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Davies JI, Gelb AW, Gore-Booth J, Martin J, Mellin-Olsen J, Åkerman C, Ameh EA, Biccard BM, Braut GS, Chu KM, Derbew M, Ersdal HL, Guzman JM, Hagander L, Haylock-Loor C, Holmer H, Johnson W, Juran S, Kassebaum NJ, Laerdal T, Leather AJM, Lipnick MS, Ljungman D, Makasa EM, Meara JG, Newton MW, Østergaard D, Reynolds T, Romanzi LJ, Santhirapala V, Shrime MG, Søreide K, Steinholt M, Suzuki E, Varallo JE, Visser GHA, Watters D, Weiser TG. Global surgery, obstetric, and anaesthesia indicator definitions and reporting: An Utstein consensus report. PLoS Med 2021; 18:e1003749. [PMID: 34415914 PMCID: PMC8415575 DOI: 10.1371/journal.pmed.1003749] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 09/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. These aimed to capture access to surgery, surgical workforce, surgical volume, perioperative mortality rate, and catastrophic and impoverishing financial consequences of surgery. Despite being rapidly taken up by practitioners, data points from which to derive the indicators were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define-for the first time-the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care globally. METHODS AND FINDINGS The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a 2-day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. The meeting was held between June 16 to 18, 2019; discussions continued until August 2020. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high-, middle-, and low-income countries. Considering each of the 6 indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2 to 5 (intermediate) and >5 year (full) time frames. We removed one of the original 6 indicators (one of 2 financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. A strength of the process was the number of people from global institutes and multilateral agencies involved in the collection and reporting of global health metrics; a limitation was the limited number of participants from low- or middle-income countries-who only made up 21% of the total attendees. CONCLUSIONS To track global progress towards timely access to quality SAO care, these indicators-at the basic level-should be implemented universally as soon as possible. Intermediate and full indicator sets should be achieved by all countries over time. Meanwhile, these evolutions can assist in the short term in developing national surgical plans and collecting more detailed data for research studies.
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Affiliation(s)
- Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Public Health, Wits University, Johannesburg, South Africa
- * E-mail:
| | - Adrian W. Gelb
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia & Perioperative Care, University of California San Francisco, California, United States of America
| | - Julian Gore-Booth
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
| | - Janet Martin
- Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
| | - Jannicke Mellin-Olsen
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway
| | - Christina Åkerman
- Dell Medical School, University of Texas at Austin, Austin, Texas, United States of America
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, Massachusetts, United States of America
| | - Emmanuel A. Ameh
- Division of Paediatric Surgery, The National Hospital, Abuja, Nigeria
- National Surgical, Obstetric and Anaesthesia Planning Committee, Federal Ministry of Health, Abuja, Nigeria
| | - Bruce M. Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Western Cape, South Africa
| | - Geir Sverre Braut
- Research Department of Community Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Miliard Derbew
- School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Hege Langli Ersdal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway
| | | | - Lars Hagander
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carolina Haylock-Loor
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
- Department of Anesthesia, Intensive Care Medicine, Interventional Pain Unit, Hospital Del Valle, San Pedro Sula, Honduras
| | - Hampus Holmer
- Paediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Walter Johnson
- Department of Neurosurgery, Loma Linda University, Loma Linda, California, United States of America
| | - Sabrina Juran
- Population and Development, United Nations Population Fund, New York, New York, United States of America
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nicolas J. Kassebaum
- Anesthesiology and Pain Medicine, Health Metrics Sciences, Global Health, and Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Andrew J. M. Leather
- King’s Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Michael S. Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, United States of America
| | - David Ljungman
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emmanuel M. Makasa
- SADC-Wits Regional Collaboration Centre for Surgical Healthcare (WitSSurg), Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Mark W. Newton
- Department of Anesthesiology and Pediatrics, Vanderbilt University Medical Center, Tennessee, United States of America
- AIC Kijabe Hospital, Kenya
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation, The University of Copenhagen, Copenhagen, Denmark
| | - Teri Reynolds
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Lauri J. Romanzi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Vatshalan Santhirapala
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Anaesthesia and Perioperative Care, Guy’s and St. Thomas’ Hospital, London, United Kingdom
| | - Mark G. Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Margit Steinholt
- Helgeland Hospital Trust, Sandnessjøen, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Emi Suzuki
- The World Bank, Washington, DC, United States of America
| | - John E. Varallo
- Department of Safe Surgery, Jhpiego, Baltimore, Maryland, United States of America
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center, Utrecht, the Netherlands
| | - David Watters
- University Hospital Geelong, Victoria, Australia
- Faculty of Health, School of Medicine, Deakin University, Victoria, Australia
- Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Thomas G. Weiser
- Stanford University School of Medicine, Department of Surgery Division of General Surgery, Section of Trauma & Critical Care Stanford University, Stanford, United States of America
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland
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Affiliation(s)
- Lauri J Romanzi
- Clinical associate professor of urology at New York University Langone Medical Center in New York City, and a visiting associate professor at Yale University School of Medicine, and co-chair of the Ghana Project of the International Urogynecology Association and an international consultant on capacity building and program development relating to obstetric fistula and female pelvic disorders
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Marson L, Brotto LA, Romanzi LJ. Current Literature Review. J Sex Med 2014. [DOI: 10.1111/jsm.12631] [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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Marson L, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2014. [DOI: 10.1111/jsm.12579] [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: 11/27/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M, Bella AJ. Current Literature Review. J Sex Med 2014. [DOI: 10.1111/jsm.12432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2013. [DOI: 10.1111/jsm.12371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M, Bella AJ. Current Literature Review. J Sex Med 2013. [DOI: 10.1111/jsm.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M, Bella AJ. Current Literature Review. J Sex Med 2012. [DOI: 10.1111/jsm.12019] [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: 11/27/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2012. [DOI: 10.1111/j.1743-6109.2012.02858.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marson L, Brotto LA, Romanzi LJ. Current Literature Review. J Sex Med 2012. [DOI: 10.1111/j.1743-6109.2012.02801.x] [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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Romanzi LJ, Tyagi R. Hysteropexy compared to hysterectomy for uterine prolapse surgery: does durability differ? Int Urogynecol J 2012; 23:625-31. [PMID: 22310923 DOI: 10.1007/s00192-011-1635-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to assess the impact of hysterectomy on durability of uterine prolapse repair by comparing hysterectomy/uterosacral cuff suspension (VH) to a new vaginal uterosacral hysteropexy (USH). METHODS A retrospective chart review of uterine prolapse patients after USH or VH with concomitant procedures as indicated was conducted, analyzing Baden-Walker grading of apex, anterior, and posterior compartments (Kaplan-Meier analysis) Baden et al. (Tex Med 64(5):56-58, 1968). RESULTS A total of 200 charts met criteria. USH women weighed less, were younger, and more constipated with larger rectoceles. Levator parameters did not differ Romanzi et al. (Neurourol Urodyn 18(6):603-612, 1999). Baden-Walker data were entered at recurrence or minimum of 6 months (2.4 months-10 years; median, 1.5 years). All-apex durability was 96.4%, with no difference between hysteropexy and cuff suspension (96.0% vs. 96.8%, p = 0.90), cystocele (86.8% vs. 93.8%, p = 0.31), or rectocele (97.8% vs. 100%, p = 0.16) at 2 years. CONCLUSION In uterine prolapse patients, technically similar uterosacral hysteropexy durability did not differ from hysterectomy-based cuff suspension nor between cohorts for cystocele or rectocele.
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Affiliation(s)
- Lauri J Romanzi
- Obstetrics and Gynecology, New York Presbyterian Hospital, Weill Cornell Medical College, 133 East 58th Street, New York, NY 10022, USA.
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Marson L, Brotto LA, Romanzi LJ, Miner M, Bella AJ. Current Literature Review. J Sex Med 2012. [DOI: 10.1111/j.1743-6109.2011.02636.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2011. [DOI: 10.1111/j.1743-6109.2011.02477.x] [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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Marson L, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2011. [DOI: 10.1111/j.1743-6109.2011.02400.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2010. [DOI: 10.1111/j.1743-6109.2010.02106.x] [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: 11/30/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2010. [DOI: 10.1111/j.1743-6109.2010.02023.x] [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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Marson L, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2010. [DOI: 10.1111/j.1743-6109.2010.01984.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marson L, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2010. [DOI: 10.1111/j.1743-6109.2010.01946.x] [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: 11/27/2022]
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Kim NN, Romanzi LJ, Brotto LA, Miner M. Current Literature Review. J Sex Med 2010. [DOI: 10.1111/j.1743-6109.2010.01864.x] [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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Gonzalez-Cadavid NF, Brotto LA, Romanzi LJ, Miner M. Current Literature Review. J Sex Med 2010. [DOI: 10.1111/j.1743-6109.2010.01773.x] [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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Gonzalez‐Cadavid NF, Brotto LA, Romanzi LJ, Miner M. Survey of Literature: Current Literature Review. J Sex Med 2009. [DOI: 10.1111/j.1743-6109.2009.01594.x] [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: 11/27/2022]
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Affiliation(s)
- Andrew T Goldstein
- Center For Vulvovaginal Disorders, Washington, DC, USA;; Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lauri J Romanzi
- Department of Obstetrics and Gynecology, Weill Medical College, Cornell University, New York, USA
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Affiliation(s)
- Garron J Solomon
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Medical College of Cornell University, New York, USA.
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Romanzi LJ. Pathophysiology of overactive bladder and its pharmacologic management. Manag Care Interface 2005; 18 Suppl B:10-5. [PMID: 16201227] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Lauri J Romanzi
- Weill Medical College of Cornell University, New York City, USA
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Abstract
PURPOSE OF REVIEW Numbers of women seeking consultation for pelvic floor disorders, a large portion of which will involve pelvic organ prolapse (POP) and lower urinary tract dysfunction, are expected to reach epidemic proportions within the next decade. A full understanding of the complex impact of pelvic organ prolapse on lower urinary tract function is crucial to successful management. RECENT FINDINGS Recent data lend support to the concept that women with POP, but no associated urethral dysfunction, may be best served by a surgical repair that carefully avoids dissection in the periurethral area. Conversely, preoperative evaluation will often reveal bladder outlet obstruction concomitant with 'hidden', 'potential', or 'occult' stress urinary incontinence when the prolapse is reduced. Many of these women will not have incontinence symptoms in daily life. Paradoxically, the mechanical bladder outlet obstruction may induce detrusor instability with subsequent obstructed/overactive bladder symptom complexes not dissimilar to those of men with prostatic bladder outlet obstruction. Anatomic research shows that the vessels and nerves supplying the urethra are particulary vulnerable to surgical techniques used in pelvic organ prolapse repair. SUMMARY This mix of obstructed, overactive bladder with hidden stress incontinence increases with degree of POP, and all women with severe prolapse will fair best if evaluated for all three conditions prior to surgical repair.
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Affiliation(s)
- Lauri J Romanzi
- Obstetrics and Gynecology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA.
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Romanzi LJ, Groutz A, Feroz F, Blaivas JG. Evaluation of female external genitalia sensitivity to pressure/touch: a preliminary prospective study using Semmes-Weinstein monofilaments. Urology 2002; 57:1145-50. [PMID: 11377329 DOI: 10.1016/s0090-4295(01)00964-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the use of pressure aesthesiometers (Semmes-Weinstein monofilaments) in the evaluation of female external genitalia. The pressure aesthesiometers are widely used to assess the pressure/touch perceptions of the hand, face, and breast dermatomes. METHODS Thirty-two consecutive neurologically intact women (mean age 48.7 +/- 13.8 years) and 5 neurologically impaired women referred for a routine gynecologic examination were prospectively enrolled. The monofilaments were applied to the S2-S5 vulvar dermatomes using specific anatomic landmarks. Test-retest reliability studies were performed at the same clinical session. A comparison was made between premenopausal (n = 17) and postmenopausal (n = 15) women; hypoestrogenic (n = 9) and normoestrogenic (n = 23) women; postmenopausal women with (n = 6) and without (n = 9) estrogen replacement therapy; women with normal (n = 18) and abnormal (n = 14) sexual function; and neurologically impaired (n = 5) and neurologically intact (n = 5) women, matched by age, parity, and estrogen status. RESULTS A clear association was found between reduced vulvar sensitivity to pressure/touch and estrogen deficiency, sexual dysfunction, and neurologic impairment. Postmenopausal women had significantly reduced sensitivity to pressure/touch compared with premenopausal women. Similar decreased sensitivity was found in hypoestrogenic compared with normoestrogenic women, with significantly reduced sensitivity in postmenopausal women not using estrogen replacement therapy. Women with sexual dysfunction and those with neurologic impairment had significantly reduced vulvar sensitivity to pressure/touch. No correlation was found between the sensitivity to pressure/touch and either levator ani muscle bulk or the levator contraction score, but significant differences were found between women with and without vulvovaginal atrophy at the time of the examination. Test-retest analysis confirmed the reliability of the monofilaments in testing vulvar sensation. CONCLUSIONS The Semmes-Weinstein monofilaments may be used as a valid and reliable diagnostic tool in the evaluation of vulvar sensitivity to pressure/touch. Additional studies with larger series are needed to establish the role of this clinical tool in the evaluation of various treatment outcomes.
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Affiliation(s)
- L J Romanzi
- Department of Obstetrics and Gynecology, Weill Medical College, Cornell University, New York, New York, USA
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Romanzi LJ. Urinary incontinence in women and men. J Gend Specif Med 2002; 4:14-20. [PMID: 11605351] [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: 02/21/2023]
Abstract
Urinary incontinence is one of the top 10 chronic health conditions in the United States and affects the lives of 13 million Americans. Although common in both men and women, it is a gender-specific condition whose lifetime distribution, incidence, and etiology differ between the two sexes. Recent advances in health care, along with the increasing aging of the population, create a demand for the treatment of urinary incontinence. This article reviews the currently available treatment options, many of which vary inter- and intra-gender.
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Affiliation(s)
- L J Romanzi
- College of Medicine, Cornell University, 962 Park Ave, New York, NY 10028, USA.
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Abstract
Data regarding the prevalence and urodynamic characteristics of involuntary detrusor contractions (IDC) in various clinical settings, as well as in neurologically intact vs. neurologically impaired patients, are scarce. The aim of our study was to evaluate whether the urodynamic characteristics of IDC differ in various clinical categories. One hundred eleven consecutive neurologically intact patients and 21 consecutive neurologically impaired patients, referred for evaluation of persistent irritative voiding symptoms, were prospectively enrolled. All patients were presumed by history to have IDC, and underwent detailed clinical and urodynamic evaluation. Based on clinical evaluation, patients were placed into one of four categories according to the main presenting symptoms and the existence of neurological insult: 1) frequency/urgency; 2) urge incontinence; 3) mixed stress incontinence and irritative symptoms; and 4) neurogenic bladder. IDC was defined by detrusor pressure of > or = 15 cm H2O whether or not the patient perceived the contraction; or < 15 cm H2O if perceived by the patient. Eight urodynamic characteristics of IDC were analyzed and compared between the four groups. IDC were observed in all of the neurologically impaired patients, compared with 76% of the neurologically intact patients (P < 0.001). No correlation was found between amplitude of IDC and subjective report of urgency. All clinical categories demonstrated IDC at approximately 80% of cystometric capacity. Eighty-one percent of the neurologically impaired patients, compared with 97% of the neurologically intact patients, were aware of the IDC at the time of urodynamics (P < 0.04). The ability to abort the IDC was significantly higher among continent patients with frequency/urgency (77%) compared with urge incontinent patients (46%) and neurologically impaired patients (38%). In conclusion, when evaluating detrusor overactivity, the characteristics of the IDC are not distinct enough to aid in differential diagnosis. However, the ability to abort IDC and stop incontinent flow may have prognostic implications, especially for the response to behavior modification, biofeedback, and pelvic floor exercise.
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Affiliation(s)
- L J Romanzi
- Weill Medical College, Cornell University, New York, New York, USA
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Romanzi LJ, Blaivas JG. Protracted urinary retention necessitating urethrolysis following tension-free vaginal tape surgery. J Urol 2000; 164:2022-3. [PMID: 11061909] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- L J Romanzi
- Department of Obstetrics and Gynecology, Weill Medical College, Cornell University, New York, New York, USA
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Romanzi LJ, Groutz A, Blaivas JG. Urethral diverticulum in women: diverse presentations resulting in diagnostic delay and mismanagement. J Urol 2000; 164:428-33. [PMID: 10893602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE We describe various clinical presentations of urethral diverticulum, which may mimic other pelvic floor disorders and result in diagnostic delay. Management and outcome results are reported. MATERIALS AND METHODS We reviewed retrospectively 46 consecutive cases of urethral diverticulum. Patient characteristics, history, clinical evaluation, management and long-term followup are reported. RESULTS Mean patient age plus or minus standard deviation was 36.3 +/- 11.7 years. Most (83%) cases were referred as diagnostic dilemmas with symptoms present for 3 months to 27 years. Mean interval between onset of symptoms to diagnosis was 5.2 years. The most common symptoms were pain (48% of cases), urinary incontinence (35%), dyspareunia (24%) and frequency/urgency (22%). The number of physicians previously consulted ranged from 3 to 20 and prior therapies included oral and/or vaginal medications, anti-incontinence surgery and psychotherapy. The diverticulum was palpable on examination in 24 patients (52%), in only 6 of whom was it possible to "milk" contents per meatus. Of these 24 palpable diverticula 2 contained malignancy, and 2 others contained endometriosis and stones, respectively. Diagnosis was made by voiding cystourethrography in 30 cases (65%), double balloon urethrography in 5 (11%) and transvaginal ultrasound or magnetic resonance imaging in 7 (15%). Diverticula were incidental findings during vaginal surgery in 4 cases (9%). Treatment consisted of diverticulectomy and/or Martius flap, pubovaginal sling and urethral reconstructive procedures when indicated in 35 cases (76%), and 2 other patients underwent radical surgery for diverticular malignancy. Subsequently all but 2 patients with pain were cured. In another patient de novo stress incontinence developed postoperatively. None of the patients who underwent concomitant pubovaginal sling had postoperative incontinence. CONCLUSIONS The symptoms of urethral diverticulum may mimic other disorders. This condition should be considered in women with pelvic pain, urinary incontinence and irritative voiding symptoms not responding to therapy. Surgical treatment is usually effective in alleviating associated symptoms.
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Affiliation(s)
- L J Romanzi
- Departments of Obstetrics and Gynecology, and Urology, Weill Medical College, Cornell University, New York, New York
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Abstract
The objective of this work was to evaluate the utility of a "Kegel" contraction test in a primary care setting. Fifty-seven adult women completed a questionnaire, underwent pelvic examination, "Kegel" assessment, and measurement of same by vaginal sensor electromyography. Thirty-seven underwent repeat evaluations within 4 weeks. Inter- and intra-rater reliability of digital scale, intra-rater reliability for sEMG measurement, correlation between raters and sEMG, and correlation between scale scores and sEMG with history and pelvic exam were determined. Fifty-six percent were pre-menopausal, 44% post-menopausal. Urinary (62%) and rectal (37%) dysfunction were reported. Inter-rater reliability, intra-observer reproducibility for both raters and sEMG measurements, and correlation between raters and sEMG were significant (P< 0.05). Comparison of continence status and digital scores showed scores </=4 were more frequently associated with reported urinary incontinence (P<0.05). sEMG data also correlated to hormonal status and parity (P < 0.05). This digital scale is a useful assessment of "Kegel" contraction, correlating well to sEMG vaginal sensor readings and self-reported overall urinary continence status. Neurourol. Urodynam. 18:603-612, 1999.
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Affiliation(s)
- L J Romanzi
- Department of Obstetrics and Gynecology, Division of Urogynecology, The New York Hospital-Cornell University Medical College, New York, New York, USA
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Romanzi LJ, Chaikin DC, Blaivas JG. The effect of genital prolapse on voiding. J Urol 1999; 161:581-6. [PMID: 9915453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
PURPOSE We determined whether genital prolapse causes obstruction that may be relieved by a vaginal pessary as well as the degree to which voiding difficulty, urethral hypermobility, bladder outlet obstruction, occult stress incontinence, detrusor instability and impaired detrusor contractility are associated with prolapse. MATERIALS AND METHODS We prospectively evaluated 60 women with a mean age of 52 years who had genital prolapse, including 35 (58%) with grade 1 or 2 and 25 (42%) with grade 3 or 4 cystocele, using pressure-flow video urodynamics and cotton swab testing. Leak point pressure and uroflowmetry were repeated in patients with severe prolapse after insertion of a ring pessary. RESULTS Urethral hypermobility (p<0.05) and symptoms of voiding difficulty (p<0.01) were more common in women with grade 3 or 4 cystocele. Urodynamics revealed bladder outlet obstruction in 2 patients (4%) with grade 1 or 2 cystocele and 18 (58%) with grade 3 or 4 cystocele (p<0.001). After vaginal pessary placement bladder outlet obstruction reverted to normal free flow in 17 women (94%) with grade 3 or 4 cystocele. Seven women (20%) with grade 1 or 2 cystocele versus 13 (52%) with grade 3 or 4 cystocele had detrusor instability (p<0.05). Impaired detrusor contractility was noted in each group (p>0.05). In patients with stress incontinence intrinsic sphincter deficiency did not correlate with the degree of prolapse and urethral hypermobility did not correlate with leak point pressure. CONCLUSIONS Lower urinary tract symptoms are common in women with genital prolapse. Voiding difficulty, bladder outlet obstruction and occult stress incontinence may coexist and they are associated with prolapse. Detrusor instability and urethral hypermobility also correlate with the degree of prolapse but impaired detrusor contractility and intrinsic sphincter deficiency do not. In women with severe prolapse ring pessary reduction of prolapse during urodynamics is useful to determine symptomatic and occult conditions.
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Affiliation(s)
- L J Romanzi
- Department of Obstetrics and Gynecology, New York Hospital-Cornell Medical Center, New York, USA
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Romanzi LJ. Urinary incontinence: a family affair. J Gend Specif Med 1998; 1:52-3. [PMID: 11281013] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- L J Romanzi
- College of Medicine, Cornell University, 962 Park Ave, New York, NY 10028, USA
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Romanzi LJ, Heritz DM, Blaivas JG. Preliminary assessment of the incontinent woman. Urol Clin North Am 1995; 22:513-20. [PMID: 7645153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Assessment of urinary incontinence begins with a thorough history and physical examination. This article reviews the collection of subjective, semi-objective, and objective data that allows for comprehensive evaluation of the incontinent female patient. These results will help direct further evaluation and develop an efficient and effective treatment plan.
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Affiliation(s)
- L J Romanzi
- New York Hospital/Cornell Medical Center, NY, USA
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Blaivas JG, Heritz DM, Romanzi LJ. Early versus late repair of vesicovaginal fistulas: vaginal and abdominal approaches. J Urol 1995; 153:1110-2; discussion 1112-3. [PMID: 7869475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We reviewed retrospectively 24 consecutive women who presented with a vesicovaginal fistula repaired by a single surgeon between 1989 and 1993. All patients underwent preoperative investigation, including cystoscopy, excretory urography and bilateral retrograde pyelography. Followup ranged from 6 months to 5 years. Postoperatively, 96% of the women were cured. Two patients had persistent symptomatic detrusor instability and 1 had mild stress incontinence. In 1 woman a vaginal repair failed and she was subsequently cured after an abdominal repair. Five patients presented 6 to 12 months after fistula formation. Among the other 17 patients the average interval from pelvic surgery to vesicovaginal fistula repair was 10.8 weeks. Indications for abdominal repair were indurated vaginal epithelium approximately 2 cm. in circumference around the fistula, a vault fistula with poor vaginal exposure and fistulas involving the ureters. Surgical timing and route of repair are best tailored to the individual patient.
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Affiliation(s)
- J G Blaivas
- Urology Department, New York Hospital-Cornell Medical Center, New York
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Affiliation(s)
- Jerry G. Blaivas
- Urology Department, The New York Hospital-Cornell Medical Center, and The Department of Obstetrics and Gynecology, St. Luke's/Roosevelt Hospital Center, New York, New York
| | - Dianne M. Heritz
- Urology Department, The New York Hospital-Cornell Medical Center, and The Department of Obstetrics and Gynecology, St. Luke's/Roosevelt Hospital Center, New York, New York
| | - Lauri J. Romanzi
- Urology Department, The New York Hospital-Cornell Medical Center, and The Department of Obstetrics and Gynecology, St. Luke's/Roosevelt Hospital Center, New York, New York
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