Cathy Flood

Studies in emergency medicine show that patients believe it is important to know the training level of their doctor, but most do not understand the responsibilities of physicians-in-training. No research on this topic has been published in gynecology, even though gynecological surgeons have been sued by patients alleging they did not understand the role of residents in their surgery. The goal of this research was to explore what gynecological surgery patients understand about the role of resident doctors. A questionnaire was distributed to female patients in pre-admission clinics awaiting gynecological surgery in Edmonton. Surveys included knowledge and opinion-based questions about resident duties. Anonymous responses were entered into a REDCap database. Descriptive statistics were used to characterize the results. Of 108 participants, 83% understood that residents had a higher level of training than medical students, yet 40% were unsure if residents were doctors. Almost half (43%) were uncertain if residents required supervision, including while operating (20%). The majority (92%) felt it was important to know their physician's level of training, yet only 63% reported actually knowing this information. Only half of participants would be comfortable with residents operating on them under supervision. A considerable number (56%) wanted to learn more about residents' roles. Patients do not fully understand the role of residents and many are uncomfortable with trainees operating on them under supervision. Considering the significant role of residents in patient care, educating patients is essential to improve their comfort and the overall consent process.

Suprapubic (SP) catheterisation is commonly used for drainage of the bladder following pelvic surgery. Although it is a widely employed procedure, it is not without complications, such as infection and blockage. The authors report a rare complication of SP catheterisation involving a persistent SP catheter site fistulous tract and an infected haematoma significantly complicating a patient’s postoperative course. Wound debridement, bladder drainage and a prolonged course of antibiotics were employed to successfully treat this complication. The exact mechanism of her complication is only speculative, however to our knowledge no similar cases of a fistula after removal of a SP catheter used for short-term bladder drainage have been reported.

Objective The purpose of this study was to determine the effectiveness of a teaching module using simulation for the tension-free vaginal tape (TVT) procedure on procedural knowledge and skill. Methods Twenty-five gynecology residents participated in a teaching module about the TVT procedure and urinary incontinence, which included a simulated insertion on a training model. Questionnaires using 10-point scales for self-rated competence and knowledge and a written examination were administered before and after the module. A simulated TVT insertion was evaluated at an examination at 7 weeks and at 7 months. Results A significant median improvement of 44% on the written examination and at least one point on each of the self-rated competence and knowledge scales were observed after the teaching module. Residents performed the insertion well at both examinations (89% and 90%), regardless of surgical experience. More than 94% agreed the module was useful and improved their understanding of the procedure. Conclusion A short teaching module and simulation session can effectively teach residents and improve their perceived competence with the TVT procedure.

Genital prolapse is common among ageing women. Urinary obstruction and hydronephrosis have been reported as one of the most severe and fortunately uncommon complications. An 82-year-old multiparous woman with symptomatic pelvic organ prolapse quantification stage 4 genital procidentia fails multiple trials of pessary and abandons the trials due to significant side effects. She chooses to pursue conservative management with estrogen cream and tight underwear. However, she fails to follow up as planned. Two years later, she presents with acute abdomen and renal failure due to renal calyceal rupture and perirenal urinary extravasation from complete procidentia. She is treated promptly with urinary catheter, manual prolapse reduction, and Gellhorn pessary which relieves anuria and stabilizes her condition. She then receives definitive surgical treatment 2 weeks later. Her renal failure and abdominal pain resolve post-operatively.

Venous thromboembolism (VTE) remains a significant cause of postoperative morbidity and mortality. There are few reports on acute symptomatic pulmonary embolism (PE) following urogynaecological surgery. The authors report a case of an adult woman who developed a massive acute PE early on postoperative day 1 following a complex reconstructive surgery. Following anticoagulation treatment and placement of an inferior vena cava filter, the patient recovered and was discharged without discomfort on the ninth postoperative day. While recognition of the early occurrence of VTE is important to ensure optimal patient care following major pelvic surgery, this case highlights the need to reconsider VTE prophylaxis protocols in moderate to high-risk populations undergoing elective surgery.