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Kobashi KC. Kathleen C. Kobashi, MD, MBA, FACS. Urol Pract 2023; 10:217. [PMID: 37103514 DOI: 10.1097/upj.0000000000000395] [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: 04/28/2023]
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Kobashi KC, Vasavada S, Bloschichak A, Hermanson L, Kaczmarek J, Kim SK, Kirkby E, Varela N, Malik R. Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023). J Urol 2023; 209:1091-1098. [PMID: 37096580 DOI: 10.1097/ju.0000000000003435] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE The purpose of this guideline is to provide a clinical structure with which to approach the diagnosis, counseling, and treatment of female patients with stress urinary incontinence (SUI). MATERIALS/METHODS The primary source of evidence for the 2017 version of the SUI guideline was the systematic literature review conducted by the ECRI Institute. The initial search spanned literature from January 2005 to December 2015, with an additional updated abstract search through September 2016. The current amendment represents the first update to the 2017 iteration and includes updated literature published through February 2022. RESULTS This guideline has been amended to reflect changes in and additions to the literature since 2017. The Panel maintained that the differentiation between index and non-index patients remained important. The index patient is a healthy female with minimal or no prolapse who desires surgical therapy for treatment of pure SUI or stress-predominant mixed urinary incontinence. Non-index patients have factors that may affect their treatment options and outcomes, such as high grade prolapse (grade 3 or 4), urgency-predominant mixed incontinence, neurogenic lower urinary tract dysfunction, incomplete bladder emptying, dysfunctional voiding, SUI following anti-incontinence treatment, mesh complications, high body mass index, or advanced age. CONCLUSION While gains have been made in the field to support new methods for the diagnosis, treatment, and follow-up of patients with SUI, the field continues to expand. As such, future reviews of this guideline will take place to stay in keeping with the highest levels of patient care.
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Affiliation(s)
| | | | | | | | | | - Sennett K Kim
- American Urological Association, Linthicum, Maryland
| | - Erin Kirkby
- American Urological Association, Linthicum, Maryland
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Kreshover JE, Vanni AJ, Sternberg KM, Bhojani N, Kobashi KC. Urological Education in United States Medical Schools: Where Are We Now and How Can We Do Better? Urol Pract 2022; 9:581-586. [PMID: 37145808 DOI: 10.1097/upj.0000000000000336] [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: 03/21/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION While urological complaints increase in aging populations and conditions commonly require management by multiple physician specialty types, exposure to formal urological education in United States medical schools is limited and has been decreasing over time. We aim to update the current status of urological education in the United States curriculum and delve further into the subject matter being taught and the type and timing of this education. METHODS An 11-question survey was developed to describe the current status of urological education. The survey was distributed using Survey Monkey to the American Urological Association's medical student listserv in November 2021. Descriptive statistics were used to summarize survey findings. RESULTS Of 879 invitations sent, 173 responded (20%). Most (112/173, 65%) of respondents were in their fourth year. Only 4 (2%) reported that their school had a required clinical urology rotation. Kidney stones (98%) and urinary tract infections (100%) were the most frequent topics taught. The least exposure included infertility (20%), urological emergencies (19%), bladder drainage (17%), and erectile dysfunction (13%). Videos and case vignettes were the preferred learning modalities and the majority (84%) of respondents were familiar with the American Urological Association's medical student curriculum material. CONCLUSIONS The majority of United States medical schools do not have a required clinical urology rotation and some core urological topics are not taught at all. Future incorporation of urological educational material through video and case vignette learning may be the best opportunity to provide exposure to clinical topics that will commonly be encountered regardless of chosen medical discipline.
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Affiliation(s)
| | - Alex J Vanni
- Lahey Hospital and Medical Center, Burlington, Vermont
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Donahue RP, Stamm AW, Daily AM, Kozlowski PM, Porter CR, Govier FE, Cowan NG, Lucioni A, Kuhr CS, Kobashi KC, Hanson NA, Corman JM, Lee UJ. Opioid-Limiting Pain Control After Transurethral Resection of the Prostate: A Randomized Controlled Trial. Urology 2022; 166:202-208. [PMID: 35314185 DOI: 10.1016/j.urology.2022.03.010] [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] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess whether a multimodal opioid-limiting protocol and patient education intervention can reduce postoperative opioid use following transurethral resection of the prostate. METHODS This prospective, non-blinded, single-institution, randomized controlled trial (NCT04102566) assigned 50 patients undergoing a transurethral resection of the prostate to either a standard of care control (SOC) or multimodal experimental group (MMG). The intervention included adding ibuprofen to the postoperative pain regimen, promoting appropriate opioid use while hospitalized, an educational intervention, and discharging without opioid prescription. Data regarding demographics, operative data, opioid use, pain scores, and patient satisfaction were compared. RESULTS A total of 47 patients were included, n = 23 (MMG) and n = 24 (SOC). Demographic and operative findings were similar. Statistical analysis for noninferiority demonstrated non-inferior inpatient pain control (mean pain score 2.5 MMG vs 2.4 SOC, P = 0.0003). The multimodal group used significantly fewer morphine milligram equivalents after discharge (0 vs 4.1, P = 0.04). Inpatient use was reduced but did not reach statistical significance (6.0 vs 9.8, P = 0.2). Mean satisfaction scores with pain control were similar (9.6 MMG vs 9.2 SOC, P = 0.32). No opioid prescriptions were requested after discharge. Adverse events and medication side effects were infrequent and largely similar between groups. CONCLUSION Implementation of an opioid-limiting postoperative pain protocol and patient education resulted in no outpatient opioid use while maintaining patient satisfaction with pain control. Eliminating opioids following a common urologic procedure will decrease risk of opioid-related adverse events and have a positive downstream impact.
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Affiliation(s)
- Ryan P Donahue
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Andrew W Stamm
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Adam M Daily
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Paul M Kozlowski
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Christopher R Porter
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Fred E Govier
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Nicholas G Cowan
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Christian S Kuhr
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Neil A Hanson
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN
| | - John M Corman
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA.
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Vasavada SP, Ginsberg DA, Quentin Clemens J, Kobashi KC, Dmochowski RR. Editorial. Neurourol Urodyn 2022. [DOI: 10.1002/nau.24929] [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: 11/10/2022]
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Gonzalez G, Dallas K, Arora A, Kobashi KC, Anger JT. Underrepresentation of Racial and Ethnic Diversity in Research Informing the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Stress Urinary Incontinence Guideline. Urology 2021; 163:16-21. [PMID: 34536408 DOI: 10.1016/j.urology.2021.08.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/16/2021] [Accepted: 08/27/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To characterize the racial/ethnic representation in the studies used in the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction stress urinary incontinence guideline. METHODS Cited studies were reviewed using inclusion and exclusion criteria. The inclusion criteria focused on United States literature to allow for demographic comparison with census data. To compare the racial representation in a study to the diversity in the surrounding city, we calculated the differences between county census data and the study race reported data and performed regression analyses. RESULTS Eighty-seven cited studies were reviewed, of which 33 were excluded and 52 studies were further evaluated. Seventeen studies were US studies, nine of which reported race. Eighty percent of the women included in the 9 studies were non-Hispanic white women. A diverse geographic region did not correlate with increased study enrollment of non-White patients. CONCLUSION The majority of cited studies used to develop the stress urinary incontinence management guidelines did not report the race/ethnicity of participants. Among those studies that did, Asian, Black, and Hispanic women were included at lower rates than non-Hispanic white women, identifying an area of opportunity to improve research recruitment and promote health equity. Non-Hispanic women were consistently overrepresented while other women were either under-represented or completely excluded.
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Affiliation(s)
- Gabriela Gonzalez
- Department of Urology, University of California, Davis School of Medicine, Sacramento, CA
| | - Kai Dallas
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Aman Arora
- University of California, Davis School of Medicine, Sacramento, CA
| | | | - Jennifer T Anger
- Department of Urology, University of California, San Diego School of Medicine, La Jolla, CA.
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Vasavada SP, Ginsberg DA, Clemens JQ, Kobashi KC, Dmochowski RR. Editorial. Neurourol Urodyn 2021; 40 Suppl 1:S5. [PMID: 33792950 DOI: 10.1002/nau.24639] [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: 11/06/2022]
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Lee UJ, Ward JB, Feinstein L, Matlaga BR, Martinez-Miller E, Bavendam T, Kirkali Z, Kobashi KC. National Trends in Neuromodulation for Urinary Incontinence Among Insured Adult Women and Men, 2004-2013: The Urologic Diseases in America Project. Urology 2020; 150:86-91. [PMID: 33296698 DOI: 10.1016/j.urology.2020.11.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine US trends in neuromodulation for urinary incontinence (UI) treatment from 2004 to 2013. METHODS This study utilized 2 data sources: the Optum© de-identified Clinformatics® Data Mart Database for privately insured adults aged 18-64 years with a UI diagnosis (N≈40,000 women and men annually) and the Medicare 5% Sample for beneficiaries aged ≥65 years with a UI diagnosis (N≈65,000 women and men annually). We created annual cross-sectional cohorts and assessed prevalence of UI-related neuromodulation procedures among men and women separately from 2004 to 2013. Analyses were conducted overall and stratified by age, race/ethnicity, and geographic region. RESULTS Nearly all neuromodulation procedures occurred in outpatient settings. Sacral neuromodulation (SNM) procedures for UI in both women and men grew steadily from 2004 to 2013, with more procedures performed in women than men. Among women with UI, SNM prevalence grew from 0.1%-0.2% in 2004 to 0.5%-0.6% in 2013. Posterior tibial nerve stimulation (PTNS) experienced growth from 2011 to 2013. Chemodenervation of the bladder with onabotulinumtoxinA (BTX) combined with other injectable procedures (including urethral bulking) remained stable over time. CONCLUSIONS From 2004 to 2013, SNM procedures remained relatively uncommon but increased consistently. PTNS experienced growth starting in 2011 when PTNS-specific insurance claims became available. BTX trends remain unclear; future studies should assess it separately from other injectable procedures. Neuromodulation has a growing role in UI treatment, and ongoing trends will be important to examine.
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Affiliation(s)
- Una J Lee
- Section of Urology, Virginia Mason Medical Center, Seattle, WA
| | | | | | - Brian R Matlaga
- Johns Hopkins Brady Urological Institute, Department of Urology, Baltimore, MD
| | | | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Uberoi P, Lee W, Lucioni A, Kobashi KC, Berry DL, Lee UJ. Listening to Women: A Qualitative Analysis of Experiences after Complications from Mesh Mid-urethral Sling Surgery. Urology 2020; 148:106-112. [PMID: 33197484 DOI: 10.1016/j.urology.2020.11.006] [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] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To gain a detailed understanding of women's experiences after undergoing revision surgery for mesh mid-urethral sling (MUS) complications, qualitatively organize those experiences, and present insights as potential springboards for future research. METHODS We conducted a series of semistructured focus groups and interviews of patients who had undergone mesh MUS revision surgery at a single tertiary referral institution. Discussions were recorded, transcribed, de-identified, and analyzed using deductive and inductive content analysis. Two researchers independently performed line-by-line coding and 2 additional researchers reviewed the codes and transcripts as an audit. RESULTS Nineteen women participated in the study. Complications from mesh MUS surgery impacted participants psychologically, socially, sexually, and physically. Participants recounted that risks and alternatives to MUS surgery were understated during the informed consent process whereas benefits were overstated. Participants shared insights into negative and positive ways surgeons responded to postoperative complications and how their experiences impacted the patient-surgeon relationship. CONCLUSION The impact of complications from mesh MUS surgery is broad and can involve multiple domains of a woman's life. Improved pre-operative patient preparedness, empathetic response toward patients who present with complications, prompt referral to surgeons with experience in mesh MUS complications and multidisciplinary care will likely improve the patient experience and can serve as foci for future studies.
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Affiliation(s)
- Pansy Uberoi
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA.
| | - Wai Lee
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Alvaro Lucioni
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Kathleen C Kobashi
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
| | - Una J Lee
- Female Pelvic Medicine and Reconstructive Surgery, Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
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Shoureshi PS, Lee W, Kobashi KC, Sajadi KP. Media coverage of the 2019 United States Food and Drug Administration ordered withdrawal of vaginal mesh products for pelvic organ prolapse. Int Urogynecol J 2020; 32:375-379. [PMID: 32601782 DOI: 10.1007/s00192-020-04401-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/18/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS On April 16, 2019, the United States Food and Drug Administration announced a withdrawal on sales and distribution of transvaginal mesh products for pelvic organ prolapse. The aim of this study was to asses online user behavior on pelvic-mesh related articles after the withdrawal and to evaluate article accuracy. MATERIALS AND METHODS We used Google Trends© to identify the terms related to pelvic mesh that experienced increased activity after the FDA announcement. The terms were analyzed for worldwide social media engagement (Facebook, Twitter, Pinterest, and Reddit) between April 16-19, 2019. The top ten lay press articles shared for each term were evaluated. We also examined the top ten Google search results for each term on June 6, 2019, in the US to evaluate what information was available after peak interest subsided. RESULTS During peak activity in April, 30 unique articles were identified after the FDA announcement. Two (6.7%) did not mention the April 2019 FDA announcement. Seven (23%) discussed mesh for stress urinary incontinence. After peak interest on June 6, 2019, Google identified 26 unique articles for the four terms. Seven (27%) did not mention the FDA announcement, and 3 (12%) mentioned mesh for incontinence. CONCLUSIONS Internet search patterns and social media behavior following the April 2019 ordered withdrawal on transvaginal mesh for pelvic organ prolapse reveal that some of the most disseminated information did not accurately or thoroughly distinguish the type of mesh discussed. This could lead to negative consequences for other mesh indications in female pelvic medicine and reconstructive surgery.
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Affiliation(s)
- Poone S Shoureshi
- Department of Urology, Oregon Health and Science University, 3303 S.W. Bond Avenue, Mail Code CH10U, Portland, OR, 97939, USA.
| | - Wai Lee
- Department of Urology, Virginia Mason Medical Center, Seattle, WA, USA
| | | | - Kamran P Sajadi
- Department of Urology, Oregon Health and Science University, 3303 S.W. Bond Avenue, Mail Code CH10U, Portland, OR, 97939, USA
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Du C, Lee W, Moskowitz D, Lucioni A, Kobashi KC, Lee UJ. I leaked, then I Reddit: experiences and insight shared on urinary incontinence by Reddit users. Int Urogynecol J 2019; 31:243-248. [DOI: 10.1007/s00192-019-04165-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
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Blau EK, Adelstein SA, Amin KA, Durfy SJ, Lucioni A, Kobashi KC, Lee UJ. Tobacco use, immunosuppressive, chronic pain, and psychiatric conditions are prevalent in women with symptomatic mesh complications undergoing mesh removal surgery. Investig Clin Urol 2019; 61:S57-S63. [PMID: 32055755 PMCID: PMC7004833 DOI: 10.4111/icu.2020.61.s1.s57] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/13/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To identify demographic and clinical characteristics of patients with symptomatic pelvic floor mesh complications who underwent mesh removal at our academic medical center. The secondary goal was to determine patient-reported outcomes after mesh removal. Materials and Methods We conducted a retrospective review of consecutive patients from 2011-2016 undergoing removal of mesh graft for treatment of symptomatic mesh-related complications. Patient demographics, comorbidities, symptoms, and mesh factors were evaluated. Outcomes after explant were determined by the Patient Global Impression of Improvement and a Likert satisfaction scale. Results One hundred fifty-six symptomatic patients underwent complete or partial pelvic floor mesh removal during the study period. Mid-urethral slings comprised 86% of explanted mesh grafts. Mesh exposure or erosion was identified in 72% of patients. Eighty-one percent of patients presented with pain, and 35% reported pain in the absence of exposure or erosion. Pre-operative comorbidities included psychiatric disease (54.5%), chronic pain (34.0%), irritable bowel syndrome (20.5%) and fibromyalgia (9.6%). Forty-three percent of patients reported current or past tobacco use. At mean follow-up of 14 months, 68% of responding patients reported improvement on the Patient Global Impression of Improvement after surgery. Conclusions This research identified tobacco use, and psychiatric, immunosuppressive, and chronic pain conditions as prevalent in this cohort of patients undergoing mesh removal. Surgical removal can improve presenting symptoms, including for patients with pain in the absence of other indications.
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Affiliation(s)
- Elliot K Blau
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sarah A Adelstein
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Katherine A Amin
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Sharon J Durfy
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
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Affiliation(s)
- Gamal M Ghoniem
- Pelvic Reconstructive Surgery and Voiding Dysfunction, Department of Urology, University of California (UC) Irvine Health, Orange, CA, USA
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
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Adelstein SA, Lee W, Gioia K, Moskowitz D, Stamnes K, Lucioni A, Kobashi KC, Lee UJ. Outcomes in a contemporary cohort undergoing sacral neuromodulation using optimized lead placement technique. Neurourol Urodyn 2019; 38:1595-1601. [DOI: 10.1002/nau.24018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - Wai Lee
- Virginia Mason, Section of Urology and Renal TransplantationSeattle Washington
| | - Kevin Gioia
- Hackensack Meridian Health GroupRumson New Jersey
| | - Dena Moskowitz
- Department of UrologyUniversity of California IrvineIrvine California
| | - Kelsey Stamnes
- Virginia Mason, Section of Urology and Renal TransplantationSeattle Washington
| | - Alvaro Lucioni
- Virginia Mason, Section of Urology and Renal TransplantationSeattle Washington
| | - Kathleen C. Kobashi
- Virginia Mason, Section of Urology and Renal TransplantationSeattle Washington
| | - Una J. Lee
- Virginia Mason, Section of Urology and Renal TransplantationSeattle Washington
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Moskowitz D, Adelstein SA, Lucioni A, Kobashi KC, Lee UJ. Practice patterns in the diagnosis and treatment of fecal incontinence with sacral neuromodulation: Can urologists impact this gap in care? Turk J Urol 2019; 45:37-41. [PMID: 30668308 DOI: 10.5152/tud.2018.94041] [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] [Received: 06/30/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The prevalence of fecal incontinence (FI) is 8% in the United States. Many patients will not seek treatment and the condition is underdiagnosed. Sacral neuromodulation (SNM) is effective in treating FI, and so urologists can play a key role in its treatment. We examine the practice patterns and treatment of FI with SNM in our institution. MATERIAL AND METHODS The electronic medical record was queried for the proportion of patients seen for FI in the institution, the urology department, and among the female pelvic medicine and reconstructive surgery (FPMRS) urologists. The patients who underwent SNM for FI were evaluated for progression to second stage procedure. RESULTS The proportion of patients seen for FI is 0.96% in the institution as a whole, 7.9% in the urology department, and 17.9% among FPMRS urologists. Fourteen patients underwent first stage SNM for FI or dual urinary/fecal incontinence, and they all progressed to a second stage procedure. Thirteen of these were performed by FPMRS urologists. CONCLUSION In our institution, the proportion of patients seen for FI was lower than the prevalence of this condition. Because patients with urinary incontinence are more likely to have FI, urologists are in a unique position to identify these patients and offer treatment that can improve their quality of life. We acknowledge a gap in care of the patients with FI and an opportunity for urologists to help patients with this devastating yet treatable condition.
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Affiliation(s)
- Dena Moskowitz
- Department of Urology, University of California Irvine, Orange, CA, USA
| | - Sarah A Adelstein
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
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Moskowitz D, Gioia KT, Wolff EM, Massman JD, Lucioni A, Kobashi KC, Lee UJ. Analysis of the Completely Dry Rate Over Time After Mid-urethral Sling in a Real-world Clinical Setting. Urology 2019; 126:65-69. [PMID: 30634028 DOI: 10.1016/j.urology.2018.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 10/03/2018] [Revised: 12/23/2018] [Accepted: 12/29/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To improve patient counseling regarding mid-urethral slings (MUS), we performed an analysis of MUS patients dry at initial follow-up to evaluate probability of remaining dry over time, and analyzed clinical factors potentially influencing the probability of remaining dry. METHODS A retrospective review of our prospectively-collected institutional database identified patients who underwent retropubic MUS (RMUS) or transobturator MUS (TMUS) between January 2001 and March 2016 and were completely dry, defined as an answer of "not at all" to UDI-6 question 3, at first follow-up within 1.5 years of surgery. Proportion remaining dry over time was estimated by Kaplan-Meier. Associated factors were evaluated using Cox proportional hazards modeling. Proportion with urge urinary incontinence at time of sling failure was assessed. RESULTS Of 1102 patients undergoing MUS, 38.4% returned questionnaires and 47.5% of these were completely dry at initial follow-up (139 RMUS, 62 TMUS). Probability (95% CI, n = total patients) of remaining dry after RMUS at 3, 5, and 10 years was 72% (64%-81%, n = 70), 60% (51%-70%, n = 51), and 26% (18%-43%, n = 17). Probability estimates for TMUS at 3 and 5 years were 74% (62%-88%, n = 27) and 50% (35%-70%, n = 14). Obesity (Hazard ratio 2.22, P = .003) and age (Hazard ratio 1.043, P < .001) were associated with lower probability of remaining dry after RMUS. Of patients no longer completely dry at last follow-up, 72% RMUS and 75% TMUS had urge urinary incontinence. CONCLUSION In our real-world cohort, patients who are dry within the first 1.5 years following MUS have ≥50% chance of remaining dry for 4 more years.
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Affiliation(s)
- Dena Moskowitz
- Department of Urology, University of California, Irvine, CA
| | - Kevin T Gioia
- Hackensack Meridian Medical Group, Urology, Hackensack, NJ
| | - Erika M Wolff
- University of Washington, Department of Surgery, Seattle, WA
| | | | - Alvaro Lucioni
- Virginia Mason Medical Center, Section of Urology and Renal Transplantation, Seattle, WA
| | - Kathleen C Kobashi
- Virginia Mason Medical Center, Section of Urology and Renal Transplantation, Seattle, WA
| | - Una J Lee
- Virginia Mason Medical Center, Section of Urology and Renal Transplantation, Seattle, WA
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Kobashi KC, Govier FE. A Tribute to Robert P. Gibbons, M.D., F.A.C.S. Urology 2018. [DOI: 10.1016/j.urology.2018.01.047] [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: 11/28/2022]
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Stamm AW, Adelstein SA, Chen A, Lucioni A, Kobashi KC, Lee UJ. Inconsistency in the Definition of Urinary Tract Infection after Intravesical Botulinum Toxin A Injection: A Systematic Review. J Urol 2018; 200:809-814. [PMID: 29653162 DOI: 10.1016/j.juro.2018.03.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Accepted: 03/31/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To more accurately examine the rate of urinary tract infection following onabotulinumtoxinA injection of the bladder we systematically reviewed the literature for definitions of urinary tract infection in studies of onabotulinumtoxinA injections. We assessed the studies for consistency with guideline statements defining urinary tract infections. MATERIALS AND METHODS We systematically reviewed the literature by querying MEDLINE® and Embase®. We included original studies on adult patients with idiopathic overactive bladder and/or neurogenic detrusor overactivity who underwent cystoscopy with onabotulinumtoxinA injection and in whom urinary tract infection was a reported outcome. RESULTS We identified 299 publications, of which 50 met study inclusion criteria. In 27 studies (54%) urinary tract infection diagnostic criteria were defined with a total of 10 definitions among these studies. None of the overactive bladder studies used a definition which met the EAU (European Association of Urology) criteria for urinary tract infection. Only 2 of the 10 studies on patients with neurogenic bladder used a urinary tract infection definition consistent with the NIDRR (National Institute on Disability and Rehabilitation Research) standards. CONCLUSIONS Definitions of urinary tract infection are heterogeneous and frequently absent in the literature on onabotulinumtoxinA to treat overactive bladder and/or neurogenic bladder. Given the potential for post-procedure urinary symptoms in this setting, explicit criteria are imperative to establish the true urinary tract infection rate following treatment with onabotulinumtoxinA.
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Affiliation(s)
| | | | - Andrew Chen
- Cedars Sinai Medical Center, Los Angeles, California
| | | | | | - Una J Lee
- Virginia Mason Medical Center, Seattle, Washington
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Amin K, Moskowitz D, Kobashi KC, Lee UJ, Lucioni A. MP75-17 DO PATIENTS DISCONTINUE OVERACTIVE BLADDER MEDICATIONS AFTER SACRAL NEUROMODULATION? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2109] [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: 11/25/2022]
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Weissbart SJ, Zimmern PE, Nitti VW, Lemack GE, Kobashi KC, Vasavada SP, Wein AJ. The history of the Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction. Neurourol Urodyn 2018; 37:2015-2025. [DOI: 10.1002/nau.23540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/22/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Victor W. Nitti
- Department of Urology; NYU Langone Medical Center; New York New York
| | - Gary E. Lemack
- Department of Urology; UT Southwestern Medical Center; Dallas Texas
| | - Kathleen C. Kobashi
- Section of Urology and Renal Transplantation; Virginia Mason Medical Center; Seattle Washington
| | - Sandip P. Vasavada
- Department of Urology, Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland Ohio
| | - Alan J. Wein
- Division of Urology; University of Pennsylvania; Philadelphia Pennsylvania
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Donahue RP, Stamm AW, Gibbons RP, Porter CR, Kobashi KC, Corman JM, Lee UJ. Evolution of the Ureteral Stent: The Pivotal Role of the Gibbons Ureteral Catheter. Urology 2018; 115:3-7. [PMID: 29545037 DOI: 10.1016/j.urology.2018.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the pioneering contributions of Dr. Robert Gibbons of Virginia Mason Medical Center to the evolution and development of the modern ureteral stent. METHODS We reviewed Dr. Gibbons' extensive work through primary sources, including interviews, projector slides, radiology images, stent prototypes, his personal writings, and archived documents. In addition, we performed a review of historical texts and manuscripts describing important innovations in the development of the ureteral stent. RESULTS In 1972, motivated by a desire to provide his patients with a long-term alternative to open nephrostomy and inspired by Drs. David Davis and Paul Zimskind, who in 1967 had described the use of indwelling ureteral silicone tubing, Dr. Gibbons began to experiment with modifications to improve upon existing stents. To address distal migration, Dr. Gibbons added "wings" that collapsed as the stent was advanced and expanded once in proper position to secure the stent in place. Barium was embedded into the proximal tip to facilitate radiographic visualization. A flange was added to the distal end, preventing proximal migration and minimizing trigonal irritation, and a tail was attached to aid in stent removal. The result was the original Gibbons stent, the first commercially available ureteral stent, and the establishment of Current Procedural Terminology code 52332, still used today. CONCLUSION The ureteral stent is a fundamental component of urologic practice. In developing the Gibbons stent, Dr. Gibbons played a pivotal role in addressing the challenge of internal urinary diversion particularly for those who needed long-term management. Urologists and the patients they serve owe Dr. Gibbons and other surgeon-inventors a debt of gratitude for their innovative work.
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Affiliation(s)
- Ryan P Donahue
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Andrew W Stamm
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Robert P Gibbons
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Christopher R Porter
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - John M Corman
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA.
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Lemack GE, Kobashi KC, Vasavada SP, Rovner ES, Dmochowski RR. Editorial. Neurourol Urodyn 2018. [DOI: 10.1002/nau.23523] [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: 11/10/2022]
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Affiliation(s)
- Kathleen C. Kobashi
- Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
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Moskowitz D, Adelstein SA, Lucioni A, Lee UJ, Kobashi KC. Use of Third Line Therapy for Overactive Bladder in a Practice with Multiple Subspecialty Providers-Are We Doing Enough? J Urol 2017; 199:779-784. [PMID: 28965782 DOI: 10.1016/j.juro.2017.09.102] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 09/23/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Overactive bladder impacts more than 15% of the adult population. Compliance with medical treatment is low due to inadequate symptom control or intolerable side effects. Although third line therapies have improved the treatment of overactive bladder, many patients do not receive optimal treatment. We hypothesized that third line treatment use is higher among female pelvic medicine and reconstructive surgery urologists, and we examined its use at our tertiary referral center. MATERIALS AND METHODS The electronic medical record was queried for patients with overactive bladder seen in 1 year. The number of visits associated with an overactive bladder prescription and the number of patients who received third line therapy were determined and subcategorized by department. Female pelvic medicine and reconstructive surgery providers were considered separately. RESULTS A total of 5,445 patients (8,994 visits) were seen for overactive bladder. Of all patients seen for overactive bladder 3.5% received third line therapy compared with 10.0% and 14.1% of those seen by urology providers and female pelvic medicine and reconstructive surgery providers, respectively. CONCLUSIONS The use of third line therapy was reported to be less than 5%. This rate is higher at our institution, which is likely due to multiple female pelvic medicine and reconstructive surgery providers. We also apply an algorithm that facilitates patient education on available options should first and second line treatments fail. Given the limited compliance with medical treatment for overactive bladder, we are likely missing a segment of the patient population who would benefit from third line treatment. Our data demonstrate an opportunity for urologists to improve the quality of overactive bladder treatment and subsequently improve patient quality of life.
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Affiliation(s)
- Dena Moskowitz
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington.
| | - Sarah A Adelstein
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Kathleen C Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
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Kobashi KC, Albo ME, Dmochowski RR, Ginsberg DA, Goldman HB, Gomelsky A, Kraus SR, Sandhu JS, Shepler T, Treadwell JR, Vasavada S, Lemack GE. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline. J Urol 2017. [PMID: 28625508 DOI: 10.1016/j.juro.2017.06.061] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Stress urinary incontinence is a common problem experienced by many women that can have a significant negative impact on the quality of life of those who suffer from the condition and potentially those friends and family members whose lives and activities may also be limited. MATERIALS AND METHODS A comprehensive search of the literature was performed by ECRI Institute. This search included articles published between January 2005 and December 2015 with an updated abstract search conducted through September 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. RESULTS The AUA (American Urological Association) and SUFU (Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction) have formulated an evidence-based guideline focused on the surgical treatment of female stress urinary incontinence in both index and non-index patients. CONCLUSIONS The surgical options for the treatment of stress urinary incontinence continue to evolve; as such, this guideline and the associated algorithm aim to outline the currently available treatment techniques as well as the data associated with each treatment. Indeed, the Panel recognizes that this guideline will require continued literature review and updating as further knowledge regarding current and future options continues to grow.
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Affiliation(s)
- Kathleen C Kobashi
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Michael E Albo
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Roger R Dmochowski
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - David A Ginsberg
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Howard B Goldman
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Alexander Gomelsky
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Stephen R Kraus
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jaspreet S Sandhu
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Tracy Shepler
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Jonathan R Treadwell
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Sandip Vasavada
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
| | - Gary E Lemack
- American Urological Association Education and Research Inc., Linthicum, Maryland; Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, Schaumburg, Illinois
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Lemack GE, Kobashi KC, Vasavada SP, Rovner ES, Dmochowski RR. Editorial Message. Neurourol Urodyn 2017; 36:S5. [DOI: 10.1002/nau.23227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kobashi KC, Leach GE. Bladder Dysfunction in Multiple Sclerosis. Neurorehabil Neural Repair 2016. [DOI: 10.1177/154596839901300204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis (MS) involves focal neural demyelmation with relative sparing of axons and resultant impaired nerve conduction. Demyelination commonly affects the posterolateral columns of the spinal cord, with the majority of patients having cervi cal cord involvement. Forty percent of patients have lumbar cord involvement and 18 percent have sacral cord involvement. The cerebral cortex and midbram may also be affected. Lesions in any of these areas can affect voiding function.
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Rovner ES, Lemack GE, Kobashi KC, Winters JC, Dmochowski RR. Editorial Comment. Neurourol Urodyn 2016; 35 Suppl 1:S5. [DOI: 10.1002/nau.22966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lee EW, Chang A, Lee UJ, Lucioni A, Massman JD, Wolff EM, Govier FE, Kobashi KC. PD28-06 OUTCOMES OF AUTOLOGOUS RECTUS FASCIA PUBOVAGINAL SLING FOR SEVERE INTRINSIC SPHINCTER DEFICIENCY AND/OR RECURRENT STRESS URINARY INCONTINENCE: UP TO 11-YEAR FOLLOW-UP. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rovner ES, Lemack GE, Kobashi KC, Winters JC, Dmochowski RR. Editorial. Neurourol Urodyn 2015. [DOI: 10.1002/nau.22737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lee EW, Lucioni A, Lee UJ, Kobashi KC. National Practice Patterns of Infection Prophylaxis for Sacral Neuromodulation Device: A Survey of High Volume Providers. Urology Practice 2015. [PMID: 37537802 DOI: 10.1016/j.urpr.2014.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Sacral neuromodulation using the InterStim® device is a safe, effective treatment for urgency, frequency, urgency incontinence, nonobstructive urinary retention and fecal incontinence. However, there is no standard recommendation regarding infection prophylaxis. Therefore, we surveyed the infection prophylaxis patterns of high volume device providers to describe current practice patterns of perioperative infection prophylaxis. METHODS A web based survey was sent to 35 high volume providers, including urologists, gynecologists and colorectal surgeons. RESULTS Our response rate was 89% (31 of 35 participants). Of the providers 51% were urologists, 39% were gynecologists and 10% were colorectal surgeons. Of the respondents 74% had performed more than 200 procedures and 22% had done more than 500. The testing period was generally 1 to 2 weeks. Only 13% of the surveyed providers routinely screened for methicillin resistant Staphylococcus aureus. All providers administered antibiotics preoperatively, most commonly cefazolin or vancomycin, and 81% administered antibiotics postoperatively, most commonly cephalexin and trimethoprim-sulfamethoxazole. Most providers prescribed 5 to 7 days of treatment but 6 (19%) prescribed no postoperative antibiotics. In addition, 71% of respondents used adjunctive measures, frequently intraoperative wound irrigation and/or a preoperative chlorhexidine shower. After stages 1 and 2, 19% of providers prohibited showering for more than 3 days postoperatively while 61% permitted showering after 1 or 2 days and 19% recommended no bathing restriction. CONCLUSIONS We present the infection prevention practices of high volume InterStim sacral neuromodulation device implanters in the United States. Further study is warranted to guide evidence-based practice in InterStim infection prophylaxis.
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Affiliation(s)
- Eugene W. Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Una J. Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Kathleen C. Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
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Abstract
PURPOSE Elderly women have a high incidence of refractory overactive bladder. Clinicians and elderly patients may be hesitant to consider sacral neuromodulation. We investigated outcomes of sacral neuromodulation in women 80 years old or older. MATERIALS AND METHODS From 2000 to 2013, 24 octogenarians with overactive bladder underwent stage 1 implantation of the InterStim® sacral neuromodulation device. We defined stage 1 success as 50% or greater improvement in incontinence episodes and/or pads. Those patients underwent placement of an implantable pulse generator. The primary study outcome was the rate of stage 1 success. Secondary outcomes were the complication rate and patient reported improvement/satisfaction. RESULTS We identified 24 octogenarians with a median age of 85 years (range 80 to 89), of whom 18 (75%) experienced stage 1 success. At a mean 17-month followup (range 1 to 59) success was sustained in 13 patients (72%) and 15 (83%) were medication free. Two patients (12%) experienced complications, including urinary tract infection in 1 and pain at the implantable pulse generator site in 1, which resolved within 1 month. Three patients (17%) underwent lead revision and 2 subsequently regained success. Five of the 10 patients (50%) who returned the PGI-I questionnaire reported that their condition was very much or much improved, 3 felt a little improved and 2 reported no change. The self-reported satisfaction rate was 60%. CONCLUSIONS Octogenarian women treated with sacral neuromodulation had a high rate of stage 1 success with no major complications. Most of them reported improvement and satisfaction at a mean followup of 17 months. Advanced age alone should not preclude consideration of sacral neuromodulation as a treatment option for overactive bladder in the properly selected elderly patient.
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Affiliation(s)
- Eugene W. Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Una J. Lee
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Alvaro Lucioni
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
| | - Kathleen C. Kobashi
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington
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Patel BN, Longo E, Govier FE, Kobashi KC, Lucioni A. Long-term follow-up of polypropylene bone anchored slings. Int Braz J Urol 2013; 39:493-7. [PMID: 24054378 DOI: 10.1590/s1677-5538.ibju.2013.04.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/14/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The transvaginal bone anchored polypropylene sling (BAS) has proven to be a successful treatment for patients with SUI. However, there is limited data on long-term outcomes following BAS with polypropylene mesh. We report our series of patients who had at least 3 years of follow-up after placement of BAS. MATERIALS AND METHODS A retrospective review of prospectively collected data of patients undergoing BAS for stress urinary incontinence (SUI) with minimum 3 year follow-up was performed. Outcomes and complications were determined from annual mailed post-operative questionnaires. RESULTS 142 patients who had undergone BAS and had answered post-operative questionnaires at a minimum of 3 years were identified. Average follow-up was 58 months (range 36-97 months). The overall success rate was 71 % with a dry rate of 27 %. Complications occurred in 9 % of patients, more commonly in patients without a history of anti-incontinence procedure. CONCLUSIONS Although less commonly used, BAS with polypropylene mesh is associated with an acceptable success rate at long term follow-up but a low completely dry rate.
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Affiliation(s)
- Bhavin N Patel
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
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Kobashi KC, Patel B. Commentary on: Anticholinergic Therapy vs OnabotulinumtoxinA for Urgency Urinary Incontinence. Urology 2013; 82:14-5. [DOI: 10.1016/j.urology.2012.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 11/27/2022]
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Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, Lemack GE, Nitti VW, Rovner ES, Wein AJ. Urodynamic studies in adults: AUA/SUFU guideline. J Urol 2012; 188:2464-72. [PMID: 23098783 DOI: 10.1016/j.juro.2012.09.081] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The authors of this guideline reviewed the literature regarding use of urodynamic testing in common lower urinary tract symptoms. The findings are intended to assist clinicians in the appropriate selection of urodynamic tests, following an evaluation and symptom characterization. MATERIALS AND METHODS A systematic review of the literature using the MEDLINE® and EMBASE databases (searched from 1/1/90 to 3/10/11) was conducted to identify peer-reviewed publications relevant to using urodynamic tests for diagnosis, determining prognosis, guiding clinical management decisions and improving patient outcomes in patients with various urologic conditions. The review yielded an evidence base of 393 studies after application of inclusion/exclusion criteria. These publications were used to create the evidence basis for characterizing the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinion. RESULTS The evidence-based guideline statements are provided for diagnosis and overall management of common LUTS conditions. CONCLUSIONS The Panel recognizes that each patient presenting with LUTS is unique. This Guideline is intended to serve as a tool facilitating the most effective utilization of urodynamic testing as part of a comprehensive evaluation of patients presenting with LUTS.
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Affiliation(s)
- J Christian Winters
- American Urological Association Education and Research, Inc., Linthicum, Maryland, USA
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Abstract
Introduction: Various grafts have been used in the treatment of urinary incontinence and pelvic prolapse. Autologous materials such as muscle and fascia were first utilized to provide additional anatomic support to the periurethral and pelvic tissues; however, attempts to minimize the invasiveness of the procedures have led to the use of synthetic materials. Complications such as infection and erosion or extrusion associated with these materials may be troublesome to manage. We review the literature and describe a brief overview of grafts used in pelvic floor reconstruction and focus on the management complications specifically related to synthetic materials. Materials and Methods: We performed a comprehensive review of the literature on grafts used in pelvic floor surgery using MEDLINE and resources cited in those peer-reviewed manuscripts. The results are presented. Results: Biologic materials provide adequate cure rates but have associated downfalls including potential complications from harvesting, variable tissue quality and cost. The use of synthetic materials as an alternative graft in pelvic floor repairs has become a popular option. Of all synthetic materials, the type I macroporous polypropylene meshes have demonstrated superiority in terms of efficacy and fewer complication rates due to their structure and composition. Erosion and extrusion of mesh are common and troublesome complications that may be managed conservatively with observation with or without local hormone therapy, with transvaginal debridement or with surgical exploration and total mesh excision, dependent upon the location of the mesh and the mesh type utilized. Conclusions: The ideal graft would provide structural integrity and durability with minimal adverse reaction by the host tissue. Biologic materials in general tend to have fewer associated complications, however, the risks of harvesting, variable integrity of allografts, availability and high cost has led to the development and use of synthetic grafts. Synthetic grafts have a tendency to cause higher rates of erosion and extrusion; however, these complications can be managed successfully.
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Affiliation(s)
- Tanya M Nazemi
- Continence Center at Virginia Mason Medical Center, Seattle, Washington, USA
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Rapp DE, Neil NJ, Kobashi KC. Defining success following sling surgery: association of satisfaction with patient reported outcomes. Can J Urol 2010; 17:4995-5001. [PMID: 20156379] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS The assessment of incontinence therapies is complicated by the variety of patient reported outcomes (PRO) measures used in research protocol. Patient satisfaction may be one of the most relevant albeit complex PRO measures and is a function of many related variables. We sought to assess the relationship between patient satisfaction and other PRO. METHODS A retrospective review of patients undergoing SPARC (n = 314) and autologous rectus pubovaginal sling (PVS) (n = 127) was performed, with 204 (SPARC) and 67 (PVS) patients completing questionnaire surveillance and minimum 12 month follow up. Outcomes were assessed using validated incontinence questionnaires (UDI-6, IIQ-7) supplemented with additional items addressing subjective improvement. Comparisons were made between patients reporting a willingness to recommend and repeat surgical intervention (combined variable, satisfaction surrogate) and achievement of defined endpoints in the remaining outcome measures. RESULTS A large difference in outcomes was seen depending on PRO measure analyzed. Dry was the strictest measure used (33%, SPARC; 39%, PVS; p = NS), while >or= 50% improvement was reported with the greatest frequency (75%, SPARC; 73%, PVS; p = NS). With the exception of pad use, a statistically significant association between all PRO measures and the willingness to recommend/repeat surgery was identified. CONCLUSIONS Our data demonstrate an association between a variety of PRO measures and patient reported satisfaction. Based on this finding, the development of a simplified and standardized PRO instrument, one that maintains an accurate reflection of patient satisfaction and is less cumbersome for the patient may be possible.
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Affiliation(s)
- David E Rapp
- The Continence Center at Virginia Mason Medical Center, Seattle, Washington 98111, USA
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Rapp DE, Kobashi KC, Govier FE. Reply. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- David E. Rapp
- Continence Center at Virginia Mason Medical Center, Seattle, Washington, and Lifecycle Sciences Group, Icon Clinical Research, San Francisco, California
| | - Nancy J. Neil
- Continence Center at Virginia Mason Medical Center, Seattle, Washington, and Lifecycle Sciences Group, Icon Clinical Research, San Francisco, California
| | - Fred E. Govier
- Continence Center at Virginia Mason Medical Center, Seattle, Washington, and Lifecycle Sciences Group, Icon Clinical Research, San Francisco, California
| | - Kathleen C. Kobashi
- Continence Center at Virginia Mason Medical Center, Seattle, Washington, and Lifecycle Sciences Group, Icon Clinical Research, San Francisco, California
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Rapp DE, Neil N, Govier F, Kobashi KC. IDENTIFICATION OF MEASURES OF BLADDER SENSATION IN PATIENTS WITH OVERACTIVE BLADDER. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61683-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cisternas MG, Foreman AJ, Marshall TS, Runken MC, Kobashi KC, Seifeldin R. Estimating the prevalence and economic burden of overactive bladder among Medicare beneficiaries prior to Medicare Part D coverage. Curr Med Res Opin 2009; 25:911-9. [PMID: 19250059 DOI: 10.1185/03007990902791025] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [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: 11/23/2022]
Abstract
OBJECTIVE The goal of this study is to provide annual estimates for the treated prevalence and expenditures attributable to overactive bladder (OAB) in the elderly prior to Medicare Part D drug coverage. RESEARCH DESIGN AND METHODS All Medicare claims were extracted for beneficiaries over 65 with continuous coverage for Medicare Parts A and B during 2003-2004. Two OAB definitions were created: (1) the base case included diagnosis codes that narrowly defined OAB, and (2) the sensitivity variant included additional codes indicative of OAB. Descriptive comparisons of baseline characteristics, annual expenditures, and events and procedures were performed for OAB vs. non-OAB subjects meeting the inclusion criteria. CMS expenditures (2004 US dollars) for individuals were totaled and multiple regression techniques were used to estimate costs attributable to OAB after adjusting for demographic characteristics and comorbid conditions. RESULTS The prevalence of subjects with an OAB diagnosis ranged from 8.8 to 13.6% for the base and sensitivity definitions, respectively. While mean total annual expenditures ranged from $9331 to $9655, mean annual expenditures attributable to OAB ranged from $825 to $1184 per subject (9-12% of total medical expenditures for OAB subjects), with aggregate total OAB-attributable expenditures of $1.8-3.9 billion per year. CONCLUSIONS The treated prevalence of individuals seeking treatment for OAB in the elderly Medicare population is comparable to some common chronic conditions in that population, and OAB-attributable CMS expenditures are considerable. However, due to study limitations this is a conservative estimate of the direct cost of OAB in the elderly population. The reported estimates exclude pharmacy and out-of-pocket costs, are extrapolated to only two-thirds of the elderly Medicare population, and do not include expenditures by Medicaid for long-term care. Additionally, claims data limits detection of chronic conditions to patients who receive treatment or consultation for OAB; diagnosis codes used were based on expert opinion rather than a review of medical records to identify OAB patients; and long-term care costs are not included.
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Rapp DE, Govier FE, Kobashi KC. Outcomes following mid-urethral sling placement in patients with intrinsic sphincteric deficiency: comparison of Sparc and Monarc slings. Int Braz J Urol 2009; 35:68-75; discussion 75. [DOI: 10.1590/s1677-55382009000100011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2008] [Indexed: 11/22/2022] Open
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