relative lack of data, the results reported in these 4 studies of MS seem fairly promising. Successful test stimulation was defined variably in different studies as 50% to 75% improvement in inconti- nence episodes and pad use, allowing full device implantation, and 80% of these 50 patients were implanted. That is a pretty high successful test stimulation rate for SNM. While subsequent symp- tom control varied, in general, most patients re- mained markedly improved. These findings should certainly be regarded favorably for management of these challenging patients, and hopefully randomized trials compar- ing SNM to other standard modalities for neuro- genic bladder symptoms can be completed. Such trials would very likely need to be done in a multi- site network, but standardization of inclusion and exclusion criteria could surely be agreed upon. Comparators to SNM could reasonably be BTX or percutaneous tibial nerve stimulation or even anticholinergic medications. Patient-centered out- comes could be a primary focus. We need to learn if these limited data on SNM in MS patients hold up in a larger population.—ACW) Continuous Versus Cyclic Oral Contraceptives After Laparoscopic Excision of Ovarian Endometriomas: A Systematic Review and Meta-analysis Ludovico Muzii, Chiara Di Tucci, Chiara Achilli, Violante Di Donato, Angela Musella, Innocenza Palaia, and Pierluigi Benedetti Panici Department of Obstetrics and Gynecology, Sapienza University of Rome, Rome, Italy Am J Obstet Gynecol 2016;214:203–211 ABSTRACT Up to 44% of patients with endometriosis have endometriomas that are usually associated with pelvic pain and infertility. The first-line option for endometriosis-associated pain symptoms is usually medical therapy with oral contraceptives (OCs) and progestins. Because ovarian endometriomas do not respond to medical therapy, standard treatment when they are present is considered to be surgical excision. Medical treatment is often administered after surgical excision of the endometrioma to reduce postoperative pain and cyst recurrence rates, but its effectiveness remains unclear. Several studies and systematic reviews that compared postoperative medical treatment versus placebo or no treatment had conflicting results. One systematic review and meta-analysis suggested that postoperative OC may be effective in reducing recurrence rates, especially when administered in the long term. After excisional surgery for endometriomas, OCs may be administered either with a conventional cyclic regimen or a con- tinuous regimen with no pill-free interval. Few studies have compared these 2 regimens. Results of such studies have been inconsistent as to the efficacy of either regimen on cyst or pain recurrence. There is no consensus in evidence-based guidelines for recommendation of either schedule. The aim of this systematic review and meta-analysis was to compare a continuous versus a cyclic OC regimen administered after surgical excision of ovarian endometriomas. An electronic search was conducted using PubMed, MedLine, and Embase databases through December 2014 to identify relevant articles. The search employed the following combination of terms: endometrioma, endometriosis, OCs, oral estroprogestins, laparoscopy, and surgery. Three investigators independently assessed methodology and extracted data from studies selected. Included studies directly compared a continuous versus a cy- clic schedule administered after surgical treatment of endometrioma. The primary outcomes were pain and endometrioma recurrence rates. Pain recurrence was evaluated separately for dysmen- orrhea, noncyclic chronic pelvic pain, and dyspareunia; endometrioma recurrence was evaluated at ultrasonography. Data from each study for dichotomous outcomes were expressed as risk ratio (RR) with a 95% confidence interval (CI). Four studies were included at final analysis: 3 randomized clinical trials and 1 prospective controlled cohort study. A total of 557 patients with endometriosis were evaluated; among these, 343 patients with ovarian endometriomas completed the 403 Office Gynecology Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.