Objective: To evaluate the referral pattern to a tertiary care center for vaginal mesh complicati... more Objective: To evaluate the referral pattern to a tertiary care center for vaginal mesh complications following surgeries for pelvic organ support defect. Methods: This was a retrospective review of women presenting to our clinic for complications of vaginal mesh. Results: One hundred thirty three patients were included in the study. The median age was 58.4 years, median parity was two, and 95.4% were Caucasian. The pattern of referral was as follows: 10% continued care at the tertiary center where mesh or graft was initially inserted, 18% were referred by the surgeon who initially implanted the mesh or graft, 71% were referred from an outside secondary health care provider, and 1% was self referred. Conclusion: The majority of patients presenting to our clinic with mesh vaginal mesh complications were referred by someone other than the implanting surgeon.
Objective: To assess practice preferences in the repair of severe obstetric lacerations among obs... more Objective: To assess practice preferences in the repair of severe obstetric lacerations among obstetrician/gynecologists in the United States. Study design: A survey detailing third and fourth degree laceration repair techniques was distributed to 634 obstetrician/gynecologists from demographically diverse areas of the United States. Categorical outcomes were compared among respondents using chi2 or Fisher's exact test where appropriate. Results: Of the 266 respondents, there were 124 self-reported "experts" (47%) and 106 physicians-in-training (40%). Repair techniques were compared between experts versus nonexperts and trainees versus practicing physicians. There were no significant differences found between either comparison group on the type and size of suture utilized or preferred method of closure for repair. Conclusion: There is little variation in the practice pattern of complex laceration repairs among obstetrician-gynecologists in the United States. This commonality should encourage the design of standard teaching models and techniques for physicians in training.
Patients with anorectal dysfunction are common and can be quite challenging to diagnose. The comm... more Patients with anorectal dysfunction are common and can be quite challenging to diagnose. The common underlying causes for such conditions are usually anatomical in nature, which may be difficult to fully evaluate by clinical examination alone. The aim of this video was to demonstrate how multicompartmental ultrasound imaging can be utilized clinically in the evaluation of patients with anorectal dysfunction. Pertinent ultrasound findings of the common anatomical causes of defecatory dysfunction were discussed in this video. Different ultrasound techniques were shown. In conclusion, multicompartmental ultrasound imaging is an easy, cost-efficient, and valuable tool in the evaluation of patients with anorectal dysfunction.
We present a novel technique for visualization of a urethrovaginal fistula. A 52-year-old patient... more We present a novel technique for visualization of a urethrovaginal fistula. A 52-year-old patient presented with persistent urinary incontinence, after having three midurethral sling procedures performed within the past year. The diagnosis of a urethrovaginal fistula was made by endovaginal 3-D endovaginal ultrasound and confirmed intraoperatively. We have described a novel technique that may benefit patients with urethrovaginal fistulas that are difficult to visualize.
Objectives: The pelvic floor muscle examination is an important skill for clinicians who practice... more Objectives: The pelvic floor muscle examination is an important skill for clinicians who practice in the field of pelvic floor dysfunction. Teaching students to perform an accurate examination of the pelvic floor musculature poses a challenge for many institutions. The benefit of using standardized patients to train medical students to perform accurate pelvic examinations is well supported in the literature. The purpose of this pilot study is to evaluate the feasibility of the use of standardized patients to instruct physical therapy students in a pelvic floor muscle examination and to measure the impact of the instruction on student's confidence in performing components of the examination. Methods: Six female physical therapy students completed a questionnaire before and after participation in a 2-hour didactic session followed by an examination on a standardized patient. Paired t tests and the Wilcoxon sign rank tests were conducted to compare mean differences between students' pre-and post-seminar questionnaire scores. Results: Mean pre-and post-seminar scores documented improvement in familiarity with the pelvic floor muscle examination (P ؍ 0.0019), confidence in identifying external genitalia (P ؍ 0.0172), identifying the puborectalis muscle (P ؍ 0.0313), ability to grade a levator ani muscle contraction (P ؍ 0.0313), and ability to perform a pelvic floor muscle examination (P ؍ 0. 0313). Conclusions: The use of standardized patients is a feasible method of instruction in pelvic floor muscle examination and provides an opportunity for physical therapy students to improve their confidence in examination performance. Future research should investigate the use of standardized patient models in medical and nursing student populations.
Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost... more Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost poses a barrier to medication compliance. The purpose of our study is to report patient cost savings by utilizing compounding pharmacies in the preparation of topical vaginal estrogen. Methods: A survey of 10 topical vaginal estrogen compounding pharmacies was performed and prescription cost data was obtained. The University of Oklahoma Outpatient Pharmacy and the 2008 Wolters Kluwer Health Pharmaceutical Audit Suite were cost comparisons for compounded estrogen. All data was processed using statistical software yielding descriptive statistics. Results: The average cost of compounded estrogen was $42.22. At the University of Oklahoma Outpatient Pharmacy, average cost for branded vaginal estrogen preparation was $137.70. The national cost average for branded vaginal estrogen preparations was $82.42. Cost savings of $94.98 (69%) locally and $40.20 (51%) nationally was identified. Conclusions: Compounded estrogen is a cost conscious alternative than branded preparations.
Objective: To evaluate medical students in the United States at several medical schools regarding... more Objective: To evaluate medical students in the United States at several medical schools regarding their knowledge of the global health burden of obstetric fistulas. Study design: A cross-sectional survey was conducted in 8 schools across the United States over a period of 6 months. The survey was composed of 18 questions on epidemiology, pathology, and treatment of fistulas. It was a web-based module accessed through an emailed link. It was sent to 5,103 medical students' email addresses at the 8 institutions once a week for 4 weeks. SPSS paired student t tests was used for statistical analysis. Results: Of the 1,089 students from 8 medical schools that initially began the survey, 965 completed this voluntary and anonymous survey, with a 21% response rate and 19% completion rate. Overall the students averaged 11/18 (60.7%) correct on this survey. The knowledge of obstetric fistula improved, but not significantly, with increasing level of medical school education, with first-year medical students achieving 10/18 (55%) correct and senior medical students achieving 12/18 (67%) correct (p = 0.1). Conclusion: U.S. medical students' knowledge of obstetric fistulas in developing countries does not increase significantly over 4 years of medical school education. While this condition presents largely in the developing world, given rapid globalization as well as increased international health experiences for U.S.-trained health professionals,further effort should be placed in improving medical student knowledge of this devastating condition.
Journal of Pelvic Medicine and Surgery, Nov 1, 2006
Background: Squamous papilloma of a prolapsed vagina has not been reported. Case: A 72-year-old w... more Background: Squamous papilloma of a prolapsed vagina has not been reported. Case: A 72-year-old woman who presented with a POPQ stage IV posthysterectomy prolapse containing squamous papilloma. The patient's defect and the covering lesion were both managed by a colpocleisis. Conclusion: An everted vagina with squamous papilloma was safely managed by colpocleisis.
Objective: To evaluate the referral pattern to a tertiary care center for vaginal mesh complicati... more Objective: To evaluate the referral pattern to a tertiary care center for vaginal mesh complications following surgeries for pelvic organ support defect. Methods: This was a retrospective review of women presenting to our clinic for complications of vaginal mesh. Results: One hundred thirty three patients were included in the study. The median age was 58.4 years, median parity was two, and 95.4% were Caucasian. The pattern of referral was as follows: 10% continued care at the tertiary center where mesh or graft was initially inserted, 18% were referred by the surgeon who initially implanted the mesh or graft, 71% were referred from an outside secondary health care provider, and 1% was self referred. Conclusion: The majority of patients presenting to our clinic with mesh vaginal mesh complications were referred by someone other than the implanting surgeon.
Objective: To assess practice preferences in the repair of severe obstetric lacerations among obs... more Objective: To assess practice preferences in the repair of severe obstetric lacerations among obstetrician/gynecologists in the United States. Study design: A survey detailing third and fourth degree laceration repair techniques was distributed to 634 obstetrician/gynecologists from demographically diverse areas of the United States. Categorical outcomes were compared among respondents using chi2 or Fisher's exact test where appropriate. Results: Of the 266 respondents, there were 124 self-reported "experts" (47%) and 106 physicians-in-training (40%). Repair techniques were compared between experts versus nonexperts and trainees versus practicing physicians. There were no significant differences found between either comparison group on the type and size of suture utilized or preferred method of closure for repair. Conclusion: There is little variation in the practice pattern of complex laceration repairs among obstetrician-gynecologists in the United States. This commonality should encourage the design of standard teaching models and techniques for physicians in training.
Patients with anorectal dysfunction are common and can be quite challenging to diagnose. The comm... more Patients with anorectal dysfunction are common and can be quite challenging to diagnose. The common underlying causes for such conditions are usually anatomical in nature, which may be difficult to fully evaluate by clinical examination alone. The aim of this video was to demonstrate how multicompartmental ultrasound imaging can be utilized clinically in the evaluation of patients with anorectal dysfunction. Pertinent ultrasound findings of the common anatomical causes of defecatory dysfunction were discussed in this video. Different ultrasound techniques were shown. In conclusion, multicompartmental ultrasound imaging is an easy, cost-efficient, and valuable tool in the evaluation of patients with anorectal dysfunction.
We present a novel technique for visualization of a urethrovaginal fistula. A 52-year-old patient... more We present a novel technique for visualization of a urethrovaginal fistula. A 52-year-old patient presented with persistent urinary incontinence, after having three midurethral sling procedures performed within the past year. The diagnosis of a urethrovaginal fistula was made by endovaginal 3-D endovaginal ultrasound and confirmed intraoperatively. We have described a novel technique that may benefit patients with urethrovaginal fistulas that are difficult to visualize.
Objectives: The pelvic floor muscle examination is an important skill for clinicians who practice... more Objectives: The pelvic floor muscle examination is an important skill for clinicians who practice in the field of pelvic floor dysfunction. Teaching students to perform an accurate examination of the pelvic floor musculature poses a challenge for many institutions. The benefit of using standardized patients to train medical students to perform accurate pelvic examinations is well supported in the literature. The purpose of this pilot study is to evaluate the feasibility of the use of standardized patients to instruct physical therapy students in a pelvic floor muscle examination and to measure the impact of the instruction on student's confidence in performing components of the examination. Methods: Six female physical therapy students completed a questionnaire before and after participation in a 2-hour didactic session followed by an examination on a standardized patient. Paired t tests and the Wilcoxon sign rank tests were conducted to compare mean differences between students' pre-and post-seminar questionnaire scores. Results: Mean pre-and post-seminar scores documented improvement in familiarity with the pelvic floor muscle examination (P ؍ 0.0019), confidence in identifying external genitalia (P ؍ 0.0172), identifying the puborectalis muscle (P ؍ 0.0313), ability to grade a levator ani muscle contraction (P ؍ 0.0313), and ability to perform a pelvic floor muscle examination (P ؍ 0. 0313). Conclusions: The use of standardized patients is a feasible method of instruction in pelvic floor muscle examination and provides an opportunity for physical therapy students to improve their confidence in examination performance. Future research should investigate the use of standardized patient models in medical and nursing student populations.
Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost... more Background: Vaginal estrogen is a common therapy for many gynecologic conditions. Medication cost poses a barrier to medication compliance. The purpose of our study is to report patient cost savings by utilizing compounding pharmacies in the preparation of topical vaginal estrogen. Methods: A survey of 10 topical vaginal estrogen compounding pharmacies was performed and prescription cost data was obtained. The University of Oklahoma Outpatient Pharmacy and the 2008 Wolters Kluwer Health Pharmaceutical Audit Suite were cost comparisons for compounded estrogen. All data was processed using statistical software yielding descriptive statistics. Results: The average cost of compounded estrogen was $42.22. At the University of Oklahoma Outpatient Pharmacy, average cost for branded vaginal estrogen preparation was $137.70. The national cost average for branded vaginal estrogen preparations was $82.42. Cost savings of $94.98 (69%) locally and $40.20 (51%) nationally was identified. Conclusions: Compounded estrogen is a cost conscious alternative than branded preparations.
Objective: To evaluate medical students in the United States at several medical schools regarding... more Objective: To evaluate medical students in the United States at several medical schools regarding their knowledge of the global health burden of obstetric fistulas. Study design: A cross-sectional survey was conducted in 8 schools across the United States over a period of 6 months. The survey was composed of 18 questions on epidemiology, pathology, and treatment of fistulas. It was a web-based module accessed through an emailed link. It was sent to 5,103 medical students' email addresses at the 8 institutions once a week for 4 weeks. SPSS paired student t tests was used for statistical analysis. Results: Of the 1,089 students from 8 medical schools that initially began the survey, 965 completed this voluntary and anonymous survey, with a 21% response rate and 19% completion rate. Overall the students averaged 11/18 (60.7%) correct on this survey. The knowledge of obstetric fistula improved, but not significantly, with increasing level of medical school education, with first-year medical students achieving 10/18 (55%) correct and senior medical students achieving 12/18 (67%) correct (p = 0.1). Conclusion: U.S. medical students' knowledge of obstetric fistulas in developing countries does not increase significantly over 4 years of medical school education. While this condition presents largely in the developing world, given rapid globalization as well as increased international health experiences for U.S.-trained health professionals,further effort should be placed in improving medical student knowledge of this devastating condition.
Journal of Pelvic Medicine and Surgery, Nov 1, 2006
Background: Squamous papilloma of a prolapsed vagina has not been reported. Case: A 72-year-old w... more Background: Squamous papilloma of a prolapsed vagina has not been reported. Case: A 72-year-old woman who presented with a POPQ stage IV posthysterectomy prolapse containing squamous papilloma. The patient's defect and the covering lesion were both managed by a colpocleisis. Conclusion: An everted vagina with squamous papilloma was safely managed by colpocleisis.
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Papers by Mikio Nihira