Dr. Rogo-Gupta has a particular interest in a multi-disciplinary approach to women’s healthcare. Dr. Rogo-Gupta’s research interests include prolapse and incontinence surgery outcomes on both institutional and national levels, and the impact of surgical volume on outcomes.
- Obstetrics and Gynecology
- Pelvic Organ Prolapse
- Urinary Incontinence
- Fecal Incontinence
- Uterine Prolapse
Clinic Chief, Ambulatory Gynecology and Gynecologic Specialties, Stanford University School of Medicine (2016 - Present)
Honors & Awards
Award for Excellence in Faculty Teaching, Association of Professors of Gynecology and Obstetrics (2016)
Award for Article of Special Interest, Journal of Urology (2012)
Award for Article Placed on American Board of Obstetricians and Gynecologists Annual Reading List, American Board of Obstetrics and Gynecology (2011)
Chief Resident, Obstetrics and Gynecology, Columbia University (2010)
Best Teaching Resident, Columbia University (2010)
Best Teaching Resident, Columbia University (2008)
Best Teaching Resident, Columbia University (2007)
John Gibbons Medical Student Award, American College of Obstetricians and Gynecologists (2006)
Boards, Advisory Committees, Professional Organizations
Member, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (2010 - Present)
Member, American Urogynecologic Association (2009 - Present)
Member, American College of Obstetricians & Gynecologists (2005 - Present)
Medical Education:University of Southern California Keck School of Medicine Registrar (2006) CA
Board Certification: Female Pelvic Medicine and Reconstructive Surgery, American Board of Obstetrics and Gynecology (2018)
Board Certification, Female Pelvic Medicine and Reconstructive Surgery, American Board of Obstetrics and Gynecology (2018)
Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (2013)
Fellowship:University of California Los Angeles (2013) CA
Residency:Columbia University (2010) NY
Long-term reoperation rates are equivalent for pelvic organ prolapse repairs with biologic and synthetic grafts in a large population based cohort
WILEY. 2019: S228–S229
View details for Web of Science ID 000462357800318
Ureteral injury and fistula following hysterectomy for benign indications
WILEY. 2019: S65–S66
View details for Web of Science ID 000462357800077
Prophylactic midurethral slings at the time of pelvic organ prolapse repair surgery to prevent de-novo stress urinary incontinence-a need to reappraise?
WILEY. 2019: S70–S71
View details for Web of Science ID 000462357800084
How can a patient find reliable information online? Machine learning algorithms successfully identify the quality of lay-person directed articles
WILEY. 2019: S115
View details for Web of Science ID 000462357800140
- Care Seeking Patterns for Women Requiring a Repeat Pelvic Organ Prolapse Surgery Due to Native Tissue Repair Failure Compared to a Mesh Complication UROLOGY 2018; 122: 70–75
Association Between Concomitant Hysterectomy and Repeat Surgery for Pelvic Organ Prolapse Repair in a Cohort of Nearly 100,000 Women.
Obstetrics and gynecology
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.
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
- Where do Women go for Revision Surgeries? Geographic Migration Patterns after Urethral Sling Placement in California UROLOGY PRACTICE 2018; 5 (2): 93–100
CONCOMITANT HYSTERECTOMY LOWERS THE RATE OF RECURRENT PROLAPSE SURGERY FOR ALL COMPARTMENTS IN A COHORT OF OVER 100,000 WOMEN
WILEY. 2018: S556
View details for Web of Science ID 000427016100064
THE PREVALENCE OF PELVIC FLOOR DISORDERS IN ACTIVE DUTY FEMALE SOLDIERS: DATA FROM THE STANFORD MILITARY DATA REPOSITORY
WILEY. 2018: S567–S568
View details for Web of Science ID 000427016100082
IS PROPHYLACTIC STRESS INCONTINENCE SURGERY NECESSARY AT THE TIME OF PELVIC ORGAN PROLAPSE REPAIR? - RATES OF FUTURE SURGERY IN A LARGE POPULATION BASED COHORT IN CALIFORNIA
WILEY. 2018: S567
View details for Web of Science ID 000427016100081
Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology
Women's Health Issues
Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians.Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey.This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013-August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ2 tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC).Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient-physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37-0.78; p = .001).Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood.
View details for DOI 10.1016/j.whi.2018.01.001
Racial and Socioeconomic Disparities in Short-term Urethral Sling Surgical Outcomes
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
- Sex Differences in Patient Satisfaction With Outpatient Obstetrics/Gynecology Care LIPPINCOTT WILLIAMS & WILKINS. 2017: 75S
Impact of Distance to Treatment Center on Care Seeking for Pelvic Floor Disorders.
Female pelvic medicine and reconstructive surgery
The aim of this study was to evaluate the impact of distance from residence to treatment center on access to care for female pelvic floor disorders at an academic institution.A retrospective cross-sectional study was conducted of women seen for pelvic floor disorders at an academic institution from 2008 to 2014. Patient characteristics were extracted from charts. Geographical and US census data was obtained from public records and used to calculate distance from patient residence to physician office. Statistical analysis was performed using R Software (Version 0.98.1102) and Microsoft Excel (Version 14.4.7). Statistical significance was defined as a 2-sided P value of less than 0.05, and the χ test was used to determine associations of categorical variables.A total of 3015 patients were included in the analysis. The mean distance traveled was 93 miles. Thirty percent of patients traveled more than 50 miles. Many patients (43%) reported having the symptoms for more than 2 years. Patients who traveled farther were significantly more likely to be white, English-speaking, and with pelvic organ prolapse as primary complaint. These patients were more likely to plan surgery at the first visit than patients who traveled less far (29% vs 14%). Patients who traveled farther were also more likely to live in counties with a low percentage of persons older than 65 years and low percentage of female inhabitants.Women who travel the farthest for treatment of pelvic floor disorders have experienced the symptoms for longer duration and are more willing to plan surgery at presentation. These women also come from counties with fewer elderly women, suggesting future outreach care should focus on similar geographic areas.
View details for DOI 10.1097/SPV.0000000000000411
View details for PubMedID 28430729
Unplanned Hospital Visits in the First 30 Days After Urethral Sling Procedures.
To evaluate unplanned hospital visits within 30 days of urethral sling placement in the form of emergency department visits, inpatient admissions, or repeat surgery.We accessed nonpublic data from the Office of Statewide Health Planning and Development in the state of California for the years 2005-2011. All female patients who underwent an ambulatory urethral sling procedure (Current Procedural Terminology 57288) without concomitant surgery (other than cystoscopy) were included. Any subsequent emergency department visit, inpatient admission, or sling revision operation within 30 days of the original surgery were then examined.A total of 28,635 women were identified who underwent outpatient urethral sling placement as a sole procedure. Within 30 days, 1630 women (5.7%) had at least 1 unplanned hospital visit. This included 1327 emergency department visits (4.7%), 295 inpatient admissions (1.0%), and 79 sling revisions (0.28%). Urinary retention and Foley catheter problems were the most common emergency department visit diagnoses (18.7% of visits), followed by urinary tract infection (9.3% of visits).One in 18 women will have an unplanned hospital visit within 30 days of urethral sling placement, the majority of which are emergency department visits (~81%). Our findings can be used to improve patient counseling and suggest areas that one might target to decrease unnecessary emergency department visits in the early postoperative period.
View details for DOI 10.1016/j.urology.2017.01.025
View details for PubMedID 28153590
Assessing the use of the IUGA/ICS classification system for prosthesis/graft complications in publications from 2011 to 2015
INTERNATIONAL UROGYNECOLOGY JOURNAL
2016; 27 (12): 1905-1911
Complications of pelvic organ prolapse and urinary incontinence surgery have gained increasing attention from both lay media and medical societies. The International Urogynecological Association and International Continence Society proposed the category-time-site system to classify complications in 2011. Our objective is to assess the usage of the category-time-site system in the literature.We conducted a systematic review and identified records using PubMed search terms "mesh" and "prolapse or incontinence" and "complication or excision" (February 2011 to December 2015) to select publications following the introduction of category-time-site system. Relevant publications were included and reviewed for study design, initial procedure, number of patients assigned codes, number of unique codes applied, purpose of assigning codes, and duration of clinical follow-up.Of 167 eligible records, 23 (14 %) used the system, 137 (82 %) used no system, and 7 (4 %) used another system. They included three study designs: randomized control trials, case reports, and case series. Given the very limited amount of data, no statistical tests were performed, but trends were noted.Fourteen percent of the reports in the literature describing complications related to prosthesis/graft use in pelvic surgery utilize the category-time-site system. The system's limited and inconsistent use hinders the ability to draw conclusions useful for clinical practice. Effort should be directed toward improving appropriate usage or revising the system to increase its exposure in related publications. An improved system will better prepare pelvic surgeons for assessing future generations of prostheses/grafts.
View details for DOI 10.1007/s00192-016-3056-y
View details for PubMedID 27250834
When and how to excise vaginal mesh
CURRENT OPINION IN OBSTETRICS & GYNECOLOGY
2016; 28 (4): 311-315
Since 2011, there has been increasing attention paid to the use of synthetic grafts (mesh) in pelvic reconstructive surgery. Although synthetic grafts are considered permanent implants to improve outcomes, the use of this material has created inadvertent complications such as erosion, chronic pain, and dyspareunia. Patient evaluation is complex and surgical techniques carry risks not yet completely understood. This review summarizes current opinions in synthetic graft excision for the treatment of mesh-related complications.Recent studies reveal excisions are being increasingly performed and graft placement is decreasing. Patients of lower-volume surgeons have a higher risk of complication and need for excisional procedures. Pain is becoming the most common indication for vaginal mesh excision and that pain is mostly elicited with palpation of the mesh arms. Explantation is technically challenging and carries significant risks.Vaginal synthetic graft complications are increasingly being managed by surgical excision. Careful evaluation of patient symptoms and objective findings should help guide management. Surgeons considering operative management should counsel patients regarding the risks of excision including but not limited to hemorrhage, nerve damage, muscular injury, and recurrent symptoms.
View details for DOI 10.1097/GCO.0000000000000292
View details for Web of Science ID 000379586200014
View details for PubMedID 27273309
- Glomus Tumor Excision With Clitoral Preservation. Journal of lower genital tract disease 2016; 20 (2): e20-1
Symptom Improvement After Prolapse and Incontinence Graft Removal in a Case Series of 306 Patients
FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY
2015; 21 (6): 319-324
We report our experience with removal of synthetic and biologic implants used in pelvic reconstruction in a tertiary referral center from 2005 to 2012.We performed a retrospective cohort study of all consecutive patients who underwent surgical implant removal for treatment of implant-related complications. Symptoms were determined by patient self-assessment including validated questionnaires. One hundred seventy-nine patients completed follow-up.Three hundred six patients underwent removal for exposure or erosion (57%), pain (46%), and urinary symptoms or incontinence (54%). Ninety patients (29%) had previous revision. Eleven percent had pelvic organ prolapse (POP) implants, 48% had sling implants, and 41% had both implants. Mean time from removal to follow-up was 2 years (median, 2 years; range, <1-7).The majority of patients experienced symptom improvement after implant removal. Seventy-eight percent of those with pain reported pain improvement, 9% reported no change, and 14% experienced worsening. Symptom improvement was reported by 79% of those who underwent removal of a POP implant alone, 79% of those who underwent removal of POP and sling implants, and 83% of those who underwent removal of a sling alone. Quality of life was significantly improved after implant removal overall (P < 0.05) for those who underwent removal of POP and slings, and slings alone, but not for those with POP removal only.Pain is among the most common symptoms reported in women referred to our institution for implant-related complications. In a series of 306 complex patients with a range of implants and symptoms, removal improved implant-related pain in the majority of patients.
View details for DOI 10.1097/SPV.0000000000000191
View details for Web of Science ID 000364314600005
View details for PubMedID 26506159
- Challenges in the Treatment of Overactive Bladder in the Octogenarian Female CURRENT BLADDER DYSFUNCTION REPORTS 2015; 10 (1): 14–19
Long-term symptom improvement and overall satisfaction after prolapse and incontinence graft removal.
Female pelvic medicine and reconstructive surgery
2013; 19 (6): 352-355
We report long-term symptom improvements and overall satisfaction in patients after removal of grafts used in pelvic reconstruction in a tertiary referral center.We analyzed patients who underwent graft removal for treatment of related complications and who were followed for at least 2 years. Symptoms were determined by patient self-assessment questionnaires.Seventy-nine patients underwent partial or complete graft removal from 2005 to 2011 and met inclusion criteria. The mean follow-up time was 4.0 years (median, 3.4 years; range, 2.0-7.6 years). Forty-seven percent (37 patients) had implants for both prolapse and incontinence, 40% (32 patients) had incontinence implants only, and 13% (10 patients) had prolapse implants only. Thirty percent of those with both implants presented with multiple symptoms compared to 50% of those with prolapse implants and 44% of those with incontinence implants only. At follow-up, 75% (56 patients) reported that their symptoms were better and 15% (11 patients) reported that their symptoms were worse. Of patients who underwent graft removal for pain alone, 74% (17 patients) improved whereas17% (4 patients) were worse. When asked about spending the rest of their lives with their current symptoms, 49% (38 patients) reported positively whereas 44% (34 patients) reported negatively. Forty-one patients underwent one or more additional treatments.Graft-related complications are often treated with surgical excision. In a cohort of 79 patients in whom implants were removed an average of 4 years earlier, 75% still report symptom improvement and 49% report good quality of life. However, many patients still feel dissatisfied and sought additional treatment during long-term follow-up. These data can be used to counsel patients considering removal of pelvic reconstruction grafts.
View details for DOI 10.1097/SPV.0b013e3182a4488b
View details for PubMedID 24165449
Current trends in surgical repair of pelvic organ prolapse
CURRENT OPINION IN OBSTETRICS & GYNECOLOGY
2013; 25 (5): 395-398
Over the past decade, surgical prolapse correction has evolved significantly, taking a sharp turn in 2011 when the USFDA publicly questioned synthetic graft safety. This controversy has been widely publicized and debated amongst laymen and experts alike. This review summarizes current trends in mesh implantation for prolapse repair, highlighting the impact of the current controversy.Recent studies revealed nonmesh prolapse repair may have better outcomes than previously reported; the USFDA states there is insufficient evidence to support vaginal mesh for apical or posterior compartment prolapse; mesh prolapse repair increased over the past decade, 75% of which was placed vaginally; approximately 30% of mesh prolapse repair is performed with hysterectomy and approximately 40% is performed with concomitant incontinence repair. Anterior and apical prolapse are most likely to include mesh and of apical repair procedures, minimally invasive approaches exceed laparotomy.This year's population-based studies describe the impact of surgeon experience, prolapse compartment, and national trends in surgical technique on mesh prolapse repair. The impact of the recent investigation on future mesh use remains unknown.
View details for DOI 10.1097/GCO.0b013e3283648cfb
View details for Web of Science ID 000326586300009
View details for PubMedID 24018877
Trends in the Surgical Management of Stress Urinary Incontinence Among Female Medicare Beneficiaries, 2002-2007
2013; 82 (1): 38-42
To describe trends in the surgical management of female stress urinary incontinence (SUI) in the United States from 2002 to 2007.As part of the Urologic Diseases of America Project, we analyzed data from a 5% national random sample of female Medicare beneficiaries aged 65 and older. Data were obtained from the Centers for Medicare and Medicaid Services carrier and outpatient files from 2002 to 2007. Women who were diagnosed with urinary incontinence identified by the International Classification of Diseases, Ninth Edition (ICD-9) diagnosis codes and who underwent surgical management identified by Current Procedural Terminology, Fourth Edition (CPT-4) procedure codes were included in the analysis. Trends were analyzed over the 6-year period. Unweighted procedure counts were multiplied by 20 to estimate the rate among all female Medicare beneficiaries.The total number of surgical procedures remained stable during the study period, from 49,340 in 2002 to 49,900 in 2007. Slings were the most common procedure across all years, which increased from 25,840 procedures in 2002 to 33,880 procedures in 2007. Injectable bulking agents were the second most common procedure, which accounted for 14,100 procedures in 2002 but decreased to 11,320 in 2007. Procedures performed in ambulatory surgery centers and physician offices increased, although those performed in inpatient settings declined. Hospital outpatient procedures remained stable.The surgical management of women with SUI shifted toward a dominance of procedures performed in ambulatory surgery centers from 2002 to 2007, although the overall number of procedures remained stable. Slings remained the dominant surgical procedure, followed by injectable bulking agents, both of which are easily performed in outpatient settings.
View details for DOI 10.1016/j.urology.2012.10.087
View details for Web of Science ID 000321036200013
View details for PubMedID 23706251
How Dry is "OAB-Dry"? Perspectives from Patients and Physician Experts
JOURNAL OF UROLOGY
2012; 188 (5): 1811-1815
Overactive bladder is subtyped into overactive bladder-wet and overactive bladder-dry, based on the presence or absence, respectively, of urgency incontinence. To better understand patient and physician perspectives on symptoms among women with overactive bladder-wet and overactive bladder-dry, we performed patient focus groups and interviews with experts in urinary incontinence.Five focus groups totaling 33 patients with overactive bladder symptoms, including 3 groups of overactive bladder-wet and 2 groups of overactive bladder-dry patients, were conducted. Topics addressed patient perceptions of overactive bladder symptoms, treatments and outcomes. A total of 12 expert interviews were then done in which experts were asked to describe their views on overactive bladder-wet and overactive bladder-dry. Focus groups and expert interviews were transcribed verbatim. Qualitative data analysis was performed using grounded theory methodology, as described by Charmaz.During the focus groups sessions, women screened as overactive bladder-dry shared the knowledge that they would probably leak if no toilet were available. This knowledge was based on a history of leakage episodes in the past. Those few patients with no history of leakage had a clinical picture more consistent with painful bladder syndrome than overactive bladder. Physician expert interviews revealed the belief that many patients labeled as overactive bladder-dry may actually be mild overactive bladder-wet.Qualitative data from focus groups and interviews with experts suggest that a spectrum exists between very mild overactive bladder-wet and severe overactive bladder-wet. Scientific investigations are needed to determine whether urgency without fear of leakage constitutes a unique clinical entity.
View details for DOI 10.1016/j.juro.2012.07.044
View details for Web of Science ID 000310438600049
View details for PubMedID 22999694
Long-Term Durability of the Distal Urethral Polypropylene Sling for the Treatment of Stress Urinary Incontinence: Minimum 11-Year Followup
JOURNAL OF UROLOGY
2012; 188 (5): 1822-1827
We report on the long-term outcomes of the distal urethral polypropylene sling for stress urinary incontinence in a patient cohort that was closely followed and whose outcomes were reported at 1 and 5 years after surgery.We performed a prospective study of all consecutive patients who underwent a distal urethral polypropylene sling procedure between November 1999 and April 2000. The 1 and 5-year outcomes for this particular patient cohort were previously reported. At the minimum 11-year followup, outcome was determined by patient self-assessment including validated questionnaires.A total of 69 patients were followed prospectively and followup was obtained for 30. Of those lost to followup 10 were deceased and 5 were cognitively impaired. Mean patient age at followup was 73 years (range 40 to 97). More than 11 years after surgery 48% of patients reported no stress urinary incontinence symptoms and 63% were never bothered by stress urinary incontinence. Patients reported a mean overall symptom improvement of 64% compared to 81% at 5 years. Overall 82% of patients met the criteria for treatment success by symptom scores and 80% met the criteria by bother scores.The distal urethral polypropylene sling procedure has excellent long-term durability in the treatment of stress urinary incontinence, in addition to low morbidity and low cost as previously described. Eleven years after the procedure the majority of patients report symptom improvement. Nevertheless, many older patients are unable to participate in followup. When choosing an anti-incontinence procedure, durability should be considered in light of patient age given that the theoretical advantages of long-term durability are limited by cognitive decline and mortality.
View details for DOI 10.1016/j.juro.2012.07.033
View details for Web of Science ID 000310438600051
View details for PubMedID 22999687
Trends in Surgical Mesh Use for Pelvic Organ Prolapse From 2000 to 2010
OBSTETRICS AND GYNECOLOGY
2012; 120 (5): 1105-1115
To describe trends in and predictors of surgical mesh use for pelvic organ prolapse (POP) repair and to estimate the influence of safety advisories on mesh use.Analysis of women aged 18 years and older recorded in a health care quality and resource utilization database who underwent POP repair from 2000 to 2010, identified by International Classification of Diseases, 9th Revision, Clinical Modification procedure codes, and stratified by mesh use. Odds ratios were calculated with adjustments for patient, physician, and hospital-level characteristics.Among 273,275 women in the cohort, 64,968 (23.8%) underwent a mesh-augmented repair. Concurrent incontinence surgery was a strong predictor of mesh use (odds ratio [OR] 9.95; 95% confidence interval [CI] 9.70-10.21). Mesh use increased from 7.9% in 2000 to a peak of 32.1% in 2006, and declined slightly to 27.5% in 2010. Among women without incontinence, mesh use increased from 3.3% in 2000 to 13.5% in 2006, and remained stable at 12.8% in 2010. Intermediate-volume (OR 1.53; 95% CI 1.44-1.62) and high-volume (OR 2.74; 95% CI 2.58-2.92) surgeons were more likely to use mesh than low-volume surgeons. Compared with women who underwent operation by gynecologists, those treated by urologists were more than three times more likely to undergo mesh-augmented prolapse repair (OR 3.36; 95% CI 3.09-3.66). Black women were 27% less likely to undergo mesh repair (OR 0.73; 95% CI 0.66-0.82).Mesh-augmented prolapse repairs increased substantially over the past decade, and this increase was most pronounced in the years before the publication of safety advisories. Physician specialty and surgical volume are important factors underlying mesh use. Additional measures must ensure evidence-based use of mesh for pelvic reconstruction.II.
View details for DOI 10.1097/AOG.0b013e31826ebcc2
View details for PubMedID 23090529
Foreign body in the bladder 11 years after intravaginal pessary
INTERNATIONAL UROGYNECOLOGY JOURNAL
2012; 23 (9): 1311-1313
Vaginal pessaries used for symptomatic pelvic organ prolapse (POP) rarely develop complications when regularly monitored. However, many reports of complications of neglected pessaries have been described. Patients presenting with pessary complications report a variety of symptoms ranging from malodorous discharge or recurrent infections to more severe symptoms such as vaginal bleeding, complete urinary incontinence, or defecatory obstruction. Complete pessary encapsulation within the bladder is rare. We present the case of a 79-year-old postmenopausal woman referred to a tertiary care center for treatment of a large intravesical foreign body 11 years after pessary placement. The patient successfully underwent minimally invasive surgery to remove the foreign body and repair the bladder defect. Physicians should have a low threshold for diagnostic imaging in patients presenting with unclear history. Large intravesical foreign bodies can be removed by a vaginal approach with good outcomes.
View details for DOI 10.1007/s00192-012-1722-2
View details for Web of Science ID 000307705500028
View details for PubMedID 22402642
Surgical options for apical prolapse repair.
Women's health (London, England)
2012; 8 (5): 557-566
Pelvic organ prolapse is a common medical condition that affects the quality of life of many women. Approximately 50% of parous women have pelvic organ prolapse and the lifetime risk for surgical intervention is 6.7% at the age of 80 years. In the USA, the number of women at risk for symptomatic prolapse is increasing, which is consistent with the recent increase in the overall number of prolapse and incontinence procedures being performed. Although prolapse is usually multicompartmental and isolated defects are rare, the apical compartment deserves special attention because apical support is integral to a durable prolapse repair. Since many women may initially present to their primary care physicians, all members of the medical community should have a basic understanding of the diagnosis and treatment for apical prolapse.
View details for DOI 10.2217/whe.12.44
View details for PubMedID 22934729
Missed diagnosis of complete urethral transection after sling: the case for translabial ultrasound.
Female pelvic medicine and reconstructive surgery
2012; 18 (1): 60-62
Patients with complications of urethral sling placement for stress urinary incontinence are often treated for recurrent symptoms for years after initial reassuring evaluation. Translabial ultrasound is a noninvasive modality with minimal risks that can clearly diagnose urethral mesh complications. We present a 47-year-old premenopausal woman referred for treatment of urethral stricture and diverticulum 8 years after mesh sling placement. The diagnosis was made at an outside institution by voiding cystourethrogram and cystoscopy. However, translabial ultrasound confirmed the diagnosis of complete urethral transection, and the patient underwent a complex urethral reconstruction. Ultrasound should be used to evaluate patients with a history of urethral sling and persistent lower urinary tract symptoms. Referral to a center with advanced pelvic reconstruction services may be required.
View details for DOI 10.1097/SPV.0b013e31823bc342
View details for PubMedID 22453271
The Effect of Surgeon Volume on Outcomes and Resource Use for Vaginal Hysterectomy
OBSTETRICS AND GYNECOLOGY
2010; 116 (6): 1341-1347
To estimate the effect of surgical volume on outcomes and resource use in women undergoing vaginal hysterectomy.Women who underwent total vaginal hysterectomy and were registered in the Perspective database were examined. Perspective is a nationwide database developed to measure quality and resource use. Procedure-associated intraoperative, perioperative, and postoperative medical complications as well as hospital readmission, length of stay, intensive care unit (ICU) use, operating time, and cost were analyzed. Based on the overall gynecologic surgical volume and vaginal surgical volume of their surgeons, patients were stratified into tertiles. Complications were compared using adjusted generalized estimating equations and reported as odds ratios (ORs).A total of 77,109 patients operated on by 6,195 gynecologic surgeons were identified. After adjustment for the effects of other demographic variables and concomitant procedures, patients operated on by high-volume vaginal surgeons were 31% (OR 0.69; 95% confidence interval [CI] 0.59-0.80) less likely to experience an operative injury, whereas perioperative complications were reduced by 19% (OR 0.81; 95% CI 0.72-0.92), medical complications decreased by 24% (OR 0.76; 95% CI 0.67-0.86), ICU admission reduced by 46% (OR 0.56; 95% CI 0.43-0.73), and the transfusion rate decreased by 28% (OR 0.72; 95% CI 0.61-0.85) in patients treated by high-volume vaginal surgeons, whereas rates of readmission were higher (OR 1.24; 95% CI 1.04-1.47) in patients treated by high-volume surgeons. Operative times were lower in patients operated on by high-volume surgeons (P<.001). Although total gynecologic surgical volume had no effect on cost, patients treated by high-volume vaginal surgeons had lower costs (P<.001).Perioperative morbidity and resource use are lower in women undergoing vaginal hysterectomy when the procedure is performed by high-volume vaginal surgeons.
View details for DOI 10.1097/AOG.0b013e3181fca8c5
View details for Web of Science ID 000284491000015
View details for PubMedID 21099600