Diana Atashroo

All Publications

• Differences in Menstrual Cytokine Profiles of Women with and without Symptomatic Uterine Fibroids. F&S science Dhanani, Z., Ramirez, N. J., Nguyen, J., Rosenberg-Hasson, Y., Naseri, S., Lum, D., Atashroo, D., Chen, B. 2023

  View details for DOI 10.1016/j.xfss.2023.09.006

  View details for PubMedID 37797816

• DIFFERENCES IN MENSTRUAL CYTOKINE PROFILES OF WOMEN WITH AND WITHOUT UTERINE FIBROIDS Dhanani, Z., Ramirez, N., Nguyen, J., Hasson, Y., Naseri, S., Atashroo, D., Lum, D. A., Chen, B. ELSEVIER SCIENCE INC. 2022: E104-E105

  View details for Web of Science ID 000891804600257

• Clinical Investigation of Fertility After Uterine Artery Embolization OBSTETRICAL & GYNECOLOGICAL SURVEY Serres-Cousine, O., Kuijper, F., Curis, E., Atashroo, D. 2022; 77 (2): 92-93

  View details for DOI 10.1097/01.ogx.0000816496.50775.90

  View details for Web of Science ID 000754035100013

• Chronic pelvic pain educational experience among Minimally Invasive Gynecologic Surgery fellows and recent graduates: a needs assessment. Journal of minimally invasive gynecology Orlando, M. S., Moulder, J. K., Carrillo, J. F., Carey, E. T., Findley, A. D., Atashroo, D., Dassel, M. 2021

  Abstract

  STUDY OBJECTIVE: Learning to evaluate and treat chronic pelvic pain (CPP) is an established curriculum objective within the Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS). Our aim was to investigate current educational experiences related to the evaluation and management of CPP and the impacts of those experiences on FMIGS fellows and recent fellowship graduates, including satisfaction, confidence in management, and clinical interest in CPP.DESIGN: The AAGL-Elevating Gynecologic Surgery Special Interest Group for pelvic pain developed a 33-item survey tool to investigate the following topics: 1) current educational experiences with the assessment and management of patients with CPP, 2) satisfaction with fellowship training in CPP, 3) perceived preparedness to treat patients with CPP, 4) plans to incorporate management of CPP into clinical practice, and 5) perceived desires to expand CPP exposure. Composite scores were created to examine experiences related to diseases associated with CPP and pharmaceutical and procedural treatment options.SETTING: Electronic survey.PATIENTS: Not applicable.INTERVENTIONS: The survey was distributed via AAGL email lists and offered on FMIGS social media sites August 2017 to November 2017 to all active FMIGS fellows and individuals who graduated the fellowship during the preceding five years.MEASUREMENTS AND MAIN RESULTS: Fifty-three of 82 (65%) current FMIGS fellows and 104 of 169 (62%) recent fellowship graduates completed the survey. Only, 66% of current fellows endorsed working with a fellowship faculty member whose clinical work focused on CPP. Most current fellows reported having a "good amount" or "extensive" experience with superficial endometriosis (39/53, 74%) and deeply infiltrative endometriosis (34/53, 64%), while the majority reported having "no" or "little" experience with frequently comorbid conditions like irritable bowel syndrome (68%), pelvic floor tension myalgia (55%), and interstitial cystitis/painful bladder syndrome (51%). For both current fellows and recent graduates, increased CPP Disease Experience composite scores were associated with satisfaction with CPP training (current fellows OR 1.9, p=0.0016; recent graduates OR 1.5, p=0.0006), perceived preparedness to treat patients with CPP (current fellows OR 2.0, p=0.0021; recent graduates OR 1.5, p=0.0006), and the desire to incorporate the treatment of CPP into future clinical practice (current fellows OR 1.8, p=0.0099; recent graduates OR 1.3, p=0.0178). Over 80% (43/53) of current fellows indicated that they believed an expanded pelvic pain curriculum should be part of the FMIGS fellowship.CONCLUSION: This needs assessment of FMIGS fellows and recent graduates suggests that there are gaps between FMIGS curriculum objectives and current educational experiences, and that fellows desire increased CPP exposure. Expansion and standardization of the CPP educational experience is needed and could lead to increased focus on this disease process among subspecialty benign gynecologic surgeons.

  View details for DOI 10.1016/j.jmig.2021.04.021

  View details for PubMedID 33962024

• The Symptoms-Varices-Pathophysiology classification of pelvic venous disorders: A report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Phlebology Meissner, M. H., Khilnani, N. M., Labropoulos, N., Gasparis, A. P., Gibson, K., Greiner, M., Learman, L. A., Atashroo, D., Lurie, F., Passman, M. A., Basile, A., Lazarshvilli, Z., Lohr, J., Kim, M., Nicolini, P. H., Pabon-Ramos, W. M., Rosenblatt, M. 2021: 268355521999559

  Abstract

  [Box: see text]With the support of the American College of Obstetricians and Gynecologists, the American Vein & Lymphatic Society, the American Venous Forum, the Canadian Society of Phlebology, the Cardiovascular and Interventional Radiology Society of Europe, the European Venous Forum, the International Pelvic Pain Society, the International Union of Phlebology, the Korean Society of Interventional Radiology, the Society of Interventional Radiology, and the Society for Vascular Surgery.

  View details for DOI 10.1177/0268355521999559

  View details for PubMedID 33849310

• The Symptoms-Varices-Pathophysiology (SVP) Classification of Pelvic Venous Disorders A Report of the American Vein & Lymphatic Society International Working Group on Pelvic Venous Disorders. Journal of vascular surgery. Venous and lymphatic disorders Meissner, M. H., Khilnani, N. M., Labropoulos, N., Gasparis, A. P., Gibson, K., Greiner, M., Learman, L. A., Atashroo, D., Lurie, F., Passman, M. A., Basile, A., Lazarshvilli, Z., Lohr, J., Kim, M., Nicolini, P. H., Pabon-Ramos, W. M., Rosenblatt, M. 2021

  Abstract

  As the importance of pelvic venous disorders (PeVD) has been increasingly recognized, progress in the field has been limited by the lack of a valid and reliable classification instrument. Misleading historical nomenclature, such as the "May-Thurner," "pelvic congestion," and "nutcracker" syndromes, often fails to recognize the interrelationship of many pelvic symptoms and their underlying pathophysiology. Based upon a perceived need, the American Vein and Lymphatic Society (AVLS) convened an international, multidisciplinary panel charged with the development of a discriminative classification instrument for PeVD. This instrument, the "SVP" classification for PeVD, includes three domains - Symptoms (S), Varices (V), and Pathophysiology (P), with the pathophysiology domain encompassing the Anatomic (A), Hemodynamic (H), and Etiologic (E) features of the patient's disease. An individual patient's classification is designated as SVPA, H, E. For patients with pelvic origin lower extremity signs or symptoms, the SVP instrument is complementary to and should be used in conjunction with CEAP. The SVP instrument accurately defines the diverse patient populations with PeVD, an important step in improving clinical decision making, developing disease-specific outcome measures and identifying homogenous patient populations for clinical trials.

  View details for DOI 10.1016/j.jvsv.2020.12.084

  View details for PubMedID 33529720

• CLINICAL INVESTIGATION OF FERTILITY AFTER UTERINE ARTERY EMBOLIZATION. American journal of obstetrics and gynecology Serres-Cousine, O., Kuijper, F. M., Curis, E., Atashroo, D. 2021

  Abstract

  Uterine artery embolization is an effective and safe technique for the treatment of uterine fibroids, but its use remains controversial for women who wish to procreate.To study the clinical, anatomical and obstetrical results of uterine artery embolization in patients of childbearing age not eligible for myomectomy.This was a retrospective cohort study of 398 female patients under the age of 43 years who were treated by uterine artery embolization between 2003 and 2017 for symptomatic fibroids and/or adenomyosis. Uterine artery embolization was performed according to a standardized procedure (fertility-sparing uterine artery embolization technique), with ovarian protection in the event of dangerous utero-ovarian anastomosis. Magnetic Resonance Imaging and pelvic ultrasounds were performed before and after uterine artery embolization.The overall clinical success rate (i.e. resolution of pre-embolization symptoms such as heavy menstrual bleeding, iron-deficiency anemia, pelvic pressure) was 91.2% and there were no major complications. One year after uterine artery embolization, we observed a mean 73% reduction in myoma volume. One hundred eight patients (49.3%) presented with dangerous utero-ovarian anastomosis and 33 (14.5%) benefited from ovarian protection. In our group, there were 148 pregnancies and 109 live births. Seventy-four children were born at term; 23 were born preterm, on average at 35.12 ± 2.78 weeks. Including preterm births, the mean birth weight and birth length of the children were within normal limits. Restoration of uterine anatomy and ovarian protection were identified as the main predictive factors for obstetrical success. Restoration was also a major predictive factor for clinical success and was associated with a lower rate of miscarriage.This study provides detailed clinical and obstetrical outcomes for 398 female patients who underwent uterine artery embolization for fibroid treatment; it contributes to the identification of anatomical and technical factors that could have an impact on fertility after uterine artery embolization. Further controlled clinical trials are needed to confirm our findings and re-evaluate this procedure's indications and limitations for women with a desire to procreate.

  View details for DOI 10.1016/j.ajog.2021.05.033

  View details for PubMedID 34058169

• Clinical Profile of Comorbid Dysmenorrhea and Bladder Sensitivity: A Cross-Sectional Analysis. American journal of obstetrics and gynecology Tu, F. F., Datta, A. n., Atashroo, D. n., Senapati, S. n., Roth, G. n., Clauw, D. n., Hellman, K. M. 2019

  Abstract

  Antecedents of chronic pelvic pain are not well characterized, but pelvic organ visceral sensitivity is a hallmark of these disorders. Recent studies have identified that some dysmenorrhea sufferers are much more likely to exhibit comorbid bladder hypersensitivity. Presumably, these otherwise healthy women may be at higher risk of developing full-blown chronic bladder pain later in life. To encourage early identification of patients harboring potential future risk of chronic pain, we describe the clinical profile of women matching this putative pain-risk phenotype.Characterize demographic, menstrual, pelvic exam, and psychosocial profiles of young women with comorbid dysmenorrhea and bladder hypersensitivity, defined using a standardized experimental visceral provocation test, contrasted with healthy controls, pure dysmenorrhea sufferers, and women with existing bladder pain syndrome.This prospective cohort study acquired data on participants with moderate-to-severe dysmenorrhea (n=212), healthy controls (n=44), and bladder pain syndrome (n=27). A subgroup of dysmenorrhea patients was found on screening with noninvasive oral water challenge to report significantly higher bladder pain during experimentally monitored spontaneous bladder filling (>15/100 on visual analogue scale, based on prior validation studies) and separately defined as a group with dysmenorrhea+bladder pain. Medical/menstrual history and pain history were evaluated with questionnaires. Psychosocial profile and impact were measured with validated self-reported health status PROMIS short forms and a Brief Symptom Inventory for somatic sensitivity. Pelvic anatomy and sensory sensitivity were examined via a standardized physical examination and a tampon provocation test.In our largely young, single, nulliparous cohort (24 ± 1 yo), roughly a quarter (46/212) of dysmenorrhea sufferers tested positive for the dysmenorrhea+bladder pain phenotype. Dysmenorrhea only sufferers were more likely to be African-American (24%) than healthy controls (5%, post-hoc X2, p=0.007). Pelvic exam findings did not differ in the non-chronic pain groups, except for tampon test sensitivity, which was worse in dysmenorrhea+bladder pain and dysmenorrhea sufferers vs. healthy controls (2.6 ± 0.3 and 1.7 ± 0.2, vs. 0.7 ± 0.2, p <0.05). Consistent with heightened pelvic sensitivity, participants with dysmenorrhea+bladder pain also had more nonmenstrual pain, dysuria, dyschezia and dyspareunia (p's <0.05). Participants with dysmenorrhea+bladder pain had PROMIS Global Physical T-scores of 47.7±0.9, lower than in women with dysmenorrhea only (52.3±0.5), and healthy controls 56.1±0.7 (p< 0.001). Similarly they had lower PROMIS Global Mental T-score than healthy controls (47.8±1.1 vs. 52.8±1.2, p = 0.017). Similar specific impairments were observed on PROMIS scales for anxiety, depression, and sleep in participants with dysmenorrhea+bladder pain vs. healthy controls.Women with dysmenorrhea who are unaware they also have bladder sensitivity, exhibit broad somatic sensitivity and elevated psychological distress, suggesting combined preclinical visceral sensitivity may be a precursor to chronic pelvic pain. Defining such precursor states is essential to conceptualize and test preventative interventions for chronic pelvic pain emergence. Dysmenorrhea+bladder pain is also associated with higher self-reported pelvic pain unrelated to menses, suggesting central nervous system changes are present in this potential precursor state.

  View details for DOI 10.1016/j.ajog.2019.12.010

  View details for PubMedID 31870730

• Surgical interventions for chronic pelvic pain. Current opinion in obstetrics & gynecology Senapati, S., Atashroo, D., Carey, E., Dassel, M., Tu, M. F. 2016; 28 (4): 290-6

  Abstract

  The objective of this study is to review an evidence-based approach to surgical treatment of key chronic pelvic pain (CPP) contributors emphasizing the importance of preoperative evaluation and counseling.CPP is a poorly understood but highly prevalent condition and there are limited, well constructed studies to guide effective, durable treatment. CPP arises from factors originating in multiple organ systems, including reproductive, urologic, gastrointestinal, and myofascial, all informing the central nervous system. For those with severe disabling conditions, who have a suboptimal response to medical management, surgical interventions can be offered for diagnostic evaluation and/or treatment. Leiomyoma, adenomyosis, adnexal disorder, pelvic adhesions, and pelvic varicosities are common considerations in the differential diagnosis of CPP amenable to surgical approach.Surgical treatments of CPP range from conservative/fertility-sparing approaches to extirpative therapy. Consistently, successful outcomes often are predicated on correctly identifying the abnormal peripheral pain process (which often is only part of the complete picture for these patients). Further research is needed to better guide clinicians as to when to choose surgical therapy vs. targeting secondary contributors to pelvic pain.

  View details for DOI 10.1097/GCO.0000000000000281

  View details for PubMedID 27285959

• Trainee Perception of Uterine Morcellation: The University of Chicago Resident Experience. Journal of minimally invasive gynecology Senapati, S., Atashroo, D., Tu, F. 2015; 22 (6S): S33-S34

  View details for DOI 10.1016/j.jmig.2015.08.092

  View details for PubMedID 27679210

• A Model for Resection of Endometriosis: A Feasibility Study. Journal of minimally invasive gynecology Atashroo, D. T., Senapati, S., Tu, F. 2015; 22 (6S): S119

  View details for DOI 10.1016/j.jmig.2015.08.336

  View details for PubMedID 27678626