Female Pelvic Medicine & Reconstructive Surgery, 2021
Objective: Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry f... more Objective: Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry for Research, we (1) compared generic quality of life (QOL) in women planning pelvic organ prolapse (POP) treatment (surgery vs pessary), (2) correlated generic and condition-specific QOL scores, and (3) identified associations between generic QOL and other factors. Methods: This cross-sectional analysis assessed generic physical and mental QOL using the Patient-Reported Outcomes Measurement Information System Global Health Scale at baseline. Global Physical and Mental T-scores center on a representative US population sample (mean [SD], 50 [10]; higher scores, better health). Condition-specific QOL was assessed with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire. Linear regression models identified associations between clinical factors and Global Physical/Mental scores. Results: Five hundred sixty-eight women (419 surgery, 149 pessary) were included. Surgery patients were younger, heavier, and more often sexually active (all P's ≤ 0.01). Global Physical scores were lower in the surgery versus pessary group, but not likely clinically meaningful (mean [SD], 48.8 [8.1] vs 50.4 [8.5]; P = 0.035); Global Mental scores were similar (51.4 [8.4] vs 51.9 [9.
Women with overactive bladder (OAB) report psychological distress, anxiety and depression, but sh... more Women with overactive bladder (OAB) report psychological distress, anxiety and depression, but short-term associations between these symptoms are poorly studied. Our objectives were to study daily associations between OAB symptoms and psychological symptoms and test whether these associations were stable when reassessed after 3 months. We hypothesized that OAB symptoms are positively associated with anxiety and depression symptoms over a short-term (daily) basis. Female patients with OAB [bothersome urgency and/or urgency urinary incontinence (UUI)] assessed OAB and mood symptoms at baseline and 3 months using a 3-day bladder diary and visual analog scale (VAS) ratings (0–100 mm) for anxiety, depression and stress. Daily OAB and mood symptom associations were tested using Spearman correlations. Generalized estimating equation (GEE) models tested associations between daily urgency scores and each psychological rating adjusting for covariates, time and a time-symptom interaction term. Participants (n = 69) had mean (SD) age 63.3 (13.4) years. Baseline diary outcomes [median (IQR)/day] included day voids 8 (7–11), nocturia 0 (0–1), UUI episodes 1 (0–3) and urgency score 1.75 (1–2.25). Anxiety and depression diagnoses (dx) and treatment (tx) were common (anxiety dx 30.4%, tx 21.7%; depression dx 47.8%, tx 37.7%), but daily anxiety, depression and stress ratings were low [median (IQR) mm 10 (3–35), 5 (1–16), and 16 (4–39), respectively]. Daily urgency scores correlated with anxiety (r = 0.30–0.40, days 1–3, p ≤ 0.01 for all), depression (r = 0.24–0.35, p ≤ 0.05 all) and stress (r = 0.27–0.34, p ≤ 0.03 all). GEE models indicated no significant change in these associations between baseline and 3 months, and OAB treatment did not impact the associations. Urgency scores were positively associated with same-day ratings of anxiety, depression and stress in OAB patients.
To describe the association between childhood traumas (death of a family member, severe illness, ... more To describe the association between childhood traumas (death of a family member, severe illness, sexual trauma, parental separation) reported by women and men and lower urinary tract symptoms (LUTS).
American Journal of Physiology-Renal Physiology, 2019
Altered Toll-like receptor (TLR)4 activation has been identified in several chronic pain conditio... more Altered Toll-like receptor (TLR)4 activation has been identified in several chronic pain conditions but has not been well studied in interstitial cystitis/bladder pain syndrome (IC/BPS). Our previously published human studies indicated that patients with IC/BPS present altered systemic TLR4-mediated inflammatory responses, which were significantly correlated with reported pain severity. In the present study, we sought to determine whether altered TLR4 activation plays a role in pelvic/bladder pain seen in patients with IC/BPS using our validated IC/BPS-like transgenic autoimmune cystitis model (URO-OVA). URO-OVA mice developed responses consistent with pelvic and bladder pain after cystitis induction, which was associated with increased splenocyte production of TLR4-mediated proinflammatory cytokines IL-1β, IL-6, and TNF-α. Increased spinal expression of mRNAs for proinflammatory cytokines IL-6 and TNF-α, glial activation markers CD11b and glial fibrillary acidic protein, and endoge...
The current literature on pelvic organ prolapse (POP) employs wildly varying definitions of surgi... more The current literature on pelvic organ prolapse (POP) employs wildly varying definitions of surgical success. Understanding which definitions of success have been used and how these may impact reported outcomes is critical. Therefore, we performed a systematic review to identify and summarize these definitions and how they have changed over time. A PubMed search was performed for studies reporting POP surgical outcomes (1996 and later). Inclusion criteria were: original research, English, adult women with POP, nonobliterative surgical treatment, comparison group, reported prolapse-specific outcomes, and clear definition of treatment success. This definition was categorized according to presence of anatomic, subjective, retreatment, or other components and whether these components were evaluated individually or in a composite definition (in which all components must be present for success). One-hundred forty articles were included. The number of included studies increased over time (...
Female pelvic medicine & reconstructive surgery, Jan 5, 2018
The 2016 American Urogynecologic Society Prolapse Consensus Conference brought together thought l... more The 2016 American Urogynecologic Society Prolapse Consensus Conference brought together thought leaders in the field of pelvic organ prolapse (POP). The goal was to identify critical areas of need for future research. This article summarizes the findings. Prior to the conference, 5 major focus areas were identified. Focus areas were explored over the 2-day conference. Clinicians, clinical and basic science researchers, and representatives from government agencies, industry, patient advocacy groups, and the public convened to identify the major gaps in knowledge in each of these focus areas. The 5 major topics were as follows: (1) mechanistic research on pelvic supportive structures and how these are altered with pregnancy, delivery, and aging; (2) novel prostheses or implants that address pathophysiology and provide mechanical support; (3) large-scale community-based research; (4) clinical trials to optimize outcomes after POP surgery; and (5) evidence-based quality measures for POP...
Although many factors have been proposed to trigger symptom exacerbations ("flares") in... more Although many factors have been proposed to trigger symptom exacerbations ("flares") in patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, few studies have investigated these factors empirically. Therefore, we embedded a case-crossover study in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain longitudinal study to evaluate a range of patient-reported triggers. Exposure to proposed triggers (diet, physical activities, sedentary behaviors, stress, sexual activities, infection-like symptoms, and allergies) was assessed by questionnaire a maximum of three times when participants reported flares and at three randomly-selected times. Participants' pre-flare to -non-flare exposures were compared by conditional logistic regression. In our full analytic sample (n=292 participants), only two factors, recent sexual activity (odds ratio (OR)=1.44, 95% confidence interval (CI): 1.06-1.96) and symptoms of...
Previous studies have shown that seeing or feeling a vaginal bulge is the most specific symptom f... more Previous studies have shown that seeing or feeling a vaginal bulge is the most specific symptom for identifying pelvic organ prolapse (POP). It has been suggested that the critical point at which bulge symptoms appear in most women is prolapse to or beyond the level of the hymen. After POP surgery, the absence of bulge symptoms has been associated with subjective improvement to a greater extent than anatomic results alone. Self-reported vaginal bulge symptoms together with anatomic findings may be useful for diagnosing POP and to assess response to treatment. It is unclear whether (or how) age or obesity and other patient characteristics impact the report of vaginal bulge symptoms. The aims of this retrospective, cross-sectional analysis were to identify patient characteristics associated with vaginal bulge symptoms and to determine whether those characteristics impact the association between these symptoms and anatomic
Bladder inflammation frequently causes cystitis pain and lower urinary tract dysfunction (LUTD) s... more Bladder inflammation frequently causes cystitis pain and lower urinary tract dysfunction (LUTD) such as urinary frequency and urgency. Although mast cells have been identified to play a critical role in bladder inflammation and pain, the role of mast cells in cystitis-associated LUTD has not been demonstrated. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating inflammatory condition of the urinary bladder characterized by the hallmark symptoms of pelvic pain and LUTD. In this study we investigated the role of mast cells in LUTD using a transgenic autoimmune cystitis model (URO-OVA) that reproduces many clinical correlates of IC/BPS. URO-OVA mice express the membrane form of the model antigen ovalbumin (OVA) as a self-antigen on the urothelium and develop bladder inflammation upon introduction of OVA-specific T cells. To investigate the role of mast cells, we crossed URO-OVA mice with mast cell-deficient KitW-sh mice to generate URO-OVA/KitW-sh mice th...
INTRODUCTION AND OBJECTIVES: The presentation of lower urinary tract symptoms (LUTS) is diverse i... more INTRODUCTION AND OBJECTIVES: The presentation of lower urinary tract symptoms (LUTS) is diverse in quality and variable in severity. We examined symptom changes longitudinally and e568
Female Pelvic Medicine & Reconstructive Surgery, 2020
§ on behalf of the American Urogynecologic Society (AUGS) Scientific Committee Objectives: There ... more § on behalf of the American Urogynecologic Society (AUGS) Scientific Committee Objectives: There are few quality measures that allow for optimization of care for pelvic organ prolapse (POP). In coordination with the American Urogynecologic Society (AUGS), a prior group agreed upon health care provider-reported data elements that are important for large-scale quality measurement. The primary objective was to review existing patientreported outcome (PRO) measurement tools for POP and consider where improvements are needed for inclusion in a quality measurement tool. A secondary objective was to discuss enhanced strategies to improve the quality of care for women with mesh complications. Methods: The AUGS Scientific Committee convened a 1-day meeting titled "Deciding our Future: Consensus Conference on Prolapse Outcomes and Best Practices for Mesh Complications." Speakers discussed the current state of POP outcome measurement and meaningful ways of measuring and improving quality. Furthermore, past and future work for standardization of care regarding mesh complications was discussed. Results: Conference participants included invited speakers, representatives from AUGS and partner societies, 5 patient representatives from the AUGS Patient Advisory Committee, and 38 registered participants from academic institutions, community practices, and industry. Participants developed a roadmap for incorporating PROs into a national POP quality improvement registry. Participants also discussed important gaps in our knowledge of treatment of mesh complications and previewed proposed terminology and treatment algorithms. Conclusions: Using appropriate methodology, existing PRO measurement tools can be collapsed into one concise tool for POP quality measurement. Over the next year, work will continue toward this goal. Proposed updates to mesh terminology and treatment algorithms will be published separately.
INTRODUCTION AND OBJECTIVES: Previous studies showed bladder afferent hyperexcitability in bladde... more INTRODUCTION AND OBJECTIVES: Previous studies showed bladder afferent hyperexcitability in bladder pain syndrome/ interstitial cystitis (IC/BPS). The aim of current study is to investigate the urothelial neurotrophin and their receptors expression of IC/BPS patients. METHODS: The patients with IC/BPS who were admitted for cystoscopic hydrodistention were recruited. The symptoms severity was investigated with Interstitial Cystitis Symptoms and Problem Index (ICSI and ICPI), O 0 Leary-Saint symptom score (OSS), Visual Analogue Scale for pain (VAS) and cystometric bladder capacity (CBC). Random cold-cup biopsies of the posterior bladder wall were obtained during the procedure. Western blotting with quantification was used to investigate the neurotrophin expression of growth associated protein 43 (GAP-43), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF). The urothelial tropomyosin receptor kinase A (TrkA, receptor of NGF) and Trk-B (receptor of BDNF) were also investigated. Bladder specimens from female patients with stress urinary incontinence were also obtained for western blotting and were considered as control subjects. RESULTS: Total 24 control subjects, 51 non-ulcer IC/BPS and 23 ulcer IC/BPS were enrolled. The patients with non-ulcer IC/BPS was significantly younger than ulcer IC/BPS and control subjects (p<0.001). The expression of urothelium NGF and Trk-A was significantly higher in ulcer IC/BPS than that in control and non-ulcer IC/BPS (Table 1). The urothelium BDNF expression in non-ulcer IC/BPS was significantly lower, and the Trk-B was also significantly lower in ulcer IC/BPS. Among the all IC/BPS patients, the urothelium GAP-43 expression was significantly correlated with ICSI (r¼-0.363, ¼0.007) and OSS (r¼-0.301, p¼0.027). The Trk-A was also correlated with ICSI (r¼0.372,p¼0.006), OSS (r¼0.316, p¼0.020), VAS (r¼0.331, p¼0.015) and CBC (r¼-0.315, p¼0.013). CONCLUSIONS: The urothelium NGF and Trk-A expression was elevated in the ulcer IC/BPS, while the urothelium Trk-B expression was decreased. The GAP-43 and Trk-A expression were correlated to clinical symptoms. The urothelium expression of neurotrophin and their receptors may involve the pathogenesis of IC/BPS.
shift artifacts in the measurements of bladder wall thickness (BWT), CNR and T1 from 20 pixels. R... more shift artifacts in the measurements of bladder wall thickness (BWT), CNR and T1 from 20 pixels. RESULTS: Subjects did not complain of any pain or discomfort from 50mL NCM instillation, beyond that caused by the catheterization process. Four-fold increase in bladder wall CNR (*p<0.02) and spatial resolution of 0.35mm with minimal influence of artifacts made it feasible to determine the significant bladder wall thinning of~0.46mm (*p<0.05) from 50mL NCM. Pre-contrast bladder wall T1 of 1544AE 34.2ms was shortened by Gadobutrol diffusion into the bladder wall to 860.09 AE13.95 ms in Hunner type IC (*p<0.0001, two way ANOVA) relative to only 1257.42AE 20.59 ms and 1258.16 AE 6.16ms in non-Hunner type IC and controls, respectively. Post-contrast pixel-wise T1 mapping differentiated the bladder wall into layers with greater Gadobutrol mediated T1 shortening in pixels representing the urothelium and lamina propria (blue and green) compared to the detrusor region (yellow in attached picture). CONCLUSIONS: Recapitulation of the published pre-clinical findings in the clinical setting demonstrates the safety and feasibility of NCM enhanced MRI to achieve artifact-free differential contrast and spatial resolution of human bladder wall, which is suitable for first pixelwise measurement of T1 in both pre-and post-contrast settings. Quantitative T1 measurement holds promise in the non-invasive characterization of diffuse pathophysiological changes in bladder wall of IC patients.
We examined how mental health measures, sleep and physical function are associated with the prese... more We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms. This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity. We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Cau...
11,000 women from 110 studies of transvaginal mesh repairs found then overall mesh erosion incide... more 11,000 women from 110 studies of transvaginal mesh repairs found then overall mesh erosion incidence was 10.3%, and more than half of cases required surgical intervention.
Female Pelvic Medicine & Reconstructive Surgery, 2021
Objective: Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry f... more Objective: Using the American Urogynecologic Society multicenter Pelvic Floor Disorder Registry for Research, we (1) compared generic quality of life (QOL) in women planning pelvic organ prolapse (POP) treatment (surgery vs pessary), (2) correlated generic and condition-specific QOL scores, and (3) identified associations between generic QOL and other factors. Methods: This cross-sectional analysis assessed generic physical and mental QOL using the Patient-Reported Outcomes Measurement Information System Global Health Scale at baseline. Global Physical and Mental T-scores center on a representative US population sample (mean [SD], 50 [10]; higher scores, better health). Condition-specific QOL was assessed with Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and POP/Urinary Incontinence Sexual Function Questionnaire. Linear regression models identified associations between clinical factors and Global Physical/Mental scores. Results: Five hundred sixty-eight women (419 surgery, 149 pessary) were included. Surgery patients were younger, heavier, and more often sexually active (all P's ≤ 0.01). Global Physical scores were lower in the surgery versus pessary group, but not likely clinically meaningful (mean [SD], 48.8 [8.1] vs 50.4 [8.5]; P = 0.035); Global Mental scores were similar (51.4 [8.4] vs 51.9 [9.
Women with overactive bladder (OAB) report psychological distress, anxiety and depression, but sh... more Women with overactive bladder (OAB) report psychological distress, anxiety and depression, but short-term associations between these symptoms are poorly studied. Our objectives were to study daily associations between OAB symptoms and psychological symptoms and test whether these associations were stable when reassessed after 3 months. We hypothesized that OAB symptoms are positively associated with anxiety and depression symptoms over a short-term (daily) basis. Female patients with OAB [bothersome urgency and/or urgency urinary incontinence (UUI)] assessed OAB and mood symptoms at baseline and 3 months using a 3-day bladder diary and visual analog scale (VAS) ratings (0–100 mm) for anxiety, depression and stress. Daily OAB and mood symptom associations were tested using Spearman correlations. Generalized estimating equation (GEE) models tested associations between daily urgency scores and each psychological rating adjusting for covariates, time and a time-symptom interaction term. Participants (n = 69) had mean (SD) age 63.3 (13.4) years. Baseline diary outcomes [median (IQR)/day] included day voids 8 (7–11), nocturia 0 (0–1), UUI episodes 1 (0–3) and urgency score 1.75 (1–2.25). Anxiety and depression diagnoses (dx) and treatment (tx) were common (anxiety dx 30.4%, tx 21.7%; depression dx 47.8%, tx 37.7%), but daily anxiety, depression and stress ratings were low [median (IQR) mm 10 (3–35), 5 (1–16), and 16 (4–39), respectively]. Daily urgency scores correlated with anxiety (r = 0.30–0.40, days 1–3, p ≤ 0.01 for all), depression (r = 0.24–0.35, p ≤ 0.05 all) and stress (r = 0.27–0.34, p ≤ 0.03 all). GEE models indicated no significant change in these associations between baseline and 3 months, and OAB treatment did not impact the associations. Urgency scores were positively associated with same-day ratings of anxiety, depression and stress in OAB patients.
To describe the association between childhood traumas (death of a family member, severe illness, ... more To describe the association between childhood traumas (death of a family member, severe illness, sexual trauma, parental separation) reported by women and men and lower urinary tract symptoms (LUTS).
American Journal of Physiology-Renal Physiology, 2019
Altered Toll-like receptor (TLR)4 activation has been identified in several chronic pain conditio... more Altered Toll-like receptor (TLR)4 activation has been identified in several chronic pain conditions but has not been well studied in interstitial cystitis/bladder pain syndrome (IC/BPS). Our previously published human studies indicated that patients with IC/BPS present altered systemic TLR4-mediated inflammatory responses, which were significantly correlated with reported pain severity. In the present study, we sought to determine whether altered TLR4 activation plays a role in pelvic/bladder pain seen in patients with IC/BPS using our validated IC/BPS-like transgenic autoimmune cystitis model (URO-OVA). URO-OVA mice developed responses consistent with pelvic and bladder pain after cystitis induction, which was associated with increased splenocyte production of TLR4-mediated proinflammatory cytokines IL-1β, IL-6, and TNF-α. Increased spinal expression of mRNAs for proinflammatory cytokines IL-6 and TNF-α, glial activation markers CD11b and glial fibrillary acidic protein, and endoge...
The current literature on pelvic organ prolapse (POP) employs wildly varying definitions of surgi... more The current literature on pelvic organ prolapse (POP) employs wildly varying definitions of surgical success. Understanding which definitions of success have been used and how these may impact reported outcomes is critical. Therefore, we performed a systematic review to identify and summarize these definitions and how they have changed over time. A PubMed search was performed for studies reporting POP surgical outcomes (1996 and later). Inclusion criteria were: original research, English, adult women with POP, nonobliterative surgical treatment, comparison group, reported prolapse-specific outcomes, and clear definition of treatment success. This definition was categorized according to presence of anatomic, subjective, retreatment, or other components and whether these components were evaluated individually or in a composite definition (in which all components must be present for success). One-hundred forty articles were included. The number of included studies increased over time (...
Female pelvic medicine & reconstructive surgery, Jan 5, 2018
The 2016 American Urogynecologic Society Prolapse Consensus Conference brought together thought l... more The 2016 American Urogynecologic Society Prolapse Consensus Conference brought together thought leaders in the field of pelvic organ prolapse (POP). The goal was to identify critical areas of need for future research. This article summarizes the findings. Prior to the conference, 5 major focus areas were identified. Focus areas were explored over the 2-day conference. Clinicians, clinical and basic science researchers, and representatives from government agencies, industry, patient advocacy groups, and the public convened to identify the major gaps in knowledge in each of these focus areas. The 5 major topics were as follows: (1) mechanistic research on pelvic supportive structures and how these are altered with pregnancy, delivery, and aging; (2) novel prostheses or implants that address pathophysiology and provide mechanical support; (3) large-scale community-based research; (4) clinical trials to optimize outcomes after POP surgery; and (5) evidence-based quality measures for POP...
Although many factors have been proposed to trigger symptom exacerbations ("flares") in... more Although many factors have been proposed to trigger symptom exacerbations ("flares") in patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, few studies have investigated these factors empirically. Therefore, we embedded a case-crossover study in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain longitudinal study to evaluate a range of patient-reported triggers. Exposure to proposed triggers (diet, physical activities, sedentary behaviors, stress, sexual activities, infection-like symptoms, and allergies) was assessed by questionnaire a maximum of three times when participants reported flares and at three randomly-selected times. Participants' pre-flare to -non-flare exposures were compared by conditional logistic regression. In our full analytic sample (n=292 participants), only two factors, recent sexual activity (odds ratio (OR)=1.44, 95% confidence interval (CI): 1.06-1.96) and symptoms of...
Previous studies have shown that seeing or feeling a vaginal bulge is the most specific symptom f... more Previous studies have shown that seeing or feeling a vaginal bulge is the most specific symptom for identifying pelvic organ prolapse (POP). It has been suggested that the critical point at which bulge symptoms appear in most women is prolapse to or beyond the level of the hymen. After POP surgery, the absence of bulge symptoms has been associated with subjective improvement to a greater extent than anatomic results alone. Self-reported vaginal bulge symptoms together with anatomic findings may be useful for diagnosing POP and to assess response to treatment. It is unclear whether (or how) age or obesity and other patient characteristics impact the report of vaginal bulge symptoms. The aims of this retrospective, cross-sectional analysis were to identify patient characteristics associated with vaginal bulge symptoms and to determine whether those characteristics impact the association between these symptoms and anatomic
Bladder inflammation frequently causes cystitis pain and lower urinary tract dysfunction (LUTD) s... more Bladder inflammation frequently causes cystitis pain and lower urinary tract dysfunction (LUTD) such as urinary frequency and urgency. Although mast cells have been identified to play a critical role in bladder inflammation and pain, the role of mast cells in cystitis-associated LUTD has not been demonstrated. Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating inflammatory condition of the urinary bladder characterized by the hallmark symptoms of pelvic pain and LUTD. In this study we investigated the role of mast cells in LUTD using a transgenic autoimmune cystitis model (URO-OVA) that reproduces many clinical correlates of IC/BPS. URO-OVA mice express the membrane form of the model antigen ovalbumin (OVA) as a self-antigen on the urothelium and develop bladder inflammation upon introduction of OVA-specific T cells. To investigate the role of mast cells, we crossed URO-OVA mice with mast cell-deficient KitW-sh mice to generate URO-OVA/KitW-sh mice th...
INTRODUCTION AND OBJECTIVES: The presentation of lower urinary tract symptoms (LUTS) is diverse i... more INTRODUCTION AND OBJECTIVES: The presentation of lower urinary tract symptoms (LUTS) is diverse in quality and variable in severity. We examined symptom changes longitudinally and e568
Female Pelvic Medicine & Reconstructive Surgery, 2020
§ on behalf of the American Urogynecologic Society (AUGS) Scientific Committee Objectives: There ... more § on behalf of the American Urogynecologic Society (AUGS) Scientific Committee Objectives: There are few quality measures that allow for optimization of care for pelvic organ prolapse (POP). In coordination with the American Urogynecologic Society (AUGS), a prior group agreed upon health care provider-reported data elements that are important for large-scale quality measurement. The primary objective was to review existing patientreported outcome (PRO) measurement tools for POP and consider where improvements are needed for inclusion in a quality measurement tool. A secondary objective was to discuss enhanced strategies to improve the quality of care for women with mesh complications. Methods: The AUGS Scientific Committee convened a 1-day meeting titled "Deciding our Future: Consensus Conference on Prolapse Outcomes and Best Practices for Mesh Complications." Speakers discussed the current state of POP outcome measurement and meaningful ways of measuring and improving quality. Furthermore, past and future work for standardization of care regarding mesh complications was discussed. Results: Conference participants included invited speakers, representatives from AUGS and partner societies, 5 patient representatives from the AUGS Patient Advisory Committee, and 38 registered participants from academic institutions, community practices, and industry. Participants developed a roadmap for incorporating PROs into a national POP quality improvement registry. Participants also discussed important gaps in our knowledge of treatment of mesh complications and previewed proposed terminology and treatment algorithms. Conclusions: Using appropriate methodology, existing PRO measurement tools can be collapsed into one concise tool for POP quality measurement. Over the next year, work will continue toward this goal. Proposed updates to mesh terminology and treatment algorithms will be published separately.
INTRODUCTION AND OBJECTIVES: Previous studies showed bladder afferent hyperexcitability in bladde... more INTRODUCTION AND OBJECTIVES: Previous studies showed bladder afferent hyperexcitability in bladder pain syndrome/ interstitial cystitis (IC/BPS). The aim of current study is to investigate the urothelial neurotrophin and their receptors expression of IC/BPS patients. METHODS: The patients with IC/BPS who were admitted for cystoscopic hydrodistention were recruited. The symptoms severity was investigated with Interstitial Cystitis Symptoms and Problem Index (ICSI and ICPI), O 0 Leary-Saint symptom score (OSS), Visual Analogue Scale for pain (VAS) and cystometric bladder capacity (CBC). Random cold-cup biopsies of the posterior bladder wall were obtained during the procedure. Western blotting with quantification was used to investigate the neurotrophin expression of growth associated protein 43 (GAP-43), nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF). The urothelial tropomyosin receptor kinase A (TrkA, receptor of NGF) and Trk-B (receptor of BDNF) were also investigated. Bladder specimens from female patients with stress urinary incontinence were also obtained for western blotting and were considered as control subjects. RESULTS: Total 24 control subjects, 51 non-ulcer IC/BPS and 23 ulcer IC/BPS were enrolled. The patients with non-ulcer IC/BPS was significantly younger than ulcer IC/BPS and control subjects (p<0.001). The expression of urothelium NGF and Trk-A was significantly higher in ulcer IC/BPS than that in control and non-ulcer IC/BPS (Table 1). The urothelium BDNF expression in non-ulcer IC/BPS was significantly lower, and the Trk-B was also significantly lower in ulcer IC/BPS. Among the all IC/BPS patients, the urothelium GAP-43 expression was significantly correlated with ICSI (r¼-0.363, ¼0.007) and OSS (r¼-0.301, p¼0.027). The Trk-A was also correlated with ICSI (r¼0.372,p¼0.006), OSS (r¼0.316, p¼0.020), VAS (r¼0.331, p¼0.015) and CBC (r¼-0.315, p¼0.013). CONCLUSIONS: The urothelium NGF and Trk-A expression was elevated in the ulcer IC/BPS, while the urothelium Trk-B expression was decreased. The GAP-43 and Trk-A expression were correlated to clinical symptoms. The urothelium expression of neurotrophin and their receptors may involve the pathogenesis of IC/BPS.
shift artifacts in the measurements of bladder wall thickness (BWT), CNR and T1 from 20 pixels. R... more shift artifacts in the measurements of bladder wall thickness (BWT), CNR and T1 from 20 pixels. RESULTS: Subjects did not complain of any pain or discomfort from 50mL NCM instillation, beyond that caused by the catheterization process. Four-fold increase in bladder wall CNR (*p<0.02) and spatial resolution of 0.35mm with minimal influence of artifacts made it feasible to determine the significant bladder wall thinning of~0.46mm (*p<0.05) from 50mL NCM. Pre-contrast bladder wall T1 of 1544AE 34.2ms was shortened by Gadobutrol diffusion into the bladder wall to 860.09 AE13.95 ms in Hunner type IC (*p<0.0001, two way ANOVA) relative to only 1257.42AE 20.59 ms and 1258.16 AE 6.16ms in non-Hunner type IC and controls, respectively. Post-contrast pixel-wise T1 mapping differentiated the bladder wall into layers with greater Gadobutrol mediated T1 shortening in pixels representing the urothelium and lamina propria (blue and green) compared to the detrusor region (yellow in attached picture). CONCLUSIONS: Recapitulation of the published pre-clinical findings in the clinical setting demonstrates the safety and feasibility of NCM enhanced MRI to achieve artifact-free differential contrast and spatial resolution of human bladder wall, which is suitable for first pixelwise measurement of T1 in both pre-and post-contrast settings. Quantitative T1 measurement holds promise in the non-invasive characterization of diffuse pathophysiological changes in bladder wall of IC patients.
We examined how mental health measures, sleep and physical function are associated with the prese... more We examined how mental health measures, sleep and physical function are associated with the presence and type of urinary incontinence and severity in women seeking treatment for lower urinary tract symptoms. This baseline cross-sectional analysis was performed in treatment seeking women with lower urinary tract symptoms. All participants completed the LUTS (Lower Urinary Tract Symptoms) Tool (Pfizer, New York, New York), which was used to classify women based on urinary incontinence symptoms and measure severity. The PROMIS (Patient-Reported Outcomes Measurement Information System) questionnaire for depression, anxiety, sleep disturbance and physical function, the PSS (Perceived Stress Scale) and the IPAQ-SF (International Physical Activity Questionnaire Short Form) were administered. Multivariable regression modeling was done to assess associations with urinary symptom presence, type and severity. We studied 510 women with a mean ± SD age of 56 ± 14 years. Of the women 82% were Cau...
11,000 women from 110 studies of transvaginal mesh repairs found then overall mesh erosion incide... more 11,000 women from 110 studies of transvaginal mesh repairs found then overall mesh erosion incidence was 10.3%, and more than half of cases required surgical intervention.
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Papers by Catherine S Bradley