Stephen Jeffery

St. George's School, Middletown, Rhode Island, United States

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Publications (11)20 Total impact

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    ABSTRACT: The aim of this study was to prospectively evaluate long-term outcomes of a modified high uterosacral ligament suspension (HUSLS) at vaginal hysterectomy for pelvic organ prolapse (POP). POP was assessed 5 years postoperatively in 42 women who underwent vaginal hysterectomy and HUSLS for POP. Bladder, bowel, sexual function and quality of life (QoL) were evaluated. Preoperatively, 27/42 women had at least BW grade 2 uterine prolapse. At a mean follow-up period of 59.4 months (range: 40-79 months), two women had undergone surgical intervention for vault prolapse, 33 had no vault prolapse and six grade 1 vault prolapse. One woman declined vaginal examination. Twenty women were sexually active and 18 completed the PISQ-31. The mean total score for all domains was 91/125. On QoL assessments high scores were noted in all domains. Modified HUSLS at vaginal hysterectomy is associated with satisfactory long-term objective and subjective outcomes, sexual function and quality of life scores.
    International Urogynecology Journal 12/2010; 22(5):577-84. · 2.17 Impact Factor
  • International Journal of Gynecology & Obstetrics 10/2009; 107. · 1.56 Impact Factor
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    ABSTRACT: To evaluate the outcomes of a modified high uterosacral ligament suspension (HUSLS) performed at vaginal hysterectomy for uterine prolapse. Prolapse was assessed pre- and postoperatively in 53 consecutive women, using Baden-Walker Halfway and Pelvic Organ Prolapse Quantification systems. Sexually active women completed the Prolapse and Incontinence Sexual Function Questionnaire at follow up. The technique involves placement of one HUSLS suture on each side without a fascial reconstruction. Preoperatively, 37 (66%) women had at least Grade 2 prolapse of the cervix. At mean follow-up of 15 months, 45 (85%) had no vault prolapse and 7 (13%) had Grade 1 prolapse. Nineteen (36%) women were sexually active at follow up and completed the Prolapse and Incontinence Sexual Function Questionnaire. Mean scores for pain, vaginal tightness, partner perception of tightness and vaginal length were 2.8, 3.2, 4.0, and 3.8 respectively, indicating excellent function. We report excellent objective, subjective and sexual function outcomes following this modified HUSLS.
    Journal of Obstetrics and Gynaecology Research 07/2009; 35(3):539-44. · 0.93 Impact Factor
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    ABSTRACT: Aims: To evaluate outcomes, recurrence rates, and postoperative sexual function after secondary vaginal prolapse surgery using the Small Intestinal Submucosa (SIS) xenograft. Methods: Twenty one women underwent surgery for recurrent vaginal prolapse using the SIS graft anteriorly, posteriorly, or in both compartments. Results: Eleven women had anterior repair with SIS (AVR + SIS), 7 women had posterior repair with SIS (PVR + SIS), and 3 had both. At a mean follow up of 26 months, 10 of the women who had AVR + SIS had a Grade 1 cystocele and Stage 1 or less prolapse for points Aa and Ab. At a mean follow up of 31 months, of those women who had PVR + SIS, all had Grade 1 prolapse or Stage 1 or less on point Pa or Pb. Conclusions: The porcine SIS graft is associated with low anatomic recurrence rates when used in vaginal prolapse surgery. It is also associated with good postoperative sexual function.
    Journal of Pelvic Medicine and Surgery 04/2009; 15(3):151-156.
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    ABSTRACT: To examine the relationship between voiding symptoms and objective measurements of voiding dysfunction. We prospectively collected data from 116 consecutive women attending for urodynamic investigations. Symptoms of voiding dysfunction and objective voiding parameters including uroflowmetry and post-void residual volume were evaluated. Sixteen (14%) patients reported a symptom of straining, 21 (18%) double voiding, 32 (27%) post-micturition dribbling, 10 (8%) poor stream and 34 (29%) incomplete emptying. Using receiver-operator curves we were unable to determine a cut-off value for flow or residual volume where symptoms became more prevalent. Poor stream was, however, a good predictor for a residual volume of >100 mL and >150 mL. Strain predicted a residual volume of >100 and >150 mL and it correlated with maximum flow rate <15 mL/s. The other three symptoms did not correlate with any of the cut-off values. Poor steam and strain are weakly predictive of abnormal voiding function.
    International Journal of Urology 12/2008; 15(12):1044-8. · 1.80 Impact Factor
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    ABSTRACT: Prospective evaluation of outpatient cystoscopy in a Urogynaecology Unit. Prospective observational series. St. George's Hospital, London. Department of Pelvic Reconstructive Surgery and Urogynaecology. A total of 131 consecutive women, who underwent outpatient rigid cystoscopy over a 24-month-period. Prospective data collection included cystoscopic findings, microbiology data, uroflowmetry and radiological results. An Immediate Feedback Questionnaire was completed at the end of the procedure. Success rates of the procedure, cystoscopy findings, requirements for additional investigations, including inpatient cystoscopy and patient satisfaction rates. The mean age was 56.4 years (range 20-87 years). A total 126 women (96.2%) had a successful outpatient cystoscopy. In five (3.8%) women the procedure had to be abandoned because of inability to insert the cystoscope. Eleven women (8.7%) experienced pain but were able to tolerate the discomfort. Fifty-three (42.7%) women had abnormalities detected at cystoscopy. Thirty-seven women had trabeculations. Focal vesical lesions were found in 21 women. Thirty-nine (30.9%) women did not require any additional treatment. Six (6.9%) women were scheduled for repeat cystoscopy under general anaesthetic to facilitate a bladder biopsy. Fifteen women (17.2%) were referred for urodynamics or renal imaging. Three women (3.4%) were referred to a urologist. More than 75% reported high satisfaction with the care they received. Four women had symptoms of UTI and two had positive urinary cultures and required antibiotics. The benefits of outpatient cystoscopy include high levels of tolerability and patient satisfaction, shorter waiting time, quicker implementation of treatment strategies, avoidance of the risks of general anaesthesia and lower procedural cost.
    Archives of Gynecology 10/2008; 279(5):631-5. · 1.28 Impact Factor
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    ABSTRACT: Female voiding dysfunction unrelated to childbirth is common but poorly understood, and most often occurs as a result of detrusor hypotonia and less frequently in association with bladder outlet obstruction. Specific causes include anti-incontinence surgery, bladder over-distension, painful infective, allergic or chemical reactions of the urogenital tissues, bladder outlet obstruction, dyssynergia of the bladder-urethral sphincter mechanism, neurogenic, pharmacological, and psychogenic causes. A thorough history and examination is essential in the clinical assessment. It should be followed by investigations including urine microbiology, frequency volume diaries, ultrasound scan, uroflowmetry, and, when indicated, subtracted voiding cystometry, electromyography, and cystourethroscopy. The main treatment modalities are catheterization (self-intermittent, suprapubic, urethral, in order of preference), bladder retraining, biofeedback, and, rarely, surgery or sacral neuromodulation.
    Obstetrical & gynecological survey 08/2008; 63(8):519-26. · 3.10 Impact Factor
  • Stephen Jeffery, Anna Franco, Michelle Fynes
    International Urogynecology Journal 02/2008; 19(10):1457. · 2.16 Impact Factor
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    ABSTRACT: To evaluate the efficacy and complications of botulinum A toxin (Dysport, Ipsen Ltd, Slough, UK) 500 U in refractory idiopathic detrusor overactivity (IDO). In a prospective study of 25 patients with refractory IDO, the baseline evaluation included an assessment of symptoms, a 7-day voiding diary, 24-h pad test, record of symptoms on a visual analogue scale (VAS) (0-10), the Kings Health Questionnaire (KHQ) and urodynamics. Dysport 500 U was administered at 20 sites in the bladder, sparing the trigone. Patients were followed at 6 weeks and 3, 6 and 9 months; the urodynamic assessment was repeated at 3 months. Fifteen (63%) patients reported being continent from 1 week after treatment; at 3 months, six (32%) (P = 0.01) patients were still dry, remaining so at 6 months (P = 0.025). Weekly leakage episodes decreased from 5.5 to 1.8 (P = 0.044) at 6 weeks and this was sustained, at 2.7 episodes (P = 0.012), at 9 months. The mean VAS score (0-10) decreased from 8.3 to 5.0 (P = 0.001) at 1 week, to 5.0 at 6 weeks (P = 0.001) and 3 months (P = 0.03) and to 6.1 (P = 0.013) at 6 months. On the KHQ there was a significant improvement in the severity measures domain (P = 0.021) and incontinence impact domain (P = 0.015) up to 9 months. The volume at first desire to void increased from 177 to 251 mL (P = 0.04) at 3 months. At 6 weeks and 3 months, 35% of patients required catheterization, as did 22% at 6 months, but only one at 9 months. Intradetrusor Dysport 500 U was associated with significant subjective and objective improvements in refractory IDO. The present patients initially had a significant increase in voiding dysfunction that resolved by 9 months.
    BJU International 01/2008; 100(6):1302-6. · 3.13 Impact Factor
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    ABSTRACT: We assessed the clinical effectiveness and patient satisfaction with nurse-led telephone follow-up of women with lower urinary tract symptoms. Participants were offered telephone follow-up with a nurse instead of a conventional outpatient appointment. Suitability was decided by the doctor who saw the women at her last visit. The consultation was conducted using the same principles as a routine clinic visit. Patient satisfaction was evaluated by postal questionnaire and they were also sent a standard urinary continence questionnaire, the Kings Health Questionnaire (KHQ), to evaluate their current symptoms. In total, 116 women were included. The mean number of telephone consultations was 2 (range 1-12). The mean overall satisfaction score was 77 (maximum 100, where a higher score indicates greater satisfaction). Only 16 patients (17%) did not prefer telephone follow-up to a clinic visit. Women who had been discharged via the telephone follow-up clinic expressed similar mean satisfaction scores to those whose next visit was a clinic visit (80 and 82, respectively). The KHQ also indicated that the patients had been appropriately discharged or given a further follow-up appointment. Nurse-led telephone follow-up is associated with high satisfaction and has the advantages of consistent follow-up by the same clinician, convenience to the patient and cost-savings.
    Journal of Telemedicine and Telecare 02/2007; 13(7):369-73. · 1.74 Impact Factor
  • Article: PD12.12
    S. Jeffery, K. Wang, F. Lee, R. Morley, M. Fynes
    Urology 01/2006; 68:46-47. · 2.13 Impact Factor