Dr. Enemchukwu received her undergraduate degree from Duke University. She subsequently earned her combined degree in Medicine (MD) and Public Health (MPH) at the University of North Carolina School of Medicine and Gillings School of Global Public Health. She completed her General Surgery and Urology training at Vanderbilt University Medical Center. She then went on to complete a prestigious fellowship in Female Pelvic Medicine & Reconstructive Surgery with concurrent training in Male Voiding Dysfunction and Neurourology at NYU Langone Medical Center in New York City.

She specializes in medical and minimally invasive surgical management of pelvic floor disorders, including pelvic organ prolapse (cystocele, rectocele, vaginal vault prolapse, and uterine prolapse repairs), female genitourinary fistula, overactive bladder, urinary incontinence, mesh complications, refractory fecal incontinence, and urethral stricture disease (including graft reconstruction). She performs open, robotic, endoscopic, and laser surgery.

She is a health services researcher with interests in the areas of urinary incontinence and refractory overactive bladder syndrome- specifically in the areas of improving health equity through access to care, reducing barriers to treatment adherence, and shared decision making in vulnerable populations (underserved, low income, frail/elderly, neurogenic lower urinary tract dysfunction). Additionally, she is an expert in OAB related-quality of life, patient outcomes, and patient satisfaction. She has authored numerous manuscripts and conducted invited lectures as well as television and radio interviews on the topic of overactive bladder.

COVID-19 has presented unparalleled challenges for our most vulnerable patient populations at Stanford Medicine. As the medical director of the Stanford Multidisciplinary Pelvic Health Center, she has the unique opportunity to advance Stanford Medicine’s mission of improving health equity not in the area of pelvic floor disorders but also by training the next generation of doctors at Stanford School of Medicine.

Clinical Focus

  • Urogynecology
  • Pelvic Organ Prolapse
  • Neurogenic Bladder
  • Urinary Incontinence
  • Female Pelvic Medicine and Reconstructive Surgery

Academic Appointments

Administrative Appointments

  • Medical Director, Stanford Pelvic Health Center, Stanford Medicine (2021 - Present)
  • Director, Urology at Pelvic Health Center, Stanford HealthCare (2018 - Present)
  • Director, Diversity and Inclusion, Stanford University School of Medicine, Department of Urology (2019 - 2022)

Honors & Awards

  • International Continence Society (ICS) Best of Urogynecology and Urology Podium Presentation, ICS (9/2023)
  • Best Poster, American Urological Association (5/2023)
  • NIH K23 Career Development Award, NIDDK (2022-present)
  • Neurourology and Urodynamics (Wiley Periodicals, Inc.) Top Reviewer, NAU (2022-2023)
  • Stanford School of Medicine Excellence in Patient Care Award Nominee, Stanford School of Medicine (2022)
  • Stanford Medicine Diversity, Equity and Inclusion Leadership Award (Inaugural awardee), Stanford University School of Medicine (2021)
  • NIH/NICHD R25 Research Scholar (UrogynCREST), NICHD (2020-2022)
  • NIH Loan Repayment Award (Selected), NIDDK (2019)
  • Stanford School of Medicine Teaching Award Nominee, Stanford School of Medicine (2017)
  • HCOE Faculty Development Research Award, Stanford University School of Medicine (2015)
  • Stanford Biodesign Mentorship award, Stanford University (2015)
  • Careers in Academic Medicine Workshop Travel Award, NIH/NIDDK/NMA (2013)
  • Resident Mentorship Conference Travel Award, Society of Women in Urology (SWIU) (2012)
  • American Urological Association Traveling Fellowship Award, Society for the Study of Male Reproduction (SSMR)/Sexual Medicine Society (SMS) (2011)
  • Mayer Community Service Honor Society Inductee, UNC School of Medicine (2005)
  • Loyalty Fund Full Tuition Scholarship, UNC School of Medicine (2004-2008)
  • Aimee Gibson Memorial Scholarship, UNC School of Medicine (2003-2008)

Boards, Advisory Committees, Professional Organizations

  • Board of Directors, Western Section of the American Board of Urology (2023 - Present)
  • Board of Director, Society of Women in Urology (2023 - Present)
  • Bladder Health Committee Member, Urology Care Foundation (2021 - Present)
  • Member, Fellow of the American College of Surgeons (FACS) (2021 - Present)
  • Member, American Urogynecologic Association (AUGS) (2013 - Present)
  • Member, Vanderbilt Urology Society (VUS) (2013 - Present)
  • Member, Society of Urodynamics and Female Pelvic Medicine and Urogenital reconstruction (SUFU) (2009 - Present)
  • Member, American Urological Association (AUA) (2009 - Present)

Professional Education

  • Board Certification: American Board of Urology, Female Pelvic Medicine and Reconstructive Surgery (2019)
  • Board Certification, American Board of Urology, Urology (2017)
  • Fellowship, NYU Langone Medical Center, Departments of Urologic Surgery and Obstetrics & Gynecology, NY, Female Pelvic Medicine and Reconstructive Surgery (2015)
  • Residency, Vanderbilt University Medical Center, Department of Urologic Surgery, Urology (2013)
  • Internship, Vanderbilt University Medical Center, Department of General Surgery, General Surgery (2009)
  • MD, University of North Carolina School of Medicine (2008)
  • MPH, University of North Carolina Gillings School of Global Public Health (2008)
  • BS, Duke University (2002)

Current Research and Scholarly Interests

Refractory overactive bladder in elderly and frail patient populations, detrusor underactivity, quality of life, patient outcomes, quality improvement, patient satisfaction, and shared decision making

Clinical Trials

  • Improving Overactive Bladder Treatment Access and Adherence Not Recruiting

    Overactive bladder (OAB) and urinary incontinence (UI) are chronic debilitating and embarrassing conditions that affect 33 million Americans. Yet, both are underdiagnosed and undertreated with significant financial and health-related consequences. OAB syndrome is characterized by urinary urgency, with and without urinary incontinence, urinary frequency, and nocturia. Evidence-based treatments are available, including behavioral therapy, pharmacotherapy, and minimally invasive procedures. Diagnosis and treatment are also associated with improvement in urinary symptoms and overall quality of life (QOL).3 However, 70-80% of treated patients will discontinue use of therapy in the first year due to one of several factors (e.g., cost, tolerability, inadequate effect). In addition, only 4.7% progress to advanced therapies suggesting undertreatment for those that need it most. Vulnerable populations are especially at risk, as therapy utilization are lowest among older, lower income, and/or minority groups. Poor access, insufficient patient education regarding disease chronicity, expected outcomes, costs, and potential side effects lead to unrealistic patient perceptions about therapy. This leads to suboptimal therapy duration, poor treatment efficacy, adherence, and undertreatment. The study aims to evaluate a tailored patient-centered tool to begin the treatment process.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ekene Enemchukwu, MD, MPH, 650-723-1867.

    View full details

2023-24 Courses

Stanford Advisees

Graduate and Fellowship Programs

  • Adult Reconstruction (Fellowship Program)

All Publications

  • Pelvic Floor Disorders among Minority Women: Differences in Prevalence, Severity and Health-Related Social Needs. Urology Gurayah, A. A., Satish, S., Yarborough, C. C., Perez, N., Amin, K., Enemchukwu, E. A., Syan, R. 2024


    To characterize prevalence and severity of pelvic floor disorders (PFDs) in various healthcare settings and to examine unmet Health-related Social Needs (HRSN) among minority women.Minority women with PFDs were recruited from our academic urogynecology clinic (UG), a general urology clinic at our institution's safety net hospital (SNH), and a community outreach mobile clinic (MC). Questions from the Urinary Distress Index-6 (UDI), Pelvic Organ Prolapse Distress Inventory-6 (POPDI), and Female Genitourinary Pain Index (GUPI) were used to identify patients with stress urinary incontinence (SUI), overactive bladder (OAB) and chronic pelvic pain syndrome (CPPS).61 (46.6%) women identified as Hispanic, 53 (40.4%) as Black, and 17 (12.9%) as Other. Overall, self-reported PFDs included SUI in 45%, OAB in 74.8%, and CPPS in 24.4% of women. Hispanic women were more likely to report OAB symptoms, compared to Black women (OR 3.4 [1.2-10.2], p = 0.03) or Other women (OR = 5.1 [1.3-20.4], p = 0.02). Participants held a median of five unmet HRSN. Minority women facing issues with family and community support, transportation, and utilities were more likely to report CPPS symptoms, compared to those without psychosocial issues (Support OR: 4.8 [1.7-13.7], p = 0.002; Transportation OR: 2.0 [1.0-8.2], p = 0.05; Utility OR: 7.0 [1.9-28.1], p = 0.005).Minority women with PFDs may have several unmet HRSNs which impact their ability to receive appropriate medical care. Our findings may assist in the development of effective strategies to improve healthcare outcomes for women dealing with PFDs.

    View details for DOI 10.1016/j.urology.2024.02.023

    View details for PubMedID 38395073

  • Editorial Comment to "The Future State of Race/Ethnicity in Urology: Urology Workforce". Urology Enemchukwu, E. A. 2024

    View details for DOI 10.1016/j.urology.2024.01.008

    View details for PubMedID 38369195

  • A Multicenter Study Evaluating the FREquency of Use and Efficacy of a Novel Closed-Loop Wearable Tibial Neuromodulation System for Overactive Bladder and Urgency Urinary Incontinence (FreeOAB). Urology Goudelocke, C., Sobol, J., Poulos, D., Enemchukwu, E., Zaslau, S., Dhir, R. 2023


    OBJECTIVE: To evaluate the effectiveness and safety of a novel wearable neuromodulation system incorporating embedded electromyographic (EMG) evaluation, representing the first closed-loop wearable therapy for bladder control.METHODS: This 12-week, multicenter, open-label, single-arm study of subjects with Overactive Bladder assessed response of bladder diary parameters and Quality of Life (QOL) metrics. Subjects used the transcutaneous tibial neuromodulation system, either once or three times weekly, with evaluations at weeks 1, 4, 8, and 12. Enrolled subjects (N=96) were assessed for changes in urinary frequency, urgency, and urgency urinary incontinence episodes, and QOL changes using various questionnaires.RESULTS: In the intent-to-treat population (N=96, mean age 60.8 ± 13.0 years, 88.5% female), significant reductions in 3-day diary parameters were observed for daily voids, incontinence and urgency episodes at 12 weeks. Quality of life improvements exceeded the minimal clinically important difference for all QOL questionnaires. Long-term results remained robust at 12 months. Device-related adverse events were mild and there were no device-related serious adverse events. Mean therapy compliance at 12 weeks was 88.5%. High satisfaction rates were reported for the device overall.CONCLUSION: The Avation device demonstrates promising efficacy in treating adults with OAB and UUI. At 12 weeks, both diary parameters and QOL indicators showed significant improvement and remained robust at 12 months. The device had a favorable safety profile with high compliance and patient satisfaction. This novel, closed-loop wearable tibial neuromodulation system represents a significant advancement in bladder control therapy, offering a non-invasive, patient-centered alternative with improved accessibility and ease of use.

    View details for DOI 10.1016/j.urology.2023.10.007

    View details for PubMedID 37944596

  • Reflections on Diversity, Equity, and Inclusion in Medical Publishing: The Journal of Urology HEAD Table. The Journal of urology Avulova, S., Enemchukwu, E., Kaufman, M., Khavari, R., Mir, C., Moses, K., Pierorazio, P., Samplaski, M., Seideman, C., Siemens, D. R., Suskind, A. 2023; 209 (5): 830-832

    View details for DOI 10.1097/JU.0000000000003376

    View details for PubMedID 37026640

  • DISPARITIES IN AWARENESS AND TREATMENT- SEEKING BEHAVIOR FOR PELVIC FLOOR DISORDERS AMONG MINORITY WOMEN Gurayah, A., Yarborough, C., Gurayah, A., Kannikal, J., Amin, K., Enemchukwu, E., Syan, R., Shermoen, C. WILEY. 2023: S57-S58
  • Science and Politics. The Journal of urology Avulova, S., Enemchukwu, E., Kaufman, M., Khavari, R., Moses, K., Pierorazio, P., Samplaski, M., Siemens, D. R. 2022; 208 (4): 771-772

    View details for DOI 10.1097/JU.0000000000002895

    View details for PubMedID 36082544

  • A Personalized, Surgery-free Wearable Bladder Modulation and Digital Therapy System to Treat OAB Shows Comparable Results to More Invasive Treatments Goudelocke, C., Togami, J., Galwankar, N., Dhir, R., Amber, R., Elser-Poulus, D., Rajendran, K., Sobol, J., Smith, K., Enemchukwu, E., Comiter, C., Talavara, K., Zaslau, S., Jackson, B., Lukban, J., Suh, R., Williamson, M., Rovner, E., Jenkins, J. SPRINGER LONDON LTD. 2022: S479-S480
  • Identifying Real-World Practice Patterns in Second-Line Treatments for Patients With Overactive Bladder Receiving Navigated or Routine Care From a US National Retrospective Database Study Syan, R., Miles-Thomas, J., Abraham, N., Luo, L., Newman, D., Nelson, M., Enemchukwu, E. SPRINGER LONDON LTD. 2022: S337
  • Baseline Characteristics of Patients With Overactive Bladder Receiving Navigated or Routine Care Identified From a US National Retrospective Database Study Enemchukwu, E., Miles-Thomas, J., Abraham, N., Luo, L., Newman, D., Nelson, M., Syan, R. SPRINGER LONDON LTD. 2022: S434-S435
  • Management of complex OAB patients: A call to action. Neurourology and urodynamics Enemchukwu, E., Cameron, A. 2022

    View details for DOI 10.1002/nau.25048

    View details for PubMedID 36116063

  • Current State of Non-surgical Devices for Female Stress Urinary Incontinence. Current urology reports Burton, C. S., Korsandi, S., Enemchukwu, E. 2022


    PURPOSE OF REVIEW: The purpose of this review is to summarize and assess the current non-surgical devices for the treatment of stress urinary incontinence (SUI).RECENT FINDINGS: Devices for SUI can generally be divided into two categories. One category is the augmentation of pelvic floor muscle training (PFMT), wherein devices such as vaginal cones, intravaginal biofeedback, and electrical or magnetic stimulation are used to strength the pelvic floor musculature, though none are more effective than traditional PFMT. The second category of devices mechanically occludes the outlet and includes incontinence pessaries, intravaginal occlusion devices, and urethral plugs and patches. While these are palliative rather than curative, they share similar rates of improvement in leakage. A number of novel devices exist for the treatment and management of SUI. Though no single device has been shown to be more effective than PFMT alone, they may be beneficial for women who have difficulty isolating their pelvic floor muscles, desire accountability, or prefer technology-based engagement. Outlet occlusion devices are less comfortable for the patient, but remain an option for women who do not desire surgery.

    View details for DOI 10.1007/s11934-022-01104-x

    View details for PubMedID 35997889

  • Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States. Prostate cancer and prostatic diseases Del Giudice, F., Huang, J., Li, S., Sorensen, S., Enemchukwu, E., Maggi, M., Salciccia, S., Ferro, M., Crocetto, F., Pandolfo, S. D., Autorino, R., Krajewski, W., Crivellaro, S., Cacciamani, G. E., Bologna, E., Asero, V., Scornajenghi, C., Moschini, M., D'Andrea, D., Brown, D. R., Chung, B. I. 2022


    PURPOSE: To identify trends, costs, and predictors in the use of different surgical procedures for post-radical prostatectomy incontinence (PPI).MATERIALS AND METHODS: We identified 21,589 men who were diagnosed with localized prostate cancer (PCa) and treated with radical prostatectomy (RP) from 2003 to 2017. The primary outcome was the incontinence procedure performances. Optum's de-identified Clinformatics Data Mart Database was queried to define the cohort of interest. The average costs of the different incontinence procedures were obtained and compared. Also, demographic, and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis.RESULTS: Of the 21,589 men with localized PCa treated with RP, 740 (3.43%) underwent at least one incontinence procedure during a median of 5 years of follow-up. In total, there were 844 unique incontinence procedures. Male slings were the most common procedure (47.5%), had an intermediate cost compared to the other treatment options, and was the first-choice treatment for the majority of patients (50%). The use of an artificial urinary sphincter (AUS) was the second most common (35.3%), but also was the most expensive treatment and was first-choice-treatment for 32.3% of patients. On multivariable analysis, metabolic syndrome related disorders, adjuvant/salvage radiation therapy as well as a history of neurological comorbidities were independently associated with an increased likelihood of incontinence surgery.CONCLUSIONS: The receipt of male slings increased and then subsequently decreased, while AUS utilization was stable, and the use of urethral bulking agents was uncommon. From a cost standpoint, AUS was the most expensive option. Finally, patient's comorbidity history and RP related factors were found to influence the choice for primary or subsequent PPI interventions.

    View details for DOI 10.1038/s41391-022-00558-x

    View details for PubMedID 35729329

  • Barriers and facilitators to overactive bladder therapy adherence. Neurourology and urodynamics Enemchukwu, E. A., Subak, L. L., Markland, A. 2022


    To provide an overview of the barriers and facilitators to overactive bladder (OAB) therapy initiation and adherence.A PubMed and Embase literature search was conducted to identify barriers to OAB therapy adherence.OAB therapy adherence is associated with improvements in urinary symptoms, and quality of life with reductions in annual costs for OAB-related expenditures. However, adherence rates to behavioral therapies are as low as 32% at 1 year, only 15%-40% of treated patients remain on oral medications at 1 year due to several factors (e.g., inadequate efficacy, tolerability, and cost), and 5%-10% of OAB patients progress to advanced therapies. While some common barriers to therapy adherence are often fixed (e.g., costs, lack of efficacy, time, side effects, treatment fatigue), many are modifiable (e.g., lack of knowledge, poor relationships, negative experiences, poor communication with providers). Patient-centered care may help address some modifiable barriers. Emerging data demonstrate that patient-centered care in the form of treatment navigators improves OAB therapy adherence and progression to advanced therapies in the appropriate patient.There are numerous modifiable barriers to OAB therapy adherence. A patient-centered lens is needed to elicit patient goals, establish realistic treatment expectations, and tailor therapy to improve therapy adherence, optimize outcomes, and reduce healthcare expenditures. Further research is needed to develop and study low-cost, scalable solutions.

    View details for DOI 10.1002/nau.24936

    View details for PubMedID 35510540

  • A Systematic Review of Racial/Ethnic Disparities in Female Pelvic Floor Disorders. Urology Gonzalez, D. C., Khorsandi, S., Mathew, M., Enemchukwu, E., Syan, R. 2021


    Numerous studies have investigated the influence of health disparities among women with pelvic floor disorders with varied results. Racial/ethnic disparities, in particular, inconsistently indicate differences in prevalence of disease, disease severity, and treatment outcomes. We aim to review the body of literature examining racial/ethnic disparities in pelvic floor disorders, including overactive bladder, stress urinary incontinence, pelvic organ prolapse, and interstitial cystitis. A better understanding of these disparities may help guide clinicians, researchers, and advocates in providing improved education, outreach opportunities, and access to care in minority women with pelvic floor disorders.

    View details for DOI 10.1016/j.urology.2021.09.018

    View details for PubMedID 34627869

  • Defining the Variance: The Current State of Female and URM Concordance of Urology Resident Workforce to the General U.S. Population. Urology Marthi, S., Enemchukwu, E., Thavaseelan, S. 2021


    OBJECTIVE: To compare the current representation of women and underrepresented minorities in medicine (URM) of the urologic resident workforce to the general U.S.POPULATION: MATERIALS AND METHODS: Data on current gender and racial distribution of U.S. urology residents was obtained from the 2019-2020 ACGME Data Resource Book and compared to the projected 2019 U.S. population as reported in the U.S. Census data. In this study, URM status included Black/African American, Hispanic/Latino, Native American/Alaskan, Native Hawaiian or Pacific Islander and Other. For each gender and race/ethnicity, the percent differences in representation were calculated by subtracting the frequency in the general U.S. population from that of the urology resident workforce and two sample z-tests were performed.RESULTS: 1734 urology residents were identified in 2019-2020, of which 471 (27.2%) were female and 258 (14.9%) were URM. Two sample z-tests revealed a significantly lower representation in urologic residency programs for women (-23.6%, p-value < 0.05) and URMs (-19.1%, p-value < 0.05). Race/ethnicity subgroup analyses revealed underrepresentation of Black/African American (-9.7%, p-value < 0.05), Hispanic/Latino (-14.2%, p-value < 0.05), Native American/Alaskan (-1.1%, p-value < 0.05).CONCLUSION: Women and URMs continue to be significantly underrepresented in urology residency relative to the general U.S.POPULATION: Further study should better understand barriers to entering the urologic workforce and identify strategies to encourage interest in urology among female and URM prospective trainees.

    View details for DOI 10.1016/j.urology.2021.06.039

    View details for PubMedID 34293375

  • Adult residual rectourethral fistula and diverticulum presenting decades after imperforate anus repair: acase report. Journal of medical case reports McShane, E. K., Gurland, B., Sheth, V. R., Bruzoni, M., Enemchukwu, E. 2021; 15 (1): 370


    BACKGROUND: This report describes a rare surgical case of an intraabdominal mass in a middle-aged patient 40years after imperforate anus repair.CASE PRESENTATION: A 44-year-old Latino male with history of repaired anorectal malformation presented with recurrent urinary tract infections and rectal prolapse with bothersome bleeding and fecal incontinence. During his preoperative evaluation, he was initially diagnosed with a prostatic utricle cyst on the basis of magnetic resonance imaging findings, which demonstrated a cystic, thick-walled mass with low signal contents that extended inferiorly to insert into the distal prostatic urethra. However, at the time of surgical resection, the thick-walled structure contained an old, firm fecaloma. The final pathology report described findings consistent with colonic tissue, suggesting a retained remnant of the original fistula and diverticulum.CONCLUSIONS: Although rare, persistent rectourethral fistula tracts and rectal diverticula after imperforate anus repair can cause symptoms decades later, requiring surgical intervention. This is an important diagnostic consideration for any adult patient with history of imperforate anus.

    View details for DOI 10.1186/s13256-021-02921-3

    View details for PubMedID 34261520

  • Workforce Diversity in Female Pelvic Medicine and Reconstructive Surgery: An analysis of the American Urological Association Census Data. Urology Dielubanza, E. J., Enemchukwu, E. A., Atiemo, H. O. 2021


    OBJECTIVE: To describe the current state of workforce diversity in Female Pelvic Medicine and ReconstructiveSurgery(FPMRS) using the 2014-2019 American Urological Association (AUA) census data.MATERIALS: We evaluated FPMRS workforce diversity using the AUA census data from 2014 to 2019. Underrepresented in medicine (URiM) groups were categorized as individuals who self-identified as non-Hispanic Black/African American,Hispanic,Multiracial, and Other. The FPMRS workforce was then compared to the overall urologic workforce and the other urologic subspecialties (oncology, pediatric urology, and endourology) and assessed by AUA section.RESULTS: In 2019, 602 urologists self-identified as FPMRS providers. Of these 12.4% (n=74) were categorized as URiM urologists compared to 8% of the overall urologic workforce. Women who represent 9.9% of all urologists were overrepresented in FPMRS workforce (46.5%). FPMRS had the largest proportion of URiM and women urologists when compared to the other subspecialty areas.CONCLUSION: The FPMRS urologic subspecialty has the highest percentage of women and URiM urologists compared to all other urologic subspecialty areas. Engagement initiatives and targeted programs may offer insights into this trend. Further research is required to determine the impact of such programs in attracting URiM and women to FPMRS.

    View details for DOI 10.1016/j.urology.2021.06.031

    View details for PubMedID 34274388

  • Female Sexual Function During the COVID-19 Pandemic in the United States. Sexual medicine Bhambhvani, H. P., Chen, T., Kasman, A. M., Wilson-King, G., Enemchukwu, E., Eisenberg, M. L. 2021; 9 (4): 100355


    INTRODUCTION: International studies have demonstrated increasing rates of sexual dysfunction amidst the coronavirus disease 2019 (COVID-19) pandemic; however, the impact of the pandemic on female sexual function in the United States is unknown.AIM: To assess the impact of the COVID-19 pandemic on female sexual function and frequency in the United States.METHODS: A pre-pandemic survey containing the Female Sexual Function Index (FSFI) and demographic questions was completed by adult women in the United States from October 20, 2019 and March 1, 2020. The same women were sent a follow-up survey also containing the FSFI, as well as the Patient Health Questionnaire for Depression and Anxiety with 4 items (PHQ-4), and questions pertaining to mask wearing habits, job loss, and relationship changes. Risk for female sexual dysfunction (RFSD) was defined as FSFI < 26.55.MAIN OUTCOME MEASURE: Differences in pre-pandemic and intra-pandemic female sexual function, measured by the FSFI, and sexual frequency.RESULTS: Ninety-one women were included in this study. Overall FSFI significantly decreased during the pandemic (27.2 vs 28.8, P=.002), with domain-specific decreases in arousal (4.41 vs 4.86, P=.0002), lubrication (4.90 vs 5.22, P=.004), and satisfaction (4.40 vs 4.70, P=.04). There was no change in sexual frequency. Contingency table analysis of RFSD prior to and during the pandemic revealed significantly increased RFSD during the pandemic (P=.002). Women who developed RFSD during the pandemic had higher PHQ-4 anxiety subscale scores (3.74 vs 2.53, P=.01) and depression subscale scores (2.74 vs 1.43, P=.001) than those who did not. Development of FSD was not associated with age, home region, relationship status, mask wearing habits, knowing someone who tested positive for COVID-19, relationship change, or job loss and/or reduction during the pandemic.CONCLUSION: In this population of female cannabis users, risk for sexual dysfunction increased amidst the COVID-19 pandemic and is associated with depression and anxiety symptoms. Bhambhvani HP, Chen T, Wilson-King AM, etal. Female Sexual Function During the COVID-19 Pandemic in the United States. Sex Med 2021;9:100355.

    View details for DOI 10.1016/j.esxm.2021.100355

    View details for PubMedID 34174585

  • Removing Race from eGFR calculations: Implications for Urologic Care. Urology Vilson, F. L., Schmidt, B., White, L., Soerensen, S. J., Ganesan, C., Pao, A. C., Enemchukwu, E., Chertow, G. M., Leppert, J. T. 2021


    Equations estimating the glomerular filtration rate are important clinical tools in detecting and managing kidney disease. Urologists extensively use these equations in clinical decision making. For example, the estimated glomerular function rate is used when considering the type of urinary diversion following cystectomy, selecting systemic chemotherapy in managing urologic cancers, and deciding the type of cross-sectional imaging in diagnosing or staging urologic conditions. However, these equations, while widely accepted, are imprecise and adjust for race which is a social, not a biologic construct. The recent killings of unarmed Black Americans in the US have amplified the discussion of racism in healthcare and has prompted institutions to reconsider the role of race in eGFR equations and raced-based medicine. Urologist should be aware of the consequences of removing race from these equations, potential alternatives, and how these changes may affect Black patients receiving urologic care.

    View details for DOI 10.1016/j.urology.2021.03.018

    View details for PubMedID 33798557

  • Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. International urogynecology journal Wallace, S. L., Enemchukwu, E. A., Mishra, K. n., Neshatian, L. n., Chen, B. n., Rogo-Gupta, L. n., Sokol, E. R., Gurland, B. H. 2021


    Our primary objectives were to compare < 30-day postoperative complications and RP recurrence rates after RP-only surgery and combined surgery. Our secondary objectives were to determine preoperative predictors of < 30-day complications and RP recurrence.A prospective IRB-approved cohort study was performed at a single tertiary care center from 2017 to 2020. Female patients with symptomatic RP underwent either RP-only surgery or combined surgery based on the discretion of the colorectal and FPMRS surgeons. Primary outcome measures were < 30-day complications separated into Clavien-Dindo (CD) classes and rectal prolapse on physical examination.Seventy women had RP-only surgery and 45 had combined surgery with a mean follow-up time of 208 days. Sixty-eight percent underwent abdominal RP repair, and 32% underwent perineal RP repair. Twenty percent had one or more complications, 14% in the RP-only group and 29% in the combined surgery group (p = 0.06). On multivariate analysis, combined surgery patients had a 30% increased risk of complications compared to RP-only surgery patients (RR = 1.3). Most of these complications were minor (14/17, 82.4%) and categorized as CD I or II, including urinary retention and UTI. Twelve percent of this cohort had RP recurrence, 11% in the RP-only group and 13% in the combined surgery group (p = 0.76). Preoperative risk factors for RP recurrence included a primary complaint of rectal bleeding (RR 5.5) and reporting stools consistent with Bristol Stool Scale of 1 (RR 2.1).Patients undergoing combined RP + POP surgery had a higher risk of complications and equivalent RP recurrence rates compared to patients undergoing RP-only surgery.

    View details for DOI 10.1007/s00192-021-04778-y

    View details for PubMedID 33864476

  • Supporting Black voices in urology. Nature reviews. Urology Downs, T. M., Enemchukwu, E., Lee, C. T., Moses, K. A., Nyame, Y. A., Powell, I. J., Vince, R., Williams, H., Wilson, S., Washington, S. L. 2020

    View details for DOI 10.1038/s41585-020-00401-9

    View details for PubMedID 33318668

  • Mirabegron versus solifenacin in multiple sclerosis patients with overactive bladder symptoms: a prospective comparative non-randomized study. Urology Brucker, B. M., Jericevic, D., Rude, T., Enemchukwu, E., Pape, D., Rosenblum, N., Charlson, E. R., Zhovtis-Ryerson, L., Howard, J., Krupp, L., Peyronnet, B. 2020


    OBJECTIVE: To determine the patient-perceived effectiveness and tolerability of mirabegron compared to solifenacin in a multiple sclerosis (MS) population with overactive bladder (OAB) symptoms.MATERIALS AND METHODS: MS patients with OAB symptoms who were not on medication for their urinary symptoms at enrollment were prospectively recruited. Patients enrolled in years 1-2 were prescribed mirabegron, whereas patients enrolled in years 3-4 were prescribed solifenacin. At enrollment and 6-week followup, patients completed several patient reported outcome measures (PROMs). The primary outcome was change in Overactive Bladder Questionnaire Short Form (OAB-q SF) symptom severity and minimal clinically important difference (MCID) achievement. The Patient Assessment of Constipation Symptoms (PAC-SYM) was used to assess bowel function over the treatment period.RESULTS: 61 patients were enrolled. The majority of the mirabegron (70%) and the solifenacin (69%) group achieved the OAB-q SF symptom severity MCID. The solifenacin group had a statistically significant greater decrease in its end of study OAB-q SF score (Delta = -37.87 versus -20.43, p=0.02). Constipation improved in the mirabegron group and worsened in the solifenacin group (DeltaPAC-SYM =-0.38 versus +0.22; p=0.02), with 30% of patients prescribed solifenacin experiencing worsening above the MCID threshold.CONCLUSION: Among MS patients, we demonstrated similar response rates to mirabegron and solifenacin, with approximately 50-70% achieving each PROM's MCID. Though this small study showed some short-term evidence that improvement in urinary symptom severity was greater with solifenacin, this potential benefit must be weighed against the observed risk of worsening constipation. Further studies are needed to confirm these findings.

    View details for DOI 10.1016/j.urology.2020.08.008

    View details for PubMedID 32822687

  • Sacral Nerve Stimulation in Parkinson's Disease Patients with Overactive Bladder Symptoms. Urology Greenberg, D. R., Sohlberg, E. M., Zhang, C. A., Santini, V. E., Comiter, C. V., Enemchukwu, E. A. 2020


    OBJECTIVES: To assess the efficacy, safety, and outcomes of sacral nerve stimulation (SNS) for Parkinson's Disease (PD) patients with overactive bladder (OAB) symptoms.METHODS: We retrospectively reviewed PD patients who underwent Stage I SNS. Demographics, urodynamic data, and baseline voiding function were analyzed. Efficacy and safety of treatment were determined by rate of progression to Stage II, explantation, and surgical revision. Long-term outcomes were assessed using voiding diaries and/or clinic notes.RESULTS: 60% (9/15) experienced ≥50% improvement in urinary parameters and proceeded to Stage II. There was no significant difference in age, BMI, comorbidities, PD disease duration, or levodopa equivalent daily dose between successful and non-successful Stage I patients. However, 100% of female patients experienced Stage I success compared to 44% of male PD patients (p=0.04). Individuals with >12-month follow-up experienced an average reduction of 6 voids/day. No patients required revision or explantation of their device at latest clinic follow-up (22.2 ± 7.8 months). Higher maximal urethral closure pressures (MUCP), detrusor pressure at maximum flow rate (PdetQmax), post-void residual (PVR) volume, and mean BOOI were observed in the Stage I trial failures.CONCLUSION: At our institution, PD patients have a similar rate of progression to Stage II compared to the general population. SNS is an effective therapy that should be considered among the treatment options for PD patients with OAB symptoms. Urodynamic parameters associated with obstruction may be predictive of SNS failure in PD patients and may help guide patient selection, however further studies are needed.

    View details for DOI 10.1016/j.urology.2020.06.063

    View details for PubMedID 32681915

  • INCREASED RISK OF INCIDENT DEMENTIA FOLLOWING USE OF ANTICHOLINERGIC AGENTS: A META-ANALYSIS Dmochowski, R., Thai, S., Iglay, K., Enemchukwu, E., Tee, S., Varano, S., Girman, C., Radican, L., Mudd Jr, P. WILEY. 2020: S124–S126
  • Balancing the possibility of needing a future incontinence procedure versus a future urethral sling revision surgery: a tradeoff analysis for continent women undergoing pelvic organ prolapse surgery. International urogynecology journal Dallas, K., Rogo-Gupta, L., Syan, R., Enemchukwu, E., Elliott, C. S. 2020


    INTRODUCTION AND HYPOTHESIS: Although urinary incontinence surgery has potential benefits such as preventing de novo stress urinary incontinence in women undergoing pelvic organ prolapse (POP) surgery, it comes with the potential cost of overtreatment and complications. We compared future surgery rates in a population cohort of women undergoing vaginal pelvic organ prolapse surgery.METHODS: All women undergoing POP repair in California from 2005 to 2011 were identified from the Office of Statewide Health Planning and Development databases. Rates of repeat surgery in those with and without concomitant urethral sling procedures were compared. To control for confounding effects, multivariate mixed effects logistic regression models were constructed to compare each woman's individualized risk of undergoing either sling revision surgery or future incontinence surgery.RESULTS: In the cohort, 38,456 underwent a sling procedure at the time of POP repair and 42,858 did not. The future surgery rate was higher for sling-related complications in the POP + sling cohort compared with future incontinence surgery in the POP alone cohort (3.5% versus 3.0% respectively, p<0.001). The difference persisted in multivariate modeling, where most women (60%) are at a higher risk of requiring sling revision surgery compared with needing a future primary incontinence procedure (40%).CONCLUSIONS: Women who undergo vaginal prolapse repair without an incontinence procedure are at a low risk of future incontinence surgery. Women without urinary incontinence who are considering vaginal POP surgery should be informed of the risks and benefits of including a sling procedure.

    View details for DOI 10.1007/s00192-020-04226-3

    View details for PubMedID 32125489

  • Current Role of Urethrolysis and Partial Excision in Patients Seeking Revision of Anti-incontinence Sling OBSTETRICAL & GYNECOLOGICAL SURVEY Drain, A., Enemchukwu, E., Shah, N., Syan, R., Rosenblum, N., Nitti, V. W., Brucker, B. M. 2020; 75 (3): 162–63
  • Patient satisfaction improved when patients seen by multiple providers at a multidisciplinary pelvic health center Speed, J., Montalvo, C., Cuevas, J., Gurland, B., Enemchukwu, E. WILEY. 2020: S179–S180
  • Do preoperative demographics or symptoms predict recurrence in patients following combined surgical repair for pelvic organ prolapse and rectal prolapse? Syan, R., Wallace, S., Gurland, B., Enemchukwu, E. WILEY. 2020: S174–S175
  • Vaginal energy-based devices: characterization of adverse events based on the last decade of MAUDE safety reports. Menopause (New York, N.Y.) Wallace, S. L., Sokol, E. R., Enemchukwu, E. A. 2020


    Energy-based devices have gained momentum as minimally invasive procedures to treat both medical and cosmetic pelvic floor disorders including genitourinary syndrome of menopause, vaginal laxity, stress urinary incontinence, dyspareunia, and vulvar disorders such as lichen diseases and vestibulitis. However, the FDA recently issued a statement cautioning patients and providers that the safety and efficacy of energy-based devices for the treatment of vaginal symptoms has not been well established. Additionally, the FDA sent letters to the manufactures of energy-based devices with notifications that they could be violating the marketing standards of the FDA. The existing data on side effects is insufficient and limited to observational studies. We sought to characterize the safety events of vaginal energy-based devices by analysis of surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database and specifically look at those events that occurred prior to the July 30, 2018 warning.The MAUDE database was queried between September 30, 2013 and October 31, 2019 for all vaginal energy-based devices. The incidence of safety events was reported for these devices and the most common complaints were described and characterized. Event reporting was analyzed before and after July 30, 2018.Forty-two unique and relevant medical device reports (MDRs) were retrieved. The Mona Lisa Touch had the highest number of MDRs (40.5%) followed by ThermiVa (16.7%) and Viveve (14.2%). Each medical device report was associated with a single patient experience and within the 42 medical device reports, there were 85 complaints. A majority of the MDR complaints (52.9%) were also indications for energy-based devices procedures, which include vaginal pain, dyspareunia, lichen sclerosis, and urinary frequency. Two-thirds of the complaints (68.2%) were related to pain, but serious adverse events such as third-degree burns (3.5%) were rare. Most of the reportable events occurred before July 30, 2018 (83.3%), but most were reported after July 30, 2018 (78.6%).MAUDE-reported data suggests that the majority of patient complaints after vaginal energy-based device treatment include vaginal pain, bladder pain, and urinary symptoms. This study suggests that the majority of complaints are not severe, and some may be related to progression of the disease. The few severe adverse events reported in the MAUDE database may have contributed to the FDA warning regarding energy-based devices. Recall bias after the FDA warning, as well as the potential for litigation, may have prompted an increase in adverse event reporting after July 30, 2018. : Video Summary:

    View details for DOI 10.1097/GME.0000000000001661

    View details for PubMedID 33003133

  • Racial and Socioeconomic Factors Influence Utilization of Advanced Therapies in Commercially Insured OAB Patients: An Analysis of over 800,000 OAB Patients. Urology Syan, R. n., Zhang, C. A., Enemchukwu, E. A. 2020


    To determine if racial and/or socioeconomic factors influence advanced therapy utilization for refractory overactive bladder (OAB) amongst the commercially insured.We queried Optum®, a national claims database, between 2003-2017. Non-neurogenic OAB patients were identified using ICD-9/10 diagnosis codes. Demographic and treatment data were collected, including oral medication therapies (anticholinergic, beta3 agonists), and advanced therapies (OnabotulinumtoxinA (BTX), Sacral Nerve Stimulation (SNS), percutaneous tibial nerve stimulation (PTNS)). Associations between patient sociodemographic factors and advanced therapy utilization were explored.Of 4,229,617 OAB patients, 807,612 (19%) received medical therapies, of which 95% received oral medications only and 4.7% received advanced therapies. Asians had the lowest use of oral therapies (14% versus 18-19% in other races/ethnicities, p<0.05), and advanced therapies (0.44% vs 0.71-0.93%, p<0.05). Asians and Hispanics were least likely to utilize SNS therapy and most likely to use PTNS compared to Blacks and Whites. BTX use was similar between races/ethnicities (p<0.05). Female gender (OR 1.65 [CI 1.61,1.69]), younger age (<65) (OR 1.28 [1.25,1.31]), higher annual income ≥$40K (OR 1.09 [1.06,1.12]) and prior use of oral medications (OR 3.30 [3.21,3.38] for 1 medication) were significantly associated with receiving advanced therapies. Nonwhite race (OR 0.89 [0.87,0.91]), lower education level (less than a bachelor's degree) (OR 0.97 [0.94,0.99]), and Northeast region were associated with a lower likelihood of receiving advanced therapies (p<0.05 for all).Amongst commercially insured, racial and socioeconomic factors predict utilization of advanced OAB therapies, including race/ethnicity, age, gender, education level, and region.

    View details for DOI 10.1016/j.urology.2020.04.109

    View details for PubMedID 32439551

  • Trends in the Diagnosis and Management of Combined Rectal and Vaginal Pelvic Organ Prolapse. Urology Speed, J. M., Zhang, C. A., Gurland, B. n., Enemchukwu, E. n. 2020


    To examine the rates of surgical repair of comorbid rectal prolapse (RP) and pelvic organ prolapse (POP) over time in a large population-based cohort.We queried Optum®, a national administrative claims database, from 2003-2017. We evaluated female patients age 18 or older with a diagnosis of POP and/or RP. Sociodemographic characteristics, comorbidities, and rates of procedures were collected.We identified 481,051 women diagnosed with RP and/or POP. Only 2.0% of women in the cohort had comorbid POP and RP. While 29.9% of women with RP had dual prolapse, only 2.1% of women with POP had both diagnoses. Overall, 25.8% of women had one or more surgical repairs. Surgical repairs were done in 26.0% of women with POP, 15.0% of women with RP, and 48.2% of women with comorbid POP/RP, though only 19.8% of patients with dual diagnoses had both RP and POP repairs. Over the study period, the rate of multidisciplinary surgical repairs increased by 2.7-fold.The prevalence of comorbid RP and POP among women in our cohort is low (2.0%). Rates of multidisciplinary surgery have increased possibly due to the increased use of imaging, laparoscopic surgery, and awareness of the shared pathophysiology of the disease.

    View details for DOI 10.1016/j.urology.2020.05.010

    View details for PubMedID 32439552

  • Surgical approach, complications, and reoperation rates of combined rectal and pelvic organ prolapse surgery. International urogynecology journal Wallace, S. L., Syan, R. n., Enemchukwu, E. A., Mishra, K. n., Sokol, E. R., Gurland, B. n. 2020


    Our primary objective was to determine rectal prolapse (RP) and pelvic organ prolapse (POP) reoperation rates and postoperative < 30-day complications after combined RP and POP surgery at a single institution.This was an IRB-approved retrospective cohort study of all female patients who received combined RP and POP surgery at a single tertiary care center from 2008 to 2019. Recurrence was defined as the need for subsequent repeat RP or POP surgery at any point after the index surgery. Surgical complications were separated into Clavien-Dindo classes.Sixty-three patients were identified, and 18.3% (12/63) had < 30-day complications (55% Clavien-Dindo grade 1; 27% Clavien-Dindo grade 2; 18% Clavien-Dindo grade 4). Of patients undergoing combined abdominal RP and POP repair, no postoperative < 30-day complications were noted in the MIS group compared to 37.5% of those patients in the laparotomy group (p < 0.01). Overall, in those patients who underwent combined RP and POP surgery, the need for subsequent RP surgery for recurrent RP was 14% and the need for subsequent POP surgery for recurrent POP was 4.8% (p = 0.25).In this cohort of women undergoing combined RP and POP surgery, a higher proportion required subsequent RP surgery compared to those requiring subsequent POP surgery, although this was not statistically significant. Almost one-fifth of patients undergoing combined RP and POP surgery experienced a < 30-day surgical complication, regardless of whether the approach was perineal or abdominal. For those patients undergoing abdominal repair, < 30-day complications were more likely in those patients who had a laparotomy compared to those who had a minimally invasive surgery.

    View details for DOI 10.1007/s00192-020-04394-2

    View details for PubMedID 32577789

  • Increased risk of incident dementia following use of anticholinergic agents: A systematic literature review and meta-analysis. Neurourology and urodynamics Dmochowski, R. R., Thai, S. n., Iglay, K. n., Enemchukwu, E. n., Tee, S. n., Varano, S. n., Girman, C. n., Radican, L. n., Mudd, P. N., Poole, C. n. 2020


    Long-term treatment with anticholinergic agents may increase the risk of cognitive impairment or dementia. This systematic literature review and meta-analysis aimed to assess the impact of ≥3 months of exposure to anticholinergics as a class on the risk of dementia, mild cognitive impairment, and change in cognitive function. The impact of anticholinergic agents specifically used to treat overactive bladder was also evaluated.A systematic literature review was conducted to identify English language articles evaluating the impact of anticholinergic use for ≥3 months on dementia or cognitive function in adult patients. Databases searched included PubMed, Embase, and the Cochrane Library. Meta-analyses were conducted using random-effects models; 95% confidence intervals (CIs) and 95% prediction intervals (PIs) were reported.A total of 2122 records were identified. Out of those, 21 studies underwent qualitative synthesis and 6 reported endpoints relevant for inclusion in a meta-analysis assessing the risk of incident dementia. The overall rate ratio for incident dementia was 1.46 (95% CI: 1.17-1.81; 95% PI: 0.70-3.04; n = 6). The risk of incident dementia increased with increasing exposure (n = 3). In addition, two studies from the meta-analysis reported an increased risk of dementia with ≥3 months of use of bladder antimuscarinics (adjusted odds ratios ranged from 1.21 to 1.65, depending on exposure category).Anticholinergic use for ≥3 months increased the risk of dementia on average by an estimated 46% versus nonuse. This relationship was consistent in studies assessing overactive bladder medications. The risk of developing dementia should be carefully considered in the context of potential benefit before prescribing anticholinergics.

    View details for DOI 10.1002/nau.24536

    View details for PubMedID 33098213

  • Current Role of Urethrolysis and Partial Excision in Patients Seeking Revision of Anti-Incontinence Sling FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY Drain, A., Enemchukwu, E., Shah, N., Syan, R., Rosenblum, N., Nitti, V. W., Brucker, B. M. 2019; 25 (6): 409–14
  • Clinical phenotypic presentation of rectal prolapse varies with age Neshatian, L., Lee, A., Wallace, S., Enemchukwu, E., Rogo-Gupta, L., Mishra, K., Garcia, P., Nguyen, L. B., Gurland, B. WILEY. 2019
  • Outcomes of Sacral Nerve Stimulation for Treatment of Refractory Overactive Bladder Among Octogenarians. Neuromodulation : journal of the International Neuromodulation Society Greenberg, D. R., Syan, R., Young-Lin, N., Comiter, C. V., Enemchukwu, E. 2019


    OBJECTIVE: Sacral nerve stimulation (SNS) is an effective treatment for refractory overactive bladder (OAB). However, advanced age is often cited as a reason to avoid SNS in the elderly. This study evaluates the safety and efficacy of SNS for refractory OAB among our octogenarian population.METHODS: A retrospective review from a single institution was performed on all SNS lead placements from December 1998 to June 2017 for refractory OAB. Octogenarians were characterized as 80years of age or older at the time of Stage I. Efficacy and safety were determined by the rate of progression to Stage II, subsequent need for multimodal therapy, and rate of surgical revision and explantation. All patients were followed for a minimum of 12months.RESULTS: Of 374 patients in this study, 37 (9.9%) were octogenarians. There was no difference in gender, race, smoking history, or prior OAB treatment regimens between cohorts. The rate of progression to Stage II was 56.8% for octogenarians compared to 60.5% for nonoctogenarians (p = 0.66). The rate of surgical revision, explantation, and need for multimodal therapy did not differ between groups. Subgroup analysis of octogenarians did not reveal any significant differences between successful and nonsuccessful Stage I patients.CONCLUSIONS: The safety and efficacy of SNS was similar between cohorts. This result suggests that SNS is a safe and effective therapy that should be considered among the treatment options for refractory OAB in octogenarian patients. Further studies are needed to determine predictive factors of Stage I success in elderly patients.

    View details for DOI 10.1111/ner.12981

    View details for PubMedID 31215713

  • Transvaginal Suture-Based Repair. The Urologic clinics of North America Enemchukwu, E. A. 2019; 46 (1): 97–102


    An estimated 300,000 women undergo pelvic organ prolapse (POP) surgery in the United States every year at a cost of more than 1 billion dollars per year. The prevalence of POP is approximately 2.9% to 8%, and increases with age. Apical support is required to achieve successful prolapse repair. As the search for the safest, most durable, surgical repair continues, transvaginal native tissue repairs have the advantage of providing minimally invasive surgical repairs without the added risk of abdominal, laparoscopic, or robotic surgery while avoiding the risk of mesh augmentation.

    View details for PubMedID 30466707

  • Transvaginal Suture-Based Repair UROLOGIC CLINICS OF NORTH AMERICA Enemchukwu, E. A. 2019; 46 (1): 97-+
  • Exploring the bowel and bladder dysfunction relationship in a multiple sclerosis population Jericevic, D. K., Peyronnet, B., Rude, T., Enemchukwu, E., Palmerola, R., Sussman, R., Pape, D., Rosenblum, N., Sammarco, C., Zhovtis-Ryerson, L., Kister, I., Howard, J., Krupp, L., Brucker, B. WILEY. 2019: S125–S126
  • Basic Evaluation of the Patient with Pelvic Floor Dysfunction Challenging Clinical Scenarios in Female Pelvic Medicine Syan, R., Enemchukwu, E., Dobberfuhl, A., Comiter, C. Springer International Publishing. 2019
  • Rates and Risk Factors for Future Stress Urinary Incontinence Surgery after Pelvic Organ Prolapse Repair in a Large Population-based Cohort in California UROLOGY Syan, R., Dallas, K. B., Sohlberg, E., Rogo-Gupta, L., Elliott, C. S., Enemchukwu, E. A. 2019; 123: 81–86
  • Association Between Concomitant Hysterectomy and Repeat Surgery for Pelvic Organ Prolapse Repair in a Cohort of Nearly 100,000 Women OBSTETRICS AND GYNECOLOGY Dallas, K., Elliott, C. S., Syan, R., Sohlberg, E., Enemchukwu, E., Rogo-Gupta, L. 2018; 132 (6): 1328–36
  • Association Between Concomitant Hysterectomy and Repeat Surgery for Pelvic Organ Prolapse Repair in a Cohort of Nearly 100,000 Women. Obstetrics and gynecology Dallas, K., Elliott, C. S., Syan, R., Sohlberg, E., Enemchukwu, E., Rogo-Gupta, L. 2018


    OBJECTIVE: To evaluate the association of hysterectomy at the time of pelvic organ prolapse (POP) repair with the risk of undergoing subsequent POP surgery in a large population-based cohort.METHODS: Data from the California Office of Statewide Health Planning and Development were used in this retrospective cohort study to identify all women who underwent an anterior, apical, posterior or multiple compartment POP repair at nonfederal hospitals between January 1, 2005, and December 31, 2011, using Current Procedural Terminology and International Classification of Diseases, 9th Revision procedure codes. Women with a diagnosis code indicating prior hysterectomy were excluded, and the first prolapse surgery during the study period was considered the index repair. Demographic and surgical characteristics were explored for associations with the primary outcome of a repeat POP surgery. We compared reoperation rates for recurrent POP between patients who did compared with those who did not have a hysterectomy at the time of their index POP repair.RESULTS: Of the 93,831 women meeting inclusion criteria, 42,340 (45.1%) underwent hysterectomy with index POP repair. Forty-eight percent of index repairs involved multiple compartments, 14.0% included mesh, and 48.9% included an incontinence procedure. Mean follow-up was 1,485 days (median 1,500 days). The repeat POP surgery rate was lower in those patients in whom hysterectomy was performed at the time of index POP repair, 3.0% vs 4.4% (relative risk [RR] 0.67, 95% CI 0.62-0.71). Multivariate modeling revealed that hysterectomy was associated with a decreased risk of future surgery for anterior (odds ratio [OR] 0.71, 95% CI 0.64-0.78), apical (OR 0.76, 95% CI 0.70-0.84), and posterior (OR 0.69, 95% CI 0.65-0.75) POP recurrence. The hysterectomy group had increased lengths of hospital stay (mean 2.2 days vs 1.8 days, mean difference 0.40, 95% CI 0.38-0.43), rates of blood transfusion (2.5% vs 1.5, RR 1.62, 95% CI 1.47-1.78), rates of perioperative hemorrhage (1.5% vs 1.1%, RR 1.32, 95% CI 1.18-1.49), rates of urologic injury or fistula (0.9% vs 0.6%, RR 1.66, 95% CI 1.42-1.93), rates of infection or sepsis (0.9% vs 0.4%, RR 2.12, 95% CI 1.79-2.52), and rate of readmission for an infectious etiology (0.7% vs 0.3%, RR 2.54, 95% CI 2.08-3.10) as compared with those who did not undergo hysterectomy.CONCLUSION: We demonstrate in a large population-based cohort that hysterectomy at the time of prolapse repair is associated with a decreased risk of future POP surgery by 1-3% and is independently associated with higher perioperative morbidity. Individualized risks and benefits should be included in the discussion of POP surgery.

    View details for PubMedID 30334856

  • Rates and Risk Factors for Future Stress Urinary Incontinence Surgery After Pelvic Organ Prolapse Repair in a Large Population Based Cohort in California. Urology Syan, R., Dallas, K. B., Sohlberg, E., Rogo-Gupta, L., Elliott, C. S., Enemchukwu, E. A. 2018


    OBJECTIVES: To determine the rate and risk factors for future stress incontinence (SUI) surgery in a large population based cohort of previously continent women following pelvic organ prolapse (POP) repair without concomitant SUI treatment.METHODS: Data from the Office of Statewide Health Planning and Development (OSHPD) was used to identify all women who underwent anterior, apical or combined antero-apical POP repair without concomitant SUI procedures in the state of California between 2005-2011 with at least one-year follow-up. Patient and surgical characteristics were explored for associations with subsequent SUI procedures.RESULTS: Of 41,689 women undergoing anterior or apical POP surgery, 1,504 (3.6%) underwent subsequent SUI surgery with a mean follow-up time of 4.1 years. Age (OR 1.01), obesity (OR 1.98), use of mesh at the time of POP repair (OR 2.04), diabetes mellitus (OR 1.19), White race and combined antero-apical repair (OR 1.30) were associated with an increased odds of future SUI surgery.CONCLUSIONS: The rate of subsequent surgery for de novo SUI following POP repair on a population level is low. Patient and surgical characteristics may alter a woman's individual risk and should be considered in surgical planning.

    View details for PubMedID 30222995

  • Current Role of Urethrolysis and Partial Excision in Patients Seeking Revision of Anti-Incontinence Sling. Female pelvic medicine & reconstructive surgery Drain, A., Enemchukwu, E., Shah, N., Syan, R., Rosenblum, N., Nitti, V. W., Brucker, B. M. 2018


    OBJECTIVES: Stress urinary incontinence is highly prevalent and sling surgery has increased since 2000. Urethrolysis traditionally had been standard management of complications after anti-incontinence surgery; however, partial excision is a less aggressive option. This study describes the different populations in a contemporary cohort that undergo sling excision and urethrolysis and their surgical outcomes.METHODS: Chart analysis was performed on patients assigned Current Procedural Terminology codes for removal or revision of sling for stress incontinence, urethrolysis, or revision of graft at our institution from 2010 to 2015. Demographics, indications, outcomes, and subsequent treatment were evaluated.RESULTS: A total of 110 patients underwent surgery and were included. Partial excision was performed on 82 patients and urethrolysis on 28 patients. About 32.7% had prior revision, and median length to revision was 3.1 years. Overall success was 75.0% for urethrolysis and 86.6% for partial excision. Without concomitant sling placement, stress incontinence developed in 25.0% of urethrolysis and 21.6% of partial excision patients. New onset overactive bladder symptoms developed in 21.4% of urethrolysis patients and 7.3% of partial excision, which was significantly different (P = 0.039).CONCLUSIONS: Both approaches had good success, 75.0% for formal urethrolysis and 86.6% for partial excision. New onset urgency was lower for partial excision, but rates of all other complications were similar. These procedures are often used for different patient populations, and thus, outcomes are not meant to be directly compared. Future work on sling revision should report these procedures separately.

    View details for PubMedID 29787462

  • Tibial Nerve and Sacral Neuromodulation in the Elderly Patient Curr Bladder Dysfunct Rep Sohlberg, E., Greenberg, D., Enemchukwu, E. 2018 ; 288 (13)
  • Racial and Socioeconomic Disparities in Short-term Urethral Sling Surgical Outcomes UROLOGY Dallas, K. B., Sohlberg, E. M., Elliott, C. S., Rogo-Gupta, L., Enemchukwu, E. 2017; 110: 70–75


    To evaluate the association of racial and socioeconomic factors with the risk of adverse events in the first 30 days following urethral sling placement.We accessed nonpublic data from the Office of Statewide Health Planning and Development in California from 2005 to 2011. All female patients who underwent an ambulatory urethral sling procedure in the entire state of California over the study period were identified (Current Procedural Terminology 57288). Our main outcome was any unplanned hospital visits within 30 days of the patient's surgery in the form of an inpatient admission, revision surgery, or emergency department visit.A total of 28,635 women who underwent outpatient urethral sling placement were identified. Within 30 days, 1628 women (5.7%) had at least 1 unplanned hospital visit. In the adjusted multivariate model, black race and Medicaid insurance status were both independently associated with increased odds of having an unplanned hospital visit (odds ratio 1.80, P < .01 and odds ratio 1.53, P < .01, respectively). This significance persisted even when controlling for patient comorbidities, demographics, and facility characteristics.We found that, similar to what has been reported in other fields, disparities in outcomes exist between socioeconomic and racial groups in the field of urogynecology.

    View details for PubMedID 28847692

  • CO2 Laser Treatment is Effective for Symptoms of Vaginal Atrophy JOURNAL OF UROLOGY Anger, J. T., Enemchukwu, E. A. 2017; 198 (6): 1229–30

    View details for DOI 10.1016/j.juro.2017.09.003

    View details for Web of Science ID 000417150900004

    View details for PubMedID 29061287

  • Abdominal Imaging Following Urinary Reconstruction: Recommendations and Pitfalls CURRENT BLADDER DYSFUNCTION REPORTS Davenport, M. T., Enemchukwu, E. A. 2016; 11 (4): 291–99
  • Transvesical Repair of Vesicovaginal Fistula Hinman's Atlas of Urologic Surgery Rosenblum, N., Enemchukwu, E. 2016
  • DIAGNOSIS OF GENITOURINARY FISTULAE Textbook of Female Urology and Urogynecology Brucker, B., Enemchukwu, E. 2016
  • MANAGEMENT OF PATIENTS SEEKING REVISION OF ANTI-INCONTINENCE SLING:OUTCOMES OF URETHROLYSIS VS. PARTIAL EXCISION Drain, A., Enemchukwu, E., Nitti, V., Brucker, B. Society of Urodynamics and Female Pelvic Medicine and Urogenital reconstruction. 2016
  • Autologous Pubovaginal Sling for the Treatment of Concomitant Female Urethral Diverticula and Stress Urinary Incontinence. Urology Enemchukwu, E., Lai, C., Reynolds, W. S., Kaufman, M., Dmochowski, R. 2015; 85 (6): 1300-1303


    To describe our experience with concomitant repair of urethral diverticula and stress urinary incontinence (SUI) with autologous pubovaginal sling (PVS).A retrospective chart review between January 2006 and 2013 identified 38 women undergoing concomitant diverticulectomy and rectus sheath PVS. Patient demographics, presenting symptoms, prior urethral surgery, concomitant procedures, postoperative outcomes, and complications were evaluated.The mean duration of symptoms was 56.7 months. Eleven patients presented with recurrent diverticula and 5 patients had prior SUI surgery (3 midurethral slings, 1 PVS, and 1 bulking agent). One patient had a prior urethrolysis. All other slings were cut or excised at the time of surgery. All women had demonstrable SUI on cough stress test or urodynamics. The mean follow-up was 12.7 months. All postoperative voiding cystourethrograms were negative for contrast extravasation. One patient required prolonged (>4 weeks) suprapubic tube drainage for urinary retention. Four others required an additional 1 week of suprapubic tube drainage. Eighteen patients (47%) reported mixed urinary symptoms. Of these, 9 had complete resolution, whereas 9 experienced significant improvement. Overall, 97.3% reported resolution of their dysuria, dyspareunia, and pain symptoms and 90% reported complete resolution of their SUI symptoms. There were 2 urethral diverticula recurrences and 2 SUI recurrences. Perioperative complications, including hemorrhage, sling erosion, or urethrovaginal fistulas, were not observed.Concomitant PVS placement is a safe and effective treatment option for SUI in patients undergoing urethral diverticulectomy. The risks and benefits should be weighed and management individualized.

    View details for DOI 10.1016/j.urology.2015.02.022

    View details for PubMedID 26099875

  • Comparative Revision Rates of Inflatable Penile Prostheses Using Woven Dacron (R) Fabric Cylinders JOURNAL OF UROLOGY Enemchukwu, E. A., Kaufman, M. R., Whittam, B. M., Milam, D. F. 2013; 190 (6): 2189-2193


    American Medical Systems (AMS) CX and LGX penile prostheses use woven Dacron® fabric to produce girth, and length and girth expansion, respectively. Cylinder expansion, while desirable, can result in wear of the material which, over time, may lead to device failure. Therefore, we compared girth and length expanding vs girth expanding cylinder survival rates. In addition, we determined the impact of parylene coating on penile prosthesis revision performed for mechanical reasons.All patient information forms from AMS 700™ CX and LGX/Ultrex penile prosthesis implantation performed in the United States from January 1997 through August 2008 were retrospectively analyzed (55,013). Device failure was defined as time to first revision. Survival rates of the 2 groups were analyzed and compared, and survival curves were generated.AMS 700 Ultrex/LGX parylene and CX parylene devices demonstrated equivalent estimated survival rates (88.7% vs 89.5%, respectively, log rank p=0.6811). The parylene coated CX and Ultrex/LGX devices outperformed the nonparylene coated devices on survival analysis.This analysis demonstrated no significant difference in 7-year survival between current generation girth expanding (700 CX) and length and girth expanding (700 LGX/Ultrex) prostheses. This analysis also demonstrated that the parylene coating of the cylinder wall contact surfaces significantly reduced the revision rate of the 700 CX and 700 LGX/Ultrex inflatable penile prostheses.

    View details for DOI 10.1016/j.juro.2013.06.112

    View details for Web of Science ID 000327441000077

    View details for PubMedID 23845458

  • Safety and Efficacy of Sling for Persistent Stress Urinary Incontinence After Bulking Injection UROLOGY Koski, M. E., Enemchukwu, E. A., Padmanabhan, P., Kaufman, M. R., Scarpero, H. M., Dmochowski, R. R. 2011; 77 (5): 1076-1080


    To evaluate the impact of injectable agents on subsequent incontinence surgery outcomes to assess safety and efficacy of this treatment combination. Periurethral bulking agents are a minimally invasive treatment option for stress urinary incontinence (SUI), but often lack durability necessitating further surgical intervention.Retrospective review of 43 patients with SUI following bulking agent who underwent subsequent sling placement from November 2000 to September 2009 were evaluated for demographics, symptoms, urodynamics (UDS), bulking agent characteristics, concomitant procedures, pad requirements per day (PPD), subjective outcomes, and complications.Mean patient age was 67 years, with mean follow-up of 37.3 months. All demonstrated SUI, and mixed urinary incontinence (MUI) was noted in 81.4%. Almost half (48.8%) had undergone a prior antiincontinence procedure. Mean number of injections was 3. After a bulking injection, 25 autologous fascia pubovaginal slings, 13 midurethral slings, and 5 biological pubovaginal slings were placed. Concomitant pelvic surgery was performed in 37.2%. Postoperatively, mean PPD decreased from 5.3 to 0.65, with a 60.5% subjective cure rate (no pads or leakage under any circumstances). No association was seen between number or type of injection, or type of sling with regards to patient outcomes. Results were significantly related to concomitant surgery (P = .007). SUI recurred in 8 patients (18.6%), which was not statistically associated with other parameters. Complications included urinary retention (8 patients) de novo urgency (1 patient), UTI (4 patients), abdominal wound infection (3 patients), and cystotomy (1 patient).Prior treatment with bulking agents does not appear to negatively affect outcomes for future antiincontinence surgery in our patient population.

    View details for DOI 10.1016/j.urology.2010.10.010

    View details for Web of Science ID 000290026700016

    View details for PubMedID 21216448