Lisa Rogo-Gupta

All Publications

• Low-fat dietary pattern reduces urinary incontinence in postmenopausal women: post hoc analysis of the Women's Health Initiative Diet Modification Trial. AJOG global reports Rogo-Gupta, L. J., Yang, L., Stefanick, M. L., Hedlin, H., Wallace, R., Woods, N., Breyer, B. N., Sorensen, M. D., Chen, B. 2022; 2 (1): 100044

  Abstract

  BACKGROUND: Urinary incontinence affects >40% of women in the United States, with an annual societal cost of >$12 billion and demonstrated associations with depressive symptoms, social isolation, and loss of work productivity. Weight has been established as an exposure that increases urinary incontinence risk and certain dietary components have been associated with urinary incontinence symptoms. We hypothesized that diet plays a key role in the association between weight and urinary incontinence in US women.OBJECTIVE: This study aimed to examine the effect of a low-fat diet on urinary incontinence in postmenopausal women as a post hoc analysis of a randomized controlled trial of diet modification.STUDY DESIGN: This was a post hoc analysis of the Women's Health Initiative Dietary Modification randomized controlled trial of 48,835 postmenopausal women from 40 US centers assigned to a dietary intervention (20% energy from fat, 5 fruits or vegetable servings, and 6 whole grain servings daily and an intensive behavioral modification program) or to the usual diet comparison group. The outcome was urinary incontinence at 1 year.RESULTS: Of the participants, 60% were randomized to the usual diet comparison group and 40% to the dietary modification intervention. After adjusting for weight change, women assigned to the dietary modification intervention were less likely to report urinary incontinence (odds ratio, 0.94; 95% confidence interval, 0.90-0.98; P=.003), more likely to report urinary incontinence resolution (odds ratio, 1.11; 95% confidence interval, 1.03-1.19; P=.01), and less likely to develop urinary incontinence (odds ratio, 0.92; 95% confidence interval, 0.87-0.98; P=.01) in adjusted models.CONCLUSION: Dietary modification may be a reasonable treatment for postmenopausal women with incontinence and also a urinary incontinence prevention strategy for continent women. Our results provide evidence to support a randomized clinical trial to determine whether a reduced fat-intake dietary modification is an effective intervention for the prevention and treatment of urinary incontinence. In addition to providing further insights into mechanisms of lower urinary tract symptoms, these findings may have a substantial impact on public health based on the evidence that diet seems to be a modifiable risk factor for urinary incontinence.

  View details for DOI 10.1016/j.xagr.2021.100044

  View details for PubMedID 36274962

• Supracervical Hysterectomy is Protective Against Mesh Complications After Robotic-Assisted Abdominal Sacrocolpopexy: A Population Based Cohort Study of 12,189 Patients. The Journal of urology Dallas, K., Taich, L., Kuhlmann, P., Rogo-Gupta, L., Eilber, K., Anger, J. T., Scott, V. 2021: 101097JU0000000000002262

  Abstract

  INTRODUCTION: Although Minimally Invasive (robotic or laparoscopic) Abdominal Sacrocolpopexy (MISC) has become the new gold-standard for durable pelvic organ prolapse (POP) repair after the vaginal mesh controversy, current literature is limited. Our objective here is to study of mesh complications after MISC.METHODS: All women undergoing MISC in California from 01/2012-12/2018 were identified from the Office of Statewide Health Planning and Development datasets using appropriate ICD-9/10 and CPT codes. Univariate and multivariable analyses was performed to assess associations between patient demographics, surgical details and our primary outcomes: rates of reoperation for a mesh complication.RESULTS: Of 12,189 women undergoing MISC, 8,398 (68.9%) had concomitant hysterectomy. Total hysterectomy (TH) and supracervical hysterectomy (SCH) were performed in 5,027 (41.2%), and 3,371 (27.6%) cases, respectively. Reoperation rates for mesh complications were lower after SCH versus TH cases (overall: 0.7%-mean follow up time 1,111 days vs. 3.1%-mean follow up time 1,095 days, p <0.001; subcohort with at least 4 years of follow-up: 2.1% vs. 8.9%, p <0.001). Additionally, mesh complication rates were higher even if TH was performed remotely, as compared to concomitant SCH (5.2% vs. 0.7%, p <0.001). The increased risk for reoperation due to mesh complications after TH was preserved on multivariable analysis (OR 4.20, 95% CI 2.72-6.50, p <0.001).CONCLUSIONS AND RELEVANCE: Concomitant total hysterectomy at time of MISC is associated with a significantly higher rate of mesh complication as compared to supracervical hysterectomy. The increased risk of a mesh complication associated with TH is present even if the TH was performed prior to the MISC.

  View details for DOI 10.1097/JU.0000000000002262

  View details for PubMedID 34694142

• 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

  Abstract

  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

• Racial Disparities in Outcomes of Women Undergoing Myomectomy. Obstetrics and gynecology Dallas, K., Dubinskaya, A., Andebrhan, S. B., Anger, J., Rogo-Gupta, L. J., Elliott, C. S., Ackerman, A. L. 2021

  Abstract

  To assess the association of racial and socioeconomic factors with outcomes of abdominal myomectomies.All women undergoing abdominal myomectomy in California from 2005 to 2012 were identified from the OSHPD (Office of Statewide Health Planning and Development) using appropriate International Classification of Diseases and Current Procedural Terminology codes. Demographics, comorbidities, surgical approaches, and complications occurring within 30 days of the procedure were identified. Multivariate associations were assessed with mixed effects logistic regression models.The cohort of 35,151 women was racially and ethnically diverse (White, 38.8%; Black, 19.9%; Hispanic, 20.3%; and Asian, 15.3%). Among all procedures, 33,906 were performed through an open abdominal approach, and 1,245 were performed using a minimally invasive approach. Proportionally, Black patients were more likely than White patients to have open procedures, and open approaches were associated with higher complication rates. Overall, 2,622 (7.5%) women suffered at least one complication. Although severe complications did not vary by race or ethnicity, Black (9.0%), Hispanic (7.9%), and Asian (7.5%) patients were more likely to suffer complications of any severity compared with White patients (6.7%, P<.001). As compared with patients with private insurance (6.4%), those with indigent payer status (Medicaid [12.1%] and self-pay [11.1%]) had higher complication rates (P<.001). Controlling for all factors, Black and Asian patients were more likely to suffer complications compared with White patients.The overall complication rate after abdominal myomectomy was 7.5%. Comorbidities, an open approach, and indigent payer status were associated with increased complication risk. Controlling for all factors, Black and Asian patients still had increased risks of complications.

  View details for DOI 10.1097/AOG.0000000000004581

  View details for PubMedID 34735384

• 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

  Abstract

  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

• Joint position statement on the management of mesh-related complications for the FPMRS specialist INTERNATIONAL UROGYNECOLOGY JOURNAL Rardin, C. R., Duckett, J., Milani, A. L., Pavan, L., Rogo-Gupta, L., Twiss, C. O., Joint Writing Grp Amer Urogyne, Int Urogynecological Assoc 2020

  Abstract

  The scientific approach to categorizing mesh complications and optimal methods to address them have been complicated by the rapid proliferation and evolution of materials and techniques that have been used over the past 20 years in surgical treatment of pelvic floor disorders. In addition, terminology used to diagnose and categorize mesh complications and the descriptions of surgical procedures to manage them have been adopted inconsistently, further hampering the development of a collective experience with a standardized lexicon. Finally, much of the high-quality data on management of mesh complications is based on materials that are rarely used or not commercially available today.Women experiencing mesh complications need to be heard and should have access to resources and providers who are most able to help. Many women require multiple procedures to address their mesh complications, and for some of these patients, relief is incomplete. We should strive to optimize the treatment at the initial diagnosis of a mesh-related complication.This Position Statement has 4 goals:1. Using the best and most relevant evidence available, provide guidance for the FPMRS subspecialist caring for patients who may be experiencing mesh complications2: Provide an algorithm outlining treatment choices for patients with mesh-related complications that can be used as a platform for shared decision making in the treatment of these complications3: Identify and prioritize gaps in evidence concerning specific mesh complications and their treatments4: Identify provider and health facility characteristics that may optimize the outcomes of treatments for these complications.

  View details for DOI 10.1007/s00192-020-04248-x

  View details for Web of Science ID 000518139100002

  View details for PubMedID 32112158

• The transvaginal pelvic organ prolapse mesh ban - unfairly including biologic products? Elliott, C., Sokol, E., Rogo-Gupta, L. WILEY. 2020: S270

  View details for Web of Science ID 000519661200334

• Validated surgical steps of the robotic assisted sacrocolpopexy operation Dallas, K., Ackerman, A., Eilber, K., Rogo-Gupta, L., Scott, V., Troung, M., Cohen, T., Anger, J. WILEY. 2020: S274–S276

  View details for Web of Science ID 000519661200340

• INCIDENCE OF PELVIC FLOOR DISORDERS IN US ARMY FEMALE SOLDIERS. Urology Rogo-Gupta, L. J., Nelson, D. A., Young-Lin, N. n., Shaw, J. G., Kurina, L. M. 2020

  Abstract

  To determine the incidence of pelvic floor disorders (PFD) among active-duty US Army female soldiers.We studied 102,015 women for incident PFD using the Stanford Military Data Repository, which comprises medical, demographic and service-related information on all soldiers on active duty in the US Army during 2011-14. Cox proportional hazards estimated adjusted associations with PFD diagnoses. In the adjusted models, military-specific characteristics and fitness were evaluated alongside known PFD predictors.Among 102,015 subjects at risk there was a cumulative incidence of 6.4% over a mean of 27 months (median 29, range 1-42). In adjusted models, obese soldiers were more likely to have a PFD compared to those of normal weight (HR 1.23, CI 1.14-1.34, p<0.001) and those with recent weight gain were more likely to have a PFD compared to those without (HR 1.32, CI 1.24-1.40, p<0.05). Women with the lowest physical fitness scores were more likely to have a PFD (HR 1.14, CI 1.04-1.25) compared to those with the highest scores.Over a median follow-up time of 29 months, 1 in 15 women in this active-duty cohort was diagnosed with a PFD. Optimizing risk factors including BMI and physical fitness may benefit the pelvic health of female soldiers, independent of age, children, and years of service.

  View details for DOI 10.1016/j.urology.2020.05.085

  View details for PubMedID 32650018

• Predictors of Colpocleisis Outcomes in an Older Population-Based Cohort. The Journal of urology Dallas, K. B., Anger, J. T., Rogo-Gupta, L. n., Elliott, C. S. 2020: 101097JU0000000000001239

  Abstract

  Colpocleisis is an obliterative surgical option for women with pelvic organ prolapse (POP) which is often performed in a frail population. However, due to the fact that outcomes remain largely unknown we aimed to assess the durability and perioperative safety of colpocleisis in a large population-based cohort.All women undergoing colpocleisis and other POP repairs in California (2005-2011) were identified using the Office of Statewide Health Planning and Development datasets. Durability was defined as the absence of future POP repair after index repair for the duration of the datasets. Thirty-day morbidity was assessed by identifying readmissions, repeat surgeries, and complications. A metric to assess frailty in large administrative databases was applied to assess the impact of frailty on outcomes. Colpocleisis outcomes were compared to other types of POP repairs by developing propensity score matched groups.Of the 2,707 women undergoing colpocleisis, reoperation for prolapse occurred in 47 (1.8%). At least one complication occurred in 11.1% of the cohort, with serious complications occurring in 2%. Frail patients were more likely to experience any complication (23.3% vs. 10.3%, p<0.01) and a serious complication (5.0% vs. 1.8%, p=0.02) and was the best predictor of morbidity. Colpocleisis was associated with a more durable repair (overall failure 1.8% versus 3.5%, p<0.01) with no difference in complication rates as compared to the matched cohort.Colpocleisis provides a more durable outcome than reconstructive POP repairs, without increased perioperative morbidity. Frailty is a better predictor than age for perioperative complications after colpocleisis.

  View details for DOI 10.1097/JU.0000000000001239

  View details for PubMedID 32648798

• Urologic Injury and Fistula After Hysterectomy for Benign Indications. Obstetrics and gynecology Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. 2019

  Abstract

  OBJECTIVE: To explore the rates and risk factors for sustaining a genitourinary injury during hysterectomy for benign indications.METHODS: In this population-based cohort study, all women who underwent hysterectomy for benign indications were identified from the Office of Statewide Health Planning and Development databases in California (2005-2011). Genitourinary injuries were further classified as identified at the time of hysterectomy, identified after the date of hysterectomy; or unidentified until a fistula developed.RESULTS: Of the 296,130 women undergoing hysterectomy for benign indications, there were 2,817 (1.0%) ureteral injuries, 2,058 (0.7%) bladder injuries and 834 (0.3%) genitourinary fistulas (80/834 of which developed after an injury repair). Diagnosis was delayed in 18.6% and 5.5% of ureteral and bladder injuries, respectively. Subsequent genitourinary fistula development was lower if the injury was identified immediately (compared with delayed) for both ureteral (0.7% vs 3.4% odds ratio [OR] 0.28; 95% CI 0.14-0.57) and bladder injuries (2.5% vs 6.5% OR 0.37; 95% CI 0.16-0.83). Indwelling ureteral stent placement alone was more successful in decreasing the risk of a second ureteral repair for immediately recognized ureteral injuries (99.0% vs 39.8% for delayed injuries). With multivariate adjustment, prolapse repair (OR 1.44, 95% CI 1.30-1.58), an incontinence procedure (OR 1.40, 95% CI 1.21-1.61), mesh augmented prolapse repair (OR 1.55, 95% CI 1.31-1.83), diagnosis of endometriosis (OR 1.46, 95% CI 1.36-1.56), and surgery at a facility in the bottom quartile of hysterectomy volume (OR 1.37, 95% CI 1.01-1.89) were all associated with an increased likelihood of a genitourinary injury. An exclusively vaginal (OR 0.56, 95% CI 0.53-0.64) or laparoscopic (OR 0.80, 95% CI 0.75-0.86) approach was associated with lower risk of a genitourinary injury as compared with an abdominal approach.CONCLUSION: Genitourinary injury occurs in 1.8% of hysterectomies for benign indications; immediate identification and repair is associated with a reduced risk of subsequent genitourinary fistula formation.

  View details for DOI 10.1097/AOG.0000000000003353

  View details for PubMedID 31306326

• Machine Learning Algorithms Successfully Identify the Quality of Lay-Person Directed Articles Online Dallas, K. B., Rogo-Gupta, L., Elliott, C. LIPPINCOTT WILLIAMS & WILKINS. 2019: 222S–223S

  View details for Web of Science ID 000473810000770

• Urologic Injury and Fistula Following Hysterectomy for Benign Indications Dallas, K. B., Rogo-Gupta, L., Elliott, C. LIPPINCOTT WILLIAMS & WILKINS. 2019: 212S

  View details for Web of Science ID 000473810000730

• LONG-TERM REOPERATION RATES ARE EQUIVALENT FOR PELVIC ORGAN PROLAPSE REPAIRS WITH BIOLOGIC AND SYNTHETIC GRAFTS IN A LARGE POPULATION BASED COHORT Sohlberg, E., Dallas, K., Elliott, C., Rogo-Gupta, L. LIPPINCOTT WILLIAMS & WILKINS. 2019: E17–E18

  View details for Web of Science ID 000473345200038

• UROLOGIC INJURY AND FISTULA FOLLOWING HYSTERECTOMY FOR BENIGN INDICATIONS Dallas, K., Rogo-Gupta, L., Elliott, C. LIPPINCOTT WILLIAMS & WILKINS. 2019: E17

  View details for Web of Science ID 000473345200037

• PROPHYLACTIC MIDURETHRAL SLINGS AT THE TIME OF PELVIC ORGAN PROLAPSE REPAIR SURGERY TO PREVENT DE-NOVO STRESS URINARY INCONTINENCE-A NEED TO REAPPRAISE? Dallas, K., Rogo-Gupta, L., Syan, R., Enemchukwu, E., Elliott, C. LIPPINCOTT WILLIAMS & WILKINS. 2019: E64–E65

  View details for Web of Science ID 000473345200139

• Long-term reoperation rates are equivalent for pelvic organ prolapse repairs with biologic and synthetic grafts in a large population based cohort Dallas, K. B., Sohlberg, E., Elliott, C. S., Rogo-Gupta, L. WILEY. 2019: S228–S229

  View details for Web of Science ID 000462357800318

• Ureteral injury and fistula following hysterectomy for benign indications Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. 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? Dallas, K. B., Rogo-Gupta, L., Syan, R., Enemchukwu, E., Elliott, C. S. 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 Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. WILEY. 2019: S115

  View details for Web of Science ID 000462357800140

• 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

  View details for DOI 10.1016/j.urology.2018.09.008

  View details for Web of Science ID 000454535600026

• Does Rectocele on Defecography Equate to Rectocele on Physical Examination in Patients With Defecatory Symptoms? Female pelvic medicine & reconstructive surgery Wallace, S. L., Torosis, M. n., Rogo-Gupta, L. n. 2019

  Abstract

  Our primary objective was to determine the association between rectocele size on defecography and physical examination in symptomatic patients. Our secondary objective was to describe the associations between both defecography and physical examination findings with defecatory symptoms and progression to surgical repair of rectocele.We performed a retrospective review of all patients referred to a female pelvic medicine and reconstructive surgery clinic with a diagnosis of rectocele based on defecography and/or physical examination at a single institution from 2003 to 2017. Patients who did not have defecatory symptoms, did not undergo defecography imaging, or did not have a physical examination in a female pelvic medicine and reconstructive surgery clinic within 12 months of defecography imaging were excluded.Of 200 patients, 181 (90.5%) had a rectocele diagnosed on defecography and 170 (85%) had a rectocele diagnosed on physical examination. Pearson and Spearman tests of correlation both showed a positive relationship between the rectocele size on defecography and rectocele stage on physical examination; however, one was not reliable to predict the results of the other (Pearson correlation = 0.25; Spearman ρ = 0.29). The strongest predictor of surgery was rectocele stage on physical examination (P < 0.001). Size of rectocele on defecography was not a strong independent predictor for surgery (P = 0.01), although its significance improved with the addition of splinting (P = 0.004).Our results suggest that rectocele on defecography does not necessarily equate to rectocele on physical examination in patients with defecatory symptoms. Rectocele on physical examination was more predictive for surgery than rectocele on defecography.

  View details for DOI 10.1097/SPV.0000000000000719

  View details for PubMedID 31390332

• Reoperation rates for pelvic organ prolapse repairs with biologic and synthetic grafts in a large population-based cohort. International urogynecology journal Sohlberg, E. M., Dallas, K. B., Weeks, B. T., Elliott, C. S., Rogo-Gupta, L. n. 2019

  Abstract

  As the long-term complications of synthetic mesh become increasingly apparent, re-evaluation of alternative graft options for pelvic organ prolapse (POP) repairs is critical. We sought to compare the long-term reoperation rates of biologic and synthetic grafts in POP repair.Using the California Office of Statewide Health Planning and Development database, we identified all women who underwent index inpatient POP repair with either a synthetic or biologic graft between 2005 and 2011 in the state of California. ICD-9 and CPT codes were used to identify subsequent surgeries in these patients for either recurrent POP or a graft complication.A total of 14,192 women underwent POP repair with a biologic (14%) or synthetic graft (86%) during the study period. Women with biologic grafts had increased rates of surgery for recurrent pelvic organ prolapse (3.6% vs 2.5%, p = 0.01), whereas women with synthetic grafts had higher rates of repeat surgery for a graft complication (3.0 vs 2.0%, p = 0.02). There were no significant differences between the overall risk of repeat surgery between the groups (5.7% vs 5.6%, p = 0.79). These effects persisted in multivariate modeling.We demonstrate in a large population-based cohort that biologic grafts are associated with an increased rate of repeat surgery for POP recurrence whereas synthetic mesh is associated with an increased rate of repeat surgery for a graft complication. These competing risks result in an equivalent overall any-cause repeat surgery rate between the groups. These data suggest that neither type of graft should be excluded from use and encourage a personalized risk assessment.

  View details for DOI 10.1007/s00192-019-04035-3

  View details for PubMedID 31312846

• 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

  View details for DOI 10.1097/AOG.0000000000002913

  View details for Web of Science ID 000454043200006

• Care Seeking Patterns for Women Requiring a Repeat Pelvic Organ Prolapse Surgery Due to Native Tissue Repair Failure Compared to a Mesh Complication UROLOGY Dallas, K. B., Trimble, R., Rogo-Gupta, L., Elliott, C. S. 2018; 122: 70–75

  View details for DOI 10.1016/j.urology.2018.017

  View details for Web of Science ID 000452833300022

• 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

  Abstract

  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

  Abstract

  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

• Care Seeking Patterns for Women Requiring a Repeat Pelvic Organ Prolapse Surgery due to Native Tissue Repair Failure Compared to a Mesh Complication. Urology Dallas, K. B., Trimble, R., Rogo-Gupta, L., Elliott, C. S. 2018

  Abstract

  OBJECTIVE: To explore patient migration patterns in patients requiring repeat surgery after Pelvic Organ Prolapse repair as there is a limited understanding of care seeking patterns for repeat surgery after Pelvic Organ Prolapse (POP) repair. We hypothesized that undergoing repeat surgery for a prolapse mesh complication would be associated with an increased incidence of migration to a new facility for care compared to those undergoing repeat surgery for recurrent POP.METHODS: In this retrospective population based study, all females who underwent an index POP repair procedure (with or without mesh) at non-federal facilities who subsequently underwent a repeat surgery (recurrent prolapse repair or mesh complication) were identified from the Office of Statewide Health Planning and Development (OSHPD) for the state of California (2005-2011). The location of index repair and repeat surgery were identified and factors associated with migration were explored.RESULTS: Of the 3,930 women who underwent repeat surgery for either POP recurrence or a mesh complication, 1,331 (33.9%) had surgery at a new facility. Multivariate analysis revealed that mesh complications (OR 1.28, p=0.004) or native tissue same compartment recurrence (OR 1.19, p=0.02) were both associated with increased odds of undergoing surgery at a new facility. Having surgery in a county with multiple centers increased the odds of migration to a new facility for care (OR=1.33, p<0.001), unless the initial repair was at a high volume institution (OR=0.32, p<0.001). Overall across indications, women changing locations for their second surgery tended to migrate towards select centers in urban areas.DISCUSSION: Women who undergo repeat surgery after POP repair have similar patterns of migration to a new facility irrespective of the indication for surgery.

  View details for PubMedID 30170088

• What Impacts the All Cause Risk of Reoperation after Pelvic Organ Prolapse Repair? A Comparison of Mesh and Native Tissue Approaches in 110,329 Women JOURNAL OF UROLOGY Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. 2018; 200 (2): 389–95

  View details for DOI 10.1016/j.juro.2018.02.3093

  View details for Web of Science ID 000438718000101

• What Impacts the All Cause Risk of Reoperation after Pelvic Organ Prolapse Repair? A Comparison of Mesh and Native Tissue Approaches in 110,329 Women. The Journal of urology Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. 2018

  Abstract

  INTRODUCTION: Several factors are hypothesized to impact the risks of mesh-augmented pelvic organ prolapse (POP) repair including, 1) characteristics of the material itself, 2) surgical experience, and 3) patient selection. We present a large population-based approach to explore their impact on outcomes and to describe an ideal mesh usage strategy.METHODS: Data from the Office of Statewide Health Planning and Development was accessed identifying all women undergoing POP repair in California from 2005-2011. Multivariate mixed effects logistic regression models were constructed to explore which patient, surgical and facility factors were associated with repeat surgery for a complication due to mesh or POP recurrence.RESULTS: A total of 110,329 women underwent POP repairs during the study period of which 16.2% utilized mesh. The overall repeat surgery rate was higher in women undergoing mesh repairs (5.4% vs 4.3%, p<0.001). However, multivariate modeling revealed that mesh itself was not independently associated with repeat surgery; rather repair at a facility with a greater propensity to utilize mesh was (OR=1.55 in the highest quartile proportion of mesh use, as compared to the lowest, p<0.01). Further modeling revealed the lowest risk occurred when mesh is utilized in 5% of anterior and 10% of anterior-apical repairs.CONCLUSION: Our findings demonstrate mesh is not independently associated with an increase in complication rates for POP repair on a large scale. We present a model that supports judicious use of the product on a population level that balances the risk of complications against that of POP recurrence.

  View details for PubMedID 29510170

• Where do Women go for Revision Surgeries? Geographic Migration Patterns after Urethral Sling Placement in California. Urology practice Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. 2018; 5 (2): 93-100

  Abstract

  Although long-term rates of sling revision after urethral sling placement have been well studied, details of these revisions have not been addressed. In this study we explore the timing, location and migration of patients from one facility to another for revision procedures.Using data from the Office of Statewide Health Planning and Development (OSHPD) for the state of California (2005 to 2011), all females who underwent index outpatient urethral sling procedures at nonfederal facilities were identified (CPT 57288). Cases requiring eventual sling revision or urethrolysis were subsequently identified. Location, distance traveled and factors associated with seeking a new facility for revision were explored.Of the 44,605 patients undergoing urethral sling surgery 842 (1.9%) underwent sling revision, with 178 (22.5%) at a new facility. Facilities in the top 10% of surgical volume placed 41% of the slings and performed more than 50% of revisions. Patient proximity to multiple facilities and increased time between procedures were associated with an increased odds of changing facilities for revision (OR 2.11, p <0.0001 and OR 1.05 per month, p <0.0001, respectively). Placement at a high volume center was associated with decreased odds of changing facilities for revision (OR 0.32, p <0.0001). Patients migrated toward larger centers in urban areas for revision.Overall 78% of sling revisions are performed at the facility where the initial placement was performed. This suggests that the majority of facilities where urethral slings are placed also have the capability of sling revision surgery.

  View details for DOI 10.1016/j.urpr.2017.03.001

  View details for PubMedID 37300204

• Where do Women go for Revision Surgeries? Geographic Migration Patterns after Urethral Sling Placement in California UROLOGY PRACTICE Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. 2018; 5 (2): 93–100

  View details for DOI 10.1016/j.urpr.2017.03.001

  View details for Web of Science ID 000437132300005

• Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology. Women's health issues : official publication of the Jacobs Institute of Women's Health Rogo-Gupta, L. J., Haunschild, C., Altamirano, J., Maldonado, Y. A., Fassiotto, M. 2018; 28 (3): 281-285

  Abstract

  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

  View details for PubMedID 29429946

• THE PREVALENCE OF PELVIC FLOOR DISORDERS IN ACTIVE DUTY FEMALE SOLDIERS: DATA FROM THE STANFORD MILITARY DATA REPOSITORY Rogo-Gupta, L., Nelson, D., Young-Lin, N., Shaw, J., Kurina, L. 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 Syan, R., Dallas, K., Sohlberg, E., Rogo-Gupta, L., Elliott, C., Enemchukwu, E. WILEY. 2018: S567

  View details for Web of Science ID 000427016100081

• CONCOMITANT HYSTERECTOMY LOWERS THE RATE OF RECURRENT PROLAPSE SURGERY FOR ALL COMPARTMENTS IN A COHORT OF OVER 100,000 WOMEN Enemchukwu, E., Dallas, K., Syan, R., Sohlberg, E., Elliott, C., Rogo-Gupta, L. WILEY. 2018: S556

  View details for Web of Science ID 000427016100064

• Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology Women's Health Issues Rogo-Gupta, L. J., Haunschild, C., Altamirano, J., Maldonado, Y., Fassiotto, M. 2018: 281–85

  Abstract

  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 UROLOGY Dallas, K. B., Sohlberg, E. M., Elliott, C. S., Rogo-Gupta, L., Enemchukwu, E. 2017; 110: 70–75

  Abstract

  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 Haunschild, C., Altamirano, J., Fassiotto, M., Rogo-Gupta, L. LIPPINCOTT WILLIAMS & WILKINS. 2017: 75S

  View details for DOI 10.1097/01.AOG.0000514879.75107.12

  View details for Web of Science ID 000402705800266

• Impact of Distance to Treatment Center on Care Seeking for Pelvic Floor Disorders. Female pelvic medicine and reconstructive surgery English, E., Rogo-Gupta, L. 2017

  Abstract

  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. Urology Dallas, K. B., Rogo-Gupta, L., Elliott, C. S. 2017

  Abstract

  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 English, E., Solomon, M., Chen, B., Rogo-Gupta, L. 2016; 27 (12): 1905-1911

  Abstract

  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 Web of Science ID 000389203200017

  View details for PubMedID 27250834

• When and how to excise vaginal mesh CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Rogo-Gupta, L., Castellanos, M. 2016; 28 (4): 311-315

  Abstract

  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 Suharwardy, S., Mahal, A. S., Wieskopf, K., Rogo-Gupta, L. 2016; 20 (2): e20-1

  View details for DOI 10.1097/LGT.0000000000000196

  View details for PubMedID 27015262

• Symptom Improvement After Prolapse and Incontinence Graft Removal in a Case Series of 306 Patients FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY Rogo-Gupta, L., Grisales, T., Huynh, L., Rodriguez, L. V., Raz, S. 2015; 21 (6): 319-324

  Abstract

  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 Rogo-Gupta, L. 2015; 10 (1): 14–19

  View details for DOI 10.1007/s11884-014-0281-4

  View details for Web of Science ID 000420087100003

• Long-term symptom improvement and overall satisfaction after prolapse and incontinence graft removal. Female pelvic medicine and reconstructive surgery Rogo-Gupta, L., Huynh, L., Hartshorn, T. G., Rodríguez, L. V., Raz, S. 2013; 19 (6): 352-355

  Abstract

  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 Rogo-Gupta, L. 2013; 25 (5): 395-398

  Abstract

  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 UROLOGY Rogo-Gupta, L., Litwin, M. S., Saigal, C. S., Anger, J. T. 2013; 82 (1): 38-42

  Abstract

  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 Anger, J. T., Le, T. X., Nissim, H. A., Rogo-Gupta, L., Rashid, R., Behniwal, A., Smith, A. L., Litwin, M. S., Rodriguez, L. V., Wein, A. J., Maliski, S. L. 2012; 188 (5): 1811-1815

  Abstract

  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 Rogo-Gupta, L., Baxter, Z. C., Ngoc-Bich Le, N. B., Raz, S., Rodriguez, L. V. 2012; 188 (5): 1822-1827

  Abstract

  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 Rogo-Gupta, L., Rodriguez, L. V., Litwin, M. S., Herzog, T. J., Neugut, A. I., Lu, Y., Raz, S., Hershman, D. L., Wright, J. D. 2012; 120 (5): 1105-1115

  Abstract

  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 Web of Science ID 000310512500018

  View details for PubMedID 23090529

• Foreign body in the bladder 11 years after intravaginal pessary INTERNATIONAL UROGYNECOLOGY JOURNAL Rogo-Gupta, L., Le, N., Raz, S. 2012; 23 (9): 1311-1313

  Abstract

  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) Le, N., Rogo-Gupta, L., Raz, S. 2012; 8 (5): 557-566

  Abstract

  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 Rogo-Gupta, L., Le, N., Raz, S. 2012; 18 (1): 60-62

  Abstract

  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 Rogo-Gupta, L. J., Lewin, S. N., Kim, J. H., Burke, W. M., Sun, X., Herzog, T. J., Wright, J. D. 2010; 116 (6): 1341-1347

  Abstract

  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