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Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, Kraus SR, Sandhu JS, Shepler T, Treadwell JR, Vasavada S, Lemack GE. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. J Urol 2017. [PMID: 28625508 DOI: 10.1016/j.juro.2017.06.061] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Stress urinary incontinence is a common problem experienced by many women that can have a significant negative impact on the quality of life of those who suffer from the condition and potentially those friends and family members whose lives and activities may also be limited. MATERIALS AND METHODS A comprehensive search of the literature was performed by ECRI Institute. This search included articles published between January 2005 and December 2015 with an updated abstract search conducted through September 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS The AUA (American Urological Association) and SUFU (Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction) have formulated an evidence-based guideline focused on the surgical treatment of female stress urinary incontinence in both index and non-index patients. CONCLUSIONS The surgical options for the treatment of stress urinary incontinence continue to evolve; as such, this guideline and the associated algorithm aim to outline the currently available treatment techniques as well as the data associated with each treatment. Indeed, the Panel recognizes that this guideline will require continued literature review and updating as further knowledge regarding current and future options continues to grow.
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Lemack GE, Kobashi KC, Vasavada SP, Rovner ES, Dmochowski RR. Editorial Message. Neurourol Urodyn 2017; 36:S5. [DOI: 10.1002/nau.23227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kobashi KC, Leach GE. Bladder Dysfunction in Multiple Sclerosis. Neurorehabil Neural Repair 2016. [DOI: 10.1177/154596839901300204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) involves focal neural demyelmation with relative sparing of axons and resultant impaired nerve conduction. Demyelination commonly affects the posterolateral columns of the spinal cord, with the majority of patients having cervi cal cord involvement. Forty percent of patients have lumbar cord involvement and 18 percent have sacral cord involvement. The cerebral cortex and midbram may also be affected. Lesions in any of these areas can affect voiding function.
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Rovner ES, Lemack GE, Kobashi KC, Winters JC, Dmochowski RR. Editorial Comment. Neurourol Urodyn 2016; 35 Suppl 1:S5. [DOI: 10.1002/nau.22966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lee EW, Chang A, Lee UJ, Lucioni A, Massman JD, Wolff EM, Govier FE, Kobashi KC. PD28-06 OUTCOMES OF AUTOLOGOUS RECTUS FASCIA PUBOVAGINAL SLING FOR SEVERE INTRINSIC SPHINCTER DEFICIENCY AND/OR RECURRENT STRESS URINARY INCONTINENCE: UP TO 11-YEAR FOLLOW-UP. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rovner ES, Lemack GE, Kobashi KC, Winters JC, Dmochowski RR. Editorial. Neurourol Urodyn 2015. [DOI: 10.1002/nau.22737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee EW, Lucioni A, Lee UJ, Kobashi KC. National Practice Patterns of Infection Prophylaxis for Sacral Neuromodulation Device: A Survey of High Volume Providers. UROLOGY PRACTICE 2015. [PMID: 37537802 DOI: 10.1016/j.urpr.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Sacral neuromodulation using the InterStim® device is a safe, effective treatment for urgency, frequency, urgency incontinence, nonobstructive urinary retention and fecal incontinence. However, there is no standard recommendation regarding infection prophylaxis. Therefore, we surveyed the infection prophylaxis patterns of high volume device providers to describe current practice patterns of perioperative infection prophylaxis. METHODS A web based survey was sent to 35 high volume providers, including urologists, gynecologists and colorectal surgeons. RESULTS Our response rate was 89% (31 of 35 participants). Of the providers 51% were urologists, 39% were gynecologists and 10% were colorectal surgeons. Of the respondents 74% had performed more than 200 procedures and 22% had done more than 500. The testing period was generally 1 to 2 weeks. Only 13% of the surveyed providers routinely screened for methicillin resistant Staphylococcus aureus. All providers administered antibiotics preoperatively, most commonly cefazolin or vancomycin, and 81% administered antibiotics postoperatively, most commonly cephalexin and trimethoprim-sulfamethoxazole. Most providers prescribed 5 to 7 days of treatment but 6 (19%) prescribed no postoperative antibiotics. In addition, 71% of respondents used adjunctive measures, frequently intraoperative wound irrigation and/or a preoperative chlorhexidine shower. After stages 1 and 2, 19% of providers prohibited showering for more than 3 days postoperatively while 61% permitted showering after 1 or 2 days and 19% recommended no bathing restriction. CONCLUSIONS We present the infection prevention practices of high volume InterStim sacral neuromodulation device implanters in the United States. Further study is warranted to guide evidence-based practice in InterStim infection prophylaxis.
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Lee EW, Lee UJ, Lucioni A, Kobashi KC. Outcomes of Sacral Neuromodulation for Overactive Bladder in Octogenarian Females. UROLOGY PRACTICE 2015. [PMID: 37537803 DOI: 10.1016/j.urpr.2014.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Elderly women have a high incidence of refractory overactive bladder. Clinicians and elderly patients may be hesitant to consider sacral neuromodulation. We investigated outcomes of sacral neuromodulation in women 80 years old or older. MATERIALS AND METHODS From 2000 to 2013, 24 octogenarians with overactive bladder underwent stage 1 implantation of the InterStim® sacral neuromodulation device. We defined stage 1 success as 50% or greater improvement in incontinence episodes and/or pads. Those patients underwent placement of an implantable pulse generator. The primary study outcome was the rate of stage 1 success. Secondary outcomes were the complication rate and patient reported improvement/satisfaction. RESULTS We identified 24 octogenarians with a median age of 85 years (range 80 to 89), of whom 18 (75%) experienced stage 1 success. At a mean 17-month followup (range 1 to 59) success was sustained in 13 patients (72%) and 15 (83%) were medication free. Two patients (12%) experienced complications, including urinary tract infection in 1 and pain at the implantable pulse generator site in 1, which resolved within 1 month. Three patients (17%) underwent lead revision and 2 subsequently regained success. Five of the 10 patients (50%) who returned the PGI-I questionnaire reported that their condition was very much or much improved, 3 felt a little improved and 2 reported no change. The self-reported satisfaction rate was 60%. CONCLUSIONS Octogenarian women treated with sacral neuromodulation had a high rate of stage 1 success with no major complications. Most of them reported improvement and satisfaction at a mean followup of 17 months. Advanced age alone should not preclude consideration of sacral neuromodulation as a treatment option for overactive bladder in the properly selected elderly patient.
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Patel BN, Longo E, Govier FE, Kobashi KC, Lucioni A. Long-term follow-up of polypropylene bone anchored slings. Int Braz J Urol 2013; 39:493-7. [PMID: 24054378 DOI: 10.1590/s1677-5538.ibju.2013.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/14/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The transvaginal bone anchored polypropylene sling (BAS) has proven to be a successful treatment for patients with SUI. However, there is limited data on long-term outcomes following BAS with polypropylene mesh. We report our series of patients who had at least 3 years of follow-up after placement of BAS. MATERIALS AND METHODS A retrospective review of prospectively collected data of patients undergoing BAS for stress urinary incontinence (SUI) with minimum 3 year follow-up was performed. Outcomes and complications were determined from annual mailed post-operative questionnaires. RESULTS 142 patients who had undergone BAS and had answered post-operative questionnaires at a minimum of 3 years were identified. Average follow-up was 58 months (range 36-97 months). The overall success rate was 71 % with a dry rate of 27 %. Complications occurred in 9 % of patients, more commonly in patients without a history of anti-incontinence procedure. CONCLUSIONS Although less commonly used, BAS with polypropylene mesh is associated with an acceptable success rate at long term follow-up but a low completely dry rate.
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Kobashi KC, Patel B. Commentary on: Anticholinergic Therapy vs OnabotulinumtoxinA for Urgency Urinary Incontinence. Urology 2013; 82:14-5. [DOI: 10.1016/j.urology.2012.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/27/2022]
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Patel BN, Kobashi KC. Practical Use of the New American Urological Association Adult Urodynamics Guidelines. Curr Urol Rep 2013; 14:240-6. [DOI: 10.1007/s11934-013-0317-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, Lemack GE, Nitti VW, Rovner ES, Wein AJ. Urodynamic studies in adults: AUA/SUFU guideline. J Urol 2012; 188:2464-72. [PMID: 23098783 DOI: 10.1016/j.juro.2012.09.081] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The authors of this guideline reviewed the literature regarding use of urodynamic testing in common lower urinary tract symptoms. The findings are intended to assist clinicians in the appropriate selection of urodynamic tests, following an evaluation and symptom characterization. MATERIALS AND METHODS A systematic review of the literature using the MEDLINE® and EMBASE databases (searched from 1/1/90 to 3/10/11) was conducted to identify peer-reviewed publications relevant to using urodynamic tests for diagnosis, determining prognosis, guiding clinical management decisions and improving patient outcomes in patients with various urologic conditions. The review yielded an evidence base of 393 studies after application of inclusion/exclusion criteria. These publications were used to create the evidence basis for characterizing the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinion. RESULTS The evidence-based guideline statements are provided for diagnosis and overall management of common LUTS conditions. CONCLUSIONS The Panel recognizes that each patient presenting with LUTS is unique. This Guideline is intended to serve as a tool facilitating the most effective utilization of urodynamic testing as part of a comprehensive evaluation of patients presenting with LUTS.
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Patel BN, Lucioni A, Kobashi KC. Anterior Pelvic Organ Prolapse Repair Using Synthetic Mesh. Curr Urol Rep 2012; 13:211-5. [DOI: 10.1007/s11934-012-0246-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nazemi TM, Kobashi KC. Complications of grafts used in female pelvic floor reconstruction: Mesh erosion and extrusion. Indian J Urol 2011; 23:153-60. [PMID: 19675793 PMCID: PMC2721525 DOI: 10.4103/0970-1591.32067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: Various grafts have been used in the treatment of urinary incontinence and pelvic prolapse. Autologous materials such as muscle and fascia were first utilized to provide additional anatomic support to the periurethral and pelvic tissues; however, attempts to minimize the invasiveness of the procedures have led to the use of synthetic materials. Complications such as infection and erosion or extrusion associated with these materials may be troublesome to manage. We review the literature and describe a brief overview of grafts used in pelvic floor reconstruction and focus on the management complications specifically related to synthetic materials. Materials and Methods: We performed a comprehensive review of the literature on grafts used in pelvic floor surgery using MEDLINE and resources cited in those peer-reviewed manuscripts. The results are presented. Results: Biologic materials provide adequate cure rates but have associated downfalls including potential complications from harvesting, variable tissue quality and cost. The use of synthetic materials as an alternative graft in pelvic floor repairs has become a popular option. Of all synthetic materials, the type I macroporous polypropylene meshes have demonstrated superiority in terms of efficacy and fewer complication rates due to their structure and composition. Erosion and extrusion of mesh are common and troublesome complications that may be managed conservatively with observation with or without local hormone therapy, with transvaginal debridement or with surgical exploration and total mesh excision, dependent upon the location of the mesh and the mesh type utilized. Conclusions: The ideal graft would provide structural integrity and durability with minimal adverse reaction by the host tissue. Biologic materials in general tend to have fewer associated complications, however, the risks of harvesting, variable integrity of allografts, availability and high cost has led to the development and use of synthetic grafts. Synthetic grafts have a tendency to cause higher rates of erosion and extrusion; however, these complications can be managed successfully.
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Rapp DE, Neil NJ, Kobashi KC. Defining success following sling surgery: association of satisfaction with patient reported outcomes. THE CANADIAN JOURNAL OF UROLOGY 2010; 17:4995-5001. [PMID: 20156379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS The assessment of incontinence therapies is complicated by the variety of patient reported outcomes (PRO) measures used in research protocol. Patient satisfaction may be one of the most relevant albeit complex PRO measures and is a function of many related variables. We sought to assess the relationship between patient satisfaction and other PRO. METHODS A retrospective review of patients undergoing SPARC (n = 314) and autologous rectus pubovaginal sling (PVS) (n = 127) was performed, with 204 (SPARC) and 67 (PVS) patients completing questionnaire surveillance and minimum 12 month follow up. Outcomes were assessed using validated incontinence questionnaires (UDI-6, IIQ-7) supplemented with additional items addressing subjective improvement. Comparisons were made between patients reporting a willingness to recommend and repeat surgical intervention (combined variable, satisfaction surrogate) and achievement of defined endpoints in the remaining outcome measures. RESULTS A large difference in outcomes was seen depending on PRO measure analyzed. Dry was the strictest measure used (33%, SPARC; 39%, PVS; p = NS), while >or= 50% improvement was reported with the greatest frequency (75%, SPARC; 73%, PVS; p = NS). With the exception of pad use, a statistically significant association between all PRO measures and the willingness to recommend/repeat surgery was identified. CONCLUSIONS Our data demonstrate an association between a variety of PRO measures and patient reported satisfaction. Based on this finding, the development of a simplified and standardized PRO instrument, one that maintains an accurate reflection of patient satisfaction and is less cumbersome for the patient may be possible.
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Rapp DE, Kobashi KC, Govier FE. Reply. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rapp DE, Neil NJ, Govier FE, Kobashi KC. Bladder Sensation Measures and Overactive Bladder. J Urol 2009; 182:1050-4. [DOI: 10.1016/j.juro.2009.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Indexed: 01/01/2023]
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Lucioni A, Kobashi KC. Bone-anchored suburethral sling: Surgical technique and outcomes. Curr Urol Rep 2009; 10:384-9. [DOI: 10.1007/s11934-009-0060-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rapp DE, Neil N, Govier F, Kobashi KC. IDENTIFICATION OF MEASURES OF BLADDER SENSATION IN PATIENTS WITH OVERACTIVE BLADDER. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cisternas MG, Foreman AJ, Marshall TS, Runken MC, Kobashi KC, Seifeldin R. Estimating the prevalence and economic burden of overactive bladder among Medicare beneficiaries prior to Medicare Part D coverage. Curr Med Res Opin 2009; 25:911-9. [PMID: 19250059 DOI: 10.1185/03007990902791025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The goal of this study is to provide annual estimates for the treated prevalence and expenditures attributable to overactive bladder (OAB) in the elderly prior to Medicare Part D drug coverage. RESEARCH DESIGN AND METHODS All Medicare claims were extracted for beneficiaries over 65 with continuous coverage for Medicare Parts A and B during 2003-2004. Two OAB definitions were created: (1) the base case included diagnosis codes that narrowly defined OAB, and (2) the sensitivity variant included additional codes indicative of OAB. Descriptive comparisons of baseline characteristics, annual expenditures, and events and procedures were performed for OAB vs. non-OAB subjects meeting the inclusion criteria. CMS expenditures (2004 US dollars) for individuals were totaled and multiple regression techniques were used to estimate costs attributable to OAB after adjusting for demographic characteristics and comorbid conditions. RESULTS The prevalence of subjects with an OAB diagnosis ranged from 8.8 to 13.6% for the base and sensitivity definitions, respectively. While mean total annual expenditures ranged from $9331 to $9655, mean annual expenditures attributable to OAB ranged from $825 to $1184 per subject (9-12% of total medical expenditures for OAB subjects), with aggregate total OAB-attributable expenditures of $1.8-3.9 billion per year. CONCLUSIONS The treated prevalence of individuals seeking treatment for OAB in the elderly Medicare population is comparable to some common chronic conditions in that population, and OAB-attributable CMS expenditures are considerable. However, due to study limitations this is a conservative estimate of the direct cost of OAB in the elderly population. The reported estimates exclude pharmacy and out-of-pocket costs, are extrapolated to only two-thirds of the elderly Medicare population, and do not include expenditures by Medicaid for long-term care. Additionally, claims data limits detection of chronic conditions to patients who receive treatment or consultation for OAB; diagnosis codes used were based on expert opinion rather than a review of medical records to identify OAB patients; and long-term care costs are not included.
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Rapp DE, Govier FE, Kobashi KC. Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of Sparc and Monarc slings. Int Braz J Urol 2009; 35:68-75; discussion 75. [DOI: 10.1590/s1677-55382009000100011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2008] [Indexed: 11/22/2022] Open
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