J Christian Winters

Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana, United States

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Publications (81)188.85 Total impact

  • J Christian Winters

    No preview · Article · Jun 2015 · The Journal of urology
  • Barry G. Hallner · Ryan M. Krlin · J. Christian Winters
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    ABSTRACT: Urodynamic testing is an interactive diagnostic assessment of the lower urinary tract system composed of multiple tests to obtain physiologic data of the bladder during filling, storage, and emptying. Components of urodynamics (UDS) include simple, non-invasive tests such as non-instrumented uroflowmetry to more sophisticated invasive multichannel pressure-flow studies with sphincter electromyography and or video urodynamics. The main objective of UDS is to reproduce the patients' symptoms and if possible indentify their cause. Overactive bladder (OAB) is characterized urgency with or without incontinence and commonly has symptoms of urgency, frequency, and nocturia. There is a significant amount of controversy with regard to the role of urodynamics in the evaluation of OAB, but typically urodynamics is indicated in the evaluation of OAB when invasive procedures are required, after treatment failures, in complicated incontinence, and in neurogenic surveillance. Ideally, a filling cystometrogram and a pressure-flow study are performed. The use of EMG and fluoroscopy may be useful in patients with a neurogenic etiology to symptoms. The goal of urodynamic testing in the evaluation of OAB should be to detect abnormalities of urinary storage (reduced capacity, abnormal sensation, detrusor overactivity, stress incontinence, and abnormal compliance), as well to determine detrusor function during voiding. Also, information regarding urethral competence and outlet function during voiding may be obtained. UDS testing should be tailored to answer specific clinical questions.
    No preview · Chapter · May 2015

  • No preview · Article · Feb 2015 · Neurourology and Urodynamics
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    ABSTRACT: Objective To assess the penetration of media-based information on transvaginal mesh (TVM) in our patient population and to determine whether exposure affects patient opinion. Since the 2011 Federal Drug Administration communication on TVM, many advertisements from legal practices have been directed toward patients. Materials and Methods An 18-item survey was administered to female patients at 2 sites from August 2012 to April 2013. Patients presenting with new diagnoses of pelvic organ prolapse or stress urinary incontinence or patients who reported prior mesh surgery were excluded. Results Ninety-nine questionnaires were completed. Sixty-six of the patients (67%) were aware of TVM; and of these, 38 (58%) cited advertisements as the initial source of information. Only 12% were aware of the Food and Drug Administration's communication. Regarding opinion of TVM, 9% chose “it is a safe product,” 9% “safety depends on factors related to patient,” 4.5% “not a safe product,” 1.5% “safety depends on the doctor,” 68% “I don't know,” and 4.5% marked 2 selections. Only 12% indicated knowing the difference in the use of TVM for pelvic organ prolapse vs stress urinary incontinence. When asked what influenced their opinion of TVM the most; responses were as follows: advertisement (33.3%), medical professional (22.7%), friends or family who underwent TVM procedure (12.1%), media article (6.1%), and “not sure” (25.8%). Conclusion Advertisements of TVM lawsuits had a high penetration into our patient population but did not produce an overtly negative response in our sample. Clinicians should be aware of the impact of these advertisements on patient opinion and counsel patients accordingly with unbiased and scientifically accurate information.
    No preview · Article · Sep 2014 · Urology
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    ABSTRACT: Purpose Many investigators have used number of pads to determine severity of post prostatectomy incontinence (PPI), yet the accuracy of this tool remains unproven. The aim of this study was to determine if patient’s perception of pad use and urine loss reflects actual urine loss. We also sought to identify a quality of life (QoL) measure that distinguishes patients by severity of incontinence. Materials and Methods We prospectively enrolled 235 men from 18 sites >6 months after radical prostatectomy, with incontinence requiring protection. Patients completed a questionnaire about perception of number, size and wetness of pads and a QoL question, several standardized incontinence questionnaires, and a 24-hour pad test that assessed number, size, and weight of pads. SPSS was used for statistical analysis. Results Perception of number of pads used was in close agreement with number of pads collected during a 24-hour pad test. Perceived and actual pad size had excellent concordance (76%, p<0.001). Patients with “wet” and “soaked” pads had statistically, and clinically, significantly different pad weights uniquely different from each other, and from the “almost dry” and “slightly wet”. The response to the QoL question separated men in to 4 statistically significantly different groups based on mean 24-hour pad weight. Conclusions Patients accurately describe the number, size and the degree of wetness of pads collected during a 24-hour pad test. These correlate well with actual urine loss. The single question of “To what extent does urine loss affect your quality of life?” separated men into distinct categories.
    No preview · Article · Sep 2014 · The Journal of urology
  • Clinton W. Collins · J. Christian Winters
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    ABSTRACT: The American Urological Association/Society of Urodynamics Female Pelvic Medicine and Urogenital Reconstruction Adult Urodynamics Guideline was published with the intent of guiding the clinician in the role of urodynamics in the evaluation and management of complex lower urinary tract conditions. This article examines each guideline statement and attempts to provide clinical context for each statement. Key points are emphasized in the form of clinical case scenarios, which demonstrate application of the principles stressed in this guideline. It is hoped the reader will have a better clinical frame of reference relative to each statement in these guidelines.
    No preview · Article · Aug 2014 · Urologic Clinics of North America
  • J. Christian Winters · Eric S. Rovner · Gary Lemack · Victor Nitti

    No preview · Article · Feb 2014 · Neurourology and Urodynamics
  • Elizabeth Timbrook Brown · Ryan M Krlin · J Christian Winters
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    ABSTRACT: Urodynamics testing is a diagnostic assessment of the lower urinary tract system composed of multiple tests to obtain physiologic data regarding lower urinary tract function (detrusor and outlet) during storage and emptying. The necessity of urodynamics has been both supported and challenged in various urologic conditions such as urinary incontinence, neurogenic bladder, lower urinary tract symptoms, and bladder outlet obstruction. This review discusses the most recent studies with regards to the utility of urodynamics in current practice, highlighting the recent American Urologic Association Adult Urodynamics and Overactive Bladder Guidelines and the Value of Urodynamic Evaluation study.
    No preview · Article · Aug 2013 · Current Urology Reports

  • No preview · Article · Apr 2013 · The Journal of Urology
  • A. T. Lutz · J. C. Winters
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    ABSTRACT: The estimated prevalence of urinary incontinence in the middle-aged and elderly population is estimated between 30–60 % and increases with age (16). Stress urinary incontinence (SUI) defined as the leakage of urine with an increase in intra-abdominal pressure (coughing, laughing, or sneezing) accounts for at least half of all urinary incontinence. Estimates of SUI are as high as 46 % of women. Surgery for SUI is extremely common in the U.S. alone with more than 210,000 women undergoing surgical correction. As our population continues to age and obesity remains rampant, we will continue to treat more women for SUI. This article reviews the guidelines and current recommendations for the evaluation and management of women with stress incontinence. Furthermore, we provide an algorithm for which surgical option would be appropriate.
    No preview · Article · Mar 2013 · Current Bladder Dysfunction Reports
  • Source
    Mohamed A Ghafar · Ralph R Chesson · Cruz Velasco · Paul Slocum · J Christian Winters
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    ABSTRACT: Purpose: We correlated urogenital hiatus size and levator ani contraction strength with early postoperative emptying disorders. We also determined whether postoperative emptying disorders could be predicted before anti-incontinence procedures and pelvic organ prolapse repair. Materials and methods: We retrospectively reviewed the charts of 225 consecutive patients after surgery for pelvic organ prolapse and/or stress urinary incontinence. Urogenital hiatus size was evaluated using pelvic organ prolapse quantification. Levator contraction strength was determined by the Oxford 0 to 5 classification scale. Emptying disorders were defined as post-void residual urine volume greater than 100 ml 48 hours postoperatively and/or discharge home with a Foley catheter or on intermittent self-catheterization. Results: Median patient age, post-void residual urine volume and urogenital hiatus size were significantly related to levator contraction strength (each p <0.05). Univariate logistic regression analysis revealed a significant association of urogenital hiatus size (p = 0.001), post-void residual urine volume (p = 0.005) and levator contraction strength (p = 0.001) with emptying disorder status. Multivariate logistic regression analysis showed that levator contraction strength (p = 0.001) and post-void residual urine (p = 0.01) were independent predictors of emptying disorders. Conclusions: A wide urogenital hiatus, decreased levator ani contraction strength, increasing age and increased post-void residual urine correlated with an increased chance of early postoperative emptying disorders. The most independent predictors of early emptying disorders were decreased levator contraction strength and increased post-void residual urine.
    Full-text · Article · Feb 2013 · The Journal of urology
  • Michelle Koski · J. Christian Winters
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    ABSTRACT: With the aging of our population, pelvic organ prolapse is an increasingly common condition that negatively affects patient quality of life. Vaginal vault prolapse has been reported to occur in as many as 18.2% of all women with prolapse [1], and many would suggest that vaginal vault prolapse is a component of most high-grade anterior compartment descensus. Several repairs exist that reconstitute support to the vaginal vault, and certainly there is no single procedure that is optimal for all patients. Abdominal sacral colpopexy (ASC) offers an effective and durable repair for vaginal vault prolapse [2]. It maximizes functional vaginal length and approximates the normal vaginal axis [3]. ASC should be considered especially in patients with failed prior vaginal repairs, isolated high-grade apical prolapse, and in younger patients with apical prolapse who would like to maintain sexual function [4]. The procedure may be performed open, laparoscopically, or robotically. In our experience, the key components of the operation though the open or robotic approach include utilization of a permanent, type I macroporous mesh, secure suture fixation of the graft to the sacral promontory and vaginal cuff (Fig. 6.1), complete enterocele reduction and culdoplasty, and the addition of concomitant anti-incontinence procedures as indicated [4]. We affix the vaginal portion of the graft with multiple sutures to distribute the tension evenly over the vaginal apex (Fig. 6.2), and avoid excessive tension between the apex and sacrum (Fig. 6.3). We routinely close the peritoneum over the mesh arm. In this chapter we will address the recognition and management of complications potentially associated with this method of the repair, as well as outline complications that have arisen from other variations.
    No preview · Chapter · Jan 2013
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    Joanna M Togami · Elizabeth Brown · J Christian Winters
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    ABSTRACT: Pelvic organ prolapse is a condition that can cause significant symptoms that affect a woman's quality of life. It is the result of defects in the supporting structures of the vagina and, depending on the location and size, can alter the functions of the organs contained within the female pelvis. Approximately 11% of women will undergo surgical intervention for their prolapse or for incontinence in their lifetime. Unfortunately, one third of these will require reoperation for failed procedures. Pelvic floor surgeons have sought to improve these outcomes. Based largely on the success of midurethral slings (MUS), transvaginal mesh has been implanted, and commercial kits developed with the intent of improving these outcomes. In 2008, the Food and Drug Administration (FDA) issued a Public Health Notification in response to possible increased adverse events associated with the use of mesh compared to traditional repairs. The 2011 update required that further study be conducted for the use of transvaginal mesh. In this article, we wish to discuss the background of mesh use and the evolution of the public health warnings, and focus on future prospects.
    Preview · Article · Nov 2012 · F1000 Medicine Reports
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    ABSTRACT: Purpose: The authors of this guideline reviewed the literature regarding use of urodynamic testing in common lower urinary tract symptoms. The findings are intended to assist clinicians in the appropriate selection of urodynamic tests, following an evaluation and symptom characterization. Materials and methods: A systematic review of the literature using the MEDLINE® and EMBASE databases (searched from 1/1/90 to 3/10/11) was conducted to identify peer-reviewed publications relevant to using urodynamic tests for diagnosis, determining prognosis, guiding clinical management decisions and improving patient outcomes in patients with various urologic conditions. The review yielded an evidence base of 393 studies after application of inclusion/exclusion criteria. These publications were used to create the evidence basis for characterizing the statements presented in the guideline as Standards, Recommendations or Options. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate) or C (low). In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinion. Results: The evidence-based guideline statements are provided for diagnosis and overall management of common LUTS conditions. Conclusions: The Panel recognizes that each patient presenting with LUTS is unique. This Guideline is intended to serve as a tool facilitating the most effective utilization of urodynamic testing as part of a comprehensive evaluation of patients presenting with LUTS.
    No preview · Article · Oct 2012 · The Journal of urology
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    J Christian Winters
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    ABSTRACT: There are a number of operative approaches to correct stress urinary incontinence (SUI). There is clearly not one procedure that "fits all." This review provides a summary of key available data comparing the various interventions. These findings are then incorporated into an algorithm, which attempts to outline a rational approach to select the most appropriate procedures in women seeking surgical treatment of SUI.
    Preview · Article · Oct 2012 · Canadian Urological Association journal = Journal de l'Association des urologues du Canada
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    ABSTRACT: To characterize our experience with colpocleisis in a urologic setting because it has not been documented broadly in the urologic literature. Retrospective review of demographics, urodynamics, presenting symptoms, complications, and outcomes for patients undergoing colpocleisis from 2001-2010 was performed. A questionnaire including the short forms of the Urinary Distress Inventory and Pelvic Organ Prolapse Distress Inventory (POPDI-6), and the Patient Global Impression of Improvement was sent to consenting patients. Fifty-three patients were identified. Examinations were all POP-Q stage 3 or greater or Baden Walker grade 3 or higher; 73.6% underwent total colpocleisis and 26.4% Le Fort; 60.4% underwent concomitant sling. Complications included 1 patient requiring transfusion, 1 with pulmonary embolus, 1 needing clot evacuation, and 1 requiring intraoperative cystotomy repair. There was no postoperative de novo urgency, no recurrence of prolapse, and no chronic urinary retention. In patients not undergoing urethral sling, stress urinary incontinence persisted in 4 patients and occurred de novo in 1. Mean follow-up was 9.3 months. Twenty-two surveys were returned: 90.9% described their condition as much or very much better on Patient Global Impression of Improvement. The average POPDI-6 score was 9.1. Frequency and urgency were the most common complaints leading to bother on the UDI-6 (33.3%). Most of these responders had a preoperative urge component. In a selected patient population, colpocleisis is safe and efficacious. Persistent lower urinary tract symptoms comprise the highest frequency of complaints after colpocleisis, and this must be included in patient counseling. In an aging patient population with expected increase in demand for pelvic floor reconstruction, colpocleisis is a useful approach for the urologist.
    No preview · Article · Sep 2012 · Urology
  • Christopher J Chermansky · J Christian Winters
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    ABSTRACT: Mesh used for slings and pelvic organ prolapse (POP) repair has resulted in increased efficacy. Yet, the benefits of a more durable repair must be weighed against such risks as vaginal mesh extrusion and erosion and increased dyspareunia, and pelvic pain. We review the current literature on complications seen with the use of vaginal mesh for both stress urinary incontinence and POP. The use of mesh in midurethral slings results in similar efficacy but less morbidity compared with nonmesh sling techniques. The use of mesh in abdominal sacrocolpopexy may result in lower rates of mesh complications compared with transvaginal mesh prolapse repairs. In 2011, the Food and Drug Administration issued an updated safety communication stating that serious complications associated with transvaginal mesh for POP repair are not rare. Yet, certain patients do benefit from the use of transvaginal mesh for POP repair. Better-controlled data are needed to answer questions regarding outcomes, complications, and quality of life after transvaginal mesh prolapse procedures. The surgeon and the patient must have a proper informed consent discussion about the risks, benefits, alternatives, and indications for the use of mesh.
    No preview · Article · May 2012 · Current opinion in urology
  • J Christian Winters

    No preview · Article · May 2012 · Current opinion in urology
  • Karen Soules · J Christian Winters · Christopher J Chermansky
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    ABSTRACT: Pelvic organ prolapse is an increasingly common condition for women that has been challenging to treat due to high recurrence rates after surgical repair. The introduction of mesh-augmented prolapse repairs as a means to achieve more robust repairs had great initial promise. As more data emerge on outcomes and novel mesh complications, the when and where of mesh augmentation has become much less clear. This article reviews the relevant literature on the use of mesh in central and apical repairs. This includes a detailed look at the available data for vaginal mesh kits and several recent trials comparing mesh kits to traditional repairs. The article ends with a discussion of the recent U.S. Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh in pelvic organ prolapse and the authors' views of how practice may change in this new environment.
    No preview · Article · May 2012 · Current Urology Reports
  • Christopher J Chermansky · Ryan M Krlin · J Christian Winters
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    ABSTRACT: Management of the urethra in women without stress urinary incontinence during pelvic organ prolapse repair can be approached selectively or with a prophylactic suburethral sling. We report on patient satisfaction and outcomes in patients who underwent selective urethral management during pelvic organ prolapse repair. Patients undergoing repair of advanced apical and/or anterior compartment pelvic organ prolapse underwent prolapse reduction to screen for stress urinary incontinence. Patients with clinical, occult and urodynamic stress urinary incontinence underwent a sling procedure. Those without stress urinary incontinence did not undergo sling surgery. Patients completed responses to the UDI-6 (Urogenital Distress Inventory, PGI-I (Patient Global Impression of Improvement) and MESA (Medical, Epidemiological, and Social Aspects of Aging). Cost analysis of selective urethral management was completed. A total of 42 patients met the study inclusion criteria and 30 completed responses to all questionnaires. Patients were separated into prolapse repair only (14) and prolapse repair with sling (16) groups. In the prolapse repair only group 1 patient required a subsequent sling. Mean UDI-6, MESA urge and MESA stress scores were 3.71, 1.29 and 3.14 in the prolapse repair only group, and 2.31 (p=0.219), 2.69 (p=0.244) and 3.00 (p=0.918) in the prolapse repair with sling group, respectively. The PGI-I revealed no statistical difference between the groups. A total cost savings of $55,804 was achieved using selective urethral management. Patients undergoing prolapse repair only have continence and satisfaction outcomes that appear equivalent to those who underwent concomitant prolapse repair and sling. The decision to perform a concomitant sling at the time of prolapse repair should be tailored to the patient.
    No preview · Article · Apr 2012 · The Journal of urology

Publication Stats

853 Citations
188.85 Total Impact Points


  • 1998-2015
    • Louisiana State University Health Sciences Center New Orleans
      • Department of Urology
      New Orleans, Louisiana, United States
  • 2014
    • McGill University
      Montréal, Quebec, Canada
  • 2010
    • American Urological Association
      Linthicum, Maryland, United States
  • 2007
    • Vanderbilt University
      • Division of Urologic Surgery
      Нашвилл, Michigan, United States
    • Louisiana State University
      Baton Rouge, Louisiana, United States
  • 2006
    • Loyola University Medical Center
      Maywood, Illinois, United States
  • 2000-2006
    • Ochsner
      • Department of Urology
      New Orleans, Louisiana, United States
  • 2001
    • Wilford Hall Ambulatory Surgery Center
      Lackland Air Force Base, Texas, United States
  • 1996-1998
    • Cleveland Clinic
      • Department of Urology
      Cleveland, Ohio, United States