1
|
Sansone S, Ramos Y, Segal S, Asfaw TS, Morales DK. Uncovering Surface Penetration by Enterococci From Urinary Tract Infection Patients. Urogynecology (Phila) 2024; 30:320-329. [PMID: 38484249 DOI: 10.1097/spv.0000000000001476] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE The relationship between Enterococcus faecalis vaginal colonization and urinary tract infections (UTIs) remains uncertain. OBJECTIVE We aimed to evaluate the surface invasion capability of E faecalis isolates from patients with and without UTIs as a potential readout of pathogenicity. STUDY DESIGN Participants were females from urogynecology clinics, comprising symptomatic UTI and asymptomatic non-UTI patients, categorized by the presence or absence of E faecalis-positive cultures identified via standard urine culture techniques. Vaginal and urine samples from patients were plated on enterococci selective medium, and E faecalis isolates detected in both cohorts were species specific identified using 16S rRNA sequencing. Clinical isolates were inoculated on semisolid media, and both external colonies and underneath colony prints formed by agar-penetrating enterococci were imaged. External growth and invasiveness were quantified by determining colony-forming units of the noninvading and agar-penetrating cells and compared with the E faecalis OG1RF. RESULTS We selected E faecalis isolates from urine and vaginal samples of 4 patients with and 4 patients without UTIs. Assays demonstrated that most isolates formed similarly sized external colonies with comparable colony-forming unit. Surface invasion differed across patients and isolation sites compared with OG1RF. The vaginal isolate from UTI patient 1, who had the most recurrences, exhibited significantly greater agar-invading capacity compared with OG1RF. CONCLUSIONS Our pilot study indicates that ex vivo invasion assays may unveil virulence traits in E faecalis from UTI patients. Enhanced enterococcal surface penetration could increase urogenital invasion risk. Further research is needed to correlate penetration with disease severity in a larger patient group.
Collapse
Affiliation(s)
- Stephanie Sansone
- From the Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | | | | | | | | |
Collapse
|
2
|
Sansone S, Lu J, Drangsholt S, Asfaw TS, Segal S. No pelvic exam, no problem: patient satisfaction following the integration of comprehensive urogynecology telemedicine. Int Urogynecol J 2022; 33:2401-2407. [PMID: 35238948 PMCID: PMC8892397 DOI: 10.1007/s00192-022-05104-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/15/2022] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis The COVID-19 pandemic revolutionized the practice of medicine, requiring rapid adoption of telemedicine. However, patient satisfaction has not been well characterized for telemedicine visits for a broad range of urogynecologic conditions. Methods We performed a cross-sectional survey study following a retrospective review of all urogynecologic telemedicine visits from March 1, 2020, to March 31, 2021, at a tertiary care center. The survey queried patient satisfaction using the Likert scale. Descriptive statistics and Fisher’s exact analyses were performed. Results There were 256 telemedicine visits at our institution during the study period, and 88 patients (34% unadjusted response rate) completed the survey. The average age of study participants was 55 (SD 17; 24, 84) years old. The majority of patients were white (69%), lived within the five boroughs of NYC (81%), and had higher levels of education (72% with a bachelor’s or professional degree). Most visits were for urinary complaints (68%), with those patients reporting greater fulfillment of urogynecologic needs compared to patients presenting with pelvic complaints (p = 0.02). There were no significant differences in satisfaction among other demographics (p > 0.05). Altogether, high satisfaction rates were noted for scheduling (99%), technology (90%), provider interaction (96%), fulfillment of personal needs (91%), and overall satisfaction (94%). Conclusions We demonstrate high patient satisfaction for telemedicine visits in a tertiary urogynecology clinic for a variety of indications, with greater fulfillment of urogynecologic needs observed for those visits which may not necessitate an in-person exam (e.g., urinary complaint).
Collapse
Affiliation(s)
- Stephanie Sansone
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA.
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, 10065, USA.
| | - Jessica Lu
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA
| | - Siri Drangsholt
- Department of Urology, New York Medical College, Valhalla, NY, USA
- Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY, USA
| | - Tirsit S Asfaw
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA
| | - Saya Segal
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA
| |
Collapse
|
3
|
Chughtai B, Mao J, Asfaw TS, Heneghan C, Rardin CR, Sedrakyan A. Long-term Device Outcomes of Mesh Implants in Pelvic Organ Prolapse Repairs. Obstet Gynecol 2020; 135:591-598. [DOI: 10.1097/aog.0000000000003689] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill–Cornell Medical College/New York–Presbyterian Hospital, New York, NY
| | - Dominique Thomas
- Department of Urology, Weill–Cornell Medical College/New York–Presbyterian Hospital, New York, NY
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill–Cornell Medical College, New York, NY
| | - Tirsit S. Asfaw
- Department of Obstetrics and Gynecology, Weill–Cornell Medical College/New York–Presbyterian Hospital, New York, NY
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill–Cornell Medical College, New York, NY
| |
Collapse
|
5
|
Chai TC, Asfaw TS, Baker JE, Clarkson B, Coleman P, Hoffstetter S, Konkel K, Lavender M, Nair S, Norton J, Subak L, Visco A, Star RA, Bavendam T. Future Directions of Research and Care for Urinary Incontinence: Findings from the National Institute of Diabetes and Digestive and Kidney Diseases Summit on Urinary Incontinence Clinical Research in Women. J Urol 2017; 198:22-29. [PMID: 28286067 DOI: 10.1016/j.juro.2016.10.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Female urinary incontinence is prevalent, costly and morbid. Participants in a NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) sponsored summit reviewed findings from NIH (National Institutes of Health) funded clinical research on urinary incontinence in women and discussed the future of urinary incontinence research. MATERIALS AND METHODS The NIDDK convened the Summit on Urinary Incontinence Clinical Research in Women on March 14, 2014. Participants representing a broad range of clinical expertise reviewed completed NIH sponsored urinary incontinence related studies, including results from community based epidemiological studies such as the BACH (Boston Area Community Health) Survey and from randomized clinical trials such as PRIDE (Program to Reduce Incontinence by Diet and Exercise), and studies conducted by the Pelvic Floor Disorders Network and the Urinary Incontinence Treatment Network. RESULTS BACH Survey results improved our understanding of precursors, incidence, prevalence and natural history of urinary incontinence in a diverse group of women. The Pelvic Floor Disorders Network study found that anticholinergic medications and onabotulinumtoxinA are efficacious for treating urge urinary incontinence, and Burch colposuspension and retropubic mid urethral polypropylene slings are efficacious for decreasing stress urinary incontinence following pelvic organ prolapse surgery in women with potential stress urinary incontinence. The Urinary Incontinence Treatment Network study found that fascial slings were better than colposuspension, and that retropubic and transobturator mid urethral polypropylene slings were equivalent for stress urinary incontinence. In patients with stress urinary incontinence a preoperative urodynamic study was noninferior to basic office examinations for surgical outcome. The addition of behavioral intervention did not allow female patients to discontinue antimuscarinics for urge urinary incontinence. PRIDE showed that modest weight reductions significantly decreased urinary incontinence. CONCLUSIONS Strategies for future research on urinary incontinence should include a focus on early disease, risk factor identification, better phenotyping, incorporation of new technologies, patient centered research and prevention.
Collapse
Affiliation(s)
- Toby C Chai
- Department of Urology, Yale School of Medicine, New Haven, Connecticut.
| | - Tirsit S Asfaw
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Jan E Baker
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, Utah
| | - Becky Clarkson
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Susan Hoffstetter
- Department of Obstetrics, Gynecology and Women's Health, St. Louis University School of Medicine, St. Louis, Missouri
| | - Kimberly Konkel
- Center for Faith-Based and Neighborhood Partnerships, U.S. Department of Health and Human Services, Washington, D.C
| | | | - Shailaja Nair
- Drexel Center for Women's Health, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jenna Norton
- Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Leslee Subak
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Francisco, San Francisco, California
| | - Anthony Visco
- Division of Urogynecology, Duke University School of Medicine, Durham, North Carolina
| | - Robert A Star
- Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Tamara Bavendam
- Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| |
Collapse
|
6
|
Asfaw TS, Hypolite J, Northington GM, Arya LA, Wein AJ, Malykhina AP. Acute colonic inflammation triggers detrusor instability via activation of TRPV1 receptors in a rat model of pelvic organ cross-sensitization. Am J Physiol Regul Integr Comp Physiol 2011; 300:R1392-400. [PMID: 21474425 PMCID: PMC3119151 DOI: 10.1152/ajpregu.00804.2010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 04/03/2011] [Indexed: 12/30/2022]
Abstract
Chronic pelvic pain of unknown etiology is a common clinical condition and may develop as a result of cross-sensitization in the pelvis when pathological changes in one of the pelvic organs result in functional alterations in an adjacent structure. The aim of the current study was to compare transient receptor potential vanilloid 1 (TRPV1) activated pathways on detrusor contractility in vivo and in vitro using a rat model of pelvic organ cross-sensitization. Four groups of male Sprague-Dawley rats (N = 56) were included in the study. Animals received intracolonic saline (control), resiniferatoxin (RTX, TRPV1 agonist, 10(-7) M), 2,4,6-trinitrobenzene sulfonic acid (TNBS, colonic irritant), or double treatment (RTX followed by TNBS). Detrusor muscle contractility was assessed under in vitro and in vivo conditions. Intracolonic RTX increased the contractility of the isolated detrusor in response to electric field stimulation (EFS) by twofold (P ≤ 0.001) and enhanced the contractile response of the bladder smooth muscle to carbachol (CCh). Acute colonic inflammation reduced detrusor contractility upon application of CCh in vitro, decreased bladder capacity by 28.1% (P ≤ 0.001), and reduced micturition volume by 60% (P ≤ 0.001). These changes were accompanied by an increased number of nonmicturition contractions from 3.7 ± 0.7 to 15 ± 2.7 (N = 6 in both groups, P ≤ 0.001 vs. control). Desensitization of intracolonic TRPV1 receptors before the induction of acute colitis restored the response of isolated detrusor strips to CCh but not to EFS stimulation. Cystometric parameters were significantly improved in animals with double treatment and approximated the control values. Our data suggest that acute colonic inflammation triggers the occurrence of detrusor instability via activation of TRPV1-related pathways. Comparison of the results obtained under in vitro vs. in vivo conditions provides evidence that intact neural pathways are critical for the development of an overactive bladder resulting from pelvic organ cross talk.
Collapse
Affiliation(s)
- Tirsit S Asfaw
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Glenolden, Pennsylvania 19036-2307, USA
| | | | | | | | | | | |
Collapse
|
7
|
Asfaw TS, Saks EK, Northington GM, Arya LA. Is pelvic pain associated with defecatory symptoms in women with pelvic organ prolapse? Neurourol Urodyn 2011; 30:1305-8. [PMID: 21394762 DOI: 10.1002/nau.21059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 12/03/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the significance of pelvic pain and its association with defecatory symptoms in women with pelvic organ prolapse (POP). STUDY DESIGN This is a cross sectional study of 248 women with stage II POP or greater. Women were stratified into "pain" and "no-pain" groups based on their response to a question on the Pelvic Floor Distress Inventory short form. Associations between patient demographics, exam findings and responses to validated questionnaires were evaluated. RESULTS In women with POP, defecatory symptoms are significantly more common in women with pelvic pain including straining with bowel movement (OR 2.4, 95% CI 1.3, 4.6), sense of incomplete emptying (OR 4.4, 95% CI 2.3, 8.2), pain with bowel movement (OR 5.3, 95% CI 1.2, 23.0) and splinting with bowel movement (OR 3.8, 95% CI 2.0, 7.5). CONCLUSION In women with POP, the symptom of pelvic pain is associated with the presence of defecatory symptoms.
Collapse
Affiliation(s)
- Tirsit S Asfaw
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania 19104, USA.
| | | | | | | |
Collapse
|
8
|
Saks EK, Harvie HS, Asfaw TS, Arya LA. Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse. Int J Gynaecol Obstet 2011; 111:237-40. [PMID: 20817179 DOI: 10.1016/j.ijgo.2010.06.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/08/2010] [Accepted: 08/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine whether the presence of obstructive defecatory symptoms is associated with the site and severity of pelvic organ prolapse. METHODS A cross-sectional study was performed of women with pelvic organ prolapse of grade 2 or greater who had completed a validated questionnaire that surveyed pelvic floor symptoms. Associations between patient characteristics, site and severity of prolapse, and obstructive bowel symptoms were investigated. RESULTS Among 260 women with pelvic organ prolapse, women with posterior vaginal wall prolapse were more likely to report obstructive symptoms, such as incomplete emptying (41% vs 21%, P=0.003), straining at defecation (39% vs 19%, P=0.002), and splinting with defecation (36% vs 14%, P<0.001) compared with women without posterior vaginal wall prolapse. There was no significant association between any bowel symptom and increasing severity of prolapse. CONCLUSIONS Obstructive bowel symptoms are significantly associated with the presence of posterior vaginal wall prolapse, but not with the severity of prolapse.
Collapse
Affiliation(s)
- Emily K Saks
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
| | | | | | | |
Collapse
|
9
|
|