Harvard Catalyst Profiles

Pelvic organ prolapse is a prevalent condition; population based studies estimate that up to 8% of women may report symptoms of prolapse and the lifetime risk of undergoing surgery for pelvic organ prolapse may be as high as 13-19%. Within the United States, over 200,000 surgical procedures for the treatment of prolapse are performed annually. Like any surgical procedure there is an inherent recovery period after surgery. Surgery often induces an acute decline in physical functioning and the postoperative period is often characterized by reduced health-related quality of life. Integral to the decision to undergo surgery is an understanding of the postoperative recovery period. Patients may need to take time off from work, may need to arrange for additional assistance, or make arrangements for their dependents during the recovery period. We know that patients with worse preoperative functional status are more likely to experience postoperative complications and more likely to be readmitted following surgery. For patients undergoing pelvic reconstructive surgery, studies have shown that over 90% of patients either return to baseline or improve in functional status by three months after surgery. While it is reassuring to know that patients will generally recovered from surgery by three months, patients are typically interested in the anticipated recovery during a much shorter timeline. The goal of this study is to understand the normal trajectory of recovery after surgery and to identify risk factors for those who may have delayed resumption of functional activity. Patients complete the The Activity Assessment Scale (AAS) at 2 days, 2 weeks and 6 weeks after surgery. A student is needed to review medical records and collect the postoperative data so that we can begin analysis.

OnabotulinumA (Botox) administered intravescially is an effective treatment for idiopathic overactive bladder and was approved by the Food and Drug Administration for this indication in 2013. While generally well tolerated, in the phase 2 clinical trials as many as 40% of patients developed a urinary tract infection and in the phase 3 clinical trials, 24% developed a urinary tract infection. In clinical practice, the rate of urinary tract infections following intravesical onabotulinum toxin A for idiopathic overactive bladder ranges from 14% to 28%. Given the frequency of infections reported in the early clinical trials, antibiotic prophylaxis is a widely used practice. A number of different antibiotic regiments have been proposed to reduce the risk of a postprocedural UTI. However, the data supporting the use of prophylactic antibiotics is limited. For cystourethroscopy with manipulation or break in mucosal barriers, the American Urologic Association recommends that the provider takes into consideration both the patient risk factors and the invasiveness of the procedure. If antibiotics are decided to be necessary, the AUA recommends the use of trimethoprim-sulfamethoxazole, a first- or second-generation cephalosporins, amoxicillin/clavulanate, or an aminoglycoside ± ampicillin. This recommendation is largely based on data from patients undergoing bladder or prostate resection which is a significantly more invasive procedure than intradetrussor onabotulinum toxin A injections. The American College of Obstetrics and Gynecology doesn't provide any specific guidance on the use of prophylactic antibiotics before intradetrussor Onabotulinum toxin A injections. In our clinical practice we had traditionally administered a single dose of preprocedural nitrofurantoin 100mg which patients took approximately ten to thirty minutes before beginning the procedure. Given the low rates of urinary tract infections we observed in our clinical practice, as well as the rising rates of antibiotic resistance, in July 2020, we decided to stop the routine use of prophylactic antibiotics. This is a retrospective study that will involve analysis of UTI rates before and after implementation of our new protocol. We are looking for a student who will help review medical records to identify UTIs 30 days after OnabotulinumA (Botox) injections. This can be done remotely during free time and there is no specific deadline.