Nirit Rosenblum

NYU Langone Medical Center, New York City, NY, United States

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Publications (25)43.85 Total impact

  • Margarita M Aponte, Nirit Rosenblum
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    ABSTRACT: The objective of this review is to discuss the main goals of pelvic organ prolapse repair. Pelvic organ prolapse symptoms are variable, and prolapse degree does not necessarily correlate with perceived symptoms or other associated conditions including urinary, defecatory, and sexual dysfunction. Treatment for pelvic organ prolapse is based upon symptom bother and patient expectations. There are various surgical approaches to treat pelvic organ prolapse; however, there is no standardized definition of cure or success. Physician goals of pelvic surgery to correct prolapse include restoration of anatomy, resolution of patient symptoms, avoidance of complications and attainment of patient goals. However, patient's expectations may differ, and discussing preoperative goals and setting realistic expectations prior to treatment may guide surgical therapy and improve patient satisfaction.
    Current Urology Reports 02/2014; 15(2):385.
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    ABSTRACT: Background and Purpose: The aim of this study was to describe the surgical technique and report the safety and feasibility of robotic-assisted laparoscopic sacrohysteropexy, a uterine sparing procedure to correct pelvic organ prolapse. Hysterectomy at the time of pelvic organ prolapse surgery has yet to be proven to improve the durability of repair. Nevertheless, the leading indication for hysterectomy in postmenopausal women is pelvic organ prolapse. Patients and Methods: We reviewed the medical records of a consecutive case series of uterine sparing prolapse repair procedures from 2005 through 2011. 15 women were identified. Procedures utilized a type I polypropylene mesh securing the posterior uterocervical junction to the sacral promontory. This was later modified to utilize a Y-shaped strip that was inserted through the broad ligaments to include the anterior uterocervical junction. Results: Objective success was defined as Baden Walker grade 0 uterine prolapse and subjective success was defined as no complaint of vaginal bulge or pressure. The mean age of women was 51.8 years (28-64). No intra-operative complications were noted. Mean operating time was 159.4 minutes (130-201) and mean estimated blood loss was 35 ml (0-100). The mean length of stay was 1.6 days (1-4) and mean length of follow-up was 10.8 months. Uterine prolapse improved in all 15 patients. Objective success was 93% (14/15) and subjective success was 80% (12/15). Conclusions: Robotic-assisted laparoscopic sacrohysteropexy was found to be a safe and feasible surgical treatment option for pelvic organ prolapse patients who desire uterine preservation.
    Journal of endourology / Endourological Society 05/2013; · 1.75 Impact Factor
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    ABSTRACT: PURPOSE: To determine the utility of urodynamics (UDS) in patients with obstruction secondary to anti-incontinence surgery (AIS). MATERIAL AND METHODS: We retrospectively reviewed all procedures to relieve obstruction due to AIS from 01/01-06/11. Patients were excluded if they had prior procedures to relieve obstruction, if follow-up data was missing, or if a neurologic disorder was present. Patients were grouped into the following categories prior to intervention: UDS diagnostic of obstruction vs. non-diagnostic UDS vs. no UDS testing. In addition we separated patients with predominantly storage symptoms vs. patients with incomplete emptying. RESULTS: A total of 71 women were included in the analysis; 54 women presented with an elevated PVR, 33 (61%) were diagnosed with obstruction on UDS, 4 (7.4%) had non- diagnostic UDS and 17 (32%) did not undergo preoperative UDS. All 18 patients with predominantly storage symptoms underwent UDS. In patients with incomplete emptying there was no difference between groups with respect to improvement in storage or voiding symptoms, overall cure or success according to whether they had diagnostic UDS or not. In patients who had storage symptoms and underwent UDS, those without evidence of detrusor overactivity (DO) had significantly greater improvement of their storage symptoms when compared to those with DO (85.7% vs. 53.8%, p=0.02). CONCLUSIONS: If voiding symptoms or urinary retention are the primary indication for intervention following AIS, UDS findings are not predictive of outcomes after intervention to relieve obstruction. If storage symptoms are the main indication for intervention, UDS may be valuable for patient counseling.
    The Journal of urology 04/2013; · 4.02 Impact Factor
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    ABSTRACT: OBJECTIVES: To define the urodynamic study findings among women with insensible urinary incontinence. METHODS: Women complaining of insensible incontinence who underwent urodynamics at our center were identified. Coexisting symptoms of stress incontinence, urgency incontinence and/or mixed incontinence were recorded. The primary outcome was the urodynamic study finding. Urodynamic stress incontinence, detrusor overactivity incontinence, combination of both or neither (no incontinence) were the possible diagnoses. RESULTS: A total of 58% of patients had insensible incontinence alone and 42% had insensible incontinence combined with other urinary incontinence symptoms. Of the patients with insensible incontinence alone, 37% had no incontinence on urodynamics, whereas urodynamic stress incontinence was diagnosed in 52%. Isolated urodynamic stress incontinence was found in 73% of patients with insensible and stress incontinence symptoms. In patients with insensible plus urgency incontinence, isolated detrusor overactivity incontinence and detrusor overactivity incontinence with urodynamic stress incontinence were found in the same percentage of women (40% each). In patients with symptoms including stress urinary incontinence, stress incontinence was the predominant urodynamic finding. CONCLUSIONS: In patients who have incontinence symptoms in addition to insensible incontinence, these symptoms are highly predictive of urodynamic findings. In particular, women with insensible incontinence, concomitant stress incontinence symptoms are most predictive of urodynamic findings (i.e. urodynamic stress urinary incontinence). In contrast, where insensible incontinence represents the only symptom, urodynamic findings vary widely, with a significant proportion having non-diagnostic studies.
    International Journal of Urology 09/2012; · 1.73 Impact Factor
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    ABSTRACT: To determine the clinical and urodynamic differences in the presentation and the value of simultaneous fluoroscopy in dysfunctional voiding (DV) and primary bladder neck obstruction (PBNO); the 2 most common causes of non-neurogenic "functional" bladder outlet obstruction in women. A review of our urodynamic study database (March 2003 to August 2009) was conducted. DV was diagnosed when increased external sphincter activity was found during voluntary voiding on electromyography (EMG) or fluoroscopy. PBNO was diagnosed when a failure of bladder neck opening was noted on fluoroscopy during voiding. The demographics, symptoms, and urodynamic study parameters were collected. Comparisons were done using chi-square and 2-tailed t-tests. DV was diagnosed in 34 women and PBNO in 16. The patients with DV were younger than those with PBNO (40.9 vs 59.2 years, P < .001). Women with DV showed a clinical trend toward having more storage symptoms than those with PBNO and fewer voiding symptoms. Patients with DV had a greater mean maximal flow rate (12 vs 7 mL/s, P = .027) and lower mean postvoid residual urine volume (125 vs 400 mL, P = .012). No significant differences were found in maximal detrusor pressure, detrusor pressure at maximal flow rate, or detrusor overactivity. EMG showed increased activity during voiding in 79.4% of those with DV and 14.3% of those with PBNO (P < .001). Clinically, women with DV and PBNO had similar presentations, although those with PBNO had poorer emptying. The flow rates and patterns seemed to differ between those with DV and PBNO, although the voiding pressures were similar. EMG alone would have given the wrong diagnosis in 20.6% of those with DV (false negative) and 14.3% of those with PBNO (false positive). When fluoroscopy is used to define these entities, the accuracy of EMG to differentiate them is questionable.
    Urology 07/2012; 80(1):55-60. · 2.42 Impact Factor
  • Nirit Rosenblum
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    ABSTRACT: Pelvic reconstructive surgeons in the fields of urology, gynecology and urogynecology have continually adapted new techniques in pelvic organ prolapse (POP) repair in order to improve both anatomic and subjective outcomes. In the last 5 years, robotic surgery has gained a strong foothold in urologic oncology, gynecologic oncology, cardiothoracic surgery and now in female pelvic medicine. Robotic surgery has made its way into the armamentarium of POP treatment and has allowed pelvic surgeons to adapt the 'gold standard' technique of abdominal sacrocolpopexy to a minimally invasive approach with improved intraoperative morbidity and decreased convalescence. This review article aims to discuss the techniques of robotic prolapse repair as well as morbidity, cost and clinical outcomes. The adaptation of minimally invasive approaches to the treatment of POP initially began with laparoscopy, something only those surgeons with extensive and advanced laparoscopic skills are able to accomplish. Access to robotic technology makes conversion from open or laparoscopic to robotic surgery much more feasible for most pelvic floor surgeons. There are currently no published randomized, controlled trials comparing robotic with open or laparoscopic sacrocolpopexy, however, there are several publications reporting both retrospective and prospective series of women undergoing robotic-assisted sacrocolpopexy. Robotic-assisted pelvic floor surgery has become an important component of the pelvic surgeon's armamentarium in the treatment of symptomatic POP. Those pelvic surgeons without significant expertise in laparoscopy required for sacral dissection and intracorporeal suturing can readily learn the necessary techniques required for robotic surgery.
    Current opinion in urology 05/2012; 22(4):292-6. · 2.50 Impact Factor
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    ABSTRACT: We report our experience with surgical excision for treatment of Skene's gland abscess/infection after conservative measures have failed. A retrospective review of patients that underwent surgical excision of Skene's gland abscess/infection by a single surgeon from 06/1995 to 09/2008 was performed. Patients were separated into groups based on indication for procedure. Recurrence rate and success rate were calculated. The final study group included 34 patients. After initial excision, 88.2% (30/34) of patients had resolution of symptoms. Recurrence of signs and symptoms that prompted further treatment occurred in 30% (9/30). In those that recurred, 88.8% (8/9) of patients had resolution of symptoms after further therapy. Overall success rate in complete resolution of symptoms after all treatment was 85.3%. Only patients to fail were in the urethral pain and recurrent UTI groups. Surgical excision is a safe and effective therapy for the treatment of Skene's gland abscess/infection after conservative measures have failed.
    International Urogynecology Journal 07/2011; 23(2):159-64. · 2.17 Impact Factor
  • Nirit Rosenblum, Victor W Nitti
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    ABSTRACT: A basic understanding of female urethral anatomy is necessary to approach urethral reconstruction from an anatomic standpoint. This article reviews the techniques of female urethral reconstruction based on these anatomic divisions: proximal and bladder neck, midurethra, and distal urethra.
    Urologic Clinics of North America 02/2011; 38(1):55-64, vi. · 1.39 Impact Factor
  • Journal of Urology - J UROL. 01/2011; 185(4).
  • Journal of Urology - J UROL. 01/2011; 185(4).
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    ABSTRACT: We classified patients lost to followup after mid urethral synthetic sling placement as examples of treatment success or failure based on the Patient Global Impression of Improvement, and compared the outcomes of those who followed up to the outcomes of those who did not. We reviewed the charts of 217 patients who underwent mid urethral synthetic sling placement. Telephone interviews including the Patient Global Impression of Improvement and the Medical, Epidemiological, and Social Aspects of Aging questionnaires were conducted for patients lacking 3-month followup. Based on the Patient Global Impression of Improvement of the 48 patients who responded 13 (27.1%) were failures. The overall failure rate of patients with at least 3-month followup was 19% (23 of 124). In our study success rates for patients lost to followup were similar to the rates for those who had routine followup. However, it is uncertain if these data can be applied to other study populations, especially in a randomized controlled trial.
    The Journal of urology 02/2010; 183(4):1455-8. · 4.02 Impact Factor
  • Journal of Urology - J UROL. 01/2010; 183(4).
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    ABSTRACT: The purpose of our study was to determine the findings at both static and dynamic MRI in women with a clinically suspected urethral abnormality. MRI of the urethra was performed in 84 women with lower urinary tract symptoms using multiplanar T2-weighted turbo spin-echo and unenhanced and contrast-enhanced gradient-echo sequences. A dynamic true fast imaging with steady-state free precession sequence was performed during straining in the sagittal plane. Images were evaluated by two radiologists for urethral pathology and pelvic organ prolapse. MRI findings were correlated with clinical symptoms using the Fisher's exact and Mann-Whitney tests. Urethral abnormalities were found in 10 of 84 patients (11.9%), including two urethral diverticula, five Skene's gland cysts or abscesses, and three periurethral cysts. Thirty-three patients (39.3%) were diagnosed with pelvic organ prolapse, of whom 29 (87.9%) were diagnosed exclusively on dynamic imaging. In 29 of 33 patients with prolapse (87.9%), the urethra was structurally normal. MRI showed 13 cystoceles and 17 cases of urethral hypermobility not detected on physical examination. Patients with a greater number of vaginal deliveries, stress urinary incontinence, frequency of voiding, and voiding difficulty were statistically more likely to have anterior compartment prolapse (p < 0.05). Including a dynamic sequence permits both structural and functional evaluation of the urethra, which may be of added value in women with lower urinary tract symptoms. Dynamic MRI allows detection of pelvic organ prolapse that may not be evident on conventional static sequences.
    American Journal of Roentgenology 12/2009; 193(6):1708-15. · 2.90 Impact Factor
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    ABSTRACT: Introduction: We sought to identify our indications for a pubovaginal sling (PVS) in the midurethral synthetic sling era. Methods: Between June 2002 and July 2008, 369 consecutive, nonrandomized women underwent treatment for stress urinary incontinence with a sling surgery. Forty underwent PVS, while 329 midurethral slings were placed. This effort was focused on the reasons why PVS was chosen over a MUSS. Results: Mean patient age was 54.9 years (range, 21-86). Clinically, 69% presented with stress urinary incontinence and 31% with mixed urinary incontinence. The majority of the patients opted for a PVS for multiple previously failed incontinence surgeries 52.5%, followed by a fixed urethra 50%, concomitant surgeries involving urethral reconstruction 22.5%, compromised anatomy 18.7%, and abdominal surgery for a separate indication 5%. Forty-four percent (15/34) were cured, 17.6% (6/34) improved, 26.4% (9/34) failed, 6% (2/34) obstructed, and 6% (2/34) lost to follow-up. Conclusion: In the midurethral synthetic sling era, the PVS maintains its relevance in patients presenting with complex incontinent issues.
    Journal of Pelvic Medicine and Surgery 04/2009; 15(3):115-121.
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    Nirit Rosenblum
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    ABSTRACT: The negative impact of overactive bladder (OAB) on daily quality of life drives the large market of pharmacotherapy targeted at symptoms of urinary frequency and urgency, with or without urinary urge incontinence. Currently, the primary pharmacologic treatment modality is aimed at modulation of the efferent muscarinic receptors (M2 and M3) predominant in detrusor smooth muscle and responsible for involuntary or unwanted bladder contractions. However, due to drug effects in the muscarinic receptors of the salivary glands and intestinal smooth muscle, as well as extensive first-pass metabolism in the liver and intestinal tract yielding parent drug metabolites, adverse side effects are common and can be quite bothersome. These issues, encountered with many of the oral antimuscarinic formulations, limit their tolerability and affect long-term patient compliance and satisfaction. Thus, the benefit of pharmacotherapy for OAB must be a balance between efficacy and tolerability, also known as therapeutic index. This article reviews the current pharmacologic delivery systems available for the treatment of OAB, patient compliance, and reasons for discontinuation of medication.
    Reviews in urology 02/2009; 11(2):45-51.
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    ABSTRACT: We evaluated the protocol that we use to determine whether a mid urethral synthetic sling will be placed at transvaginal pelvic organ prolapse repair. A total of 140 patients underwent transvaginal repair for stage 2 to 4 pelvic organ prolapse, of whom 105 were treated according to the protocol and had a minimum 3 months of followup or required earlier intervention. Urodynamics were performed without prolapse reduction. When stress urinary incontinence was not identified, a pessary was placed and the study was repeated. Patients were designated as having urodynamic, occult or no stress urinary incontinence. Patients with urodynamic or occult stress urinary incontinence underwent a simultaneous mid urethral synthetic sling procedure, while those without urodynamic or occult stress urinary incontinence did not. Charts were reviewed to determine whether further intervention was required for stress urinary incontinence or obstruction. The risk of intervention due to obstruction after receiving a mid urethral synthetic sling was 8.5%. The risk of intervention for stress urinary incontinence in patients with no clinical, urodynamic or occult stress urinary incontinence and no mid urethral synthetic sling was 8.3%. The risk of intervention for stress urinary incontinence in patients with clinical stress urinary incontinence but no urodynamic or occult stress urinary incontinence and no mid urethral sling was 30%. Using our urodynamic protocol to manage the urethra at transvaginal pelvic organ prolapse repair the risk of intervention due to obstruction is essentially equal to the risk of intervention due to stress urinary incontinence when no clinical, urodynamic or occult stress urinary incontinence was present and no mid urethral synthetic sling was placed. In patients who report clinical stress urinary incontinence preoperatively despite no urodynamic or occult stress urinary incontinence there is a much higher rate of further intervention for stress urinary incontinence.
    The Journal of urology 01/2009; 181(2):679-84. · 4.02 Impact Factor
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    ABSTRACT: Our purpose was to evaluate the outcome of a subset of patients that had a tension-free vaginal tape-obturator (TVT-O) placed following a previous anti-incontinence procedure. We performed a retrospective analysis of 27 consecutive women who had a TVT-O placed from January 2004 to December 2007. Patients were given the Patient Global Impression of Improvement (PGI-I) questionnaire starting at the 3-month follow-up. Of 174 women who had a TVT-O placed, 27 (15.5%) had a prior failed anti-incontinence procedure or surgery performed. The mean age was 63.8 years (range 43-87). Mean follow-up was 25.7 months (range 12-47 months). Based on the PGI-I, the overall success rate was 80% (20/25). In the properly selected patients with prior intervention for stress urinary incontinence (SUI), the success rate for TVT-O of 80% appears to be comparable to that of patients who never had a previous surgical or minimally invasive treatment for SUI.
    International Urogynecology Journal 01/2009; 20(3):331-5. · 2.17 Impact Factor
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    ABSTRACT: The objective of our study was to retrospectively compare the degree of pelvic organ prolapse shown on dynamic true fast imaging with steady-state precession (FISP) versus HASTE sequences in symptomatic patients. Fifty-nine women (mean age, 57 years) with suspected pelvic floor dysfunction underwent MRI using both a sagittal true FISP sequence, acquired continuously during rest alternating with the Valsalva maneuver, and a sagittal HASTE sequence, acquired sequentially at rest and at maximal strain. Data sets were evaluated in random order by two radiologists in consensus using the pubococcygeal line (PCL) as a reference. Measurement of prolapse was based on a numeric grading system indicating severity as follows: no prolapse, 0; mild, 1; moderate, 2; or severe, 3. A comparison between sequences on a per-patient basis was performed using a Wilcoxon's analysis with p < 0.05 considered significant. Overall, 66.1% (39/59) of patients had more severe prolapse (>or= 1 degrees ) based on dynamic true FISP images, with 28.8% (17/59) of the cases of prolapse seen exclusively on true FISP images. Only 20.3% (12/59) of patients had greater degrees of prolapse on HASTE images than on true FISP images, with 10.2% (6/59) of the cases seen exclusively on HASTE images. A statistically significant increase in the severity of cystoceles (p < 0.01) and urethral hypermobility (p < 0.01)-with a trend toward more severe urethroceles (p < 0.07), vaginal prolapse (p < 0.09), and rectal descent (p < 0.06)-was shown on true FISP images. Overall, greater degrees of organ prolapse in all three compartments were found with a dynamic true FISP sequence compared with a sequential HASTE sequence. Near real-time continuous imaging with a dynamic true FISP sequence should be included in MR protocols to evaluate pelvic floor dysfunction in addition to dynamic multiplanar HASTE sequences.
    American Journal of Roentgenology 08/2008; 191(2):352-8. · 2.90 Impact Factor
  • Journal of Urology - J UROL. 01/2008; 179(4):533-534.
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    ABSTRACT: The objective was to determine urodynamic findings in young, premenopausal, nulliparous women with bothersome lower urinary tract symptoms and assess whether or not symptoms are predictive of specific urodynamic abnormalities. The records of 57 women were reviewed. Those with neurological disease or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent videourodynamics. Symptoms were compared in patients with and without bladder dysfunction and/or voiding phase dysfunction. Bladder dysfunction was diagnosed in 86% of patients with urge incontinence vs. 17% of those without (p<0.0001). Patients with voiding phase dysfunction had higher total and voiding AUASI scores. Occult neurological disease was later diagnosed in 4 women (24%) with urge incontinence and bladder dysfunction. Urge incontinence and voiding symptoms are frequently associated with urodynamically demonstrable abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the utility of urodynamics in this population.
    International Urogynecology Journal 01/2004; 15(6):373-7; discussion 377. · 2.17 Impact Factor

Publication Stats

112 Citations
3 Downloads
1k Views
43.85 Total Impact Points

Institutions

  • 2009–2013
    • NYU Langone Medical Center
      • Department of Urology
      New York City, NY, United States
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
  • 2009–2011
    • CUNY Graduate Center
      New York City, New York, United States
  • 2010
    • University of Kentucky
      Lexington, Kentucky, United States
  • 2001
    • New York University
      • Department of Urology
      New York City, NY, United States
  • 2000
    • State University of New York Downstate Medical Center
      • Department of Urology
      Brooklyn, NY, United States