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Lamb LE, Janicki JJ, Bartolone SN, Ward EP, Abraham N, Laudano M, Smith CP, Peters KM, Zwaans BMM, Chancellor MB. Risk Classification for Interstitial Cystitis/Bladder Pain Syndrome Using Machine Learning Based Predictions. Urology 2024:S0090-4295(24)00285-1. [PMID: 38677373 DOI: 10.1016/j.urology.2024.03.043] [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: 01/27/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To improve diagnosis of interstitial cystitis (IC)/bladder pain syndrome(IC) we hereby developed an improved IC risk classification using machine learning algorithms. METHODS A national crowdsourcing resulted in 1264 urine samples consisting of 536 IC (513 female, 21 male, 2 unspecified), and 728 age-matched controls (318 female, 402 male, 8 unspecified) with corresponding patient-reported outcome (PRO) pain and symptom scores. In addition, 296 urine samples were collected at three academic centers: 78 IC (71 female, 7 male) and 218 controls (148 female, 68 male, 2 unspecified). Urinary cytokine biomarker levels were determined using Luminex assay. A machine learning predictive classification model, termed the Interstitial Cystitis Personalized Inflammation Symptom (IC-PIS) Score, that utilizes PRO and cytokine levels, was generated and compared to a challenger model. RESULTS The top-performing model using biomarker measurements and PROs (area under the curve [AUC]=0.87) was a support vector classifier, which scored better at predicting IC than PROs alone (AUC=0.83). While biomarkers alone (AUC=0.58) did not exhibit strong predictive performance, their combination with PROs produced an improved predictive effect. CONCLUSION IC-PIS represents a novel classification model designed to enhance the diagnostic accuracy of IC/bladder pain syndrome by integrating PROs and urine biomarkers. The innovative approach to sample collection logistics, coupled with one of the largest crowdsourced biomarker development studies utilizing ambient shipping methods across the US, underscores the robustness and scalability of our findings.
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Affiliation(s)
- Laura E Lamb
- Oakland University William Beaumont School of Medicine, Rochester, MI; Strata Oncology, Ann Arbor, MI
| | | | | | - Elijah P Ward
- Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | | | | | | | - Kenneth M Peters
- Oakland University William Beaumont School of Medicine, Rochester, MI; Underactive Bladder Foundation, Pittsburgh, PA; Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - Bernadette M M Zwaans
- Oakland University William Beaumont School of Medicine, Rochester, MI; Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - Michael B Chancellor
- Oakland University William Beaumont School of Medicine, Rochester, MI; Corewell Health William Beaumont University Hospital, Royal Oak, MI.
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Zwaans BMM, Mota S, Bartolone SN, Ward EP, Peters KM, Chancellor MB. Evaluating symptom severity and urinary cytokine levels in interstitial cystitis/bladder pain syndrome patients, with and without Hunner's lesions. Am J Clin Exp Urol 2024; 12:110-118. [PMID: 38736620 PMCID: PMC11087211 DOI: 10.62347/bled2401] [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] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Interstitial cystitis/bladder pain syndrome (IC/BPS) is a condition characterized in part by urinary urgency, frequency, and pain. There is a strong interest in gathering more data to compare and assess the differences in characteristics based on the presence of Hunner's lesions in patients with IC/BPS. MATERIALS AND METHODS Using a nationwide crowdsource effort, we collected surveys and urine samples from patients with a history of IC/BPS. Participants completed the Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), Overactive Bladder questionnaire (OABq SF), and pain scores. In addition, participants reported any co-morbidities and lifestyle modifications. Urinary cytokine levels were measured and compared to symptom severity. RESULTS 491 participants enrolled: 119 with history of ulcerative Hunner's lesions (UIC), 372 reported no lesions (NHIC), and 2 unknowns. 96.3% were female, and prevalence of UIC was equal for both genders. Average age was higher for UIC vs. NHIC group (P = 0.011), as was the duration since diagnosis (P < 0.001). Symptom scores were elevated in UIC patients (P < 0.001). Both groups widely implemented lifestyle modifications, with dietary changes being most prevalent (70.1%), followed by prescription medication usage (63.1%). More UIC compared to NHIC participants experienced co-morbidities (P = 0.010). Urine samples were analyzed for GRO, IL-6, IL-8, and MCP-1. MCP-1 levels were significantly higher in UIC patients (P = 0.044). Weak positive correlation was found between cytokines and symptom scores. CONCLUSIONS Patients with UIC and NHIC from across the United States displayed distinct phenotypic and urine biological characteristics. These findings contribute to increased understanding of IC/BPS and may aid in improving our knowledge of the condition.
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Affiliation(s)
- Bernadette MM Zwaans
- Oakland University William Beaumont School of MedicineRochester, MI, USA
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Sabrina Mota
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Sarah N Bartolone
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Elijah P Ward
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Kenneth M Peters
- Oakland University William Beaumont School of MedicineRochester, MI, USA
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
| | - Michael B Chancellor
- Oakland University William Beaumont School of MedicineRochester, MI, USA
- Corewell Health William Beaumont University HospitalRoyal Oak, MI, USA
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Hoang Roberts L, Zwaans BM, Jabbar K, Bartolone SN, Padmanabhan P, Peters KM. Fibrin microthrombi in bladder urothelium after SARS-CoV-2 infection: Case report. Urol Case Rep 2023; 51:102575. [PMID: 37829494 PMCID: PMC10565678 DOI: 10.1016/j.eucr.2023.102575] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023] Open
Abstract
A 45-year-old male with diabetes, hypertension and hyperlipidemia was referred to urology due to persistent symptoms of urinary frequency, urgency, nocturia, erectile dysfunction, and constant pain localized to the bladder, pelvis, and perineal area, 3-4 months after SARS-CoV-2 infection. A bladder biopsy showed urothelial mucosa and submucosa with hemorrhage and fibrin microthrombi in blood vessels. Hydrodistention of the bladder and pelvic floor physical therapy resolved symptoms, though bladder and pain symptoms returned upon reinfection with SARS-CoV-2. Urinalysis revealed elevated urinary interleukin-8, which may indicate localized bladder inflammation.
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Affiliation(s)
| | - Bernadette M.M. Zwaans
- Department of Urology, Corewell Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kausar Jabbar
- Department of Pathology, Beaumont Health, Royal Oak, MI, USA
| | | | - Priya Padmanabhan
- Department of Urology, Corewell Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kenneth M. Peters
- Department of Urology, Corewell Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Hoang Roberts L, Peters KM. Does Cutaneous Stimulation of the Peroneal Nerve Treat Overactive Bladder? J Urol 2023; 209:661-662. [PMID: 36724063 DOI: 10.1097/ju.0000000000003203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ly Hoang Roberts
- Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Cleveland, Ohio
| | - Kenneth M Peters
- Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine Royal Oak, Michigan
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Sirls LT, Schonhoff A, Waldvogel A, Peters KM. Development of an implant technique and early experience using a novel implantable pulse generator with a quadripolar electrode array at the tibial nerve for refractory overactive bladder. Neurourol Urodyn 2023; 42:427-435. [PMID: 36573835 DOI: 10.1002/nau.25117] [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: 07/27/2022] [Revised: 11/09/2022] [Accepted: 12/08/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Tibial nerve stimulation is an effective treatment for overactive bladder (OAB) and has been utilized as an in-person recurring session treatment option for many years. The primary objective of this study was to evaluate the safety and efficacy of a long-term implantable device and the method of utilizing a retrograde approach to place the device (a percutaneous implantable pulse generator [pIPG] with integrated quadripolar electrodes) at the tibial nerve (Protect PNS; Uro Medical Corp.). METHODS A novel retrograde implant technique was developed through multiple cadaveric dissections to percutaneously implant a chronic, wireless, minimally invasive pIPG device with integrated quadripolar electrodes (now licensed to Uro Medical) at the tibial nerve. A proof-of-concept pIPG device approved as part of an FDA IDE was designed to gain early experience in subjects with refractory OAB. The pIPG was implanted in the office under local anesthesia using the novel retrograde approach, and stimulation was activated using an external wireless energy source called a transmitter. Initially, a pilot study was designed to compare outcomes in subjects randomized to either percutaneous tibial nerve stimulation (PTNS) or Protect PNS. However, due to the small sample sizes available at this time, it was not possible to compare the two groups. Thus, the purpose of this manuscript is to describe the outcome of subjects who underwent implantation of the Protect PNS system. Twelve-month safety and efficacy were evaluated. RESULTS Nine subjects were enrolled in the randomized pilot study; 5 to the pIPG group and 4 to PTNS, and all completed the 13-week primary endpoint. Subsequently, two subjects in the PTNS group chose to cross over and have the pIPG implanted after 13 weeks. Outcomes of the seven subjects who underwent implantation of the pIPG are described. No complications related to the office procedure were noted. Two of the older model pIPG devices became nonresponsive at 1 and 4 weeks and were replaced. Six minor adverse events were reported and resolved. Subjects reported improvement in urge urinary incontinence (UUI) episodes, OAB symptoms, and quality of life. Subjects impanted with a pIPG reported a 50% reduction in UUI as early as 1 week. CONCLUSIONS Results of this pilot study suggest that retrograde percutaneous implantation of a pIPG is a safe, minimally invasive one-stage office procedure for treatment for urge incontinence related OAB symptoms, without significant complications after 12 months follow-up. Future studies will be required to compare outcomes among treatment modalities.
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Affiliation(s)
- Larry T Sirls
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Amanda Schonhoff
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA
| | - Angela Waldvogel
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA
| | - Kenneth M Peters
- Department of Urology, Beaumont Health, Royal Oak, Michigan, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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Janicki JJ, Ward EP, Bartolone SN, Lamb LE, Abraham N, Laudano M, Smith CP, Peters KM, Zwaans BM, Chancellor MB. Comparing online crowdsourcing with clinic patient enrollment: Findings from the IP4IC Study on interstitial cystitis/bladder pain syndrome. Digit Health 2023; 9:20552076231216280. [PMID: 38025103 PMCID: PMC10664419 DOI: 10.1177/20552076231216280] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Interstitial cystitis/bladder pain syndrome (IC/BPS) manifests as urinary symptoms including urgency, frequency, and pain. The IP4IC Study aimed to establish a urine-based biomarker score for diagnosing IC/BPS. To accomplish this objective, we investigated the parallels and variances between patients enrolled via physician/hospital clinics and those recruited through online crowdsourcing. Methods Through a nationwide crowdsource effort, we collected surveys from patients with history of IC/BPS. Study participants were asked to complete the validated instruments of Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), as well as provide demographic information. We then compared the survey responses of patients recruited through crowdsourcing with those recruited from three specialized tertiary care urology clinics engaged in clinical research. Results Survey responses of 1300 participants were collected from all 50 states of the USA via crowdsourcing and 319 from a clinical setting. ICSI and ICPI were similar for IC/BPS patients diagnosed by the physicians in clinic and self-reported by subjects via crowdsourcing stating they have a history of previous physician diagnosis of IC/BPS. Surprisingly, ICSI and ICPI were significantly lower in crowdsourced control than in-clinic control subjects. Conclusion The IP4IC Study provides valuable insights into the similarities and differences between patients recruited through clinics and those recruited through online crowdsourcing. There were no significant differences in disease symptoms among these groups. Individuals who express an interest in digital health research and self-identify as having been previously diagnosed by physicians with IC/BPS can be regarded as reliable candidates for crowdsourcing research.
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Affiliation(s)
- Joseph J. Janicki
- Department of Urology, Underactive Bladder Foundation, Pittsburgh, PA, USA
| | - Elijah P. Ward
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Sarah N. Bartolone
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Laura E. Lamb
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nitya Abraham
- Department of Urology, Montefiore Medical Center, The Bronx, NY, USA
| | - Melissa Laudano
- Department of Urology, Montefiore Medical Center, The Bronx, NY, USA
| | | | - Kenneth M. Peters
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Bernadette M.M. Zwaans
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Michael B. Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
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Sirls E, Peters KM, Sirls LT. Intradetrusor OnabotuliniumtoxinA injection for refractory bladder spasms before vesicovaginal fistula repair. Urol Case Rep 2022; 46:102307. [PMID: 36606098 PMCID: PMC9807992 DOI: 10.1016/j.eucr.2022.102307] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 12/26/2022] Open
Abstract
This is a report of a women who failed 2 surgical repairs of vesicovaginal fistula secondary to refractory bladder spasms. After each surgical procedure - the hysterectomy and subsequent fistula repairs - the patient reported severe bladder spasms refractory to medical management. Our treatment was intradetrusor onabotuliniumtoxinA injections 4 weeks prior to a planned surgical fistula repair. The patient had successful vaginal approach fistula repair and has not required any subsequent overactive bladder (OAB) treatment.
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Affiliation(s)
| | - Kenneth M. Peters
- Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Larry T. Sirls
- Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
- Corresponding author. 3535 W 13 Mile Road, Suite 438, Royal Oak, MI, 248 561 4625, USA.
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Sharma P, Lamb LE, Bartolone SN, Ward EP, Janicki JJ, Peters KM, Abraham N, Laudano M, Smith CP, Zwaans B, Chancellor MB. A Cost, Time, and Demographic Analysis of Participant Recruitment and Urine Sample Collection Through Social Media Optimization. Urol Pract 2022; 9:561-566. [PMID: 37145804 DOI: 10.1097/upj.0000000000000339] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Clinical research can be expensive and time consuming due to high associated costs and/or duration of the study. We hypothesized that urine sample collection using online recruitment and engagement of research participants via social medial has the potential to reach a large population in a small timeframe, at a reasonable cost. METHODS We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants for urine sample collection. During this time, cost data were collected based on study associated costs from invoices and budget spreadsheets. The data were subsequently analyzed using descriptive statistics. RESULTS Each sample collection kit contained 3 urine cups, 1 for the disease sample and 2 for control samples. Out of the 3,576 (1,192 disease + 2,384 control) total sample cups mailed, 1,254 (695 control) samples were returned. Comparatively, the 2 clinical sites collected 305 samples. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $81.45 compared to $398.14 for clinic sample. CONCLUSIONS We conducted a nationwide, contactless, urine sample collection through online recruitment in the midst of the COVID-19 pandemic. Results were compared with the samples collected in the clinical setting. Online recruitment can be utilized to collect urine samples rapidly, efficiently, and at a cost per sample that was 20% of an in-person clinic, and without risk of COVID-19 exposure.
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Affiliation(s)
- Prasun Sharma
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Laura E Lamb
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - Elijah P Ward
- Beaumont Health Spectrum Health System, Royal Oak, Michigan
| | | | | | - Nitya Abraham
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Melissa Laudano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Christopher P Smith
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Bernadette Zwaans
- Beaumont Health Spectrum Health System, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Michael B Chancellor
- Beaumont Health Spectrum Health System, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Hoang Roberts L, Zwaans BM, Peters KM, Chancellor M, Padmanabhan P. Incidence of New or Worsening Overactive Bladder Among Patients with a Prior SARS-CoV-2 Infection: A Cohort Study. EUR UROL SUPPL 2022; 46:68-74. [PMID: 36245790 PMCID: PMC9554342 DOI: 10.1016/j.euros.2022.10.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/13/2022] Open
Abstract
Background Literature is sparse on COVID-19-associated cystitis (CAC), a novel condition comprising frequency, urgency, and nocturia after COVID-19 infection. Objective To determine the incidence of CAC and correlation with SARS-CoV-2 antibody levels. Design setting and participants This was a retrospective study in which urinary symptoms were scored using the International Consultation on Incontinence Questionnaire-overactive bladder (ICIQ-OAB) at three time points: before the pandemic (January 2020), 2 mo after COVID-19 infection (if applicable), and at the time of the study (May 2021). The setting was a regional health care system. The 18 785 healthcare employees who took part in the BLAST COVID study group were invited to participate, of whom 1895 responded. Outcome measurements and statistical analysis The outcome measured was the percentage of COVID-positive patients with a significant change on ICIQ-OAB over time. Pearson's χ2 test was used for comparison of categorical data, and one-way analysis of variance for continuous data and multivariate analysis. A sample size of 618 was calculated for power of 80% and α = 0.05. Results and limitations Of the 1895 participants, 31.9% (n = 605) were positive for COVID-19 according to positive serology or a polymerase chain reaction (PCR) test. Of these, 492 were PCR-positive and had 2-mo postinfection data, with 36.4% (179/492) reporting an increase of ≥1 point on the ICIQ-OAB compared to baseline (before the pandemic), with de novo OAB in 22% of these cases (40/179). Comparison of symptoms between baseline and the study time revealed that 27.4% (31/113) of those with positive serology only (asymptomatic COVID) and 37.8% (186/492) of those with PCR positivity (symptomatic COVID) had an increase of ≥1 point on the ICIQ-OAB, compared to 15.8% (n = 204) of uninfected patients, with odds ratios of 2.013 (95% confidence interval [CI] 1.294-3.138; p = 0.0015) and 3.236 (95% CI 2.548-4.080; p < 0.0001), respectively. The retrospective nature of the study and the volunteer sample are limitations. Conclusions COVID-19 infection increases the risk of developing new or worsening OAB symptoms. Patient summary We compared overactive bladder symptoms in a large group of participants between individuals with and without a previous COVID-19 infection. We found that symptomatic infection was associated with a three times greater risk of developing new or worsening overactive bladder symptoms among COVID-19 patients.
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Affiliation(s)
- Ly Hoang Roberts
- Corresponding author. Department of Urology, Oakland University William Beaumont School of Medicine, Beaumont Hospital-Royal Oak, 3535 W. 13 Mile Road, Royal Oak, MI 48073, USA. Tel. +1 405 3260972.
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Meier KM, Vecellio PM, Killinger KA, Boura JA, Peters KM. Pudendal Neuromodulation is Feasible and Effective After Pudendal Nerve Entrapment Surgery. J Sex Med 2022; 19:995-1001. [PMID: 35459633 DOI: 10.1016/j.jsxm.2022.03.219] [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: 05/18/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with intractable pain in the pudendal nerve distribution may benefit from pudendal neuromodulation; however, some may have previously undergone pudendal nerve entrapment surgery (PNES), potentially altering nerve anatomy and function. AIM We examined pudendal neuromodulation outcomes in patients with prior PNES. METHODS Patients with a history of PNES and quadripolar, tined pudendal lead placement for urogenital pain were reviewed. Symptoms and outcomes were collected from existing medical records. OUTCOMES Patients with pudendal neuromodulation and prior PNES were compared to patients with no prior PNES who had pudendal lead placement. RESULTS Fifteen patients with a history of 1, 2, or 3 prior PNES (n = 13, 1, and 1, respectively) were evaluated. Most (10; 67%) were female, with bilateral pain (9; 60%), and symptoms of 5-26 years. After trialing the lead, bladder symptoms and pain were improved in 8 of 12 and 9 of 14 patients, respectively, and 80% of patients (12/15) underwent permanent generator implantation. When prior PNES patients were compared to those with no prior PNES (n = 43), gender (67% vs 77% female; P = .50) and age (median 63 vs 58 years; P = .80), were similar; however, BMI differed (mean 24 vs 29; P = .008) and a lower proportion (12/15; 80% vs 42/43; 98%; P = .049) had generator implantation. Importantly, median lead implant time (48 vs 50 minutes; P = .65) did not differ between the 2 groups. CLINICAL IMPLICATIONS Pudendal neuromodulation has the potential to provide pain relief for a very difficult-to-treat population; furthermore, it does not appear that prior PNES surgery made lead placement significantly more challenging. STRENGTHS & LIMITATIONS Study strengths include being a tertiary referral center for urogenital pain and having a single surgeon perform all procedures in a regimented way. Limitations include the retrospective study design, small sample size and various approaches to PN CONCLUSION: Chronic pudendal neuromodulation can be a viable option even after prior PNES. Kristen M. Meier, Patrick M. Vecellio, Kim A. Killinger, Judith A. Boura, Kenneth M. Peters. Pudendal Neuromodulation is Feasible and Effective After Pudendal Nerve Entrapment Surgery. J Sex Med 2022;19:995-1001.
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Affiliation(s)
| | - Patrick M Vecellio
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kim A Killinger
- Beaumont Health, Department of Urology, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Judith A Boura
- Beaumont Health, Department of Urology, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kenneth M Peters
- Beaumont Health, Department of Urology, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Stephens JR, Peters KM. A novel approach to vulvodynia using targeted neuromodulation. Can J Urol 2022; 29:11032-11035. [PMID: 35150228] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vulvodynia is a debilitating disorder which can prove extremely difficult to treat. Neuromodulation is increasingly becoming a frontline therapy in various chronic pain syndromes. We present a relatively simple surgical technique utilizing targeted neuromodulation leading to the successful treatment of vulvodynia.
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Affiliation(s)
- Jacob R Stephens
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Kenneth M Peters
- Department of Urology, William Beaumont Hospital, Royal Oak, Michigan, USA
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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Erol B, Danacioglu YO, Peters KM. Current advances in neuromodulation techniques in urology practices: A review of literature. Turk J Urol 2021; 47:375-385. [PMID: 35118977 PMCID: PMC9612778 DOI: 10.5152/tud.2021.21152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 06/14/2023]
Abstract
Neuromodulation has become a valid therapeutic option for patients with various lower urinary tract disorders. In clinical practice, the most used and recommended neuromodulation techniques are sacral neuromodulation (SNM), pudendal neuromodulation (PN), and percutaneous tibial nerve stimulation (PTNS). There are many theories concerning the mechanism of action of neuromodulation. Although SNM, PN, and PTNS show their activities through different nerve roots, all provide central and peripheral nervous system modulations. SNM has been approved for the treatment of overactive bladder (OAB), nonobstructive urinary retention, and fecal incontinence, while PTNS has been approved for OAB treatment. However, they are also used off-label in other urinary and nonurinary pelvic floor disorders, such as neurogenic lower urinary system disorder, interstitial cystitis, chronic pelvic pain, and sexual dysfunction. Minor and nonsurgical reversible complications are usually seen after neuromodulation techniques. In addition, in the last few years, there have been various developments in neuromodulation technology. Some of the examples of these developments are rechargeable batteries with wireless charging, improvements in programing, less invasive single-stage implantation in outpatient settings, and lower-cost new devices. We performed a literature search using Medline (PubMed), Cochrane Library, EMBASE, and Google scholar databases in the English language from January 2010 to February 2021. We included reviews, meta-analyses, randomized controlled trials, and prospective and retrospective studies to evaluate the activities and reliability of SNM, PN, and PTNS and the developments in this area in the last decade based on the current literature.
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Affiliation(s)
- Bulent Erol
- Department of Urology, İstanbul Bahçeci Health Group, İstanbul, Turkey
| | - Yavuz Onur Danacioglu
- Department of Urology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Kenneth M. Peters
- Department of Urology, Oakland University Wm. Beaumont School of Medicine, Detroit, MI, United States
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Evans R, Kohan A, Moldwin R, Radecki D, Geib T, Peters KM. Safety, tolerability, and efficacy of LiRIS 400 mg in women with interstitial cystitis/bladder pain syndrome with or without Hunner lesions. Neurourol Urodyn 2021; 40:1730-1739. [PMID: 34288094 DOI: 10.1002/nau.24702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 01/23/2023]
Abstract
AIMS Two phase 2 studies were conducted to assess the efficacy and safety of lidocaine-releasing intravesical system (LiRIS) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with (Study 001; NCT02395042) or without, (Study 002; NCT02411110) Hunner lesions (HL). METHODS Both were multicenter, randomized, double-blind, placebo-controlled, and enrolled women aged ≥18 years. In Study 001, patients were randomized 2:1:1 to LiRIS 400 mg/LiRIS 400 mg, placebo/LiRIS 400 mg, or placebo/placebo for a continuous 28 (2 × 14)-day period. In Study 002, patients were randomized 1:1 to LiRIS 400 mg or placebo for a continuous (single treatment) 14-day period. RESULTS In total, 59 and 131 patients received treatment in Studies 001 and 002, respectively. There was no statistically significant difference in the primary endpoint, the change from baseline to Week 4 of follow-up post-removal in mean daily average bladder numeric rating scale (NRS) pain score in either study (Study 001: placebo/placebo, -1.6; LiRIS/LiRIS, -2.7, p = 0.142; placebo/LiRIS, -2.5, p = 0.319; Study 002: LiRIS -1.2; placebo, -1.5, p = 0.505). There was no statistically significant difference between groups in daily worst NRS pain score, number of micturitions/day or urgency episodes/day. There was no clear trend for reduction in number of HL for LiRIS vs placebo. The frequency of treatment-emergent adverse events was similar between treatment groups in both studies; most were mild or moderate intensity. CONCLUSION These studies did not demonstrate a treatment effect of LiRIS 400 mg compared with placebo, either in patients with IC/BPS with HL, or in those without HL.
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Affiliation(s)
- Robert Evans
- Urology, Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Alfred Kohan
- Bethpage Division, Advanced Urology Centers of New York, Bethpage, New York, USA
| | - Robert Moldwin
- Urologic Infectious/Inflammatory Diseases, The Arthur Smith Institute for Urology, Lake Success, New York, USA
| | | | - Till Geib
- Specialty Development, AbbVie, Irvine, California, USA
| | - Kenneth M Peters
- Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.,Urology, Beaumont Health, Royal Oak, Michigan, USA
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14
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Hoang Roberts L, Vollstedt A, Volin J, McCartney T, Peters KM. Initial experience using a novel nerve stimulator for the management of pudendal neuralgia. Neurourol Urodyn 2021; 40:1670-1677. [PMID: 34196055 DOI: 10.1002/nau.24735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/24/2021] [Revised: 05/09/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022]
Abstract
AIMS In patients with pudendal neuralgia, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc.). This feasibility study reports on the initial experience of using a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia. METHODS Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at Postoperative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the Global Response Assessment, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (h/day of stimulation). RESULTS Thirteen patients had the StimWave® lead placed at the pudendal nerve, 12 (92%) female and 1 (7.6%) male. Mean age was 50 years (range: 20-58). Failed prior therapies include medical therapy (100%), pelvic floor physical therapy (92%), pudendal nerve blocks (85%), pelvic floor muscle trigger point injections (69%), neuromodulation (30.7%), or surgeries for urogenital pain (23.1%). After the trial period, 10/13 (76.9%) had >50% improvement in pain with 6/13 (46.1%) reporting 100% pain improvement. Nine underwent permanent lead placement. At last postoperative visit (range, 6-83 days), 5/9 patients reported >50% pain improvement. Seven patients reached for phone calls (22-759 days) reported symptoms to be "markedly improved" (n = 2), "moderately improved" (n = 4), or "slightly improved" (n = 1). At follow up, complications included lead migration (n = 2), broken wire (n = 1), or nonfunctioning antenna (n = 2). CONCLUSION Complex patients with pudendal neuralgia may benefit from pudendal nerve stimulation via StimWave®.
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Affiliation(s)
- Ly Hoang Roberts
- Oakland University William Beaumont School of Medicine, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Annah Vollstedt
- Oakland University William Beaumont School of Medicine, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Joshua Volin
- Oakland University William Beaumont School of Medicine, Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Kenneth M Peters
- Oakland University William Beaumont School of Medicine, Beaumont Hospital, Royal Oak, Michigan, USA
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15
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Ward EP, Bartolone SN, Chancellor MB, Peters KM, Lamb LE. Proteomic analysis of bladder biopsies from interstitial cystitis/bladder pain syndrome patients with and without Hunner's lesions reveals differences in expression of inflammatory and structural proteins. BMC Urol 2020; 20:180. [PMID: 33160333 PMCID: PMC7648270 DOI: 10.1186/s12894-020-00751-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/10/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Interstitial cystitis/bladder pain syndrome is a bladder disease usually characterized by pain, urgency, and frequency. Interstitial cystitis is currently classified into two subtypes, with and without Hunner’s lesions. However, the underlying etiology of interstitial cystitis and its subtypes are largely unknown. Methods To better understand the biological changes in the bladder of interstitial cystitis/bladder pain syndrome patients, we directly analyzed bladder tissue of interstitial cystitis patients, both those with Hunner’s lesions and those without. Proteins in the bladder biopsies were analyzed using nanoscale high-performance liquid chromatography-tandem mass spectrometry. Disease subgroups were compared and significantly expressed proteins were mapped using STRING to determine protein associations and functions. Results We found that patients with Hunner’s lesions had significant increases in inflammatory and endoplasmic reticulum stress proteins, with a decrease in cellular adhesive proteins, compared to patients without Hunner’s lesions. These patients also exhibited a decrease in proteins associated with the Rap1 signaling pathway, which regulates cell proliferation and wound healing. When comparing diseased and non-disease-apparent tissue in patients with Hunner’s lesions, diseased tissue exhibited a decrease in ubiquitination proteins. Conclusions In summary, there are significant differences in protein expression found in the bladders of interstitial cystitis patients with and without Hunner’s lesions, indicating a disturbance in proteins associated with cellular adhesion, proliferation, protein processing, and wound healing.
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Affiliation(s)
- Elijah P Ward
- Department of Urology, Beaumont Health System, 3811 W. 13 Mile Road, Suite 504, Royal Oak, MI, 48073, USA
| | - Sarah N Bartolone
- Department of Urology, Beaumont Health System, 3811 W. 13 Mile Road, Suite 504, Royal Oak, MI, 48073, USA
| | - Michael B Chancellor
- Department of Urology, Beaumont Health System, 3811 W. 13 Mile Road, Suite 504, Royal Oak, MI, 48073, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Kenneth M Peters
- Department of Urology, Beaumont Health System, 3811 W. 13 Mile Road, Suite 504, Royal Oak, MI, 48073, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Laura E Lamb
- Department of Urology, Beaumont Health System, 3811 W. 13 Mile Road, Suite 504, Royal Oak, MI, 48073, USA. .,Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
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16
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Martin S, Han E, Peters KM. A Novel Approach to Managing Post Retropubic Vaginal Sling Pain. Urology 2019; 137:196-199. [PMID: 31738943 DOI: 10.1016/j.urology.2019.11.008] [Citation(s) in RCA: 1] [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] [Received: 09/03/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe a novel technique of using peripheral nerve neuromodulation (PNNM) for the treatment of refractory, mesh-induced chronic pelvic pain. Chronic pelvic pain associated with mesh can be a debilitating complication and there is currently no consensus on treatment. PNNM has been shown to be successful in the treatment of post-traumatic neuralgias but has yet to be studied in mesh complications. MATERIALS AND METHODS We present a case of a 50-year-old woman who had unrelenting pelvic pain after retropubic sling placement. She failed multiple therapies including medications, mesh removal, pelvic floor physical therapy, pudendal neuromodulation, and pelvic floor onabotulinumtoxinA trigger point injections. RESULTS The only treatment that provided temporary relief of this patient's pain was transvaginal trigger point injections along with a right pudendal nerve block using 40 mg triamcinolone and 0.5% ropivacaine. To help define if treatment at the site of her pain would provide relief, a series of blocks were done by advancing a needle retropubically to her area of pain and injecting triamcinolone and 0.5% ropivacaine. This injection, which corresponded to the previous tract of her retropubic sling, provided temporary, but profound, relief. PNNM was then done with placement of the electrode in the retropubic space at the site of her pain. This provided instantaneous relief of almost all of her pain symptoms. Twelve months postoperatively, the patient continued to have >90% improvement in her pain. CONCLUSION Focused PNNM is a simple procedure and can provide symptomatic relief for refractory postvaginal mesh pain.
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Affiliation(s)
| | | | - Kenneth M Peters
- Beaumont Hospital, Royal Oak, MI; Oakland University William Beaumont School of Medicine, Auburn Hills, MI
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17
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Peters KM, Newman D, Belkoff L, Nandalur K, Johnston MA, Small S, Taylor R, Sirls LT. PD05-09 ORAL ENOBOSARM SHOWS PROMISING ACTIVITY IN POST-MENOPAUSAL WOMEN WITH STRESS URINARY INCONTINENCE: RESULTS OF A PHASE 2 STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.417] [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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18
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Nguyen LN, Gruner M, Killinger KA, Peters KM, Boura JA, Jankowski M, Sirls LT. Additional treatments, satisfaction, symptoms and quality of life in women 1 year after vaginal and abdominal pelvic organ prolapse repair. Int Urol Nephrol 2018; 50:1031-1037. [PMID: 29549625 DOI: 10.1007/s11255-018-1846-5] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/12/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate additional treatments, symptoms, satisfaction and quality of life 1 year after vaginal and abdominal pelvic organ prolapse (POP) repair. METHODS Adult women enrolled in a prospective POP database were reviewed. Baseline and outcomes data 1 year after surgery were collected including the Pelvic Floor Distress Inventory (PFDI) and mailed surveys. Data were analyzed with descriptive statistics, Fisher's exact tests and t tests. RESULTS Of 222 women, 147 (66%) had vaginal and 75 (34%) had abdominal repair. Vaginal group patients were older (64.1 vs. 59.7 years; p = 0.003), but other demographic characteristics did not differ. Vaginal group patients had lower baseline anterior and apical prolapse grades (anterior 2.7 vs. 3.1, p = 0.003; apical 2.1 vs. 3.1, p < 0.001). Baseline PFDI scores were similar. Scores improved significantly for both groups after 1 year, but 1-year PFDI scores were significantly higher in the vaginal group (45.6 vs. 32.6, p = 0.032). Scores were not different when adjusted for age and prolapse grade (p = 0.24). At 1 year, most patients in the vaginal and abdominal groups reported moderately/markedly improved overall symptoms (72/108 vs. 50/60, p = 0.030) and quality of life (89/101 vs. 54/59, p = 0.601). Most were satisfied with surgery (68/101 vs. 48/59, p = 0.067). Retreatment rates (pelvic floor physical therapy, medications, coping strategies, surgical procedures) were similar (34/109 vs. 15/62, p = 0.381). Vaginal mesh use did not affect additional treatments, patient satisfaction or symptoms. CONCLUSIONS Although symptoms improve and most women are satisfied with surgery, about one in four women have additional therapy in the first year after POP repair.
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Affiliation(s)
- Laura N Nguyen
- Beaumont Health, 3535 W. 13 Mile Road, Room 428, Urology Administration, Royal Oak, MI, 48067, USA.
| | - Morgan Gruner
- Beaumont Health, 3535 W. 13 Mile Road, Room 428, Urology Administration, Royal Oak, MI, 48067, USA
| | - Kim A Killinger
- Beaumont Health, 3535 W. 13 Mile Road, Room 428, Urology Administration, Royal Oak, MI, 48067, USA.,Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Kenneth M Peters
- Beaumont Health, 3535 W. 13 Mile Road, Room 428, Urology Administration, Royal Oak, MI, 48067, USA.,Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Judith A Boura
- Beaumont Health, 3535 W. 13 Mile Road, Room 428, Urology Administration, Royal Oak, MI, 48067, USA.,Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Michelle Jankowski
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Larry T Sirls
- Beaumont Health, 3535 W. 13 Mile Road, Room 428, Urology Administration, Royal Oak, MI, 48067, USA.,Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Nguyen LN, Bartley J, Killinger KA, Gupta P, Lavin J, Khourdaji A, Gilleran J, Gaines N, Boura JA, Peters KM. Does sex matter? A matched pairs analysis of neuromodulation outcomes in women and men. Int Urol Nephrol 2018. [DOI: 10.1007/s11255-018-1843-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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20
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Sirls ER, Killinger KA, Boura JA, Peters KM. Percutaneous Tibial Nerve Stimulation in the Office Setting: Real-world Experience of Over 100 Patients. Urology 2018; 113:34-39. [DOI: 10.1016/j.urology.2017.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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21
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Tutolo M, Ammirati E, Heesakkers J, Kessler TM, Peters KM, Rashid T, Sievert KD, Spinelli M, Novara G, Van der Aa F, De Ridder D. Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature. Eur Urol 2018; 73:406-418. [PMID: 29336927 DOI: 10.1016/j.eururo.2017.11.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 01/31/2016] [Accepted: 11/03/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment. OBJECTIVE To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not responsive to conservative treatments. EVIDENCE ACQUISITION A literature research was conducted in PubMed/Medline and Scopus, restricted to articles in English, published between January 1998 and June 2017, with at least 20 patients and 6 mo of follow-up. EVIDENCE SYNTHESIS Twenty-one reports were identified. Concerning SNM, the improvement of ≥50% in leakage episodes ranged widely between 29% and 76%. Overall dry rate ranged between 43% and 56%. Overall success/improvement rate in PTNS varied between 54% and 59%. Symptom improvement or efficacy in interstitial cystitis/bladder pain syndrome patients appeared to be lower compared with other indications in both techniques. Safety data showed fewer side effects in patients submitted to PTNS. CONCLUSIONS Neuromodulation gives good results and is a safe therapy for patients with overactive bladder or chronic nonobstructive urinary retention with long-lasting efficacy. Moreover, PTNS has been shown to have good success rates and fewer side effects compared with SNM. These data have to be confirmed with long-term follow-up. PATIENT SUMMARY Sacral neuromodulation can improve low urinary tract symptoms in selected patients; it appears to be a safe therapy for nonresponders to standard medical therapies. Percutaneous tibial nerve stimulation (PTNS) is a less invasive technique that gives good results in short time with fewer side effects. However, we must consider that PTNS has not been tested in the long term and results are lower if compared with SNM.
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Affiliation(s)
- Manuela Tutolo
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Enrico Ammirati
- Department of Urology, Ospedale San Giovanni Battista, Turin, Italy
| | - John Heesakkers
- Department of Urology 610, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, Zurich, Switzerland
| | | | - Tina Rashid
- Functional Urology and Gender Services, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Karl-Dietrich Sievert
- University of Rostock Urology Clinic, Rostock, Germany; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Michele Spinelli
- Spinal Unit, Division of Neurourology, A. Zanollo Center for Sacral Area Disfunction, Ospedale Niguarda, Milan, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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22
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Lamb LE, Janicki JJ, Bartolone SN, Peters KM, Chancellor MB. Development of an interstitial cystitis risk score for bladder permeability. PLoS One 2017; 12:e0185686. [PMID: 29088231 PMCID: PMC5663335 DOI: 10.1371/journal.pone.0185686] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/18/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interstitial cystitis/bladder pain syndrome (IC) is a multifactorial syndrome of severe pelvic and genitalia pain and compromised urinary function; a subset of IC patients present with Hunner's lesions or ulcers on their bladder walls (UIC). UIC is diagnosed by cystoscopy, which may be quite painful. The objective of this study was to determine if a calculated Bladder Permeability Defect Risk Score (BP-RS) based on non-invasive urinary cytokines could discriminate UIC patients from controls and IC patients without Hunner's ulcers. METHODS A national crowdsourcing effort targeted IC patients and age-matched controls to provide urine samples. Urinary cytokine levels for GRO, IL-6, and IL-8 were determined using a Luminex assay. RESULTS We collected 448 urine samples from 46 states consisting of 153 IC patients (147 female, 6 male), of which 54 UIC patients (50 females, 4 male), 159 female controls, and 136 male controls. A defined BP-RS was calculated to classify UIC, or a bladder permeability defect etiology, with 89% validity. CONCLUSIONS The BP-RS Score quantifies UIC risk, indicative of a bladder permeability defect etiology in a subset of IC patients. The Bladder Permeability Defect Risk Score is the first validated urine biomarker assay for interstitial cystitis/bladder pain syndrome.
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Affiliation(s)
- Laura E. Lamb
- Department of Urology, Beaumont Health System, Royal Oak, MI, United States of America
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States of America
| | - Joseph J. Janicki
- Underactive Bladder Foundation, Pittsburgh, PA, United States of America
| | - Sarah N. Bartolone
- Department of Urology, Beaumont Health System, Royal Oak, MI, United States of America
| | - Kenneth M. Peters
- Department of Urology, Beaumont Health System, Royal Oak, MI, United States of America
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States of America
| | - Michael B. Chancellor
- Department of Urology, Beaumont Health System, Royal Oak, MI, United States of America
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States of America
- * E-mail:
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Wenzler DL, Gulli F, Cooney M, Chancellor MB, Gilleran J, Peters KM. Treatment of ulcerative compared to non-ulcerative interstitial cystitis with hyperbaric oxygen: a pilot study. Ther Adv Urol 2017; 9:263-270. [PMID: 29383031 DOI: 10.1177/1756287217731009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/02/2017] [Accepted: 08/20/2017] [Indexed: 12/14/2022] Open
Abstract
Background The etiology of interstitial cystitis (IC) is often idiopathic but can be due to Hunner's ulcers. Hyperbaric oxygen (HBO) is used to treat ulcerative disease of the superficial skin. We hypothesized that HBO can treat ulcerative IC (UIC) but would be less efficacious for non-ulcerative IC (NIC). Methods Patients with NIC and UIC enrolled in this study. Following informed consent, demographic information was collected. A visual analog pain scale and validated questionnaires were collected; each patient underwent cystoscopy prior to treatment. Each subject met with a hyperbaric specialist and after clearance underwent 30 treatments over 6 weeks. Adverse events were monitored. Patients repeated questionnaires, visual analog pain scale and global response assessment (GRA) immediately, 2 weeks, 3, 6 and 12 months after treatment. Patients also underwent cystoscopy 6 months after treatment. Differences before and after treatment were compared. Results Nine patients were recruited to this study. One was unable to participate, leaving two subjects with NIC and six with UIC. All patients completed HBO without adverse events. Three patients completed HBO but pursued other therapies 7, 8.5 and 11 months after treatment. On GRA, 83% of patients with UIC were improved. This treatment effect persisted, as 66% of UIC patients remained better at 6 months. In contrast, only one patient in the NIC group improved. Questionnaire scores improved in both groups. Pain scores improved by 2 points in the UIC group but worsened by 1.5 points in the NIC group. Two patients with ulcers resolved at 6-month cystoscopy. Conclusion HBO appeared beneficial for both UIC and NIC. Data shows slightly better benefit in patients with UIC compared to NIC; both groups showed improvement. Given the small sample size, it is difficult to draw definitive conclusions from these data. Larger studies with randomization would be beneficial to show treatment effect.
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Affiliation(s)
- David L Wenzler
- Beaumont Health System, 3601 W 13 Mile Rd., St. 438, Royal Oak, MI 48073-6769, USA
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Killinger KA, Fergus J, Edwards L, Boura JA, Bartley J, Gupta P, Tomakowsky J, Gilleran J, Peters KM. Coexisting depressive symptoms do not limit the benefits of chronic neuromodulation: A study of over 200 patients. Neurourol Urodyn 2017; 37:815-822. [DOI: 10.1002/nau.23356] [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] [Received: 05/04/2017] [Accepted: 06/17/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Kim A. Killinger
- Beaumont Health; Royal Oak Michigan
- Oakland University William Beaumont School of Medicine; Rochester Michigan
| | - Jonathan Fergus
- Oakland University William Beaumont School of Medicine; Rochester Michigan
| | | | - Judith A. Boura
- Beaumont Health; Royal Oak Michigan
- Oakland University William Beaumont School of Medicine; Rochester Michigan
| | - Jamie Bartley
- Beaumont Health; Royal Oak Michigan
- Oakland University William Beaumont School of Medicine; Rochester Michigan
| | - Priyanka Gupta
- Department of Urology; University of Michigan; Ann Arbor Michigan
| | | | - Jason Gilleran
- Beaumont Health; Royal Oak Michigan
- Oakland University William Beaumont School of Medicine; Rochester Michigan
| | - Kenneth M. Peters
- Beaumont Health; Royal Oak Michigan
- Oakland University William Beaumont School of Medicine; Rochester Michigan
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25
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Lehnert SJ, Butts IAE, Flannery EW, Peters KM, Heath DD, Pitcher TE. Effects of ovarian fluid and genetic differences on sperm performance and fertilization success of alternative reproductive tactics in Chinook salmon. J Evol Biol 2017; 30:1236-1245. [PMID: 28387056 DOI: 10.1111/jeb.13088] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 06/10/2016] [Revised: 03/03/2017] [Accepted: 03/30/2017] [Indexed: 12/20/2022]
Abstract
In many species, sperm velocity affects variation in the outcome of male competitive fertilization success. In fishes, ovarian fluid (OF) released with the eggs can increase male sperm velocity and potentially facilitate cryptic female choice for males of specific phenotypes and/or genotypes. Therefore, to investigate the effect of OF on fertilization success, we measured sperm velocity and conducted in vitro competitive fertilizations with paired Chinook salmon (Oncorhynchus tshawytscha) males representing two alternative reproductive tactics, jacks (small sneaker males) and hooknoses (large guarding males), in the presence of river water alone and OF mixed with river water. To determine the effect of genetic differences on fertilization success, we genotyped fish at neutral (microsatellites) and functional [major histocompatibility complex (MHC) II ß1] markers. We found that when sperm were competed in river water, jacks sired significantly more offspring than hooknoses; however, in OF, there was no difference in paternity between the tactics. Sperm velocity was significantly correlated with paternity success in river water, but not in ovarian fluid. Paternity success in OF, but not in river water alone, was correlated with genetic relatedness between male and female, where males that were less related to the female attained greater paternity. We found no relationship between MHC II ß1 divergence between mates and paternity success in water or OF. Our results indicate that OF can influence the outcome of sperm competition in Chinook salmon, where OF provides both male tactics with fertilization opportunities, which may in part explain what maintains both tactics in nature.
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Affiliation(s)
- S J Lehnert
- Great Lakes Institute for Environmental Research, University of Windsor, Windsor, ON, Canada
| | - I A E Butts
- School of Fisheries, Aquaculture and Aquatic Sciences, Auburn University, Auburn, AL, USA
| | - E W Flannery
- Department of Biological Sciences, University of Windsor, Windsor, ON, Canada
| | - K M Peters
- Great Lakes Institute for Environmental Research, University of Windsor, Windsor, ON, Canada.,Department of Biological Sciences, University of Windsor, Windsor, ON, Canada
| | - D D Heath
- Great Lakes Institute for Environmental Research, University of Windsor, Windsor, ON, Canada.,Department of Biological Sciences, University of Windsor, Windsor, ON, Canada
| | - T E Pitcher
- Great Lakes Institute for Environmental Research, University of Windsor, Windsor, ON, Canada.,Department of Biological Sciences, University of Windsor, Windsor, ON, Canada
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Killinger KA, Gupta P, Gilleran JP, Bartley J, Ehlert M, Boura JA, Peters KM. The Impact of Baseline Functional Bladder Capacity on Short-term Neuromodulation Outcomes. Urology 2017; 102:68-72. [DOI: 10.1016/j.urology.2017.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/29/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
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Gaines N, Henrichsen J, Nguyen L, Sirls LT, Gilleran J, Bartley J, Gupta P, Killinger KA, Petrossian R, Odabachian L, Boura JA, Peters KM. PD39-07 PELVIC FLOOR PHYSICAL THERAPY SIGNIFICANTLY IMPROVES PAIN AND VOIDING SYMPTOMS IN WOMEN WITH PELVIC PAIN. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1734] [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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Tyagi P, Killinger K, McLennan G, Jayabalan N, Chancellor M, Peters KM. Urine chemokine levels correlate with treatment response to phosphodiesterase 4 inhibitor in prostatitis. World J Clin Urol 2017; 6:18-26. [DOI: 10.5410/wjcu.v6.i1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the association of urinary chemokines with the treatment response in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) patients.
METHODS Between 2007-2011, 18 out of 21 male CP/CPPS patients met the exclusion/inclusion criteria of the 16 wk longitudinal study on twice daily oral treatment with Phosphodiesterase 4 inhibitor called Apremilast for 12 wk. Symptom scores and urine specimen were collected at baseline and every visit at 4 wk interval from CP/CPPS patients who completed at least 8 wk of drug treatment. Urine collected at each visit was frozen and then analyzed together after thawing for chemokines and growth factors using MILLIPLEX™ MAP immunoassay. Cross sectional association of Chronic Prostatitis Symptom Index (CPSI) and visual analog scale (VAS) with chemokine levels in urine collected at baseline was assessed in 18 CP/CPPS patients relative to 10 asymptomatic male subjects. Longitudinal association between urine chemokine levels and symptom scores was assessed in 8 treatment-adherent CP/CPPS patients at baseline and at 4, 8, 12 and 16 wk.
RESULTS Urine chemokines levels of CXCL-1 (GRO-a), CXCL-8 (IL-8), CXCL-10 (IP-10) and CCL5 (RANTES) in CP/CPPS patients at baseline were significantly elevated relative to asymptomatic subjects, whereas levels of sIL-1RA in CP/CPPS were significantly lower compared to controls (P < 0.05). Quantitatively, urine levels of CXCL-10 were higher than other chemokines in CP/CPPS, but its 5 fold change relative to controls was lower than the 20 fold change noted for CXCL-8. The mean age of enrolled patients who completed at least 8 wk of treatment (n = 8) was 46.5 ± 9.4 years and analysis found that elevation of CXCL-8 and CCL5 increased the odds for higher score of CPSI by 54% and 25%, respectively (F test, P = 0.00007). Urine levels of CCL2 (MCP-1) and CXCL-10 together explained approximately 85% of variance in longitudinal data on multivariate analysis. Bivariate analysis of 5 patients who fully complied and completed the assigned dose regimen, showed strong linear correlation of reduced urine levels of CXCL-10, CXCL-8, CCL5, CCL2 and PDGF with improvement in clinical activity as measured by pain VAS and CPSI (Pearson r = 0.83-0.97; P < 0.05).
CONCLUSION Urine levels of CXCL-10, CCL2 and PDGF can be sensitive, objective and non-invasive markers of response to new therapeutic intervention in CP/CPPS patients.
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Bartley JM, Killinger KA, Boura JA, Gupta P, Gaines N, Gilleran JP, Peters KM. The impact of prior back surgery on neuromodulation outcomes: A review of over 500 patients. Neurourol Urodyn 2016; 36:1535-1542. [PMID: 27676460 DOI: 10.1002/nau.23140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 07/14/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022]
Abstract
AIMS To evaluate neuromodulation outcomes in patients with prior back surgery. METHODS Adults in our prospective observational sacral/pudendal neuromodulation study were retrospectively evaluated. History and operative details were reviewed, and outcomes were measured at 3, 6, 12, and 24 months with overactive bladder questionnaire (OAB q) symptom severity (SS)/health related quality of life (HRQOL), interstitial cystitis symptom/problem indices (ICSI - PI), voiding diaries, and global response assessments (GRA). Data were examined with Pearson's χ2 , Fisher's exact, Wilcoxon rank sum tests, and logistic regression multivariate analysis. RESULTS Five hundred and sixty patients were evaluated (mean age 58.8 ± 17 years; 83% female; 79% had a sacral lead placed), 109 (19%) had history of back surgery; 66 surgeries were lumbar. Back surgery patients were older (mean 63 ± 15 vs. 58 ± 17 years; P = 0.003) and a higher proportion had urge urinary incontinence (UUI) (64% vs. 50% P = 0.008). Generator implant rates were similar (94% vs. 91%; P = 0.34). OABq-SS and HRQOL and ICSI - PI composite scores did not differ between groups at any time point. On bladder diaries, median incontinence episodes daily at baseline and between stages were worse in the prior back surgery group but all bladder diary parameters improved significantly in both groups with the exception of mean voided volume which only improved significantly in the non-back surgery group. Most patients in both groups reported moderate/marked improvement in overall bladder symptoms. CONCLUSIONS This study suggests that prior back surgery does not appear to impact clinical outcomes; therefore, neuromodulation may be offered in this patient population.
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Affiliation(s)
- Jamie M Bartley
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - Judith A Boura
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | | | - Jason P Gilleran
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Kenneth M Peters
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Bartley JM, Ramirez V, Killinger KA, Boura JA, Gupta P, Gaines N, Gilleran JP, Peters KM. Outcomes of Sacral Neuromodulation in Patients with Prior Surgical Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2016; 23:8-12. [PMID: 27636222 DOI: 10.1097/spv.0000000000000324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy of sacral neuromodulation in patients with prior stress urinary incontinence (SUI) or pelvic organ prolapse (POP) surgery. METHODS Women in our prospective neuromodulation database were evaluated. Patients with a history of prior SUI/POP surgery were compared to those without. Medical records at baseline were reviewed, and primary outcome was defined as moderate/marked improvement on Global Response Assessment (GRA) at 3 months. Secondary outcomes were measured using bladder diaries and Overactive Bladder Symptom Severity (OABq-SS)/health-related quality of life (HRQOL). Data were analyzed with Pearson χ test, Fisher exact test, Wilcoxon rank-sum test, and repeated-measures analyses. RESULTS Of 210 subjects, 108 (51%) had prior SUI/POP surgery. Patients with SUI/POP surgery had more prior hysterectomies. At 3 months, there was no difference between groups on GRA outcomes. On the bladder diary, both groups had improvement in median voids per 24 hours, urgency severity, and urge incontinence over 2 years. On the GRA, fewer patients in the SUI/POP group were treatment responders at 12 and 24 months. For urinary urgency, a few in this group were moderately/markedly improved at 6 months, and a higher proportion are reported still leaking urine at 6 and 12 months. Similar proportions in each group reported moderate/marked improvement in leaking. Satisfaction was similar between groups. The OABq-SS/HRQOL scores improved, and there was no difference between the groups. CONCLUSION Sacral neuromodulation improves bladder symptoms in women with prior SUI/POP surgery, but response may be slightly less in those with prior surgery due to underlying bladder or pelvic floor issues.
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Affiliation(s)
- Jamie M Bartley
- From the *Oakland University William Beaumont School of Medicine, Rochester, MI; and †Beaumont Health, Royal Oak, MI
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Nault T, Gupta P, Ehlert M, Dove-Medows E, Seltzer M, Carrico DJ, Gilleran J, Bartley J, Peters KM, Sirls L. Does a history of bullying and abuse predict lower urinary tract symptoms, chronic pain, and sexual dysfunction? Int Urol Nephrol 2016; 48:1783-1788. [PMID: 27495323 DOI: 10.1007/s11255-016-1383-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/04/2016] [Accepted: 07/22/2016] [Indexed: 01/30/2023]
Abstract
PURPOSE To investigate associations of bullying and abuse with pelvic floor symptoms, urogenital pain, and sexual health characteristics of women presenting to a multidisciplinary women's urology center. METHODS Retrospective review of a prospective database. Patients completed questions about bullying, abuse, sexual health and validated questionnaires including the Pelvic Floor Dysfunction Inventory (PFDI-20), Overactive Bladder Questionnaire (OAB-q), and visual analog scale (VAS 0-10) for genitourinary pain. Statistical analyses included Chi-squared and t tests, which compared victims of bullying and/or abuse to non-victims. RESULTS Three hundred and eighty patients were reviewed. Three hundred and thirty-eight had data on bullying and abuse history. Out of 380, 94 (24.7 %) reported that they were victims of bullying. Out of 380, 104 (27.4 %) reported that they were victims of abuse. Women with a history of bullying and abuse had increased overall pain scores compared to those without a history of either. Women with a history of abuse and bullying had increased PFDI-20, POPDI, and UDI-6 scores compared to women who were not bullied or abused. There was no difference in being sexually active or in sexual satisfaction between the groups. Patients with a history of abuse and bullying had the greatest percentage of dyspareunia (p = 0.009). CONCLUSIONS Women with a history of bullying, abuse, or both predict increased pelvic floor distress, urological symptoms, increased urogenital pain, and increased dyspareunia. Clinicians should screen for exposure to bullying or abuse in order to provide comprehensive resources to address these psychosocial issues.
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Affiliation(s)
- Tori Nault
- Oakland University, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Priyanka Gupta
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA.
| | - Michael Ehlert
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA
| | - Emily Dove-Medows
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA
| | - Marlene Seltzer
- Oakland University, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Donna J Carrico
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA
| | - Jason Gilleran
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA
| | - Jamie Bartley
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA
| | - Kenneth M Peters
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA
- Oakland University, William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Larry Sirls
- Department of Urology, William Beaumont Health System, 3535 West 13 Mile Rd, Suite 438, Royal Oak, MI, USA
- Oakland University, William Beaumont School of Medicine, Royal Oak, MI, USA
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Schober MS, Ching CB, Peters KM, Alpert SA. Novel Use of Pudendal Neuromodulation in a Pediatric Patient With Caudal Regression and Partial Sacral Agenesis for Refractory Bowel Bladder Dysfunction. Urology 2016; 94:224-6. [PMID: 27034090 DOI: 10.1016/j.urology.2016.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/26/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
Sacral neuromodulation (SNM) has been used off-label in the United States for over a decade in the pediatric population. Many published studies have demonstrated efficacy with SNM in this population; however, a significant number of children with refractory bowel bladder dysfunction (BBD) also have underlying comorbidities. Children with certain spinal abnormalities pose a problem for the urologist treating BBD. Patients with caudal regression can have various sacral anomalies, making SNM challenging or impossible. We present the first case in the United States of pudendal neuromodulation in a pediatric BBD patient with caudal regression.
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Affiliation(s)
- Megan S Schober
- Department of Urology, William Beaumont Hospital, Royal Oak, MI.
| | - Christina B Ching
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Seth A Alpert
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH; Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
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Gaines N, Gupta P, Hu JC, Killinger KA, Boura JA, Bartley J, Gilleran J, Peters KM. MP77-16 DOES UPPER MEDIAL PLACEMENT OF A SACRAL LEAD AFFECT NEUROMODULATION OUTCOMES? A RADIOLOGIC STUDY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1930] [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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35
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Gupta P, Gaines N, Gilleran J, Killinger KA, Bartley J, Wolfert C, Boura JA, Peters KM. MP37-19 DOES SEX MATTER? A MATCHED PAIRS ANALYSIS OF NEUROMODULATION OUTCOMES IN WOMEN AND MEN. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1696] [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: 11/29/2022]
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Roth A, Beckmann J, Bohndorf K, Fischer A, Heiß C, Kenn W, Jäger M, Maus U, Nöth U, Peters KM, Rader C, Reppenhagen S, Smolenski U, Tingart M, Kopp I, Sirotin I, Breusch SJ. S3-Guideline non-traumatic adult femoral head necrosis. Arch Orthop Trauma Surg 2016; 136:165-74. [PMID: 26667621 DOI: 10.1007/s00402-015-2375-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The treatment of adult non-traumatic avascular necrosis of the femoral head (AVN; N-ANFH) within an estimated incidence of 5000-7000 cases per annum in Germany remains a challenge. Risk factors include steroids, alcohol abuse, chemotherapy and immunosuppressive medication, but a genetic predisposition has been suggested. Early diagnosis of this often bilateral disease process is essential for successful conservative or joint preserving surgical management. In this review, we present the update German consensus S3 guideline "diagnosis and management for N-ANFH" as a concise summary. MATERIALS AND METHODS This systematic review is based on the published literature from January 1, 1970 to April 31, 2013 (German and English language). Inclusion criteria were systematic reviews, meta-analyses and relevant peer review publications. We identified a total of 3715 related publications, of which 422 were suitable according to the SIGN criteria, but only 159 fulfilled our inclusion criteria. RESULTS AND CONCLUSIONS Clinical suspicion of N-ANFH mandates radiographic evaluation. If radiographs are normal MRI scans are recommended, which should be evaluated according to the ARCO-classification. Differential diagnoses include transient osteoporosis, bone bruise, insufficiency fracture and destructive arthropathy. Untreated, subchondral fractures commonly occur within 2 years, during which the risk for contralateral involvement is high-thereafter unlikely. Conservative management with Ilomedin and Alendronat can be tried, but other pharmacological or physical treatments are inappropriate. No specific joint preserving procedure can be recommended, but core decompression should be considered in early stages if necrosis is <30 %. In ARCO stages IIIc or IV total hip arthroplasty (THA) should be contemplated, which offers similar outcome compared to osteoarthritis. Young age is the main risk factor for higher revision rates after THA for N-ANFH.
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Affiliation(s)
- A Roth
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie; Bereich Endoprothetik/Orthopädie, Universitätsklinik Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Germany.
| | - J Beckmann
- Sektion Endoprothetik, Sportklinik Stuttgart, Stuttgart, Germany
| | - K Bohndorf
- Universitätsklinik für Radiologie und Nuklearmedizin, Exzellenzzentrum für Hochfeld MR, Medizinische Universität Wien, Vienna, Austria.,Christian Doppler Laboratory for Molecular Imaging, Medizinische Universität Wien, Vienna, Austria
| | - A Fischer
- Abteilung für Physikalische und Rehabilitative Medizin, Klinikum Burgenlandkreis GmbH, Naumburg, Germany
| | - C Heiß
- Klinik für Unfallchirurgie, Universitätsklinikum Gießen-Marburg, Marburg, Germany
| | - W Kenn
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - M Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen-Duisburg, Essen, Germany
| | - U Maus
- Klinik für Orthopädie und orthopädische Chirurgie, Universitätsklinik für Orthopädie und Unfallchirurgie, Pius-Hospital, Oldenburg, Germany
| | - U Nöth
- Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany
| | - K M Peters
- Orthopädie und Osteologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht, Germany
| | - C Rader
- Praxisklinik Orthopädie Aachen, Franziskushospital Aachen, Aachen, Germany
| | - S Reppenhagen
- Orthopädische Klinik König-Ludwig-Haus, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - U Smolenski
- Institut für Physiotherapie, Friedrich-Schiller Universität Jena, Jena, Germany
| | - M Tingart
- Klinik für Orthopädie, Universitätsklinikum Aachen, Aachen, Germany
| | - I Kopp
- AWMF-Institut, Philipps-Universität Marburg, Marburg, Germany
| | - I Sirotin
- Pirogov-Universität Moskau, 64. Städtisches Krankenhaus, Moscow, Russia
| | - S J Breusch
- FRCS Ed, Orthopaedic Department, Edinburgh Royal Infirmary, Edinburgh, UK
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Gupta P, Gaines N, Sirls LT, Peters KM. A multidisciplinary approach to the evaluation and management of interstitial cystitis/bladder pain syndrome: an ideal model of care. Transl Androl Urol 2016; 4:611-9. [PMID: 26816861 PMCID: PMC4708537 DOI: 10.3978/j.issn.2223-4683.2015.10.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a complex syndrome that has long been treated with bladder directed therapies, which often fail to address the multiple underlying etiologies that can contribute to this disease process. This disease often involves symptoms that extend beyond the bladder and involve the pelvic floor making it crucial for clinicians to approach the patient using a multidisciplinary team. This article will discuss the underlying etiologies for IC/BPS and describe the multidisciplinary approach which we have found to be extremely successful in managing this patient population.
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Affiliation(s)
- Priyanka Gupta
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
| | - Natalie Gaines
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
| | - Larry T Sirls
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
| | - Kenneth M Peters
- 1 Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Beaumont Health System, Royal Oak, Michigan 48073, USA ; 2 Oakland University William Beaumont School of Medicine, Rochester, Michigan 48309, USA
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Peters KM, Killinger KA, Gilleran JP, Bartley J, Wolfert C, Boura JA. Predictors of reoperation after sacral neuromodulation: A single institution evaluation of over 400 patients. Neurourol Urodyn 2015; 36:354-359. [PMID: 26587581 DOI: 10.1002/nau.22929] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/02/2015] [Indexed: 11/09/2022]
Abstract
AIMS To explore factors that may predispose patients to reoperation after sacral neuromodulation (SNM). METHODS Patients enrolled in our longitudinal neuromodulation database were reviewed. Medical records data, and voiding diaries, Interstitial Cystitis Symptom-Problem Indices (ICSI-PI), and Overactive Bladder Questionnaires (OAB-q) at baseline and 3 months were analyzed with Pearson's χ2 , Fisher's Exact test, Wilcoxon rank tests, and multivariable logistic regression. RESULTS Of 407 patients, 134 (33%) had at least one reoperation over median 28.9 months follow-up (range 1.6-121.7); 78/407 (19%) were revised, and 56/407 (14%) were explanted. The most common reason for reoperation was lack of efficacy/worsening symptoms (n = 87). The reoperations group had a higher proportion of women (P = 0.049), lower mean body mass index (BMI; P = 0.010), more reprogramming events (P < 0.0001), longer median follow-up (P = 0.0008), and higher proportions with interstitial cystitis (P = 0.013), using hormone replacement therapy (P = 0.0004), and complications (P < 0.0001). Both reoperations/no reoperations groups had similar improvements in ICSI-PI (P < 0.0001 for both), OAB-q severity (P < 0.0001 for both) and quality of life (P < 0.0001 for both). On multivariate analysis, only longer follow-up (P = 0.0011; OR 1.048; CI 1.019, 1.078) and having a complication (P < 0.0001; OR 23.2; CI 11.47, 46.75) were significant predictors of reoperations. In women only, using HRT at time of implant was also predictive of reoperation (P = 0.0027; OR 3.09; CI 1.48, 6.46). CONCLUSIONS In this largest known series to date, one third of the patients required reoperation and the most common reason was lack of efficacy/worsening symptoms. Ongoing study is needed as the technology continues to evolve. Neurourol. Urodynam. 36:354-359, 2017. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Kenneth M Peters
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - Jason P Gilleran
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | | | - Judith A Boura
- Beaumont Health System, Royal Oak, Michigan.,Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Kushner DS, Peters KM, Johnson-Greene D. Evaluating the Siebens Model in Geriatric-Stroke Inpatient Rehabilitation to Reduce Institutionalization and Acute-Care Readmissions. J Stroke Cerebrovasc Dis 2015; 25:317-26. [PMID: 26542820 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/29/2015] [Revised: 09/27/2015] [Accepted: 09/29/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of the study is to evaluate the use of Siebens Domain Management Model (SDMM) in geriatric-stroke patients during inpatient rehabilitation (IR) to increase functional independence, and to reduce institutionalization and acute-care readmissions, which are quality indicators under the U.S. Affordable Care Act. METHODS In 2010 (preintervention), 66 stroke patients aged more than 75 years were admitted to an IR facility, on average, 8.8 days postacute care. In 2012 (postintervention), 58 patients aged more than 75 years were admitted to the same IR facility, on average, 5.0 days postacute care. SDMM intervention involved weekly adjustments of clinical care focused on potential barriers to discharge home. Functional Independence Measure (FIM) efficiency, length of stay (LOS), and disposition rates to community or home, acute care, and long-term care were compared pre- and postintervention within facility, and facility data were compared to national case-mix-group-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). RESULTS Pre- and postintervention demographics and prestroke living support/setting were similar, but preintervention had on average 4 more days LOS in IR and 3.8 more days to IR onset. There were significantly more discharges to community in postintervention (79.3%) compared to preintervention (56.9%) (chi-square = 6.02, P < .013). The preintervention group did not significantly differ from 2010 national data whereas the postintervention/2012 group significantly differed from 2012 national data for higher FIM efficiency (t = -3.1, P < .002) and more discharges to community (chi-square = 19.7; P < .0001). From 2010 to 2012, there were 3.8 times more discharges to community (chi-square = 8535; P < .0001) and 6 times fewer acute-care dispositions postintervention than nationally (chi-square = 58.7; P < .0001).
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Affiliation(s)
- David S Kushner
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.
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Abstract
BACKGROUND The treatment of fracture nonunion (pseudarthrosis) is often lengthy and debilitating for the patient. There are operative and conservative therapies available. RESEARCH QUESTION Does the systemic use of osteoanabolic acting substances (osteoanabolics) lead to an acceleration of the delayed fracture healing and/or strengthening of the fracture? Which types of pseudarthrosis are suitable for this treatment option? MATERIALS AND METHODS A literature review was carried out focusing on the systemic anabolic therapy options for the treatment of delayed healing of fractures or pseudarthrosis. Additionally, our own case studies are presented. RESULTS Teriparatide and strontium ranelate have a positive effect on the healing of fractures in animal studies and in humans. There are also case studies on the use of both substances in delayed fracture healing or pseudarthrosis. The scientific knowledge regarding teriparatide is significantly more comprehensive. However, prospective randomized trials are lacking so far. CONCLUSION The systemic use of anabolics can be a therapeutic option, especially for biological reactive pseudarthrosis. However, these are off-label treatments and contraindications should be especially well heeded. Because of the numerous positive results, from the point of view of teriparatide treatment, a multicentric, prospective randomized study on the treatment of aseptic pseudarthrosis should be initiated.
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Affiliation(s)
- K M Peters
- Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland.
| | - T Tuncel
- Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland
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Gilleran JP, Killinger K, Boura J, Peters KM. Number of active electrodes at time of staged tined lead interstim implant does not impact clinical outcomes. Neurourol Urodyn 2015; 35:625-9. [DOI: 10.1002/nau.22766] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/23/2015] [Indexed: 11/09/2022]
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Peters KM, Killinger KA, Ehlert M, Gupta P, Bartley J, Wolfert C, Boura JA, Gilleran J. MP89-01 PUDENDAL NEUROMODULATION AFTER FAILED SACRAL STIMULATION. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1800] [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: 11/29/2022]
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Gupta P, Ehlert M, Bartley J, Killinger KA, Boura JA, Gilleran J, Wolfert C, Peters KM. MP89-03 THE IMPACT OF PRIOR BACK SURGERY ON UROLOGIC DIAGNOSES AND NEUROMODULATION OUTCOMES. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1802] [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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Tuncel T, Krämer A, Peters KM. [Score-controlled duration of follow-up treatment after alloplastic hip and knee replacement]. Z Orthop Unfall 2015; 153:30-7. [PMID: 25723578 DOI: 10.1055/s-0034-1383257] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the literature many studies can be found addressing the effectiveness of individual measures and therapies within the medical rehabilitation. The duration of the rehabilitation itself is rarely taken into account. Consequently the duration of postoperative inpatient medical rehabilitation after initial implantation of alloarthroplastic hip and knee replacements in osteoarthritis of the hip or knee was the object of our analysis. PATIENTS AND METHODS In the present prospective study 100 patients each with osteoarthritis of the hip or knee were presented at a follow-up treatment postoperatively after primary implantation of alloarthroplastic hip and knee replacements. Two different scores were used (Staffelstein score, Lequesne score), which were collected at a weekly follow-up (T1-T4) to determine the degree of mobility in the initial examination of the patient and after three weeks. By setting a target score at admission of the patient to the CSO, which stood for achieving the rehabilitation objective, the rehabilitation period could be changed individually. RESULTS Our study showed that the highest rehabilitation progress has been achieved in both the total hip replacement and total knee replacement in patients at the end of the second week of rehabilitation (T2-T3). Thus, in the Staffelstein score 74 % (n = 74) of hip replacement patients and 46 % (n = 46) of knee replacement patients had already reached their rehabilitation aim between T2 and T3. From the third week on there was a marked flattening of the rehabilitation progress. Also the Lequesne scores obtained confirmed these results. CONCLUSION Based on the score-driven detection of mobility degree of rehabilitation at the beginning of the follow-up treatment, the individual design of the rehabilitation process with the active participation of the patient is possible. In a large number of cases a reduction of the rehabilitation period can be achieved to less than 21 days. This finding is particularly important in times of limited financial resources, because the saved resources can be used for other rehabilitation groups. Therefore, in a greater number of patients, a shortening of the duration of the rehabilitation is possible.
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Affiliation(s)
- T Tuncel
- Orthopädie und Osteologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht
| | - A Krämer
- Orthopädie, Orthopädische Praxis, Königswinter
| | - K M Peters
- Orthopädie und Osteologie, Dr. Becker Rhein-Sieg-Klinik, Nümbrecht
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Chennamsetty A, Khourdaji I, Goike J, Killinger KA, Girdler B, Peters KM. Electrosurgical Management of Hunner Ulcers in a Referral Center's Interstitial Cystitis Population. Urology 2015; 85:74-8. [DOI: 10.1016/j.urology.2014.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/01/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
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Chennamsetty A, Ehlert MJ, Peters KM, Killinger KA. Advances in Diagnosis and Treatment of Interstitial Cystitis/Painful Bladder Syndrome. Curr Infect Dis Rep 2014; 17:454. [DOI: 10.1007/s11908-014-0454-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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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Wenzler DL, Burks FN, Cooney M, Peters KM. Proof of Concept Trial on Changes in Current Perception Threshold After Sacral Neuromodulation. Neuromodulation 2014; 18:228-31; discussion 232. [DOI: 10.1111/ner.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/23/2014] [Accepted: 05/13/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Frank N. Burks
- Department of Urology; Beaumont Health System; Royal Oak MI USA
- Department of Urology; Oakland University William Beaumont School of Medicine; Royal Oak MI USA
| | - Maureen Cooney
- Department of Urology; Beaumont Health System; Royal Oak MI USA
| | - Kenneth M. Peters
- Department of Urology; Beaumont Health System; Royal Oak MI USA
- Department of Urology; Oakland University William Beaumont School of Medicine; Royal Oak MI USA
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Peters KM, Dmochowski RR, Carr LK, Robert M, Kaufman MR, Sirls LT, Herschorn S, Birch C, Kultgen PL, Chancellor MB. Autologous muscle derived cells for treatment of stress urinary incontinence in women. J Urol 2014; 192:469-76. [PMID: 24582537 DOI: 10.1016/j.juro.2014.02.047] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [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: 02/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We assess the 12-month safety and potential efficacy of autologous muscle derived cells for urinary sphincter repair (Cook MyoSite Incorporated, Pittsburgh, Pennsylvania) in women with stress urinary incontinence. MATERIALS AND METHODS Pooled data from 2 phase I/II studies with identical patient selection criteria and outcome measures were analyzed. Enrolled patients had stress urinary incontinence refractory to prior treatment and no symptom improvement during the last 6 months. Patients received intrasphincter injection of 10 (16), 50 (16), 100 (24) or 200×10(6) (24) autologous muscle derived cells for urinary sphincter repair, derived from biopsies of each patient's quadriceps femoris. The primary outcome measure was safety, determined by incidence and severity of adverse events. Potential efficacy was measured by changes in 3-day voiding diaries, 24-hour pad tests, and UDI-6 and IIQ-7 scores. RESULTS A total of 80 patients underwent injection of autologous muscle derived cells for urinary sphincter repair, and 72 completed diaries and pad tests at 12-month followup. No adverse events attributed to autologous muscle derived cells for urinary sphincter repair were reported. Higher dose groups tended to have greater percentages of patients with at least a 50% reduction in stress leaks and pad weight at 12-month followup. All dose groups had statistically significant improvement in UDI-6 and IIQ-7 scores at 12-month followup compared to baseline. CONCLUSIONS Autologous muscle derived cells for urinary sphincter repair at doses of 10, 50, 100 and 200×10(6) cells appears safe. Efficacy data suggest a potential dose response with a greater percentage of patients responsive to higher doses.
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Affiliation(s)
| | | | - Lesley K Carr
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | | | | | - Colin Birch
- Foothills Medical Centre, Calgary, Alberta, Canada
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Peters KM, Rosenberg B, Boura JA, Killinger KA, Jaeger C. Reply. Urology 2013. [DOI: 10.1016/j.urology.2013.06.046] [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: 11/29/2022]
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