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Kessler L, Illinsky D, Laudano M, Abraham NE. Do patients experience decisional regret after sacral neuromodulation for refractory overactive bladder? Neurourol Urodyn 2024; 43:22-30. [PMID: 37830272 DOI: 10.1002/nau.25286] [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: 07/05/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Success following urological procedures is traditionally defined through objective endpoints. This approach may not capture the impact on patient satisfaction. There is a paucity of literature evaluating patient-centered metrics such as satisfaction and decisional regret in the field of urology. This study investigates long-term satisfaction and decisional regret amongst patients who underwent sacral neuromodulation (SNM) for the treatment of refractory overactive bladder (OAB). MATERIALS AND METHODS This study retrospectively reviewed patients who underwent SNM for refractory OAB from 2015 to 2022 at a single institution serving an ethnically diverse and underrepresented community. Demographic data were collected through chart review and surveys conducted via telephone calls. Patient satisfaction and decisional regret was measured with the validated modified SDS-DRS scale (satisfaction with decision scale-decision regret scale). Descriptive statistics, Wilcoxan rank sum, and median regression analyses were performed using STATA 15.0 with p < 0.05 as significant. RESULTS Out of 191 patients who underwent SNM, 63 were unreachable (wrong number in chart, number not in service, patient did not answer, deceased). Eighty-nine out of 128 patients reached agreed to participate (70% response rate). The mean time since surgery was 37.3 ±25.2 months. The median satisfaction with decision score was 4.0 (IQR: 3.7-4.7) with a score of 1 correlating with low satisfaction and a score of 5 correlating with high satisfaction. The median decisional regret score was 2.0 (IQR: 1.2-2.9) with a score of 1 correlating with low decisional regret and a score of 5 correlating with strong decisional regret. Ten patients reported complications after surgery, which was significantly associated with lower SDS and higher DRS scores (p < 0.01), and persisted after adjusting for age, body mass index, sex, and comorbidities (SDS β coef: -0.84, 95% CI: -1.5 to 0.15, p = 0.02; DRS β coef: 1.48, 95% CI: 0.55-2.41, p < 0.01). CONCLUSIONS Patients who underwent SNM for refractory OAB overall had low regret and high satisfaction with their decision at an average 3 years of follow-up. As expected, those who developed postoperative complications had worse scores. The inclusion of patient-centric outcomes is imperative when determining the success of a surgical procedure and is useful for shared decision-making when advancing to third-line therapy for OAB. Longer-term follow-up is necessary to assess durability of high satisfaction and low regret over time.
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Affiliation(s)
- Leia Kessler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Illinsky
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Melissa Laudano
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Department of Urology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Roselli N, Mckay E, Nauheim J, Halani PK, Abraham NE. Health disparities and access to advanced therapy for overactive bladder. Neurourol Urodyn 2022; 41:1940-1947. [PMID: 35544745 DOI: 10.1002/nau.24949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/29/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
AIMS Refractory overactive bladder (OAB) is among the most common reasons for referral to specialists in voiding dysfunction. Significant racial and ethnic disparities exist in prevalence, severity, and management of OAB, presenting care barriers for marginalized patients. We aim to explicate these disparities and explore the factors that led to their existence and persistence. We will additionally offer suggestions to mitigate such disparities and approach equitable care for our patients. METHODS This is a narrative review of pertinent articles related to health disparities in OAB. Articles on OAB prevalence stratified by race and ethnicity, and variations in treatment patterns for patients of marginalized backgrounds were identified from the PubMed database. We also included a review of evidence from governmental and historical sources to provide sociocultural context. RESULTS Patients from marginalized backgrounds are underrepresented in OAB literature. There appear to be differences in symptom severity and prevalence based on race. OAB severity seems closely entwined with social determinants of health. Patients from marginalized populations experience numerous care barriers impeding the treatment of OAB. Finally, White patients are more likely to receive advanced management for OAB. CONCLUSIONS Numerous health disparities exist in the diagnosis and management of OAB. This review is grounded in societal context: health injustice in the United States ultimately stems from systemic racism. Improving our understanding of care disparities and the systems that allow them to persist will bring us closer to equity and allow our patients from marginalized backgrounds to obtain the evidence-based care they deserve.
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Affiliation(s)
- Nicole Roselli
- Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, New York, USA
| | - Elishia Mckay
- Deparment of Obstetrics & Gynecology, Maimonides, Brooklyn, New York, USA
| | - Jennifer Nauheim
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Priyanka K Halani
- Department of Obstetrics & Gynecology, Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
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Shin C, Allen AZ, Zhu D, Tellechea L, Watts KL, Abraham NE. Patient satisfaction and savings, and clinical outcomes of televisits in female pelvic medicine and reconstructive surgery at an urban academic center. Neurourol Urodyn 2021; 40:1834-1844. [PMID: 34342368 DOI: 10.1002/nau.24759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/03/2021] [Accepted: 07/15/2021] [Indexed: 12/19/2022]
Abstract
AIM To evaluate patient satisfaction and savings, and compare visit outcomes based on chief complaint (CC) of women presenting for a televisit to a female pelvic medicine and reconstructive surgery (FPMRS) clinic at an urban academic center. METHODS A cross-sectional study of women completing a televisit with an FPMRS specialist at our institution from June 19, 2020 to July 17, 2020 was conducted. A telephone questionnaire was administered to patients to assess satisfaction and savings (travel costs/time avoided). Electronic medical records were reviewed to collect patient demographics and comorbidities, CC, and televisit outcomes (e.g., face-to-face (F2F) exam scheduled, orders placed). Logistic regression was used to analyze predictors of satisfaction and need for F2F follow-up. RESULTS One hundred eighty-seven of 290 (64.5%) women called completed the survey, of whom 168 (89.8%) were satisfied with their televisit. Eighty-eight (48.1%) saved at least an hour and 54 (28.9%) saved more than $25 on transportation. There were no significant associations between patient characteristics, CC, or televisit outcomes and satisfaction. Ninety-nine (52.9%) televisits resulted in F2F follow-up, with CC of prolapse (odds ratio [OR] = 4.2 (1.7-10.3); p = 0.002), new patient (OR = 2.2 (1.2-4.2); p = 0.01), and Hispanic ethnicity (OR = 3.9 (1.2-13.6); p=.03) as significant predictors. CONCLUSION Most patients were satisfied with FPMRS televisits at our urban academic center. Televisits resulted in patient travel time and cost savings. Women presenting with prolapse and for new patient visits would likely benefit from initial F2F visits instead of televisits. Televisits are an important mode of health care and in some cases can replace F2F visits.
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Affiliation(s)
- Christina Shin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ariel Z Allen
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Denzel Zhu
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laura Tellechea
- Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York, USA
| | - Kara L Watts
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Nitya E Abraham
- Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Urology, Montefiore Medical Center, Bronx, New York, USA
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Herbert AS, Nemirovsky A, Hess DS, Walter D, Abraham NE, Loeb S, Malik RD. Pelvic organ prolapse on YouTube: evaluation of consumer information. BJU Int 2020; 125:759-760. [DOI: 10.1111/bju.15032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Dawn Walter
- New York University (NYU) School of Medicine and the Manhattan Veterans Affairs; Medical Center; New York NY USA
| | | | - Stacy Loeb
- New York University (NYU) School of Medicine and the Manhattan Veterans Affairs; Medical Center; New York NY USA
| | - Rena D. Malik
- University of Maryland Medical Center; Baltimore MD USA
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Abstract
PURPOSE The objectives of this study were to 1) describe the patterns of repeat prostate biopsy in men with a previous negative biopsy and 2) identify predictors of prostate cancer diagnosis on repeat biopsy in these men. MATERIALS AND METHODS From a university faculty group practice we identified 1,837 men who underwent prostate biopsy between January 1, 1995 and January 1, 2010. Characteristics of repeat biopsy were examined, including the indication for biopsy, the number of repeat biopsies performed, the number of cores obtained and total prostate specific antigen before biopsy. Features of prostate cancer diagnosed on repeat biopsy were examined, including Gleason score, number of positive cores, percent of tumor and treatment choice. Multivariable logistic regression was done to identify prostate cancer predictors. RESULTS Initial biopsy was negative in 1,213 men. In 255 men a total of 798 repeat biopsies were performed. Of the 63 men diagnosed with prostate cancer Gleason score was 6 or less in 33 (52%), 7 in 22 (35%) and 8-9 in 8 (13%). When categorized by Epstein criteria, the rate of clinically insignificant cancer diagnosis decreased substantially by the third and fourth repeat biopsies. Repeat biopsy in men older than 70 years, biopsies including more than 20 cores and the fourth repeat biopsy were associated with an increased likelihood of prostate cancer diagnosis. CONCLUSIONS In men selected for multiple repeat biopsies clinically significant cancer is found at each sampling round. Given the continued likelihood of cancer detection even by the fifth biopsy, early consideration of saturation or image guided biopsy may be warranted in the repeat biopsy population.
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Affiliation(s)
- Nitya E Abraham
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, New York
| | - Neil Mendhiratta
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, New York
| | - Samir S Taneja
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, New York.
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Borofsky MS, Rosenkrantz AB, Abraham NE, Jain R, Taneja SS. 361 DOES SUSPICION OF PROSTATE CANCER BY MULTIPARAMETRIC MRI PREDICT GREATER LIKELIHOOD OF MORE ADVERSE PATHOLOGY ON RADICAL PROSTATECTOMY? J Urol 2012. [DOI: 10.1016/j.juro.2012.02.423] [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: 10/28/2022]
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Abraham NE, Simon R, Shah O. Thermal injury causing delayed perforation of small bowel after transurethral resection of bladder tumor without evidence of bladder perforation. Can J Urol 2011; 18:5836-5838. [PMID: 21854717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Risk of thermal injury to the bowel when utilizing electrocautery at the bladder dome has been reported anecdotally. This is a case report of a 64-year-old man with urothelial carcinoma in situ of the bladder who underwent transurethral resection of bladder tumor at the posterior bladder wall near the dome without evidence of perforation. The postoperative course was complicated by delayed small bowel perforation likely secondary to transmission of thermal energy during fulguration of the resection bed. This injury highlights the need for particular prudence when resecting and fulgurating bladder tumors using monopolar electrocautery, specifically in the regions adjacent to bowel.
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Affiliation(s)
- Nitya E Abraham
- Department of Urology, New York University School of Medicine, New York, 10016, USA
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Abraham NE, Makarov DV, Laze J, Stefanovics E, Desai R, Lepor H. Patient Centered Outcomes in Prostate Cancer Treatment: Predictors of Satisfaction Up to 2 Years After Open Radical Retropubic Prostatectomy. J Urol 2010; 184:1977-81. [DOI: 10.1016/j.juro.2010.06.099] [Citation(s) in RCA: 26] [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: 03/24/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Nitya E. Abraham
- Department of Urology, New York University School of Medicine, New York, New York
| | - Danil V. Makarov
- Robert Wood Johnson Clinical Scholars Program, Stanford University, Stanford, California
- Section of Urology, Yale University School of Medicine, New Haven, Connecticut
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Juliana Laze
- Department of Urology, New York University School of Medicine, New York, New York
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Rani Desai
- Robert Wood Johnson Clinical Scholars Program, Stanford University, Stanford, California
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Herbert Lepor
- Department of Urology, New York University School of Medicine, New York, New York
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