Thank you for the opportunity to present our research today. A growing body of evidence supports that same day discharge after minimally invasive gynecologic and pelvic reconstructive surgery is safe, cost effective, and does not result in increased complications when compared to inpatient surgery. Patient and procedural demographic variables that increase the chance of overnight admission after surgery are well described in the literature. We also know that direct surgeon counseling is important in establishing postoperative discharge goals. However, studies are lacking investigating surgeon's opinions regarding same day discharge, opinions which likely influence discharge practices. The primary objective of this study was to describe gynecologic surgeons' perceptions of same day discharge after minimally invasive hysterectomy and sacrocopalpexy. We also sought to identify potential barriers to same day discharge after these procedures from surgeons' perspectives. This was a cross-sectional survey study. The survey was distributed electronically for a three-week period. We included all English-speaking physician members of AAGL and excluded those who reported they do not perform minimally invasive hysterectomy or sacrocopalpexy. We developed an original survey which was beta tested by 15 gynecologic surgeons in FPMRS, minimally invasive gynecology, GYN oncology, and general OBGYN. Beta testing is used to evaluate the content validity and usability of a survey prior to survey release. Beta testing feedback was incorporated into survey questions until no new feedback was obtained. 296 physician members of AAGL completed our survey. The majority were between the ages of 30 and 49 years old and about half were male. Respondents performed on average eight minimally invasive hysterectomies and one minimally invasive sacrocopalpexy per month. Six percent of respondents were current trainees, 15 percent were zero to five years from completion of training, and the remainder were evenly divided between six to 10 years, 11 to 15 years, and more than 15 years from completion of training. About half of the respondents were non-fellowship trained. Of those with fellowship training, most completed a minimally invasive gynecologic surgery fellowship. They represented a variety of practice settings, most commonly academic institutions, and responses were gathered from 25 countries. Seventy-six percent were from the United States and represented all regions of the United States. Surgeons reported that same-day discharge is feasible and does not increase complications for either hysterectomy or sacrocopalpexy. When sacrocopalpexy is performed alone, all felt that same-day discharge is safe. However, with concomitant hysterectomy, assurance of safety was significantly reduced. Surgeons felt same-day discharge is safe after hysterectomy and sacrocopalpexy regardless of laparoscopic versus robotic approach, and most surgeons felt that same-day discharge improves patient satisfaction. When asked about their actual discharge practices, one in four surgeons reported they never discharged patients the same day after minimally invasive hysterectomy, while about half reported they almost always discharge the same day after minimally invasive hysterectomy. The exact opposite was seen with sacrocopalpexy. Over half of surgeons report they never discharge the same day after sacrocopalpexy, and only one in four reported they almost always discharge patients the same day after sacrocopalpexy. Fellowship training was not associated with the likelihood of reported same-day discharge after hysterectomy or sacrocopalpexy. Surgeons earlier in their careers were more likely to report discharging home the same day following both hysterectomy and sacrocopalpexy, and surgeons in the U.S. and Canada were more likely to report discharging the same day after hysterectomy when compared to the other countries represented. The most commonly reported reasons that surgeons do not discharge patients home the same day include if the procedure was completed late in the day, perception that the patient expects to stay overnight, or if the procedure was complex. Although not given as a survey option, seven surgeons wrote in that urinary retention or failure to pass avoiding trial was a barrier to same-day discharge. In conclusion, most surgeons feel that same-day discharge after minimally invasive hysterectomy and or sacrocopalpexy is both safe and feasible. However, diversity in discharge practices exist, and many still routinely admit patients overnight, especially after sacrocopalpexy. More research is needed to explain these discrepancies between surgeons' perceptions of same-day discharge and their discharge practices. Thank you very much. Thank you for the introduction, and thank you for letting me be here. I have no relevant financial relationships to disclose. So as we know, up to 50% of women experience urinary incontinence. Of those women, the majority have stress urinary incontinence. And the first line recommended therapy for women with stress urinary incontinence is physiotherapy. But of the women that complete a physiotherapy intervention, approximately 50% are actually cured with this. So we wanted to prospectively examine the characteristics of women with stress urinary incontinence who are cured with physiotherapy to see if we could develop a model to predict which women will benefit most from a physiotherapy intervention. To do this, we recruited women who were 18 years or older with stress urinary incontinence from surgical wait lists for midurethral sling, as well as from local physiotherapy clinics. We screened them over the phone, and we mailed them a three-day bladder diary, as well as the ICIQ short form. We then brought them to an in-lab assessment where we did a 30-minute pad test, as well as a manual assessment of their pelvic floor muscle strength and tone, and a transperineal ultrasound imaging assessment of their urogenital morphology. Women were then sent to six sessions of physiotherapy over the course of 12 weeks, at which point they returned to us for follow-up. At the follow-up assessment, we ran the same baseline assessment that they had before, and we defined cure as two grams or less of urine leakage on the pad test at the follow-up. So we did, and with this cure definition, we had 38 women who were deemed cured, giving us about a 49% cure rate. Now, we did collect a lot of outcomes, including demographic factors like age and parity, clinical ones like pelvic floor muscle strength and tone, and SUI severity, and morphological features looking at pelvic organ support, urethral mobility, and morphology, as well as pelvic floor muscle function. To figure out which predictors held the most predictive power, we ran a priori tests comparing the women who were cured versus the women who were not cured. And we kept the strongest predictors for our model and removed the others, as well as any that violated assumptions for logistic regression. So we were left with four predictors for our logistic regression model, which were bladder neck position during quiet standing, as well as during a cough, also in standing. As well, ICIQ short-form scores were kept, and pelvic floor muscle tone. With model revisions, we found that bladder neck position during a cough and pelvic floor muscle tone were not really contributing significantly to this model, so we removed them, and that left us with our two final factors. So our remaining predictors were bladder neck position in quiet standing, as well as the ICIQ short-form scores. Now, this model performed well, accurately classifying 74% of women as cured or not. Our odds ratios indicate that women who have lower scores on the ICIQ short-form displayed a lower SUI severity level, and were more likely to benefit from a physiotherapy intervention. Our other predictor, the bladder neck position in quiet standing, indicated that women with a more cranial position of their bladder neck on ultrasound were also more likely to benefit from physiotherapy. Now, we assessed the model with an ROC curve, which indicated that the model significantly predicted the desired outcomes, using the equation shown here, in which you can input the raw values from the predictors. And this will give you your desired outcome with 70% sensitivity and 75% specificity. We also looked at the performance of each individual predictor, which indicated that the model is driven mostly by the bladder neck position. Here, we have also indicated conservatively estimated cutoff scores for each predictor, such that bladder neck position should be about 14.3 millimeters or more above the levator plate line on ultrasound measure to benefit from physiotherapy, and ICIQ short-form score should be 10.5 or less to benefit from a physical therapy intervention for these women. In summary, our model was significant with the ICIQ short-form scores and bladder neck position in quiet standing. Past research has indicated that women with mild to moderate SUI benefit more from a physiotherapy intervention, which is also supported by our results. The severity of symptoms may reflect defects or the extent of these defects, such as tissue damage, nerve damage, and or reduced vascularization of your genital tissues, which physiotherapy can really only compensate for to a certain degree. Now, this is further reflected in our ultrasound measure of bladder neck position, which gives us a measure of pelvic organ support. This measure is really easy to perform, requires very little training, and ultrasound machines are readily available. However, this model does still have room for unknown variables that would further improve it and make it more robust. So identifying the factors that predict the success of physiotherapy interventions for women with SUI may help to streamline treatment, reducing costs to individuals, private insurers, and healthcare systems, while also improving the patient experience. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. At the University of Michigan, the Michigan Healthy Healing After Delivery Clinic, or the MHAT Clinic, was established in July of 2007 as a subspecialty referral center staffed by urogynecologists providing care to women who've had complex vaginal deliveries, or those who've suffered from complications following their delivery, such as urinary bowel dysfunction or dyspareunia. We've previously examined the first four years of this clinic, and with this study, our aim was to determine the prevalence and type of operative interventions that patients who have been referred to this center subsequently underwent. In regards to our methods, all new patient encounters from 2007 to 2018 were captured. From those, we determined all of the OR encounters that subsequently resulted from that initial visit within one year. Those women who had OR encounters, we reviewed their charts to abstract patient-specific data, including their medical history, obstetric data, demographic information, in addition to the indication for that initial visit and that surgical procedure they underwent. Descriptive analyses were performed to describe this cohort. Next, I'll show our results, which demonstrated a total of 1,138 new patients during this study period. Of those, 103, or 9.1% of all new patients, subsequently underwent an operative intervention following that initial visit. The remainder of this presentation will focus on this 103 women who were taken back to the operating room. Basic demographic and obstetric data of this 103 women demonstrated an average BMI of 28, average age of 30, 83% were Caucasian, 53 were primiparous, and 64 had sustained an obstetric anal sphincter injury. Of those 66 women, a little more than half of them, a little more than 50% of them actually had a fourth degree laceration during their delivery. Almost half, or 47.6% of those women who were taken back to the operating room were referred from an outside institution. This slide demonstrates all the information regarding that initial visit. To start off, it was about nine weeks from their delivery date to that initial MHAD clinic visit. This graph reveals all of the indications for that initial visit, most common being for a complex perineal laceration at 38.8%, followed by anal incontinence at 26.2%, and pelvic pain dyspnea at 17.5%. This graph reveals all of the surgical procedures that these patients underwent. The most common surgical procedure was a sphincteroplasty at 37.9%. Of note, 61.5% of those who underwent a sphincteroplasty had a fourth degree laceration. 33% had a perineal laceration revision, and 19.4% rectovaginal fistula repair or fistulotomy. It took about five and a half months from their delivery date to that OR encounter date. Documentation of conservative management being offered and or provided prior to surgical intervention was noted upon chart review for 43.7% of patients, and conservative management options included pelvic floor physical therapy, medication use, and pestery use. In conclusion, we determined from this subspecialty clinic that approximately 9% of all new patient encounters resulted in an operative intervention. The most common procedure was the anal sphincteroplasty at approximately 38%, which reinforces the need for urogynecologists to have training in diagnosing and surgically managing subacute anal sphincter lacerations. Thank you. Our next presentation by Dr. Willis-Gray, a prospective single-blinded randomized control trial on reducing pain in opioids, post-operative, sorry, actually it's risk of prolonged opioid use after surgery for stress incontinence, and pelvic organ prolapse. Thank you for allowing us to present our work. Thank you for allowing us to present our work. Here are our disclosures. There is an opioid crisis in the United States, with overdose deaths involving prescription opioids increasing five-fold from 1999 to 2017. One contributing factor is chronic opioid use after surgery. A strategy to address this crisis is to improve A strategy to address this crisis is to improve opioid prescribing habits. Few studies have evaluated the amount of opioids prescribed after stress incontinence surgery, as well as prolapse surgery. However, population-based data regarding perioperative and long-term opioid use after these surgeries are limited. Therefore, our primary objective was to evaluate the proportion of women filling perioperative opioid prescriptions, and the number of opioids prescribed perioperatively. Our secondary objective was to assess the risk of prolonged opioid use through one year after surgery. We used the MarketScan database, which includes privately insured employees, their spouses, and dependents from 2005 to 2015. MarketScan includes both inpatient and outpatient claims, as well as pharmacy claims, which allows us to evaluate opioid prescriptions. These de-identified data have been found to be both valid and reliable. We included women 18 years and older who underwent stress incontinence and or prolapse surgeries based on CPT codes. Now, it's important to remember that we are looking at opioid-naive women only, meaning non-chronic opioid users. We defined opioid-naive as having no opioid prescription filled one to six months prior to surgery. We allowed for one prescription within one month of surgery because we recognize that some patients may receive an opioid prescription at the time of their preoperative appointment. Among these opioid-naive women, we evaluated the proportion who had an opioid fill one month prior to one week after surgery, and the number of opioid tablets prescribed. As I mentioned previously, our secondary outcome is prolonged opioid use. And for that, we used two definitions. The first definition was any prescription filled three to six months after surgery. We included this definition as it has been used in prior opioid use studies. But we feel that this may not accurately capture people at risk of persistent opioid use after surgery. For example, if a postoperative patient suffers an injury unrelated to their surgery and has an opioid prescription filled during this time period, that opioid fill would count as prolonged use, although it was unrelated to their surgery. Thus, we used the second definition of continuous use, defined as ongoing monthly prescriptions through one year after surgery. And now for our results. From 2005 to 2015, over 190,000 opioid-naive women underwent stress incontinence and prolapse surgery. 59% underwent both types of surgery, while 41% had stress incontinence surgery only. For our primary outcome, 79% of women filled a perioperative opioid prescription, while 21% did not. A median quantity of 30 tablets were prescribed with an interquartile range of 20 to 30. Now for our secondary outcomes of prolonged opioid use. Using our first definition, 7.5% of women had an opioid fill between three to six months after surgery. However, looking at our second and more strict definition of continuous monthly fills, this rate dropped significantly from 1.2% at two months down to 0.03% at 12 months. Strengths of this study included being population-based with a large cohort. We assessed opioid-naive women and used two definitions of prolonged opioid use. Limitations include that our results reflect privately insured women only, and that we cannot determine an exact indication for opioid prescription fill. In conclusion, among opioid-naive women undergoing stress incontinence and prolapse surgery, 79% filled an opioid prescription. Prolonged opioid use varies widely based on definition, as you can see here comparing the rates at six months. We feel that continuous monthly fills may be a more accurate reflection of prolonged opioid use, and based on the results of our study, this rate is extremely low through one year after surgery. Thank you. My topic is a urodynamic parameter to predict stress-related incontinence after laparoscopic psychoglompexy. No disclosure. The introduction of POP frequently coexists with stress-related incontinence, and preoperatively as well as postoperatively. But it remains unclear whether postoperative SUI can be predicted preoperatively. The objective of the study is to examine the urodynamic predictor of the SUI after LSD, and we retrospectively analyzed 75 POP patients who had USD preoperatively and postoperatively. And USD included CMZ and UPP. Okay, our surgical technique is basically the normal LSD, and we dissect all the way down to the bladder neck, quite deep, and then posteriorly also we dissect to the perineal body. And our anterior mesh and posterior mesh connect to the cervix, and then prolonged fixation. Okay, this slide is showing, this is a retrospective study, and demographic of the patients. And age is 67, and BMI is 24, which is quite normal in Japanese lady. And stage three is dominant, and preoperatively in urinary incontinence is 42 patients, 42% show that stress urinary incontinence. Okay, this slide is the SUI condition and pre- and postoperatively. Okay, this is SUI minus to minus is 40%, and then minus preoperatively and plus. This is de novo SUI is 70%, and plus to minus, which is improved group is 12%, and then plus to plus is 30%. And then we compare this postoperative SUI group and preoperative SUI group, 39 in the minus group and 36 in the plus group. And this is a eurodynamic finding, a comparison of a eurodynamic finding in each group. And then basically only significant difference is MUCP. So SUI plus group has a significantly low MUCP, and then we create a cutoff in the less than 40, and then the number of the, oh sorry, number of the, number is significantly more compared to SUI minus group. The conclusion is preoperative MUCP can be considered to be a most reliable eurodynamic predictor for postoperative SUI. The limitation of this study is a relatively small number and short follow-up. And this result may help to suggest counseling such a patient for concomitant incontinence surgery. Thank you for your attention. Thank you. Thank you very much. Thank you. Thank you very much. I'm Ms. Serene McKee, I'm from the University of Minnesota. Thank you so much for having me. Today I'll be talking about a novel investigational device called the Pelvital Flight System, and its outcomes stratified based on severity of urinary leakage. I have no relevant financial relationships. The Pelvital Flight System is a two-part mechanotherapy pelvic floor muscle preconditioning where a probe is placed in the vaginal area and we get stretch of the muscles, preloading of the sarcomeres. And then the second part is the probe as well as mechanical transduction pulses that further enhance the neuromuscular function. This is thought to augment muscle anatomy, physiology, and neurotrophic signaling. Our population consists of 120 women at three different sites. They ranged in age between 18 and 75 years. They had to have only stressed urinary incontinence, so we exclude anyone with urge. If they did have pelvic organ prolapse, it was stage two or less, and they had to have at least 10 grams of leakage. And then of course the ability to contract their pelvic floor muscles. The objective of the study was to demonstrate that this device, along with pelvic floor muscle training, was helped to improve urinary incontinence, whether with or without the pulses. So we performed a randomized, controlled, double-blinded crossover study where the first arm with the probe alone then was used as the control group. And at six weeks, those subjects were then crossed over to the transduction part two. And the study at this time remains blinded, so this is interim data. So the patients did the exercises for five minutes a day for a total of 12 weeks, and then we obtained a 24-hour pad test, asked about incontinence episodes, and looked at several different questionnaires. We had 82 subjects. This was a cohort of pooled data because, again, the data still remains blinded. We did, interestingly enough, have 20% who did not respond, but this data is still included in the results. Overall, though, we saw a significant decrease in mean and median pad weight at six and 12 weeks, with 59% relative improvement at 68 weeks and 68% at 12. And interestingly, women with all levels of severity improved, and I'll show you that data in a minute. There was also significant subjective decrease in leakage episodes over the 30 days, the ICALL question number seven, which says, I am frustrated because my incontinence is limiting my daily activities, improved significantly over time. And in fact, quality of life data across multiple questionnaires improved, and was improved by 18% at six weeks and 56% at 12 weeks. So here's the severity data. And mild, moderate, and severe severity of incontinence was defined as being less than 20 grams of leakage in mild, 20 to 70 grams in moderate, and over 70 grams in severe. And you can see that the blue bars are baseline, the orange bars are at six weeks, and the gray bars are at 12 weeks, and you see an incremental decrease in each. The severe may not be so prominent, but you can see at least it was sustained. And that translates to a 25% improvement at six weeks in the mild, a 47% at 12 weeks. In the moderate, you saw a 59% improvement at six weeks and 74 at 12 weeks, and in severe, it was about 70%, which is quite significant for patients. So finally, this flight McHenna therapy improved 24-hour pad weight in subjects with all severity levels. The number of leakage episodes and quality of life improved, and it was sustained over the entire 12 weeks. So although the difference in which one is more prominent that the other plays a bigger role is yet to be determined, the combination of the two certainly offers an effective and non-invasive treatment option for women with stress urinary incontinence, regardless of the baseline severity. Thank you. Thank you very much to the speaker. The floor is open now for five minutes of question. Beth Shelley, physical therapist. This is about the novel device. I'm thinking that this sounds like a vibrator. I guess I'm not really exactly sure what McHenna oscillation is, and if it is, at what frequency are you vibrating? Yeah, we're there at 30 hertz. And we don't know exactly the mechanism of action, but it's thought to be that that's kind of activating and recruiting more of the neuromuscular function of the pelvic floor muscles, in addition to the initial kind of preloading that just having the probe end up. And are you planning to do comparison to just pelvic muscle exercise alone? Yeah, that's a great question. When we were trying to decide the design of the study, we intentionally decided not to do that because there's a plethora of RCTs out there for pelvic floor muscle therapy alone. But we will be, and some of this has already been done, be doing a post-hoc analysis comparing the mean results of those studies with our mean results. Thank you, next question. Yeah, so I actually have two questions. To Dr. Nomura, why did you pick the MUCP at less than 40? And then to Dr. Naqib, for the, I'm not sure, I'm sorry if I missed this with the methodology, but what was the pelvic floor muscle training regimen? And then also, how did you ensure compliance for the five minutes every day with the device? Okay, first of all, good question. Actually, a previous study, actually, I performed the aerodynamic study and then at the time saw the, this is like, we checked the MUCP, and then so the, one of the reliable cutoff value was 40, and that's why this kind of study, we use 40. But not specific reason. Okay, thank you. To answer your question, we had nurses train patients on, first of all, they were examined to make sure that they could do a pelvic floor contraction, and then we had nurses train them on contracting their pelvic floor muscles around the device, and they had to make some lights light up on the device that was dependent on the angle. And all that data as to whether they were doing it or not is recorded by the device that we have at that time. Thank you. And then how long was the physical therapy session? Sorry. What'd you mean? The pelvic floor muscle therapy. So there was no physical therapy. Okay. Okay, I understand. Thank you. Next question, Shinta? Oh, sorry. Yes, Shanta Zumule from Montreal. The question is for Ms. Brooke from Ottawa. Thank you for a very nice presentation. I wonder, because of what we heard this morning about patient-reported outcomes, why did you choose PAD test as your outcome? That's a good question. There are so many different ways to define cure. Eventually you have to decide on one. PAD test is really easy to use clinically, so if this model is going to continue to grow and have more drafts and then be handed to a clinician, PAD test is really accessible, rather than trying to get someone to fill out a three-day bladder diary and have that all returned. Sometimes that's more difficult. The ICIQ also showed the same trend, but we ended up picking PAD test just because it was clinically accessible and it was very standardized and easy to use. Is there any reason why you use a 30-minute PAD test instead of the most standardized one-hour PAD test? There are lots of pros and cons for picking certain PAD tests over others. The protocol that these women were doing was pretty long anyway, so we didn't want to add more time to the time that they had to take out of their day to be with us in the lab. So 30-minute PAD test got us that snapshot that we wanted without really putting too much stress on the women coming in. Okay, thank you very much. Post-operative pain evaluation using positive suggestion. Good afternoon. My name is Rika Azuma. I'm a fourth-year medical student, and I'd like to thank the Society for inviting us to talk about our study using the positive suggestion to improve pain in the post-operative period. So these are our disclosures. So positive suggestion is using communication, kind of all the different ways that we can communicate, both verbally and non-verbally, to convey to our patients that they will have positive outcomes. And medical treatment itself is often suggestive, so the question that's very often asked in different medical settings, which is, are you in any pain, can suggest to patients that they will be in pain or they should be in pain. And even though it's not often intended to be negative, it can be taken as negative. Previous studies that have looked at this have seen small to medium effects of positive suggestion on reducing pain. And physiologically, positive suggestion has been shown to activate both the opioid and cannabinoid systems. Other groups have shown that interactions between nurses and patients are perfect examples of where suggestion can happen. But no groups prior to this have actually put an intervention in that time. So positive suggestion itself is very nice as a topic because it's simple and it's non-costly and it's low risk to patients. And as the previous speaker discussed, we have this giant opioid epidemic that if we can use something like this to reduce, that would be very ideal. So this is our flow diagram. So we assessed 47 adults, adults undergoing same-day urogynecological and gynecological surgery. They had to be able to comprehend English and be able to make decisions. And then once we recruited them, we randomized them into either our comfort or control groups, which they were blinded to. So for our protocol, so our comfort protocol used the word comfort instead of pain. So our nurses in the post-anesthesia unit would ask patients, you know, are you in any discomfort or how comfortable are you feeling? And then when they were asked to rate their pain, instead of being on a 1 to 10 scale with pain being the word, 10 would be greatest discomfort. So our primary outcome was the analgesia administered during that time, so that was non-opioid and opioid. Our secondary outcome was the VAS pain scores over time. And our hypothesis was that these three things would be reduced in our comfort protocol patients. For baseline characteristics, there was no significant difference between the two groups, whether that was for age, race, prior abdominal surgery, whether the surgeries they were undergoing at the time were major or minor, and then any measures that we looked at for depression, anxiety, or catastrophizing. These are the procedures that we included. And then for our results, so for opioids we did not see a significant reduction, however, we did see a trend that it was reduced in our comfort protocol group. For non-opioids, however, we saw a statistically significant reduction, P less than 0.5. And for our VAS pain perception scores, we didn't see a significant difference. So the limitations of our study, it was a small sample size, just kind of by the nature of the protocol, it was only able to be single-blinded, and we weren't set up to be able to do protocol monitoring. But sort of in the bigger picture, the Enhanced Recovery After Surgery, or ERAS Society, supports minimizing use of opioids, and they also recognize the psychosocial effects of well-being and pain on surgical outcomes. So we believe that our study is a great way of showing how these concepts can be put into practice, and also is novel, because no other studies have looked at the immediate post-operative period. Here's our references, and thank you for your attention. Applause We'll now open up for questions. Ibuversi, New Jersey. My question is to the Chapel Hill group. I wonder if you underestimated the prevalence of chronic use, because most doctors are going to be very reluctant to prescribe in the longer term, and if someone is addicted, it's quite, well, illicit opiate access is actually cheaper than prescription medicine. Have you got any insight into that? No, not necessarily, but I think, you know, based on our definition, I think it shows how the risk of prolonged use is actually much lower than if you just use that one time at three to six months. No, I don't agree with you. I'm sorry, you don't know that. That's the problem. If you go from the medical to the non-medical access, it could be a different story, and I think that's one of the problems that we have in the United States at the moment. Thank you for your time.

same-day discharge

physiotherapy intervention

bladder neck position

operative interventions

perioperative opioid prescriptions

Pelvital Flight System

positive suggestion