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Cameron AP, Chung DE, Dielubanza EJ, Enemchukwu E, Ginsberg DA, Helfand BT, Holland P, Linder BJ, Rahimi L, Reynolds WS, Rovner ES, Souter L, Suskind AM, Takacs E, Welk B, Smith AL. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. J Urol 2024:101097JU0000000000003985. [PMID: 38651651 DOI: 10.1097/ju.0000000000003985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision-making process that will maximize symptom control and quality of life, while minimizing adverse events and burden of disease. METHODS An electronic search employing OVID was used to systematically search the MEDLINE and EMBASE databases, as well as the Cochrane Library, for systematic reviews and primary studies evaluating diagnosis and treatment of OAB from January 2013 to November 2023. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest. Following the study selection process, 159 studies were included and were used to inform evidence-based recommendation statements. RESULTS This guideline produced 33 statements that cover the evaluation and diagnosis of the patient with symptoms suggestive of OAB; the treatment options for patients with OAB, including non-invasive therapies, pharmacotherapy, minimally invasive therapies, invasive therapies, and indwelling catheters; and the management of patients with BPH and OAB. CONCLUSION Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision-making, formulate a personalized treatment approach taking into account evidence-based recommendations as well as patient values and preferences.
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Farah OK, Wang CN, Chung DE. The role of facebook support groups for women with benign urologic conditions. Neurourol Urodyn 2023; 42:1795-1801. [PMID: 37705338 DOI: 10.1002/nau.25283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To understand the availability and content of patient support groups on social media platforms. MATERIALS AND METHODS Five prevalent benign, urologic conditions affecting adult women were selected for analysis. Facebook support groups for these conditions were identified. Groups specific to one urologic condition and with at least 400 members were included, and groups for pediatric and malignant conditions were excluded. Each support group was analyzed for member count, posts per month, and period of activity. The 100 most recent posts in the largest support groups were manually reviewed and further categorized into content subsections. RESULTS A total number of 56 Facebook support groups were identified that satisfied the inclusion/exclusion criteria. Interstitial cystitis (IC) had 25 groups (68 466 members; 4825 posts), pelvic organ prolapse (POP) had 14 groups (72 342; 3067), UTI had nine groups (36 414; 3204), overactive bladder and/or urinary incontinence (OAB/UI) had seven groups (8246; 306), urinary retention had one group (1168; 118). Across all groups, post content was predominantly informational support (77.6%). Remaining post content was both informational and emotional support (10.0%), emotional support only (7.6%), or unrelated to either informational or emotional support (4.8%). CONCLUSION Individuals with benign urologic conditions are utilizing social media support groups predominantly to seek and share informational support from patient peers. The number of existing groups as well as the level of activity and number of members within individual support groups varies significantly between different urologic conditions. This suggests that there is an unmet need for accessible informational content for patients who suffer with benign urological conditions.
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Affiliation(s)
- Omar K Farah
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Connie N Wang
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
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Ferrando CA, Bradley CS, Meyn LA, Brown HW, Moalli PA, Heisler CA, Murarka SM, Foster RT, Chung DE, Whitcomb EL, Gutman RE, Andy UU, Shippey SH, Anger J, Yurteri-Kaplan LA. Twelve Month Outcomes of Pelvic Organ Prolapse Surgery in Patients With Uterovaginal or Posthysterectomy Vaginal Prolapse Enrolled in the Multicenter Pelvic Floor Disorders Registry. Urogynecology (Phila) 2023; 29:787-799. [PMID: 37733440 DOI: 10.1097/spv.0000000000001410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE The aim of the study was to compare 12-month subjective and objective outcomes between 3 approaches to apical pelvic organ prolapse (POP) surgery in patients presenting with uterovaginal or posthysterectomy vaginal prolapse enrolled in the Pelvic Floor Disorders Registry for Research. STUDY DESIGN This was an analysis of a multicenter, prospective registry that collected both patient- and physician-reported data for up to 3 years after conservative (pessary) and surgical treatment for POP. Twelve-month subjective and anatomic outcomes for patients who underwent surgical treatment were extracted from the registry for analysis. Pelvic organ prolapse recurrence was defined as a composite outcome and compared between the 3 apical surgery groups (native tissue repair, sacrocolpopexy, colpocleisis) as well as the 2 reconstructive surgery groups (native tissue repair and sacrocolpopexy). RESULTS A total of 1,153 women were enrolled in the registry and 777 (67%) opted for surgical treatment, of whom 641 underwent apical repair and were included in this analysis (404 native tissue repair, 187 sacrocolpopexy, and 50 colpocleisis). The overall incidence of recurrence was as follows: subjective 6.5%, anatomic 4.7%, retreatment 7.2%, and composite 13.6%. The incidence of recurrence was not different between the 3 surgical groups. When baseline patient characteristics were controlled for, composite POP recurrence between the native tissue and sacrocolpopexy groups remained statistically nonsignificant. Concurrent perineorrhaphy with any type of apical POP surgery was associated with a lower risk of recurrence (adjusted odds ratio, 0.43; 95% confidence interval, 0.25-0.74; P = 0.002) and prior hysterectomy was associated with a higher risk (adjusted odds ratio, 1.77, 95% confidence interval, 1.04-3.03; P = 0.036). CONCLUSION Pelvic Floor Disorders Registry for Research participants undergoing native tissue apical POP repair, sacrocolpopexy, and colpocleisis surgery had similar rates of POP recurrence 12 months after surgery.
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Affiliation(s)
- Cecile A Ferrando
- From the Center for Urogynecology and Pelvic Reconstructive Surgery, Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Catherine S Bradley
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Leslie A Meyn
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - Heidi W Brown
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Pamela A Moalli
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Research Institute, University of Pittsburgh, Pittsburgh, PA
| | - Christine A Heisler
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of Wisconsin, Madison, WI
| | - Shivani M Murarka
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Raymond T Foster
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Missouri School of Medicine, Columbia, MO
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York, NY
| | - Emily L Whitcomb
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Irvine, CA
| | - Robert E Gutman
- National Center for Advanced Pelvic Surgery, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | - Uduak U Andy
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Stuart H Shippey
- Urogynecology Division, University of Florida Obstetrics and Gynecology Residency; Ascension Sacred Heart, Pensacola, FL
| | - Jennifer Anger
- Departments of Urology and Obstetrics and Gynecology, UC San Diego Health, San Diego, CA
| | - Ladin A Yurteri-Kaplan
- Division of Gynecologic Specialty Surgery, Section of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology; Columbia University Irving Medical Center, New York, NY
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Wang CN, Chung R, Movassaghi M, Yurteri-Kaplan L, Chung DE. Images - Management of complete bladder prolapse through the urethra. Can Urol Assoc J 2023; 17:E281-E283. [PMID: 37458741 PMCID: PMC10544402 DOI: 10.5489/cuaj.8352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Connie N. Wang
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
| | - Rainjade Chung
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
| | - Miyad Movassaghi
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
| | - Ladin Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Doreen E. Chung
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
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Wang CN, Su IW, Smith AL, Badalato GM, Chung DE. Current exposure to Female Pelvic Medicine and Reconstructive Surgery faculty during urology residency. Neurourol Urodyn 2023; 42:1569-1573. [PMID: 37449376 DOI: 10.1002/nau.25247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Contemporary US resident exposure to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) faculty during urology residency is unknown. METHODS Accredited US urology residencies were identified through the American Urological Association (AUA). Accredited, urology-based FPMRS fellowships were identified through the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The number of faculty and residency positions were obtained from program AUA profiles if they were last modified within the current application cycle; this information was obtained from program websites if AUA profiles were outdated. Data on faculty fellowship training was manually extracted from program websites. A quality control cross-check of program and faculty training characteristics was performed through direct communication with 5% of programs. RESULTS Of 139 accredited residency programs assessed, 10.8% were affiliated with an accredited, urology-based FPMRS fellowship. In total, 29.5% of residency programs, representing 25% of US urology residents, had neither a FPMRS fellowship nor any FPMRS certified faculty. The national FPMRS faculty-to-resident ratio was 1:10.8, and 7.4% of faculty at all residency programs were FPMRS certified. In comparison, faculty-to-resident ratios for other subspecialties were: 1:4.7 for pediatrics, 1:3.6 for oncology, 1:5.9 for minimally invasive surgery/endourology, 1:14.2 for trauma/reconstruction, and 1:11.8 for andrology or male sexual/reproductive health. The FPMRS faculty-to-resident ratio was 1:5.1 in programs with a urology-based FPMRS fellowship compared with 1:13.4 in programs without a FPMRS fellowship. CONCLUSIONS 30% of US urology residency programs lack FPMRS trained faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Further studies are required to ascertain if inadequate exposure to FPMRS cases and mentors during training contribute to the shortage of urology residents who choose to specialize in FPMRS. This link has important implications for the current shortage of FPMRS providers.
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Affiliation(s)
- Connie N Wang
- Columbia University Irving Medical Center Department of Urology, New York, New York, USA
| | - Irene W Su
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Ariana L Smith
- University of Pennsylvania Health System Department of Urology, Philadelphia, Pennsylvania, USA
| | - Gina M Badalato
- Columbia University Irving Medical Center Department of Urology, New York, New York, USA
| | - Doreen E Chung
- Columbia University Irving Medical Center Department of Urology, New York, New York, USA
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Wang CN, Sebesta EM, Moran GW, Chung DE. Urodynamic findings in female patients with nocturia: An age-matched case-control study. Neurourol Urodyn 2023; 42:221-228. [PMID: 36259768 DOI: 10.1002/nau.25071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 08/30/2022] [Accepted: 10/06/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Nocturia negatively impacts the quality of life and is associated with poor general health, but our understanding of its etiologies is incomplete. Urodynamic studies (UDS) findings in patients with nocturia are not well described and may help guide management. Our objective was to compare UDS findings with age-matched patients with and without nocturia. MATERIALS AND METHODS We retrospectively reviewed UDS findings of 1124 patients (2010-2017). A total of 484 (43%) presented with nocturia and 821 (73%) were female. Female patients were separated into age-matched groups with and without nocturia. Urinary symptoms, past medical diagnoses, demographic information, and UDS findings were compared. RESULTS A total of 596 female patients were included, 298 (50%) with nocturia and 298 without. Past medical history, including diabetes mellitus and cardiovascular disease, did not differ between groups. Patients with nocturia were more likely to have pelvic pain (p = 0.0014) and other daytime symptoms (frequency, urgency, and urgency incontinence). On UDS, patients with nocturia were more likely to have bladder outlet obstruction (BOO) (p = 0.025) and dysfunctional voiding (DV) (p < 0.0001). There was no difference in the frequency of detrusor overactivity (DO). Bladder capacity and postvoid residual volumes were lower, though not significantly, in the nocturia group. CONCLUSIONS When comparing UDS findings in contemporary, age-matched groups of female patients with and without nocturia, we found only BOO and DV to be associated with nocturia. While the treatment of nocturia is often aimed at managing DO, our data suggest that this may not be the primary urodynamic correlation with nocturia. Further studies are needed to assess whether successful treatment of BOO and DV can improve nocturia.
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Affiliation(s)
- Connie N Wang
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Elisabeth M Sebesta
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA.,Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George W Moran
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
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Overton E, Booker WA, Mourad M, Moroz L, Nhan Chang CL, Breslin N, Syeda S, Laifer-Narin S, Cimic A, Chung DE, Weiner DM, Smiley R, Sheikh M, Mobley DG, Wright JD, Gockley A, Melamed A, St Clair C, Hou J, D'Alton M, Khoury Collado F. Prophylactic endovascular internal iliac balloon placement during cesarean hysterectomy for placenta accreta spectrum. Am J Obstet Gynecol MFM 2022; 4:100657. [PMID: 35597402 DOI: 10.1016/j.ajogmf.2022.100657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The utility of prophylactic endovascular internal iliac balloon placement in the surgical management of placenta accreta spectrum is debated. OBJECTIVE In this study, we review outcomes of surgical management of placenta accreta spectrum with and without prophylactic endovascular internal iliac balloon catheter use at a single institution. STUDY DESIGN This is a retrospective cohort study of consecutive viable singleton pregnancies with a confirmed pathologic diagnosis of placenta accreta spectrum undergoing scheduled delivery from October 2018 through November 2020. In the T1 period (October 2018-August 2019), prophylactic endovascular internal iliac balloon catheters were placed in the operating room before the start of surgery. Balloons were inflated after neonatal delivery and deflated after hysterectomy completion. In the T2 period (September 2019-November 2020), endovascular catheters were not used. In both time periods, all surgeries were performed by a dedicated multidisciplinary team using a standardized surgical approach. The outcomes compared included the estimated blood loss, anesthesia duration, operating room time, surgical duration, and a composite of surgical complications. Comparisons were made using the Wilcoxon rank-sum test and the Fisher exact test. RESULTS A total of 30 patients were included in the study (T1=10; T2=20). The proportion of patients with placenta increta or percreta was 80% in both groups, as defined by surgical pathology. The median estimated blood loss was 875 mL in T1 and 1000 mL in T2 (P=.84). The proportion of patients requiring any packed red blood cell transfusion was 60% in T1 and 40% in T2 (P=.44). The proportion of patients requiring >4 units of packed red blood cells was 20% in T1 and 5% in T2 (P=.25). Surgical complications were observed in 1 patient in each group. Median operative anesthesia duration was 497 minutes in T1 and 296 minutes in T2 (P<.001). Median duration of operating room time was 498 minutes in T1 and 205 minutes in T2 (P<.001). Median surgical duration was 227 minutes in T1 and 182 minutes in T2 (P<.05). The median duration of time for prophylactic balloon catheter placement was 74 minutes (range, 46-109 minutes). The median postoperative length of stay was similar in both groups (6 days in T1 and 5.5 days in T2; P=.36). CONCLUSION The use of prophylactic endovascular internal iliac balloon catheters was not associated with decreased blood loss, packed red blood cell transfusion, or surgical complications. Catheter use was associated with increased duration of anesthesia, operating room time, and surgical time.
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Affiliation(s)
- Eve Overton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado).
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Leslie Moroz
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Chia-Ling Nhan Chang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Noelle Breslin
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Sbaa Syeda
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Sherelle Laifer-Narin
- Department of Diagnostic Radiology, Columbia University, New York, NY (Dr Laifer-Narin)
| | - Adela Cimic
- Department of Anatomic Pathology, Columbia University, New York, NY (Dr Cimic)
| | - Doreen E Chung
- Department of Urology, Columbia University, New York, NY (Drs Chung, and Weiner)
| | - David M Weiner
- Department of Urology, Columbia University, New York, NY (Drs Chung, and Weiner)
| | - Richard Smiley
- Department of Anesthesiology, Columbia University, New York, NY (Drs Smiley, and Sheikh)
| | - Maria Sheikh
- Department of Anesthesiology, Columbia University, New York, NY (Drs Smiley, and Sheikh)
| | - David G Mobley
- Division of Interventional Radiology, Columbia University, New York, NY (Dr Mobley)
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Allison Gockley
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Caryn St Clair
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - June Hou
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Mary D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
| | - Fady Khoury Collado
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Drs Overton, Booker, Mourad, Moroz, Chang, Breslin, Syeda, Wright, Gockley, Melamed, St. Clair, Hou, D'Alton, and Collado)
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Wang CN, Chung DE. Neuromodulation for lower urinary tract symptoms in special populations. Neurourol Urodyn 2022; 41:1948-1957. [PMID: 35579275 DOI: 10.1002/nau.24954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023]
Abstract
AIMS Discuss the efficacy, safety, and future directions of neuromodulation in special populations of patients with neurological conditions. METHODS A literature review was done to find meta-analyses, review articles, studies, and case reports of the use of neuromodulation, either sacral neuromodulation or percutaneous tibial nerve stimulation, in patients with various neurological conditions of interest. RESULTS Sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS) appear to be safe and effective in special neurological populations of patients with multiple sclerosis (MS), Parkinson's disease (PD), and spinal cord injury (SCI). The majority of publications are smaller retrospective case series. Outcomes appear similar to those seen in nonneurogenic patients but also partly depend on disability progression. Magnetic resonance imaging (MRI) compatibility has helped to improve eligibility for SNM in these special populations. CONCLUSIONS In a small number of studies, SNM and PTNS appear to be safe and effective in special neurological populations of patients with MS, PD, and SCI. MRI compatibility has helped to improve eligibility for SNM in these special populations. Studies looking at SNM are limited by a small number of subjects, lack of prospective trials, and selection bias. Larger, randomized studies with long-term follow up are needed to better predict response to SNM and PTNS in these populations.
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Affiliation(s)
- Connie N Wang
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York City, New York, USA
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Reynolds WS, Suskind AM, Anger JT, Brucker BM, Cameron AP, Chung DE, Daignault-Newton S, Lane GI, Lucioni A, Mourtzinos AP, Padmanabhan P, Reyblat PX, Smith AL, Tenggardjaja CF, Lee UJ. Incomplete bladder emptying and urinary tract infections after botulinum toxin injection for overactive bladder: Multi-institutional collaboration from the SUFU research network. Neurourol Urodyn 2022; 41:662-671. [PMID: 35019167 PMCID: PMC8891079 DOI: 10.1002/nau.24871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/08/2021] [Accepted: 12/05/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Onabotulinumtoxin A (BTX-A) is an effective therapy for overactive bladder (OAB), however, adverse events may prevent patients from initiating therapy. The study objective was to report real-world rates of incomplete emptying and urinary tract infection (UTI) in men and women undergoing BTX-A for OAB. METHODS Eleven clinical sites performed a retrospective study of adults undergoing first-time BTX-A injection (100 units) for idiopathic OAB in 2016. Exclusions included: postvoid residual (PVR) > 150 ml, prior BTX-A, pelvic radiation, or need for preprocedure catheterization. Primary outcomes at 6 months were incomplete emptying (clean intermittent catheterization [CIC] or PVR ≥ 300 ml without the need for CIC); and UTI (symptoms with either positive culture or urinalysis or empiric treatment). We compared rates of incomplete emptying and UTI within and between sexes, using univariate and multivariable models. RESULTS 278 patients (48 men and 230 women) met inclusion criteria. Mean age was 65.5 years (range: 24-95). 35% of men and 17% of women had incomplete emptying. Men had 2.4 (95% CI: 1.04-5.49) higher odds of incomplete emptying than women. 17% of men and 23.5% of women had ≥1 UTI, the majority of which occurred within the first month following injection. The strongest predictor of UTI was a history of prior UTI (OR: 4.2 [95% CI: 1.7-10.3]). CONCLUSIONS In this multicenter retrospective study, rates of incomplete emptying and UTI were higher than many previously published studies. Men were at particular risk for incomplete emptying. Prior UTI was the primary risk factor for postprocedure UTI.
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Affiliation(s)
- William Stuart Reynolds
- Division of Reconstructive Urology and Pelvic Health, Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anne M. Suskind
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Jennifer T. Anger
- Department of Urology, UC San Diego Health, San Diego, California, USA
| | - Benjamin M. Brucker
- Department of Urology, New York University, Langone Health, New York, New York, USA
| | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Doreen E. Chung
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Giulia I. Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Arthur P. Mourtzinos
- Department of Urology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Priya Padmanabhan
- Department of Urology, Beaumont Health, Farmington Hills, Michigan, USA
| | | | - Ariana L. Smith
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Una J. Lee
- Virginia Mason Medical Center, Seattle, Washington, USA
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Lane GI, Smith AL, Stambakio H, Lin G, Al Hussein Alawamlh O, Anger JT, Brandes ER, Carmel ME, Chung DE, Cox L, DeLong J, Elliott CS, Eltahawy E, Aparecido França W, Gousse A, Gupta P, Hagedorn JC, High RA, Khan A, Kowalik C, Lee RK, Lee UJ, Lucioni A, MacDonald S, Malaeb B, McKay S, Padmanabhan P, Powell CR, Sajadi KP, Sutherland SE, Theva D, Vollstedt A, Welk B, Zheng Y, Cameron AP. Treatment of urethral stricture disease in women: A multi‐institutional collaborative project from the SUFU research network. Neurourol Urodyn 2020; 39:2433-2441. [PMID: 32926460 DOI: 10.1002/nau.24507] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023]
Abstract
AIM Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. METHODS This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. RESULTS Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. CONCLUSION This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.
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Affiliation(s)
- Giulia I. Lane
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | - Ariana L. Smith
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Hanna Stambakio
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - George Lin
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | | | | | - Eileen R. Brandes
- Section of Urology Dartmouth Hitchcock Medical Center Lebanon New Hampshire USA
| | - Maude E. Carmel
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas USA
| | | | - Lindsey Cox
- Department of Urology Medical University of South Carolina Charleston South Carolina USA
| | - Jessica DeLong
- Department of Urology Eastern Virginia Medical School Norfolk Virginia USA
| | | | - Ehab Eltahawy
- Department of Urology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Wagner Aparecido França
- Department of Urology Hospital do Servidor Público Estadual de São Paulo ‐ IAMSPE São Paulo Brazil
| | - Angelo Gousse
- Department of Urology Memorial Hospital Miramar Miramar Florida USA
| | - Priyanka Gupta
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | | | - Rachel A. High
- Department of Urology Baylor Scott and White Health Temple Texas USA
| | - Aqsa Khan
- Department of Urology Mayo Clinic Phoenix Arizona USA
| | - Casey Kowalik
- Department of Urology Kansas University Medical Center Kansas City Kansas USA
| | - Richard K. Lee
- Department of Urology Weill Cornell Medicine NYC New York USA
| | - Una J. Lee
- Department of Urology Virginia Mason Seattle Washington USA
| | - Alvaro Lucioni
- Department of Urology Virginia Mason Seattle Washington USA
| | - Susan MacDonald
- Division of Urology Penn State Hershey Medical Center Hershey Pennsylvania USA
| | - Bahaa Malaeb
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | - Scotty McKay
- Department of Urology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | | | | | - Kamran P. Sajadi
- Department of Urology Oregon Health & Science University Portland Oregon USA
| | | | - Didi Theva
- Department of Urology Memorial Hospital Miramar Miramar Florida USA
| | - Annah Vollstedt
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Blayne Welk
- Division of Urology Western University London Ontario Canada
| | - Yu Zheng
- Department of Urology Medical University of South Carolina Charleston South Carolina USA
| | - Anne P. Cameron
- Department of Urology University of Michigan Ann Arbor Michigan USA
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Asafu-Adjei D, Small A, McWilliams G, Galea G, Chung DE, Pak JS. The intravesical injection of highly purified botulinum toxin for the treatment of neurogenic detrusor overactivity. Can Urol Assoc J 2020; 14:E520-E526. [PMID: 32432536 DOI: 10.5489/cuaj.6182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to assess safety and efficacy of incobotulinumtoxinA for the treatment of neurogenic detrusor overactivity (NDO). METHODS We identified patients with NDO confirmed on urodynamics (UDS) and reported urgency incontinence (UI) in those who received intravesical incobotulinumtoxin A injection for neurogenic bladder between November 2013 and May 2017. Parameters studied were daytime frequency, daily incontinence episodes, daily pad use, clean intermittent catheterization (CIC) volumes, symptom scores (UDI6, IIQ7, PGII), and complications. RESULTS We examined 17 male patients who met inclusion criteria and underwent incobotulinumtoxinA injection. Mean age was 61.2±15.4 years. Fourteen patients (82%) were taking oral antimuscarinics prior to the incobotulinumtoxin A injection. There were improvements in the following parameters: average daily pads (4.5 to 3.3, p=0.465), daily urinary frequency (9.4 to 4.6, p=0.048), daily incontinent episodes (2.5 to 0.4, p=0.033), CIC volumes (400 to 550 mL, p=0.356), hours in between CIC (3.6 to 5.2, p=0.127), and the validated questionnaires UDI6 (30.6 to 7.4, p=0.543) and IIQ7 (52.4 to 6.8, p=0.029). There were no documented symptomatic urinary tract infections (UTIs) within 30 days of injection or reports of de novo urinary retention. Nine of 17 patients (53%) reported being dry at their first postoperative visit. CONCLUSIONS In this preliminary pilot study of a small cohort of males with NDO and UI, significant improvements were seen following incobotulinumtoxinA injection in daily frequency, incontinence episodes, hours in between CIC, and quality of life. Larger-scale and long-term studies are required to confirm these results, but initial findings are promising for wider use of this formulation.
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Affiliation(s)
- Denise Asafu-Adjei
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
| | - Alexander Small
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
| | - Glen McWilliams
- James J. Peters Veterans Affairs Medical Center, New York, NY, United States
| | - Giuseppe Galea
- New York-Presbyterian Hospital Brooklyn Methodist Hospital, New York, NY, United States
| | - Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
| | - Jamie S Pak
- Department of Urology, Columbia University Irving Medical Center, New York, NY, United States
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Chung DE, Antosh DD, Umpierrez D, Barbosa Z, Yurteri-Kaplan L, Grimes CL. Differences between mid-urethral sling outcomes in diabetic and nondiabetic women. Neurourol Urodyn 2020; 39:738-743. [PMID: 31899822 DOI: 10.1002/nau.24268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
AIMS The aim is to assess whether subjects with diabetes mellitus (DM) have greater urinary retention and increased post-void residual volume (PVR) following mid-urethral sling (MUS) surgery. METHODS This multi-center retrospective study included patients who underwent MUS (2012-2016). Baseline data included demographics, comorbidities, urinary symptoms, urodynamics data, PVR, and responses to validated questionnaires (UDI6 and IIQ7). Intraoperative data, postoperative voiding trial results, postop questionnaires, and complications were also noted. Patients with and without DM were compared. Significance was defined as P < .05. RESULTS A total of 605 MUS were included, 538(89%) without DM and 67(11%) with DM, of which 69% were transobturator and 31% retropubic. No differences were seen in urinary retention and passing void trial(79% DM vs 81% non-DM; P = .72). Mean PVR at discharge was similar between groups (136 mL DM vs 139 mL non-DM; P = .922). There were no differences between groups in UDI6 and IIQ7 sum scores at baseline and 1 month. DM subjects reported more bother at baseline on certain UDI-6 and IIQ-7 items including frequent urination, leakage related to urgency, and feeling frustrated. At 3 months postop, all subjects demonstrated improvement in scores. Interestingly, patients with DM reported worse quality of life on the IIQ7 sum. CONCLUSIONS Among subjects with well-controlled diabetes and more comorbidities who underwent MUS there were few differences in postoperative voiding dysfunction or PVR compared to nondiabetic women. DM patients were more bothered at baseline by urge-related symptoms. Quality of life following sling surgery appears to be worse in patients with DM at 3 months based on IIQ7. This data suggests that diabetic women with lower HbA1C can be counseled similarly to these complication rates and voiding dysfunction after MUS.
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Affiliation(s)
- Doreen E Chung
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Danielle D Antosh
- Department of Obstetrics and Gynecology, Division of Urogynecology, Houston Methodist Hospital, Houston, Texas
| | - Denise Umpierrez
- Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia
| | - Zonia Barbosa
- Department of Pediatrics, BronxCare Health System, Bronx, New York
| | - Ladin Yurteri-Kaplan
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
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13
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Chung DE, Yurteri-Kaplan LA, Asatiani T, Brennand EA, Wang A, Grimes CL. Female Pelvic Medicine & Reconstructive Surgery (FPMRS) challenges on behalf of the collaborative research in pelvic surgery consortium (CoRPS): managing complicated cases series 2: management of urinary incontinence in a neurogenic patient. Int Urogynecol J 2018; 30:193-196. [PMID: 30406416 DOI: 10.1007/s00192-018-3806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022]
Abstract
Discussion and management of incontinence in a patient with spina bifida by four international experts followed by a literature review.
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Affiliation(s)
- Doreen E Chung
- Department of Urology, Columbia University Medical Center, 161 Fort Washington Avenue, Herbert Irving Pavilion-11th Floor, New York, NY, 10032, USA.
| | - Ladin A Yurteri-Kaplan
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Tengiz Asatiani
- Department of Reproductive Health, State Medical University, Tbilisi, Georgia
| | - Erin A Brennand
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Audrey Wang
- Department of Urology, The University of Sydney, Westmead Clinical School, Sydney, Australia
| | - Cara L Grimes
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
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Aisen CM, James M, Chung DE. The Impact of Teaching on Fundamental General Urologic Procedures: Do Residents Help or Hurt? Urology 2018; 121:44-50. [PMID: 30092301 DOI: 10.1016/j.urology.2018.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/06/2018] [Accepted: 05/29/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the effects of trainee involvement on fundamental urology procedures. METHODS Current Procedural Terminology codes were used to identify patients within the National Surgical Quality Improvement Program database who underwent a selection of fundamental general urology procedures (2005-2013). Operative time and perioperative complications (30-day) were compared between cases with and without trainee involvement. RESULTS 29,488 patients had general urology procedures with information regarding trainee involvement, 13,251 (44.9%) with trainee involvement, and 16,237 (55.1%) without. Overall patients who underwent procedures with trainee involvement were younger and had fewer comorbidities (Table 1). Trainee involvement showed significant increase in operative time in all procedures included in the study (Table 2). On multivariate analysis trainee involvement increased the risk of complications (Odds Ratio (OR) 1.61, 95% CI 1.45-1.78, P < .001). Other factors that increased the risk of complications were: American Society of Anesthesiologists (ASA) class 3-4 (OR 2.01, 95% CI 1.46-2.77, P < .001), partially or totally dependent functional status (OR 2.22, 95% CI 1.68-2.94, P < .001), diabetes mellitus (OR 1.21, 95% CI 1.05-1.39, P = .008), heart disease (OR 1.19, 95% CI 1.02-1.38, P = .027), and respiratory disease (OR 1.33, 95% CI 1.09-1.63, P = .027). CONCLUSION While trainees are valuable members of the urology team at teaching hospitals and training is necessary, their involvement in urologic surgery appears to increase operative time for all procedures and complications in certain procedures. Further research needs to be done on how to mitigate these effects while preserving surgical education quality.
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Affiliation(s)
- Carrie M Aisen
- Department of Urology, Columbia University, New York, NY.
| | - Maxwell James
- Department of Urology, Columbia University, New York, NY
| | - Doreen E Chung
- Department of Urology, Columbia University, New York, NY
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Asafu-Adjei D, Benson C, Thompson S, Chung DE, Li G, Rutman M, Kashanian J, Stember D, Stahl PJ. MP32-06 DELAY IN PENILE PROSTHESIS AND ARTIFICIAL URINARY SPHINCTER SURGERY FOLLOWING RADICAL PROSTATECTOMY: LESSONS FROM A STATEWIDE DATABASE. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Aisen CM, Ditkoff E, RoyChoudhury A, Corish M, Rutman MP, Chung DE, Badalato GM, Cooper KL. Utility of catheterized specimens in reducing overdiagnosis of urinary tract infections in women. Neurourol Urodyn 2018; 37:1996-2001. [PMID: 29603811 DOI: 10.1002/nau.23553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/13/2018] [Indexed: 02/04/2023]
Abstract
AIMS To evaluate the utility of catheterized samples in reducing overdiagnosis of UTI based on voided specimens among patients presenting with a range of urinary symptoms. We also aimed to determine variables that may modify the predictive value of the voided midstream urine culture. METHODS Patient charts were reviewed to identify female patients referred to our voiding dysfunction clinic with a range of complaints warranting urine studies (5/2014-8/2016). Patients with a positive voided urine culture who also had a catheterized urine culture in our system were included. Multiple logistic regression analysis was performed to identify patient characteristics associated with a negative catheterized specimen despite a positive voided specimen. RESULTS One hundred and seven women were included in the study. Eighty percent of the cohort was post-menopausal. Although all patients had positive voided specimens, only 53 (49.5%) had positive catheterized specimens. On multivariate analysis negative nitrites on clean catch UA was a significant predictor of a negative catheterized sample (adjusted OR 8.9, 95%CI 2.2-43.7, P = 0.003). WBC/HPF <10 on clean catch UA trended towards significance (adjusted OR 4.72, 95%CI 1.1-26.1, P = 0.05). CONCLUSIONS Relying on clean catch urine samples may lead to significant over-diagnosis of UTIs. Our study suggests that in female patients who have vague symptoms of UTI, obtaining catheterized specimens may be beneficial in avoiding the overdiagnosis of UTIs and the overuse of antibiotics. Larger, prospective studies testing our hypothesis are necessary, and would greatly assist in establishing clinical practices that reduce the amount of antibiotics inappropriately prescribed.
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Affiliation(s)
- Carrie M Aisen
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Erica Ditkoff
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Arindam RoyChoudhury
- Department of Biostatistics, Columbia Universi--ty Mailman School of Public Health, New York, New York
| | - Michele Corish
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Matthew P Rutman
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Doreen E Chung
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Gina M Badalato
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Kimberly L Cooper
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
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Manasherova D, Li G, Aisen CM, Chung DE. MP27-10 HOW DOES DIABETES AFFECT VOIDING DYSFUNCTION? A MATCHED PAIRS STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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James MB, Theofanides MC, Sui W, Onyeji I, Badalato GM, Chung DE. Sling Procedures for the Treatment of Stress Urinary Incontinence: Comparison of National Practice Patterns between Urologists and Gynecologists. J Urol 2017; 198:1386-1391. [DOI: 10.1016/j.juro.2017.06.093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Maxwell B. James
- Department of Urology, Columbia University Medical Center, New York, New York
| | | | - Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ifeanyi Onyeji
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Gina M. Badalato
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Doreen E. Chung
- Department of Urology, Columbia University Medical Center, New York, New York
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Aisen CM, Lipsky MJ, Tran H, Chung DE. Understanding Simple Cystectomy for Benign Disease: A Unique Patient Cohort With Significant Risks. Urology 2017; 110:239-243. [DOI: 10.1016/j.urology.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
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Aisen CM, Chung DE. Intravesical Botulinum Toxin for Neurogenic Bladder—Can We Just Irrigate the Bladder with Botulinumtoxin? Curr Bladder Dysfunct Rep 2017. [DOI: 10.1007/s11884-017-0446-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Pearce SM, Pariser JJ, Malik RD, Famakinwa OJ, Chung DE. Outcomes following Thulium vapoenucleation of large prostates. Int Braz J Urol 2017; 42:757-65. [PMID: 27564287 PMCID: PMC5006772 DOI: 10.1590/s1677-5538.ibju.2015.0424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/01/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Thulium laser VapoEnucleation of the prostate (ThuVEP) is an evolving surgical technique for BPH. Most studies have focused on outcomes in small to médium sized prostates and have originated from Europe and Asia. We sought to describe our experience with ThuVEP for very large prostates in a North American cohort. MATERIALS AND METHODS From December 2010 to October 2014, 25 men underwent Thu-VEP using the CyberTM® (Quantastem, Italy) thulium laser, all with prostate volume >75mL. Data collected included patient demographics, comorbidities, intraoperative parameters, complications, and post-operative outcomes including maximum flow rate (Qmax), post-void residual (PVR), International Prostate Symptom Score (IPSS), and quality of life score (QoL) in one year of follow-up. Statistical analysis was done using Wilcoxon signed-rank test. RESULTS At baseline, mean age was 70±9 years and prostate size was 163±62g. Most patients (84%) were in retention and 10 (40%) patients were on anticoagulation. Seven (28%) patients went home the day of surgery (mean hospital stay: 1.2±1.2d). There were 2 intraoperative complications (8%), both cystotomies related to morcellation. Nine patients (36%) experienced a complication, all within 30 days. There were no Clavien III complications. Significant improvements were seen in Qmax, PVR, IPSS, and QoL score at each time interval to 12-months following surgery (all p<0.05). Of 21 patients initially in retention, all were voiding at last follow-up. CONCLUSIONS Our findings suggest that ThuVEP is an effective treatment for BPH in patients with large prostates with sustained results for one year.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Joseph J Pariser
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Rena D Malik
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Olufenwa J Famakinwa
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Doreen E Chung
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA.,Department of Urology, Columbia University Medical Center, New York, NY, USA
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Theofanides MC, Onyeji I, Matulay J, Sui W, James M, Chung DE. Safety of Mesh for Vaginal Cystocele Repair: Analysis of National Patient Characteristics and Complications. J Urol 2017; 198:632-637. [PMID: 28396182 DOI: 10.1016/j.juro.2017.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The use of mesh in vaginal cystocele repair has decreased. We analyzed the ACS NSQIP® (American College of Surgeons National Surgical Quality Improvement Project) database to compare outcomes of repairs with and without mesh. MATERIALS AND METHODS CPT was used to identify patients who underwent cystocele repair with and without mesh from 2006 to 2013. Patient characteristics and complications were analyzed. RESULTS We identified 6,849 patients, of whom 5,667 (82.5%) underwent native tissue repair and 1,182 (17.5%) underwent repair with mesh. Patients who received mesh were older (mean ± SD age 64 ± 11 vs 60 ± 12 years, p <0.001) and more had comorbidities (56% vs 47%, p <0.001). Mean mesh vs nonmesh operative time (97 ± 67 vs 95 ± 53 minutes, p = 0.2) and mean length of stay (1.3 ± 2.4 vs 1.4 ± 1.3 days, p = 0.2) were similar in the 2 groups. Urinary tract infection was the most common complication in cases without vs with mesh (3.8% vs 3.5%). Mesh procedure rates of mortality (0% vs 0.3%, p = 0.04) and overall surgical complications (1.8% vs 3.9% p <0.001) were higher. On multivariate analysis ASA® class 3 or greater (OR 1.4, p = 0.01), longer operative time (OR 1.004, p <0.001) and mesh (OR 1.32, p = 0.05) were associated with greater morbidity. Patient comorbidities, surgeon specialty and concomitant procedures did not confer an increased risk of complications. CONCLUSIONS Native tissue repair is performed more commonly than mesh repair. ASA class, operative time and mesh use are associated with an increased risk of postoperative morbidity. These results suggest an increased risk of complications when using mesh in vaginal anterior repair, although the overall risk in each procedure was low.
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Affiliation(s)
| | - Ifeanyi Onyeji
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Justin Matulay
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Wilson Sui
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Maxwell James
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Doreen E Chung
- Department of Urology, Columbia University Medical Center, New York, New York.
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Malik RD, Cohn JA, Fedunok PA, Chung DE, Bales GT. Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence. Int Braz J Urol 2017; 42:327-33. [PMID: 27256187 PMCID: PMC4871394 DOI: 10.1590/s1677-5538.ibju.2014.0506] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/15/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose: Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity. Materials and Methods: 25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used. Results: Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74–0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4–186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3–161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3–72.1), p<0.001). Conclusions: 24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.
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Affiliation(s)
- Rena D Malik
- University of Chicago Medical Center, Chicago, IL, USA
| | - Joshua A Cohn
- University of Chicago Medical Center, Chicago, IL, USA
| | | | - Doreen E Chung
- University of Chicago Medical Center, Chicago, IL, USA.,Mount Sinai Hospital, Chicago, IL, USA
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Theofanides MC, Sui W, Sebesta EM, Onyeji I, Matulay JT, Chung DE. Vesicovaginal fistulas in the developed world: An analysis of disease characteristics, treatments, and complications of surgical repair using the ACS-NSQIP database. Neurourol Urodyn 2016; 36:1622-1628. [DOI: 10.1002/nau.23167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | - Wilson Sui
- Department of Urology; Columbia University Medical Center; New York New York
| | | | - Ifeanyi Onyeji
- Department of Urology; Columbia University Medical Center; New York New York
| | - Justin T. Matulay
- Department of Urology; Columbia University Medical Center; New York New York
| | - Doreen E. Chung
- Department of Urology; Columbia University Medical Center; New York New York
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Anderson BB, Pariser JJ, Pearce SM, Volsky JG, Bales GT, Chung DE. Safety and Efficacy of Retropubic Mid-urethral Sling Placement in Women Who Void With Valsalva. Urology 2016; 91:52-7. [DOI: 10.1016/j.urology.2016.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
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Velez M, Onyeji I, Matulay JT, Sui W, James M, Chung DE, Cooper KL, Rutman M, Badalato GM. PD02-11 PROCEDURES FOR PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE: A NATIONAL COMPARISON OF POST-OPERATIVE COMPLICATIONS BETWEEN UROLOGISTS AND GYNECOLOGISTS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Velez M, Matulay JT, RoyChoudhury A, Sui W, Cooper KL, Chung DE. PD01-09 UNDERSTANDING DETRUSOR CONTRACTION DURATION: WHAT ARE NORMAL PARAMETERS? AND WHAT ARE DETERMINING FACTORS? J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Onyeji I, Velez M, Sui W, James M, Matulay JT, Chung DE. MP10-13 SAFETY OF MESH USE IN VAGINAL CYSTOCELE REPAIR: ANALYSIS OF NATIONAL PATIENT CHARACTERISTICS AND COMPLICATIONS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Barbalat Y, Velez MC, Sayegh CI, Chung DE. Evidence of the efficacy and safety of the thulium laser in the treatment of men with benign prostatic obstruction. Ther Adv Urol 2016; 8:181-91. [PMID: 27247628 DOI: 10.1177/1756287216632429] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2005, the high power thulium laser was introduced for the surgical treatment of benign prostatic obstruction. It has several properties that confer theoretical advantages over other lasers used for the same indication, such as technical versatility and a relatively small zone of thermal damage. Studies using the 70-150 W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications even in higher risk patients. Different techniques have been employed to treat the prostate with this technology, including enucleation, vapoenucleation, vaporization and resection. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP and holmium laser enucleation of prostate (HoLEP). In this review we discuss the current literature on the safety and efficacy of various thulium techniques for the treatment of benign prostatic hyperplasia and examine comparative studies.
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Affiliation(s)
- Yana Barbalat
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Doreen E Chung
- Columbia University Medical Center, 161 Fort Washington Avenue, HIP 11th Floor, New York, NY 10032, USA
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Pariser JJ, Famakinwa OJ, Pearce SM, Chung DE. High-power thulium laser vaporization of the prostate: short-term outcomes of safety and effectiveness. J Endourol 2014; 28:1357-62. [PMID: 24936718 DOI: 10.1089/end.2014.0336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The thulium laser was introduced in 2005 for the treatment of benign prostatic hyperplasia (BPH). Enucleation studies from outside North America show comparable efficacy and lower morbidity to transurethral resection of the prostate. A few studies exist describing outcomes of vaporization, the most commonly used technique for urologists. We present our 3-month outcomes of thulium laser vaporization of the prostate (ThuVP). MATERIALS AND METHODS From December 2010 to October 2013, 68 men underwent ThuVP using the 150 W CyberTM(®). Data were collected on demographics, comorbidities, intraoperative measures, complications, serum parameters, maximum flow rate (Qmax), postvoid residual (PVR), International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, and prostate-specific antigen. Patients were evaluated at 1 week, 1 month, and 3 months postoperatively. Nine patients were excluded for known prostate cancer. RESULTS The mean age was 66±10 years, with a mean prostate size of 57±30 mL. At baseline, the mean IPSS was 19.9±8.0, QoL score was 4.5±1.1, Qmax was 5.2±4.5 mL/sec, and PVR was 220±397 mL. The mean laser time was 35±18 minutes, and energy used was 234±139 kJ. Forty-seven (78%) patients were discharged the day of surgery. No blood transfusions were administered with a mean drop in hemoglobin of 0.7±0.8 g/dL (p<0.05). There were no Clavien grade≥III complications within 30 days of surgery. Six (10%) patients were diagnosed with urinary tract infection. Significant improvements from baseline were seen in Qmax, PVR, IPSS, and QoL score. All 15 patients who were in retention were voiding at the last follow-up. CONCLUSIONS Thulium laser vaporization of the prostate appears to be a safe and effective outpatient technique for the treatment of BPH with durable outcomes at 3 months.
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Affiliation(s)
- Doreen E Chung
- Section of Urology, Department of Surgery, The University of Chicago, Chicago, IL
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Malik RD, Cohn JA, Chang C, Anderson L, Randall B, Bales GT, Chung DE. MP76-19 A MODERN COMPARISON OF URODYNAMIC FINDINGS IN NONDIABETIC VERSUS DIABETIC FEMALES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chung DE, Dillon B, Kurta J, Maschino A, Cronin A, Sandhu JS. Detrusor underactivity is prevalent after radical prostatectomy: A urodynamic study including risk factors. Can Urol Assoc J 2013; 7:E33-7. [PMID: 22277630 DOI: 10.5489/cuaj.11038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population. METHODS Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation. RESULTS Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009). CONCLUSIONS Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.
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Affiliation(s)
- Doreen E Chung
- Sidney Kimmel Center for Prostate and Urologic Cancers, Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; ; Section of Urology, University of Chicago Mount Sinai Hospital, Chicago, IL
| | - Benjamin Dillon
- Department of Urology, The Mount Sinai Medical Center, New York, NY
| | - Jordan Kurta
- Department of Urology, The University of Tennessee Health Sciences Center, Memphis, TN
| | - Alexandra Maschino
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Angel Cronin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jaspreet S Sandhu
- Sidney Kimmel Center for Prostate and Urologic Cancers, Division of Urology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; ; James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York, NY
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Chung DE, Dillon B, Kurta J, Maschino A, Sandhu JS. Detrusor underactivity is prevalent after radical prostatectomy: A urodynamic study including risk factors. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.192] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population.Methods: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation.Results: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009).Conclusions: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.
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Mollberg NM, Johnson NB, Ying SC, Abdelhady K, Massad MG, Chung DE. Occult infiltrating bi-ventricular papillary renal cell carcinoma metastasis found during coronary artery bypass graft surgery. Can Urol Assoc J 2012. [DOI: 10.5489/cuaj.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metastatic papillary renal cell carcinoma (RCC) to the heart has never been reported. We report the case of a 73-year-old patient with papillary RCC metastatic to the left and right ventricles, found during a triple vessel coronary artery bypass graft surgery
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Kaplan SA, Chung DE, Lee RK, Scofield S, Te AE. A 5-year retrospective analysis of 5α-reductase inhibitors in men with benign prostatic hyperplasia: finasteride has comparable urinary symptom efficacy and prostate volume reduction, but less sexual side effects and breast complications than dutasteride. Int J Clin Pract 2012; 66:1052-5. [PMID: 23067029 DOI: 10.1111/j.1742-1241.2012.03010.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We evaluated 5-year safety, efficacy and prostate volume data from BPH patients treated with finasteride or dutasteride. METHODS A retrospective analysis of 378 consecutive men treated with 5α-reductase inhibitor monotherapy between January 2004 and September 2009 (197 on finasteride and 211 on dutasteride) in a single clinic was performed. Efficacy assessments included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), postvoid residual urine volume (PVR), prostate-specific antigen (PSA) and prostate volume (PV). Safety assessments included International Index of Erectile Function (IIEF) and adverse events. Patients were evaluated at 3 months, 1 year and yearly thereafter. RESULTS Mean age of the group was 58.7 ± 6.7 years. Maintenance of therapy at 5 years was 57.4% and 42.5% for the finasteride and dutasteride groups respectively. Changes in IPSS, Qmax, PVR, PV and PSA were similar for both groups at 5 years. The incidence of erectile dysfunction, ejaculatory dysfunction and decreased libido resulting in discontinuation from therapy was significantly (p < 0.01) higher in the dutasteride (5.1%, 2.4%, 2.7% respectively) compared with the finasteride (2.1%, 1.8%, 1.4% respectively) group. In addition, the incidence of self-reported breast tenderness and/or enlargement was significantly (p < 0.01) greater in the dutasteride (3.5%) compared with the finasteride (1.2%) group. CONCLUSIONS In this retrospective analysis of data from consecutive patients treated at a single clinic, both finasteride and dutasteride were effective therapies for the management of lower urinary tract symptoms. However, dutasteride resulted in significantly more sexual side effects and breast complications than finasteride.
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Affiliation(s)
- S A Kaplan
- Weill Cornell Medical College, Cornell University, New York, 10065 NY, USA.
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Kaplan SA, Lee RK, Chung DE, Te AE, Scherr DS, Tewari A, Vaughan ED. Prostate biopsy in response to a change in nadir prostate specific antigen of 0.4 ng/ml after treatment with 5α-reductase inhibitors markedly enhances the detection rate of prostate cancer. J Urol 2012; 188:757-61. [PMID: 22818135 DOI: 10.1016/j.juro.2012.04.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE We examined the effect of 5α-reductase inhibitor therapy on prostate cancer detection in men with persistently increased or fluctuating prostate specific antigen and prior negative prostate cancer biopsy. MATERIALS AND METHODS A total of 276 men with prostate specific antigen greater than 4 ng/ml (208) or a prostate specific antigen velocity change of 0.75 ng/ml (68) and a normal digital rectal examination who had previously undergone biopsy a minimum of 2 times with prostate cancer not detected were given 5 mg finasteride (154) or dutasteride (122) daily. In phase 1, 97 patients had prostate specific antigen measured at 6 and 12 months with repeat transrectal ultrasonography and biopsy (12 cores) performed at 1 year. In phase 2, 179 patients underwent biopsy triggered by a change in nadir prostate specific antigen of more than 0.4 ng/ml. RESULTS In phase 1 at 1 year prostate specific antigen had decreased by 2.4 ng/ml (-46.7%), and prostate volume had decreased 7.1 ml (-17.9%). Prostate cancer was detected in 27 of 97 (27.8%) patients and the mean minimum prostate specific antigen velocity from a nadir of 0.4 ng/ml was 0.6 ng/ml. In phase 2, 48 of 179 (26.8%) men underwent repeat biopsy at a mean of 14.6 months. Of these 48 men 26 (54.1%) were found to have prostate cancer. Of the 26 men in whom prostate cancer was detected 20 (76.9%) were found to have Gleason score 7 or greater disease. CONCLUSIONS The magnitude of change in serum prostate specific antigen after 5α-reductase inhibitor therapy may be useful in diagnosing prostate cancer in patients with persistently increased or fluctuating prostate specific antigen and prior negative prostate biopsy.
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Affiliation(s)
- Steven A Kaplan
- Weill Cornell Medical College, Cornell University, New York, New York 10021, USA
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Mollberg NM, Johnson NB, Ying SC, Abdelhady K, Massad MG, Chung DE. Occult infiltrating bi-ventricular papillary renal cell carcinoma metastasis found during coronary artery bypass graft surgery. Can Urol Assoc J 2012; 6:E54-6. [PMID: 22511433 DOI: 10.5489/cuaj.11144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metastatic papillary renal cell carcinoma (RCC) to the heart has never been reported. We report the case of a 73-year-old patient with papillary RCC metastatic to the left and right ventricles, found during a triple vessel coronary artery bypass graft surgery.
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Affiliation(s)
- Nathan M Mollberg
- Department of Surgery, Divisions of General Surgery, University of Illinois at Mount Sinai Hospital, Chicago, IL., USA.
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Abstract
Traditionally, the gold standard for treatment of BPH has been the electrocautery-based TransUrethral Resection of the Prostate (TURP). However, the number of laser techniques being performed is rapidly increasing. Potential advantages of laser therapy over traditional TURP include decreased morbidity and shorter hospital stay. There are several techniques for laser prostatectomy that continue to evolve. The main competing techniques are currently the Holmium Laser Enucleation of the Prostate (HoLEP) and the 80W 532nm laser prostatectomy. The HoLEP, using the Holmium:YAG laser, has been shown to have clinical results similar to TURP and is suitable for patients on anticoagulation as well as those with large prostates. Disadvantages of this technique are the high learning curve and requirement of a morcellator. When used to treat BPH, studies have demonstrated that, like the HoLEP, the 80W KTP laser is safe and effective in patients with large prostates and in those taking oral anticoagulation. Several studies have compared these two techniques to TURP. Frequently reported advantages of the HoLEP over the 80W laser prostatectomy are the availability after the procedure of a pathology specimen and ability to remove a higher percentage of prostate tissue during resection. However, the transurethral laser enucleation of the prostate addresses these concerns and has shown to have durable outcomes at 2-year follow-up. Two new laser systems and techniques, the thulium laser and the 980nm laser, have emerged recently. However, clinical data from these procedures are in their infancy and large long-term studies are required.
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Affiliation(s)
- Doreen E Chung
- Fellow In Voiding Dysfunction, Department of Urology, Weill Cornell Medical College, 1300 York Ave, Box 261, Suite F9 West, New York, NY 10065, USA
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Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE. Outcomes and Complications After 532 nm Laser Prostatectomy in Anticoagulated Patients With Benign Prostatic Hyperplasia. J Urol 2011; 186:977-81. [DOI: 10.1016/j.juro.2011.04.068] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Doreen E. Chung
- Section of Urology, University of Chicago and Department of Surgery, Mount Sinai Hospital, Chicago, Illinois
| | - James S. Wysock
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Richard K. Lee
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Scott R. Melamed
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Steven A. Kaplan
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Alexis E. Te
- Brady Prostate Center, Weill Cornell Medical College, Cornell University, New York, New York
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Abstract
Lower urinary tract symptoms (LUTS), overactive bladder, (OAB), and benign prostatic hyperplasia (BPH) are very commonly experienced in men. The mainstay of pharmacotherapy for OAB is the antimuscarinic class of drugs. There has been reluctance to prescribe these agents to men with BPH due to the risk of precipitating urinary retention. Several trials have supported the efficacy and safety of antimuscarinics in treating men with LUTS, alone, or in combination with α-blocker therapy. The combination of 5-α-reductase inhibitors with antimuscarinic agents or surgery are other effective treatments for men with BPH and OAB.
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Affiliation(s)
- Doreen E Chung
- Mount Sinai Hospital, University of Chicago, IL 60608, USA
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Abstract
Xanthogranulomatous inflammation is a benign condition characterized by the presence of multinucleated giant cells, chronic inflammatory cells and lipid-laden macrophages, known as xanthoma cells. Only 22 cases of xanthogranulomatous cystitis (XGC) have been reported in the Japanese and English literature. In this report, we describe the twenty-third case of XGC and the third case associated with inflammatory bowel disease (IBD). A 50-year-old woman with quiescent Crohn's disease was incidentally found to have a bladder mass on ultrasound. The lesion was resected through a transurethral approach. Pathology demonstrated XGC. At 3 months post-resection, there was no evidence of recurrence adjacent to the previous resection scar.
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Affiliation(s)
- Doreen E Chung
- Clinical Assistant Professor, Section of Urology, The University of Chicago, Chicago, IL
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Chung DE, Kaplan SA. Current role for combination therapy in male LUTS. ARCH ESP UROL 2010; 63:323-332. [PMID: 20587837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Treatment of Lower Urinary Tract Symptoms (LUTS) from Benign Prostatic Hyperplasia (BPH) has evolved from surgical therapy to medical monotherapy to combination therapy. First-line medical therapy for men with LUTS remains agents that decrease outlet resistance: alpha-adrenergic antagonists and 5alpha-reductase inhibitors. Alpha-adrenergic agents decrease smooth muscle tone in the prostate and bladder neck. The mechanism of action of 5alpha-reductase inhibitors is reduction in prostate volume. First-line therapy for OAB symptoms are antimuscarinic agents. There has been reluctance to prescribe these agents to men with BPH due to the perceived risk of precipitating urinary retention. Alpha-adrenergic antagonists, 5alpha-reductase inhibitors, and antimuscarinic agents have all been shown to be safe and effective when administered to men with BPH and LUTS. The combination of 5alpha-reductase inhibitors with alpha-adrenergic antagonists is effective in men with LUTS secondary to BPH. The combination of alpha-adrenergic antagonists plus antimuscarinic agents and the combination of 5alpha-reductase inhibitors with antimuscarinic agents are safe and effective in patients with LUTS, evidence of BPH, and OAB symptoms. At present only combination therapy with 5alpha-reductase inhibitors with alpha-adrenergic antagonists is recommended in clinical practice guidelines. MTOPS and ComBAT have demonstrated superiority of combination therapy over monotherapy in preventing disease progression. Further studies are required to elucidate which specific patient population benefits most from particular combination therapies.
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Affiliation(s)
- Doreen E Chung
- Weill Cornell Medical College & Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Chung DE, Purohit RS, Girshman J, Blaivas JG. Urethral Diverticula in Women: Discrepancies Between Magnetic Resonance Imaging and Surgical Findings. J Urol 2010; 183:2265-9. [DOI: 10.1016/j.juro.2010.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Doreen E. Chung
- Department of Urology, Weill Medical College of Cornell University, New York, New York
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Rajveer S. Purohit
- Department of Urology, Weill Medical College of Cornell University, New York, New York
| | | | - Jerry G. Blaivas
- Department of Urology, Weill Medical College of Cornell University, New York, New York
- State University of New York Downstate Medical Center, New York, New York
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Chung DE, Najari BB, Lee RK, Kaplan SA, Te AE. 1620 URODYNAMIC FINDINGS IN PATIENTS WITH DIABETES MELLITUS AND LOWER URINARY TRACT SYMPTOMS. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kaplan S, Lee R, Chung DE, Scherr D, Te A, Vaughan ED. 1991 PROSTATE BIOPSY AFTER TREATMENT WITH 5-ALPHA REDUCTASE INHIBITORS MARKEDLY ENHANCES PROSTATE CANCER DETECTION. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chung DE, Wysock JS, Tan GY, Li PS, Melamed SR, Lee RK, Te AE. V1401 HEMOSTATIC TECHNIQUES WITH THE 532 NM LASER FOR PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE FOR THE TREATMENT OF SYMPTOMATIC BPH. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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