Papers by Paul Tulikangas
Female Pelvic Medicine & Reconstructive Surgery, 2014
International Urogynecology Journal, Mar 1, 2010
Introduction and hypothesis This study seeks to compare the utility of the beef tongue model vers... more Introduction and hypothesis This study seeks to compare the utility of the beef tongue model versus an instructional video in teaching obstetric and gynecology residents how to repair a fourth-degree laceration. Methods Twenty-seven residents were randomized to participate in a workshop with a beef tongue model or assigned to watch an instructional video on repair of fourth-degree lacerations and read a chapter on the repair. All subjects were tested with a pre-and postintervention written test. These scores were compared with paired t test at 0.05 significance level. Results Residents with no prior experience in fourth-degree laceration repairs showed an improvement in knowledge (49.5% versus 64.1%, p<0.001) on written exams about the repairs. Conclusions An instructional video or beef tongue model and textbook chapter on fourth-degree laceration repair can improve skills in repair of a fourth-degree laceration among residents with no experience in these repairs.
Obstetrics & Gynecology, 2001
International Urogynecology Journal, Mar 31, 2009
Introduction and hypothesis This study aims to compare the post-operative rates of stress urinary... more Introduction and hypothesis This study aims to compare the post-operative rates of stress urinary incontinence (SUI) after abdominal sacral colpopexy (ASC) with either Burch or mid-urethral sling, tension-free vaginal tape (TVT), or no anti-incontinence procedure. The null hypothesis was there would be no difference in SUI among groups. Methods A cohort of women who had undergone ASC (n=150) either alone or with an anti-continence procedure were analyzed to determine the rates of post-operative SUI. Statistically significant differences were evaluated with a Student's t-test. Results A total of 150 subjects were evaluated, with 115 having SUI preoperatively. Post-operatively, 10% (15/150) of all subjects had SUI. Subjects with preoperative SUI who had a Burch were more likely to have post-operative SUI than those who had a TVT (10 versus 0, p=0.007). Conclusions Burch and TVT procedures improve SUI symptoms in patients undergoing ASC. Mid-urethral slings performed with ASC have lower rates of post-operative SUI.
Journal of Pelvic Medicine and Surgery, 2006
International Urogynecology Journal, 2009
The aim of this study was to compare the shortterm estimated hospital costs and charges for open,... more The aim of this study was to compare the shortterm estimated hospital costs and charges for open, laparoscopic, and robot-assisted sacral colpopexy. The null hypothesis was that there would be no difference in costs and charges. Fifteen comparable cases were reviewed for demographics, surgical information, and estimated hospital charges and costs and then compared with analysis of variance. There were no differences in demographics and surgical variables among the three groups. For estimated hospital charges, minimally invasive sacral colpopexy was most expensive; open was the least expensive approach. The estimated direct costs were significantly higher for robot-assisted compared with open sacral colpopexy, but not different between robot-assisted and laparoscopic sacral colpopexy. Robot-assisted sacral colpopexy produces the highest estimated hospital charges and is more expensive than open sacral colpopexy. The least expensive surgical approach from the hospital costs perspective is open abdominal sacral colpopexy.
Neurourology and Urodynamics, Sep 1, 2008
Aims: The relationship of detrusor overactivity (DO) to neuromuscular causes is well established,... more Aims: The relationship of detrusor overactivity (DO) to neuromuscular causes is well established, but a connection to kidney function has not yet been studied. We sought to evaluate whether patients with DO have differences in estimated glomerular filtration rate (eGFR). Methods: After Institutional Review Board approval, we collected data from all patients who underwent urodynamic testing in our office from September 1, 2006 to February 28, 2007 and calculated eGFR using the equation derived from the Modification of Diet in Renal Disease (MDRD) study. Results: Data were collected on 359 patients, who had a mean eGFR for all patients of 82.99 ml/min/1.73 m 2 (AE22.2). The patients were divided into groups by the presence or absence of DO on filling cystometry. There was no significant difference in eGFR between the patients with and without DO (80.9 ml/min/1.73 m 2 vs. 84.4, P ¼ 0.290). Conclusions: Kidney function does not differ between patients with or without DO.
Journal of Pelvic Medicine and Surgery, 2006
Journal of Pelvic Medicine and Surgery, 2006
Journal of Pelvic Medicine and Surgery, 2006
Journal of Pelvic Medicine and Surgery, 2005
Journal of Pelvic Medicine and Surgery, 2005
Journal of Pelvic Medicine and Surgery, 2005
Journal of Pelvic Medicine and Surgery, 2005
Female Pelvic Medicine & Reconstructive Surgery, 2010
ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.
Female Pelvic Medicine & Reconstructive Surgery, 2010
ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.
Journal of Minimally Invasive Gynecology, 2015
To examine the rate of abstract publication from the Society of Gynecologic Surgeons Annual Scien... more To examine the rate of abstract publication from the Society of Gynecologic Surgeons Annual Scientific Meeting (SGSASM), 2004-2012. This is a retrospective study in which all abstracts presented at the SGSASM from 2004-2012 were reviewed. Information was collected on oral (O), oral poster (OP), and poster (P) presentations. To evaluate for publication, all abstracts were searched for in the US National Library of Medicine&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s PubMed database. Chi square tests were used to evaluate whether there were differences in distribution of published studies by first author location and affiliation, and number of abstract authors. Classification: III SETTING: N/A PATIENTS: N/A INTERVENTIONS: N/A MEASUREMENTS AND MAIN RESULTS: 867 abstracts were reviewed; this included all oral, oral poster, and poster presentations. Video and tips and tricks presentations were excluded. Overall rate of publication for all abstracts from 2004-2012 is 55.7%, comprising 82.4% for oral presentations 60.9% for oral poster presentations, and 41.4% for poster presentations. Regarding published abstracts, there was no significant difference in location (p=0.878), although published abstracts had a significantly greater number of authors (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Abstracts presented by authors from university programs were more likely to be published (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). For all presentation types, the mean number of citations for published abstracts was different for the 9-year period (O, OP, P: p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), with an overall decline towards the end of the assessment period. Over a 9-year period 2004-2012, the rate of abstract publication at the SGSASM is 55.7%, which is similar to other academic meetings. The comparability of this publication rate shows that the abstract selection committee is able to select high-quality research with limited information provided in abstract submissions.
Female pelvic medicine & reconstructive surgery, 2011
Permanent suture material and synthetic grafts can be used as part of pelvic organ prolapse surge... more Permanent suture material and synthetic grafts can be used as part of pelvic organ prolapse surgery. These materials are often attached to the sacrospinous ligament or passed in retroperitoneal spaces. There is a risk for erosion and granulation tissue formation with any of these materials. Typically, this is managed through a transvaginal incision.We present a case of a postmenopausal woman with persistent granulation tissue and a sinus tract from a braided polyester (Ethibond) suture placed in the right sacrospinous ligament fixation. After failing several attempts at treating this granulation tissue through a vaginal incision, we managed this via an abdominal retroperitoneal approach.
Connecticut medicine
To evaluate whether patients with advanced pelvic-organ prolapse (POP) were less likely than cont... more To evaluate whether patients with advanced pelvic-organ prolapse (POP) were less likely than controls to obtain screening Papanicolaou (Pap) test, mammography, and colonoscopy. Records were reviewed from 7/2/2010 through 4/22/2011. We identified patients with advanced POP, defined as prolapse > or = 4 cm beyond the hymenal ring, and made age- and parity-matched controls from patients whose prolapse was <4 cm. Compliance for screening of cervical, breast and colon cancers was compared between the two groups. Of 933 records, we identified 51 patients with advanced POP and 51 controls. Neither Pap test nor colonoscopy screening differed between the groups (McNemar chi2, P=1.00; McNemar chi2, P=1.00). Mammogram screening did not differ statistically; however, there was a trend towards neglecting screening in the advanced POP group (McNemar chi2, P=0.057). Patients with POP > or = 4 cm beyond the hymenal ring were equally as likely to obtain routine health screening as age- and ...
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Fistulas inaccessible from the vagina may require abdominal repair; we sought to evaluate the rob... more Fistulas inaccessible from the vagina may require abdominal repair; we sought to evaluate the robotic-assisted laparoscopic approach for this procedure. A 41-year-old nulliparous woman presented with urinary incontinence following an abdominal hysterectomy, and office evaluation identified a vesicovaginal fistula. After discussion with the patient regarding the surgical options, the robotic approach was chosen to facilitate precise dissection, fine visualization, and suturing. A stent was placed from the bladder into the vagina, and no intentional cystotomy was made. The bladder was dissected away from the anterior vaginal wall at the fistula site, and the defects were closed independently with interposition of a fatty epiploica from the sigmoid colon. Total operative time was approximately 4 hours, and robotic time was about 2.5 hours. At 3 months after surgery, the patient had no recurrent symptoms. The robotic-assisted laparoscopic approach is a viable option for successful repai...
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Papers by Paul Tulikangas