-
[show abstract]
[hide abstract]
ABSTRACT: : To describe trends in and predictors of surgical mesh use for pelvic organ prolapse (POP) repair and to estimate the influence of safety advisories on mesh use.
: Analysis of women aged 18 years and older recorded in a health care quality and resource utilization database who underwent POP repair from 2000 to 2010, identified by International Classification of Diseases, 9th Revision, Clinical Modification procedure codes, and stratified by mesh use. Odds ratios were calculated with adjustments for patient, physician, and hospital-level characteristics.
: Among 273,275 women in the cohort, 64,968 (23.8%) underwent a mesh-augmented repair. Concurrent incontinence surgery was a strong predictor of mesh use (odds ratio [OR] 9.95; 95% confidence interval [CI] 9.70-10.21). Mesh use increased from 7.9% in 2000 to a peak of 32.1% in 2006, and declined slightly to 27.5% in 2010. Among women without incontinence, mesh use increased from 3.3% in 2000 to 13.5% in 2006, and remained stable at 12.8% in 2010. Intermediate-volume (OR 1.53; 95% CI 1.44-1.62) and high-volume (OR 2.74; 95% CI 2.58-2.92) surgeons were more likely to use mesh than low-volume surgeons. Compared with women who underwent operation by gynecologists, those treated by urologists were more than three times more likely to undergo mesh-augmented prolapse repair (OR 3.36; 95% CI 3.09-3.66). Black women were 27% less likely to undergo mesh repair (OR 0.73; 95% CI 0.66-0.82).
: Mesh-augmented prolapse repairs increased substantially over the past decade, and this increase was most pronounced in the years before the publication of safety advisories. Physician specialty and surgical volume are important factors underlying mesh use. Additional measures must ensure evidence-based use of mesh for pelvic reconstruction.
: II.
Obstetrics and Gynecology 11/2012; 120(5):1105-15. · 4.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Research has focused on treatment of overactive bladder (OAB) symptoms in women with the goal of cure. The objective of this study was to assess women's perceptions of their OAB symptoms, treatment experience, and outcomes by conducting patient focus groups.
Women seen in our academic center female urology referral clinics were identified by ICD-9 codes for OAB symptoms and recruited to participate in one of five focus groups, totaling 33 patients. Non-clinician moderators conducted the focus group sessions incorporating topics related to patients' perceptions of OAB symptoms, treatments, and outcomes. Data analysis was performed using grounded theory methodology.
Qualitative analysis yielded several preliminary themes: impact of OAB on quality of life, strategies to control wetness, medications and side effects, and triggers. The majority of focus group participants reported only a partial response to medication and other physician-recommended treatments for OAB. Therefore, they developed self-reliant personalized strategies to improve their quality of life. These strategies included fluid restriction, preventive toileting, and, most importantly, the use of incontinence pads.
The majority of the women who participated in the focus groups reported only a partial response to medical and other treatments for OAB. As a result, they developed personalized self-management strategies to improve their quality of life. Although most studies addressing the treatment of OAB aim at curing the condition, such a strategy may be unrealistic. Applying a chronic care model that uses a patient-centered symptom-management approach to OAB may optimize patient outcomes and improve quality of life.
Neurourology and Urodynamics 04/2011; 30(7):1295-9. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In order to better understand provider treatment patterns for interstitial cystitis (IC)/painful bladder syndrome, we sought to document the therapies utilized and their associated expenditures using a national dataset.
A cohort was created by applying the ICD-9 diagnosis of IC (595.1) to INGENIX claims for the year 1999. Subjects were followed for 5 years, and patterns of care and related expenditures were evaluated.
Of 553,910 adults insured in 1999, 89 subjects had a diagnosis of IC with 5-year follow-up data. All subjects were treated with oral medication(s), 26% received intravesical treatments, and 22% underwent hydrodistension. Total expenditures per subject were $2,808.
The majority of IC expenditures were attributable to oral medical therapy. Hydrodistension and intravesical instillations were utilized in less than 25% of patients. Hydrodistension was used more frequently among subjects with a new diagnosis; this may reflect its utilization as part of a diagnostic algorithm.
International Urogynecology Journal 04/2011; 22(4):395-400. · 1.83 Impact Factor
-
The Journal of urology 06/2008; 179(5):1664-5. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Midurethral slings have become the mainstay of stress urinary incontinence (SUI) treatment due to their efficacy and low complication rates. The purpose of this study was to report the presentation and treatment of major complications from these minimally invasive treatments presented to a tertiary referral practice and to highlight a discrepancy in major complications between literature and the food and drug administration (FDA) device failure database.
From 2001 through 2005, we reviewed all cases of midurethral sling complications that presented to our institution. A literature review of all complications due to midurethral slings during the same time period was performed as was the FDA manufacturer and user facility device experience (MAUDE) database queried for self-reported complications.
A total of 26 patients referred to UCLA with voiding dysfunction after sling placement was found to have mesh in the urethra or bladder. Treatments required a combination of urethrolysis with mesh removal, urethral reconstruction with graft, and bladder excision. These were compared to major complications reported in the world literature of <1%. The MAUDE database contained 161 major complications out of a total of 928 complications reported for suburethral slings. There was significantly more major complications reported in MAUDE than in published literature.
Although rare, major complications of midurethral slings are more common than appear in literature. Devastating complications involving urethral and bladder perforations can present with mild urinary symptoms and thus are likely under-diagnosed and under-reported. Most of these cases need to be managed with additional reconstructive surgery.
Neurourology and Urodynamics 01/2007; 26(1):46-52. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The sacrouterine ligament/cardinal (SULC) complex and prerectal fascia attach at the perineal body, forming a single support unit preventing levator descent. Many patients with vault prolapse have levator descent and widening of the hiatus. Existing transvaginal procedures do not address pelvic floor descent. We describe a technique utilizing polypropylene mesh to repair pelvic floor relaxation and prevent levator descent, along with restoration of the SULC complex in vaginal vault repair.
We prospectively evaluated 50 patients who had a transvaginal mesh vault/posterior wall reconstruction. A T-shaped soft prolene mesh is prepared fixing the two arms of the mesh and recreating the SULC complex in support of the cuff. The vertical segment of the mesh is transferred over the prerectal fascia and secured to the pelvic floor musculature. The rectocele is repaired incorporating the mesh distally preventing pelvic floor descent. Surgical outcome was determined by patient self-assessment including quality of life (QoL) measure as well as pelvic examination using POP-Q staging.
Mean age was 67 years. Mean follow-up was 6 months (range 3-12). There were no intraoperative complications. There have been two apical (4%) recurrences. Mean QoL score postoperatively on a 0-6 scale was 0.74 (0 = delighted, 1 = pleased). Pelvic floor descent has been repaired on all patients. Postoperative POP-Q reveals restoration of normal anatomy.
We report a new technique that recreates the SULC complex in support of the vaginal vault with the aid of prolene mesh. It is the first transvaginal procedure described to reconstruct the pelvic floor in attempt to prevent pelvic floor descent.
Neurourology and Urodynamics 02/2005; 24(7):654-8. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Introduction: Sling procedures have been used successfully for the treatment of stress urinary inconti-nence. Using similar surgical principles to the cadaveric fascia sling, we describe the placement of a thinly woven polypropylene (Prolene) mesh under the mid to distal urethra. We describe our technique and report early outcomes. Materials and Methods: A total of 263 consecutive patients were evaluated. All patients had clinical evidence of stress urinary incontinence. Patients underwent a preoperative evaluation with video-urodynamic studies, symptom questionnaire, and cystoscopy. A 1 x 10-cm Prolene mesh was placed under the mid to distal urethra. At a minimum follow-up of 1 year (12-24 months), patients were evaluated with a urogenital symptom questionnaire, physical examination, and postvoid residual volume determination. Results: Twenty-six percent of the patients had unsuccessful prior vaginal surgery. There were no major complications such as permanent retention, erosion, infection or rejection to the mesh. The mean opera-tive time was 27 minutes. In 90% of the patients, the suprapubic catheter was removed within 1 week. No patient experienced permanent retention. One hundred and twenty-eight patients had at least 12 months of follow up and were included for the outcome analysis. 96.4% of these patients were cured or improved and only 3% developed urge-incontinence again. Conclusions: We describe a new, simple, quick, inexpensive, and effective method to correct stress urinary incontinence by placing a Prolene mesh under the distal urethra.
Urological Neurology Brazilian Journal of Urology Official Journal of the Brazilian Society of Urology. 04/2002; 28:254-258.
