenorrhea sufferers are much more likely to exhibit comorbid bladder hypersensitivity. Presumably, these otherwise healthy women m...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2019.12.010
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Myofascial pain is characterized by the presence of trigger points, tenderness to palpation, and local or referred pain, and commonly involves the pelvic floor muscles in men and women. Pelvic floor myofascial pain in the absence of local or referred pain has also been observed in patients with lower urinary...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2018.06.014
更新日期:2018-11-01 00:00:00
abstract::The American College of Women's Health Physicians has been exploring an on-line educational tool-concept mapping-to facilitate the development of an interdisciplinary and woman-centered women's health curriculum, and to implement The Women's Health Care Competencies for Medical Students. By using an on-line concept ma...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2002.127360
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVES:Our purpose was to (1) determine the value of amniotic fluid interleukin-6 determination in the detection of microbial invasion of the amniotic cavity and (2) compare interleukin-6 to other rapid tests in the evaluation of preterm labor. STUDY DESIGN:Amniotic fluid interleukin-6 was determined quantitativel...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-9378(94)70057-5
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:We sought to determine the interventions utilized by maternal-fetal medicine specialists in the prediction and prevention of preterm labor in higher-order multiple (HOM) gestations. STUDY DESIGN:Online questionnaires and email surveys were sent to all the maternal-fetal medicine specialists in Canada (n=122)...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2014.12.031
更新日期:2015-05-01 00:00:00
abstract:OBJECTIVES:Our purpose was to determine whether birth weight discordance is a risk factor for preterm birth of twins, and to further characterize the relationships involved. STUDY DESIGN:Maternally linked 1978-1990 Missouri birth certificates were used to analyze gestations resulting in live twins. We used contingency...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.105346
更新日期:2000-07-01 00:00:00