94 results on '"El-Nashar S"'
Search Results
2. 10090 Adnexal Herniation through the Pelvic Floor
- Author
-
Horton, T, primary, Palin, HS, additional, and El Nashar, S, additional
- Published
- 2023
- Full Text
- View/download PDF
3. Robotic-Assisted Laparoscopic Repair of Iatrogenic Vesico-Vaginal Fistula
- Author
-
Duarte Ayala, G., primary, Lewis, G.K., additional, Dinh, T.A., additional, Chen, A.H., additional, and EL Nashar, S., additional
- Published
- 2022
- Full Text
- View/download PDF
4. 11769 The Impact of Targeted Endometriosis Treatment on Patient with Central Sensitization: A Systematic Review.
- Author
-
Gomez-Llerena, A, Shekhawat, P, Pradeep, A, Clifton, V, El Nashar, S, and Carrubba, AR
- Abstract
Patients with endometriosis have variable symptom severity. Central sensitization (CSS), a condition where the central nervous system amplifies pain signals, may impact treatment response. The objective of this study is to determine if CSS is associated with response to medical or surgical treatment for pain relief in women with endometriosis. Systematic review. N/A. Inclusion criteria were studies reporting on women with endometriosis with and without CSS. Exclusion criteria were studies primarily focused on non-endometriosis pelvic pain syndromes. A comprehensive literature search using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, Science Citation Index Expanded, and Emerging Sources Citation Index was conducted without language or date restrictions. The search strategy utilized Medical Subject Headings (MeSH) and EMTREE terms to capture concepts related to central sensitization, endometriosis, and associated symptoms like dysmenorrhea. Interventions in the reviewed studies included medical treatment, physiotherapy, or surgery. A total of 1821 abstracts were identified, and 259 full texts were reviewed for eligibility. Four studies met inclusion criteria, and two studies reported on the same cohort. Heterogeneity of the studies was evident. Catastrophization was defined using different scales (Central Sensitization Inventory > 40, Pain Catastrophizing Scale > 30, and Coping Strategies Questionnaire score 5 or 6). The percentage of patients with CSS at baseline ranged from 11.3% to 58.2%. Treatment outcomes were measured differently, including Visual Analog Scale >5 at follow-up, subjective ineffectiveness of hormone therapy, and elevated Short Form McGill Pain Questionnaire responses one year after surgery. Despite this heterogeneity, all studies reported worse outcomes in patients with higher baseline catastrophization. CSS frequently co-occurs in women with endometriosis, and studies show worse pain outcomes when these conditions coexist. This is important to consider during counseling and decision-making. Efforts to standardize reporting of CSS is beneficial for future research. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. A bundle of evidence-based opioid-sparing strategies (BOSS) to eliminate routine opioid prescribing after minimally invasive pelvic reconstructive surgery.
- Author
-
Selle, J, Strozza, D, Branda, M, Gebhart, J, Trabuco, E, Occhino, J, Linder, B, El Nashar, S, and Madsen, A
- Subjects
PLASTIC surgery ,DRUG prescribing ,OPIOIDS - Published
- 2024
- Full Text
- View/download PDF
6. Analysis of Endometriosis Related Hashtags on Instagram
- Author
-
Carlson, S., primary, Coyne, K., additional, El-Nashar, S., additional, and Billow, M., additional
- Published
- 2020
- Full Text
- View/download PDF
7. Perioperative Complications of Laparoscopic Versus Open Surgery for Pelvic Inflammatory Disease
- Author
-
Carlson, S., primary, Batra, S., additional, Billow, M., additional, El-Nashar, S., additional, and Chapman, G., additional
- Published
- 2020
- Full Text
- View/download PDF
8. Tamsulosin to Prevent Urinary Retention Following Female Pelvic Reconstructive Surgery: A Multicenter Randomized Controlled Trial
- Author
-
Chapman, G., primary, Sheyn, D., additional, Slopnick, E., additional, Roberts, K., additional, Mangel, J., additional, Pollard, R.R., additional, El-Nashar, S., additional, Henderson, J.W., additional, Hijaz, A.K., additional, and Mahajan, S., additional
- Published
- 2020
- Full Text
- View/download PDF
9. Development and Validation of a Nomogram to Predict Morbidity in Surgery for Pelvic Inflammatory Disease
- Author
-
Chapman, G., primary, McGregor, A.E., additional, Carlson, S., additional, Billow, M., additional, and El-Nashar, S., additional
- Published
- 2020
- Full Text
- View/download PDF
10. 31: Survey of the Society of Gynecologic Surgeons members on practice patterns for opportunistic OS at the time of pelvic organ prolapse repair
- Author
-
Hassani, D., Mahajan, S.T., Mangel, J., Pollard, R.R., El-Nashar, S., and Sheyn, D.
- Published
- 2018
- Full Text
- View/download PDF
11. Comparison of 30-Day Complication Rate Between Minimally Invasive Hysterectomy with and Without Concomitant Urogynecologic Procedure
- Author
-
Griebel, L, primary, Chapman, G, additional, Mahajan, S, additional, Billow, M, additional, El-Nashar, S, additional, and Dizon, AM, additional
- Published
- 2019
- Full Text
- View/download PDF
12. Comparison of 30-Day Perioperative Morbidity between Same Day Discharges and One-Day Discharges in Women Undergoing Laparoscopic Hysterectomy
- Author
-
Sheyn, D., primary, El-Nashar, S., additional, Pollard, R., additional, Mangel, J., additional, and Billow, M., additional
- Published
- 2017
- Full Text
- View/download PDF
13. Postoperative Pain after Extracorporeal Uterine Morcellation Routes at the Time of Total Laparoscopic Hysterectomy for Benign Disease
- Author
-
McGregor, A., primary, Martin, L., additional, El-Nashar, S., additional, and Billow, M., additional
- Published
- 2017
- Full Text
- View/download PDF
14. 30-Day Readmission Rates in Same Day Versus Postoperative Day One Discharges in Women Undergoing Laparoscopic Hysterectomy
- Author
-
Sheyn, D., primary, El-Nashar, S., additional, Mangel, J., additional, Mahajan, S., additional, and Pollard, R., additional
- Published
- 2017
- Full Text
- View/download PDF
15. Detection of rhinovirus-associated asthma exacerbations using reverse transcriptase - polymerase chain reaction in Egyptian children
- Author
-
El-Seify, M., primary, Al-Fahham, M.M.A.M., additional, El-Deen, N. Salah, additional, and El-Nashar, S., additional
- Published
- 2016
- Full Text
- View/download PDF
16. KLF10 Mediated Epigenetic Dysregulation of Epithelial CD40/CD154 Promotes Endometriosis
- Author
-
Delaney, A. A., primary, Khan, Z., additional, Zheng, Y., additional, Correa, L. F., additional, Zanfagnin, V., additional, Shenoy, C. C., additional, Schoolmeester, J. K., additional, Saadalla, A. M., additional, El-Nashar, S., additional, Famuyide, A. O., additional, Subramaniam, M., additional, Hawse, J. R., additional, Khazaie, K., additional, and Daftary, G. S., additional
- Published
- 2016
- Full Text
- View/download PDF
17. 440 - Postoperative Pain after Extracorporeal Uterine Morcellation Routes at the Time of Total Laparoscopic Hysterectomy for Benign Disease
- Author
-
McGregor, A., Martin, L., El-Nashar, S., and Billow, M.
- Published
- 2017
- Full Text
- View/download PDF
18. 191 - 30-Day Readmission Rates in Same Day Versus Postoperative Day One Discharges in Women Undergoing Laparoscopic Hysterectomy
- Author
-
Sheyn, D., El-Nashar, S., Mangel, J., Mahajan, S., and Pollard, R.
- Published
- 2017
- Full Text
- View/download PDF
19. 23 - Comparison of 30-Day Perioperative Morbidity between Same Day Discharges and One-Day Discharges in Women Undergoing Laparoscopic Hysterectomy
- Author
-
Sheyn, D., El-Nashar, S., Pollard, R., Mangel, J., and Billow, M.
- Published
- 2017
- Full Text
- View/download PDF
20. Can LEEP replace cold knife conization for the management of cervical intraepithelial neoplasia in women with unsatisfactory colposcopic examination? A systematic review and a meta-analysis
- Author
-
El-Nashar, S., primary, Hopkins, M., additional, Cliby, W., additional, and Famuyide, A., additional
- Published
- 2011
- Full Text
- View/download PDF
21. Management and clinical outcomes of women with BRCA1/2 mutations found to have occult cancers at the time of risk-reducing salpingo-oophorectomy
- Author
-
Iglesias, D., primary, Sun, C., additional, Langstraat, C., additional, Bakkum-Gamez, J., additional, El-Nashar, S., additional, Keeler, E., additional, Gershenson, D., additional, and Lu, K., additional
- Published
- 2011
- Full Text
- View/download PDF
22. Laparoscopic Extra-Peritoneal Para-Aortic Lymphadenectomy for Endometrial Cancer
- Author
-
Peedicayil, A., primary, El Nashar, S., additional, Bakkum-Gamez, J.N., additional, and Dowdy, S.C., additional
- Published
- 2010
- Full Text
- View/download PDF
23. Retrospective Cohort Study of 350 Women Who Have Undergone Endometrial Ablation with and without Myomectomy
- Author
-
Dwarica, D.S., primary, El Nashar, S., additional, Hopkins, M.R., additional, Famuyide, A.O., additional, and Laughlin, S.K., additional
- Published
- 2010
- Full Text
- View/download PDF
24. Feasibility of Hysterosalpingography Following a Combined Radiofrequency Global Endometrial Ablation and Hysteroscopic Sterilization Procedure
- Author
-
Carey, E.T., primary, El-Nashar, S., additional, Creedon, D.J., additional, Famuyide, A.O., additional, and Hopkins, M.R., additional
- Published
- 2009
- Full Text
- View/download PDF
25. Techniques for cryopreservation of individual or small numbers of human spermatozoa: a systematic review
- Author
-
AbdelHafez, F., primary, Bedaiwy, M., additional, El-Nashar, S. A., additional, Sabanegh, E., additional, and Desai, N., additional
- Published
- 2008
- Full Text
- View/download PDF
26. Thickened Endometrial Stripe in Women with a Common Congenital Uterine Anomaly
- Author
-
Amols, M.H., primary, El-Nashar, S., additional, Hopkins, M.R., additional, and Famuyide, A.O., additional
- Published
- 2008
- Full Text
- View/download PDF
27. Reproductive outcome after transplantation of ovarian tissue: a systematic review
- Author
-
Bedaiwy, M. A., primary, El-Nashar, S. A., additional, El Saman, A. M., additional, Evers, J. L.H., additional, Sandadi, S., additional, Desai, N., additional, and Falcone, T., additional
- Published
- 2008
- Full Text
- View/download PDF
28. The relationship between birth weight, and arm and chest circumference in Egypt.
- Author
-
Diamond, Ian D., El-Aleem, Ali M. Abd, Ali, M. Y., Mostafa, S. A. M., El-Nashar, S. M. A., Guidotti, R. J., Diamond, I D, el-Aleem, A M, Mostafa, S A, and el-Nashar, S M
- Published
- 1991
- Full Text
- View/download PDF
29. Prediction of Postoperative Urinary Tract Infection Following Benign Gynecologic Surgery.
- Author
-
Yurick S, Ray S, El-Nashar S, Brennand E, Kim-Fine S, Sanaee M, Regan S, Geoffrion R, Occhino J, Hijaz A, and Sheyn D
- Subjects
- Humans, Female, Middle Aged, Aged, Adult, Bayes Theorem, Algorithms, Logistic Models, Urinary Tract Infections epidemiology, Urinary Tract Infections etiology, Gynecologic Surgical Procedures adverse effects, Postoperative Complications epidemiology, Postoperative Complications etiology
- Abstract
Introduction and Hypothesis: The objective was to develop a prediction model for urinary tract infection (UTI) after pelvic surgery., Methods: We utilized data from three tertiary care centers of women undergoing pelvic surgery. The primary outcome was a UTI within 8 weeks of surgery. Additional variables collected included procedural data, severity of prolapse, use of mesh, anti-incontinence surgery, EBL, diabetes, steroid use, estrogen use, postoperative catheter use, PVR, history of recurrent UTI, operative time, comorbidities, and postoperative morbidity including venous thromboembolism, surgical site infection. Two datasets were used for internal validation, whereas a third dataset was used for external validation. Algorithms that tested included the following: multivariable logistic regression, decision trees (DTs), naive Bayes (NB), random forest (RF), gradient boosting (GB), and multilayer perceptron (MP)., Results: For the training dataset, containing both University of British Columbia and Mayo Clinic Rochester data, there were 1,657 patients, with 172 (10.4%) UTIs; whereas for the University of Calgary external validation data, there were a total of 392 patients with a UTI rate of 16.1% (n = 63). All models performed well; however, the GB, DT, and RF models all had an area under the curve (AUC) > 0.97. With external validation the model retained high discriminatory ability, DT: AUC = 0.88, RF: AUC = 0.88, and GB: AUC = 0.90., Conclusions: A model with high discriminatory ability can predict UTI within 8 weeks of pelvic surgery. Future studies should focus on prospective validation and application of randomized trial models to test the utility of this model in the prevention of postoperative UTI., (© 2024. The International Urogynecological Association.)
- Published
- 2024
- Full Text
- View/download PDF
30. Neglect as an undefined and overlooked aspect of medical student mistreatment: A systematic review of the literature.
- Author
-
Kloos J, Simon E, Sammarco A, El-Nashar S, and Bazella C
- Subjects
- Humans, Education, Medical, Undergraduate, Learning, Schools, Medical, Social Inclusion, Education, Medical, Students, Medical
- Abstract
Purpose: Although the mistreatment of medical students is a well-researched topic, the scope of mistreatment often leaves out neglect, a subtype for which there is no accepted definition based in the published literature. This review sought to summarize the existing data on the prevalence and descriptors of neglect, identify strategies seen in the literature designed to improve it, and offer a synthesized definition of this phenomenon to guide future research., Methods: Following PRISMA guidelines, a relevant systematic literature search from 2000 to April 2021 was performed to identify literature on neglect in clinical settings within American medical schools., Results: Neglect, a poorly defined phenomenon in medical education related to the suboptimal learning environment, is often excluded from research on medical student mistreatment. Neglect is a barrier to a successful learning environment, yet a paucity of data and the heterogeneous nature of the present literature render it difficult to estimate its true prevalence. Studies that include neglect frequently assess it solely as the result of identity discrimination or stated career interests. Recent interventions include promoting longitudinal relationships between students and clinical faculty and establishing teaching expectations., Conclusions: Neglect is the mistreatment of medical students by the medical care team via a lack of meaningful inclusion in the clinical environment such that it has a notable negative impact on learning and student well-being, regardless of intentionality. An established definition that is grounded in the literature is required to create a common point of reference and understand its true prevalence, its associated variables, and the best mitigation strategies, as well as to guide future research, which should examine neglect independently and as a consequence of personal and professional identities.
- Published
- 2023
- Full Text
- View/download PDF
31. A systematic review and in silico study of potential genetic markers implicated in cases of overactive bladder.
- Author
-
Isali I, McClellan P, Wong TR, Sun C, Stout AC, Schumacher FR, Markt S, Wilfred Wu CH, Penney KL, El-Nashar S, Hijaz A, and Sheyn D
- Subjects
- Humans, TRPV Cation Channels therapeutic use, Genetic Markers, Cholinergic Antagonists therapeutic use, Receptors, Cholinergic therapeutic use, Receptors, Purinergic therapeutic use, Receptor, Muscarinic M3 therapeutic use, Urinary Bladder, Overactive therapy
- Abstract
Objective: The contribution of genetic factors to the presence of an overactive bladder is recognized. This study aimed to (1) assemble and synthesize available data from studies assessing differential gene expression in patients with overactive bladder vs controls without overactive bladder and (2) determine possible correlations and functional pathways between genes., Data Sources: We searched PubMed, Ovid or Medline, and Wiley Cochrane Central Register of Controlled Trials databases between January 1, 2000, and December 15, 2021., Study Eligibility Criteria: Studies were included if gene expression was detected and quantified using molecular approaches performed on human bladder tissue specimens directly and excluded if the gene expression analysis was carried out from blood and urine specimens alone., Methods: A systematic review was completed to identify publications that reported differently expressed gene candidates among patients with overactive bladder vs healthy individuals. Gene networking connections and pathway analysis were performed employing Metascape software, where inputs were identified from our systematic review of differentially expressed genes in overactive bladder., Results: A total of 9 studies were included in the final analysis and 11 genes were identified as being up-regulated (purinergic receptor P2X 2 [P2RX2], smoothelin [SMTN], growth-associated protein 43 [GAP43], transient receptor potential cation channel subfamily M member 8 [TRPM8], cadherin 11 [CDH1], gap junction protein gamma 1 [GJC1], cholinergic receptor muscarinic 2 [CHRM2], cholinergic receptor muscarinic 3 [CHRM3], and transient receptor potential cation channel subfamily V member 4 [TRPV4]) or down-regulated (purinergic receptor P2X 2 [P2RX3] and purinergic receptor P2X 5 [P2RX5]) in patients with overactive bladder. Gene network analysis showed that genes are involved in chemical synaptic transmission, smooth muscle contraction, blood circulation, and response to temperature stimulus. Network analysis demonstrated a significant genetic interaction between TRPV4, TRPM8, P2RX3, and PR2X2 genes., Conclusion: Outcomes of this systematic review highlighted potential biomarkers for treatment efficacy and have laid the groundwork for developing future gene therapies for overactive bladder in clinical settings., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
32. Skene's Gland Malignancy: A Case Report and Systematic Review.
- Author
-
Slopnick EA, Bagby C, Mahran A, Nagel C, Garcia J, El-Nashar S, and Hijaz AK
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Androgen Antagonists, Androgens, Prostate-Specific Antigen, Adenocarcinoma pathology, Prostatic Neoplasms
- Abstract
Objective: To present a recent clinical case of Skene's gland carcinoma and review all published literature of Skene's gland malignancy with associated treatment and outcomes., Methods: We review a new case of metastatic Skene's gland adenocarcinoma. We then performed a systematic search of PubMed and Ovid-Medline through December 2021 and retrieved English language articles for review. Peer-reviewed articles were deemed eligible if they included patients with Skene's gland malignancy. Reports were reviewed for pathologic accuracy, patient characteristics, clinical presentation, tumor pathology, treatment and outcome., Results: We reviewed 211 articles and included 15 cases from 1974 to 2022. The median patient age was 71 years (range 46-88). The most common presentation was an asymptomatic periurethral or urethral lesion in five cases (33.3%), followed by hematuria or vaginal bleeding in three patients (20.0%). In eight cases, a prostate-specific antigen was measured and found to be elevated, range 0.8-60.8 ng/mL. Treatment approaches varied and included local excision in eight cases, radical surgical resection in two cases, radiation therapy in two cases, and adjunctive androgen deprivation therapy in one case. Pathology was consistent with adenocarcinoma resembling prostate in all cases. In all cases tested, prostate-specific antigen normalized after definitive therapy of any type. Median follow up was 11.5 months, and there were no cases of recurrence or mortality secondary to Skene's gland adenocarcinoma., Conclusion: There are 15 published cases of a Skene's gland malignancy, all adenocarcinoma resembling prostate. Local excision is most often utilized for treatment, with androgen deprivation therapy emerging as a new treatment consideration., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF
33. Factors Influencing Selection of Concomitant Total Versus Supracervical Hysterectomy at the Time of Sacrocolpopexy and Associated Perioperative Outcomes.
- Author
-
Slopnick EA, Roberts K, Sheyn DD, Chapman GC, El-Nashar S, and Mahajan ST
- Subjects
- Adult, Age Factors, Aged, Comorbidity, Databases, Factual, Female, Humans, Hysterectomy statistics & numerical data, Middle Aged, Pelvic Organ Prolapse epidemiology, Postoperative Complications epidemiology, Retrospective Studies, Clinical Decision-Making, Hysterectomy methods, Pelvic Organ Prolapse surgery
- Abstract
Objectives: The objective of this study was to describe national practice patterns of hysterectomy type performed with concurrent sacrocolpopexy and determine clinical factors associated with surgical route., Methods: We used the National Surgical Quality Improvement Program database with hysterectomy data for this retrospective cohort study. We identified sacrocolpopexy cases from 2014 to 2016 with concurrent hysterectomy and stratified patients into supracervical hysterectomy (SCH) or total hysterectomy (TH). As a secondary analysis, we compared the laparoscopic subset of cases. We performed χ2 and backward stepwise logistic regression analyses to identify factors associated with hysterectomy type and compare complication rates., Results: A total of 4,615 women underwent SCP with hysterectomy: 55.8% TH and 44.2% SCH. Mean ± SD age was 56.5 ± 11.7 years. Gynecologists represent 96.3% of surgeons; 51.2% were urogynecologists. Urogynecologists were more likely than generalists to perform SCH (58.4% vs 41.6%, P < 0.001). Total hysterectomy was associated with younger age (adjusted odds ratio [aOR], 0.98 per year [0.97-0.99]), greater uterine weight (aOR, 1.05 per 10 g [1.03-1.06]), and non-Caucasian race (aOR, 0.73 [0.58-0.92]). Complication rates were equivalent between hysterectomy type (SCH, 6.2% vs TH, 6.2%; P = 0.956). Laparoscopy was used for 84.4% of surgical procedures. In this subgroup, TH was associated with greater uterine weight (aOR, 1.06 per 10 g [1.04-1.08]) and younger age (aOR, 0.97 per year [0.96-0.98]). Complication rates were similar (SCH, 5.1% vs TH, 5.0%; P = 0.824)., Conclusions: At the time of sacrocolpopexy, TH is more common than SCH and is associated with younger age and greater uterine weight, although urogynecologists more commonly perform SCH. The overall risk of complications was low and similar between hysterectomy type., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
34. Apical suspension is underutilized for repair of stage IV pelvic organ prolapse: an analysis of national practice patterns in the United States.
- Author
-
Slopnick EA, Chapman GC, Roberts K, Sheyn DD, El-Nashar S, and Mahajan ST
- Subjects
- Aged, Female, Humans, Hysterectomy, Middle Aged, Suspensions, Treatment Outcome, United States, Vagina, Gynecologic Surgical Procedures, Pelvic Organ Prolapse surgery
- Abstract
Introduction and Hypothesis: Support of the vaginal apex is paramount for a durable repair of pelvic organ prolapse (POP). Our aim is to assess national utilization of apical suspension procedures for the surgical treatment of complete POP. We hypothesize that there might be a high rate of apical suspension with advanced prolapse., Methods: The 2006-2016 National Surgical Quality Improvement Program database was queried for a primary postoperative diagnosis of complete POP. The primary outcome was type of repair. Secondary outcomes included patient characteristics associated with apical suspension or colpocleisis. Procedures were delineated using CPT codes. Chi-squared and multivariate logistic regression analyses were used to evaluate factors associated with repair type., Results: A total of 2,784 women underwent surgery for complete POP with a mean age of 64.6 ± 11.0 years. Overall, 1,300 (46.7%) patients underwent apical suspension: 487 sacrocolpopexies (17.5%), 428 extraperitoneal suspensions (15.4%), and 391 uterosacral suspensions (14.0%). 5.2% (144) underwent colpocleisis, and 47.5% (1,332) of women had a concurrent hysterectomy (CH). With CH, 38.6% (502) had apical suspension or colpocleisis versus 69.5% (940) of post-hysterectomy cases. On logistic regression, CH was inversely associated with apical suspension (adjusted odds ratio [aOR] 0.37, CI 0.32-0.44, p < 0.001). Colpocleisis was associated with older age (aOR 4.9 per 10 years, CI 3.8-6.3, p < 0.001), post-hysterectomy surgery (aOR 0.23, CI 0.1-0.4, p < 0.001 for CH), and higher comorbidity index (OR 1.7, CI 1.1-2.6, p = 0.009). Complication rates are similar with and without apical suspension (8.2% versus 7.0%, p = 0.269)., Conclusions: During surgery for complete POP, an apical suspension procedure is performed in 46.7% of patients and is more common post-hysterectomy.
- Published
- 2021
- Full Text
- View/download PDF
35. Medical Malpractice Litigation in Non-Mesh-Related Pelvic Organ Prolapse Surgery: An Analysis of 91 Cases.
- Author
-
Yao B, Slopnick E, Sheyn D, Chapman G, El-Nashar S, Hijaz A, and Mahajan S
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Gynecologic Surgical Procedures, Humans, Middle Aged, Surgical Mesh, United States, Malpractice legislation & jurisprudence, Pelvic Organ Prolapse
- Abstract
Introduction: Malpractice litigations have significant implications for patients and physicians. Studies have investigated mesh litigations in female pelvic reconstructive surgery, but none on nonmesh pelvic organ prolapse (POP) surgery. Our purpose is to determine the reasons for and outcomes of medical malpractice after nonmesh POP surgery., Methods: Westlaw (Thompson Reuters, New York, New York) is a legal research database of US court records. We identified completed POP litigations from 1987 to 2018 using the following: "pelvic organ prolapse," "enterocele," "rectocele," "cystocele," "uterine prolapse," and "vaginal wall prolapse." Mesh-related cases were excluded. Outcomes included reasons for litigation, verdict, injury, and payments. Statistical analysis was performed with nonparametric tests and χ2 independence test., Results: Ninety-one litigations were included. The median plaintiff age was 53 years (range, 36-85 years). The leading allegation was negligence of surgery (n = 59; 65%). The jury sided with the defendant physician in 67% of cases (n = 61). There was no association between case verdict and patient age (P = 0.781), geographic region (P = 0.824), or allegation (P = 0.904). The primary complications were urinary tract injury (n = 24; 26%), need for additional surgery (n = 22; 24%), and new postoperative urinary symptoms (n = 22; 24%). The median payout was $280,000 (interquartile range, $137,250-$1,300,000), with no difference between plaintiff awards or settlements (P = 0.659)., Conclusion: The leading allegation of malpractice litigations for nonmesh POP surgery is negligence of surgery, whereas the most common complication was urinary tract injury. A verdict in favor of the physician defendant was the most likely outcome. Plaintiff awards and settlements were not statistically different with no variation by region or time., Competing Interests: Dr David Sheyn is a consultant for AristaMD. Drs Adonis K. Hijaz and Sangeeta T. Mahajan are members of the Astellas, Inc. Speaker’s Bureau. In addition, Dr Mahajan receives grant funding from Allergan, Inc, and is on their speaker’s bureau. The authors have no additional disclosures or conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
36. Baseline Brain Segmental Volumes in Responders and Nonresponders to Anticholinergic Therapy for Overactive Bladder Syndrome.
- Author
-
Sheyn D, Martin NM, Walden L, Roberts KM, El-Nashar S, Hijaz AK, and Prescott JW
- Subjects
- Cohort Studies, Female, Humans, Image Processing, Computer-Assisted, Middle Aged, Nocturia, Retrospective Studies, Brain diagnostic imaging, Cholinergic Antagonists therapeutic use, Magnetic Resonance Imaging, Urinary Bladder, Overactive drug therapy
- Abstract
Objective: Evaluate structural differences in brains of responders (R) and nonresponders (NR) to anticholinergic (AC) therapy for overactive bladder (OAB)., Materials and Methods: This was a retrospective cohort study of age matched women treated with an AC medication for OAB and underwent magnetic resonance imaging within 12 months before treatment. Data on pretreatment demographic and clinical variables and symptom severity was also collected.T1-weighted magnetic resonance images of the brain for each subject were segmented using FreeSurfer software. Structures included for analysis were cerebral cortex, white matter, subcortical gray matter, cerebellum, and brain stem.Nonresponders were defined as patients who reported less than 50% improvement after a minimum of 4 weeks on the maximum dose of the prescribed medication. Pairwise analysis between groups was performed using the Wilcoxon-Rank Sum test and Fisher exact test where appropriate. Spearman ρ was used to evaluate for correlations between neurologic structures and symptom severity., Results: There were no differences in pretreatment characteristics or symptom severity between the 21 R and 18 NR. Nonresponders had lower volumes of the right caudal anterior cingulate gyrus white matter (1919 mm3 vs 2416 mm3, P = 0.008) and right parahippocampal gyrus white matter (1008 mm3 vs 1469 mm3, P = 0.001). Incontinence episode frequency showed a negative moderate correlation with the anterior cingulate gyrus white matter volume (ρ = -0.4228, P = 0.007). The right and left cerebellar cortices showed weak and moderate negative correlations to frequency of nocturia (ρ = -0.384, P = 0.02 and ρ -0.443, P = 0.005, respectively)., Conclusion: There are measurable volumetric differences in brain structures in R and NR to AC therapy., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2020 American Urogynecologic Society. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
37. Gender differences in authorship of obstetrics and gynecology publications during the coronavirus disease 2019 pandemic.
- Author
-
Cook J, Gupta M, Nakayama J, El-Nashar S, Kesterson J, and Wagner S
- Subjects
- Female, Humans, Male, Gynecology statistics & numerical data, Obstetrics statistics & numerical data, Physicians statistics & numerical data, SARS-CoV-2, Sex Factors, Authorship standards, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 virology, Publications statistics & numerical data, Publications trends
- Published
- 2021
- Full Text
- View/download PDF
38. Gene expression in urinary incontinence and pelvic organ prolapse: a review of literature.
- Author
-
Isali I, Abdeldayem J, and El-Nashar S
- Subjects
- Female, Gene Expression, Humans, Pelvic Organ Prolapse genetics, Urinary Bladder, Overactive, Urinary Incontinence, Stress
- Abstract
Purpose of Review: To review current evidence on gene expression in women with urinary incontinence and pelvic organ prolapse (POP)., Recent Findings: Our literature review revealed numerous genes that are associated with urinary incontinence and POP. For overactive bladder and urge urinary incontinence, four genes were highlighted: adrenergic receptor β3, Rho guanine nucleotide exchange factor 10, Rho-associated coiled-coil containing protein kinase 2, and potassium two pore domain channel subfamily K member-1. For Stress Urinary incontinence (SUI), 13 genes were included: skin-derived antileukoproteinase, collagen type XVII alpha 1 chain, plakophilin 1, keratin 16, decorin, biglycan, protein bicaudal D homolog 2, growth factor receptor-bound protein 2, signal transducer and activator of transcription 3, apolipoprotein E, Golgi SNAP receptor complex member 1, fibromodulin, and glucocerebrosidase. For POP seven genes were identified: homeobox A13, matrix metallopeptidase 9, estrogen receptor 2, collagen type XIV alpha 1 chain, collagen type V alpha 1 chain, collagen type IV alpha 2 chain, and catenin beta 1., Summary: The current review highlights many genes which are potential biomarkers and targets for drug development.
- Published
- 2020
- Full Text
- View/download PDF
39. Evaluation of Choline and Acetylcholine Levels in Responders and Nonresponders to Anticholinergic Therapy for Overactive Bladder Syndrome.
- Author
-
Sheyn D, Hijaz AK, Hazlett FE Jr, El-Nashar S, Mangel JM, Li X, Mara E, and Mahajan ST
- Subjects
- Aged, Biomarkers, Pharmacological blood, Correlation of Data, Female, Geriatric Assessment methods, Humans, Surveys and Questionnaires, Symptom Assessment methods, Urinary Bladder, Overactive blood, Urinary Bladder, Overactive drug therapy, Urinary Bladder, Overactive physiopathology, Acetylcholine blood, Aging physiology, Aging psychology, Choline blood, Cholinergic Antagonists administration & dosage, Cholinergic Antagonists pharmacokinetics, Quality of Life, Urinary Incontinence diagnosis, Urinary Incontinence etiology, Urinary Incontinence psychology
- Abstract
Objective: This study aimed to determine whether levels of choline (Ch) and acetylcholine (Ach) differ between responders and nonresponders to anticholinergic therapy., Methods: Patients prescribed an anticholinergic were evaluated using the Overactive Bladder Symptom Score; Medical, Epidemiologic and Social Aspects of Aging and Incontinence Questionnaire; and Incontinence Impact Questionnaire-7. A 1-day voiding diary and a urine sample were collected. After treatment for 12 weeks, the questionnaires were administered and 1-day voiding diary was completed. Levels of Ach and Ch were measured by liquid chromatography with tandem mass spectrometry. Subjects were divided into responders and nonresponders. Wilcoxon rank sum test and Fisher exact test were used to express differences between groups. Spearman ρ correlation coefficient was used to determine the relationship between Ach and Ch and symptom severity, patient demographics, and questionnaire scores., Results: Thirty-one women were included in the analysis. The treatment response rate was 48.8%. The median age was 67 years (interquartile range, 50-76 years), and median body mass index was 32.3 kg/m2 (27.5-40.6 kg/m2), with 41.2% having an additional complaint of stress incontinence. There were no significant differences in symptom severity or questionnaire scores between groups.The median Ch and Ach levels were higher in responders (28.6 vs 9.2 μL, P = 0.04) and (83.1 vs 18.7 nL, P = 0.02), respectively. Levels of both Ch and Ach had moderate positive correlations with the Medical, Epidemiologic and Social Aspects of Aging and Incontinence Questionnaire urgency urinary incontinence score (ρ = 0.533 [P = 0.002] and ρ = 0.453 [P = 0.01], respectively)., Conclusion: In women with overactive bladder, urinary Ach and Ch levels are higher in responders to anticholinergic therapy compared with nonresponders., Competing Interests: The authors have declared they have no conflicts of interest and no funding source., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
40. Tamsulosin to Prevent Postoperative Urinary Retention After Female Pelvic Reconstructive Surgery.
- Author
-
Chapman GC, Sheyn D, Petrikovets A, Mahajan ST, El-Nashar S, Pollard R, and Mangel JM
- Subjects
- Female, Humans, Middle Aged, Plastic Surgery Procedures adverse effects, Plastic Surgery Procedures methods, Retrospective Studies, Suburethral Slings, Adrenergic alpha-1 Receptor Antagonists administration & dosage, Postoperative Complications prevention & control, Tamsulosin administration & dosage, Urinary Retention prevention & control
- Abstract
Objective: This study aimed to determine the effect of tamsulosin on postoperative urinary retention in female patients after pelvic reconstructive surgery., Methods: Data were obtained from a retrospective, matched cohort of female patients who were admitted after pelvic reconstructive surgery at a single academic institution. Patients who received tamsulosin were compared with those who did not at a 1:4 ratio, matched by surgical procedure. Patients were excluded if they were discharged on the day of surgery or if an intraoperative complication necessitated prolonged postoperative bladder drainage. Information on demographics, preoperative diagnoses, prolapse stage, preoperative voiding dysfunction, urodynamic findings, intraoperative details, postoperative complications, and voiding outcomes up to 6 weeks after surgery was gathered. The primary outcome was postoperative urinary retention, defined by failure of an active voiding trial., Results: Patients underwent surgery between January 2016 and March 2018. We identified 35 patients who received tamsulosin and matched to 140 controls. Patients in the tamsulosin group were younger; groups were otherwise similar. Patients who received tamsulosin after surgery were less likely to develop postoperative urinary retention (2.9% vs 24.3%, P = 0.004). After controlling for confounders, multivariable logistic regression identified tamsulosin use as the only independent predictor of postoperative urinary retention with a significant protective effect (odds ratio, 0.09; 95% confidence interval, 0.01-0.67; P = 0.03)., Conclusions: Prophylactic tamsulosin use may be effective in preventing postoperative urinary retention in female patients undergoing pelvic reconstructive surgery.
- Published
- 2020
- Full Text
- View/download PDF
41. Evaluation of the ACS NSQIP surgical risk calculator in patients undergoing pelvic organ prolapse surgery.
- Author
-
Wherley SD, Chapman GC, Mahajan ST, Hijaz AK, Slopnick EA, Roberts K, and El-Nashar S
- Subjects
- Humans, Postoperative Complications epidemiology, Postoperative Complications etiology, Quality Improvement, Retrospective Studies, Risk Assessment, Risk Factors, Pelvic Organ Prolapse surgery, Robotics
- Abstract
Introduction and Hypothesis: The purpose of this study was to evaluate the accuracy of the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) surgical risk calculator in predicting postoperative complications in patients undergoing pelvic organ prolapse surgery., Methods: We performed a retrospective review of 354 patients who underwent surgery for pelvic organ prolapse from 2013 to 2017 at a single academic institution. Patient medical information and surgical procedure were entered into the calculator to obtain predicted complication rates, which were compared with observed complications. Logistic regression, C-statistic, and Brier score were used to assess the accuracy of the calculator., Results: Of 354 patients included in the analysis, 79.7% were under the age of 75, and 41.5% were classified as American Society of Anesthesiologists class ≥3. The majority of patients underwent robotic sacrocolpopexy (40.7%) or uterosacral ligament suspension (36.4%), followed by colpocleisis, abdominal sacrocolpopexy, and extraperitoneal suspension. Complications were experienced by 100 patients (28.3%). Most common complications were urinary tract infection (n = 57), surgical site infection (n = 42), and readmission (n = 16); other complications were rare. The surgical risk calculator displayed poor predictive ability for experiencing a complication (C-statistic = 0.547, Brier score = 0.25)., Conclusions: The NSQIP surgical risk calculator displayed poor predictive ability in our cohort of patients undergoing surgery for pelvic organ prolapse, suggesting that this tool might have limited clinical applicability to individual patients in this population.
- Published
- 2020
- Full Text
- View/download PDF
42. Evaluation of Urine Choline Levels in Women With and Without Overactive Bladder Syndrome.
- Author
-
Sheyn D, Hijaz AK, Hazlett FE Jr, Dawodu K, El-Nashar S, Mangel JM, Petrikovets A, and Mahajan ST
- Subjects
- Adult, Aged, Biomarkers urine, Case-Control Studies, Female, Humans, Middle Aged, Prospective Studies, Surveys and Questionnaires, Urinary Bladder, Overactive complications, Urinary Incontinence, Urge complications, Choline urine, Urinary Bladder, Overactive urine
- Abstract
Objective: The objective of this study was to determine whether levels of choline (Ch) differ in women with and without overactive bladder (OAB) symptoms., Methods: New patients were evaluated using the overactive bladder symptom score; Medical, Epidemiologic, and Social Aspects of Aging (MESA) urgency incontinence questionnaire; and Impact Questionnaire 7 and provided a urine sample. Patients were stratified into asymptomatic controls, scoring 0 on overactive bladder symptom score and the MESA questionnaire, and patients with OAB and urgency incontinence (OAB-wet). Patients with conditions predisposing to OAB or had a history of OAB treatment were excluded. Choline detection was accomplished using a commercially available kit. Wilcoxon rank sum test and Fisher exact test were used to express differences between groups. Spearman ρ correlation was used to determine the relationship between Ch and questionnaire scores. Logistic regression was used to identify significant variables associated with OAB., Results: Sixty-three women were included in the final analysis. Patients with OAB-wet were older (P = 0.001), more likely to be obese (P = 0.04), had greater apical descent (P = 0.02), were more likely to be postmenopausal (P = 0.01), and were more likely to have stress incontinence (P = 0.005). Choline was 34.8% lower in OAB compared with the controls (P = 0.014). Lower Ch levels were associated with higher MESA (Spearman ρ = -0.311, P = 0.03). After logistic regression, lower Ch (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.96-0.98), age (aOR, 1.12; 95% CI, 1.08-1.18), and body mass index (aOR, 1.09; 95% CI, 1.01-1.18) were significantly associated with OAB-wet., Conclusions: Choline levels are significantly decreased in women complaining of OAB with urgency incontinence, and lower levels are associated with higher MESA scores.
- Published
- 2020
- Full Text
- View/download PDF
43. Does Living With Human Immunodeficiency Virus Increase Pelvic Reconstructive Surgery Perioperative Complication Risk? A Multicenter Retrospective Cohort Study.
- Author
-
Petrikovets A, Weber Lebrun EE, Carlos DM, Perlman B, Florian-Rodriguez ME, Bochenska K, Eto CU, Lespinasse P, Mahajan ST, El-Nashar S, Crisp CC, and Sheyn D
- Subjects
- Adult, Case-Control Studies, Female, Humans, Middle Aged, Pelvic Organ Prolapse surgery, Retrospective Studies, Risk Factors, HIV Infections complications, Pelvic Organ Prolapse complications, Postoperative Complications etiology
- Abstract
Objective: To determine if women with human immunodeficiency virus (HIV) undergoing pelvic reconstructive surgery (PRS) have an increased risk of perioperative and postoperative complications compared with HIV-negative controls., Study Design: Multicenter, retrospective matched cohort study of patients with and without HIV infection who underwent PRS between 2006 and 2016. Cases were identified using International Classification of Disease, 9th edition Clinical Modification and 10th edition Clinical Modification and current procedural terminology (CPT) codes encompassing HIV diagnoses and pelvic reconstructive surgeries. Controls were identified as patients without HIV who underwent similar procedures, performed by the same surgeon during the same 1-year period as surgeries performed on patients with HIV. Cases were matched to controls at a ratio of 1:3. The primary outcome was composite complication rate within 1 year of surgery., Results: Sixty-three patients with HIV and 187 controls were identified. There was no difference in the composite complication rate between women with HIV and HIV-negative women (36.5% vs 30.0%, P = 0.15) over 1 year. However, 19.1% of patients with HIV compared with 5.4% controls had Clavien Dindo Grade I complications (P = 0.002), and 11.1% of HIV patients had urinary retention within 6 weeks of surgery compared with 3.2% of controls (P = 0.02). After multivariable logistic regression used to adjust for confounders, living with HIV was not associated with an increased risk of complications., Conclusions: Patients living with HIV are not at an increased risk of complications within 1 year of PRS compared with patients without HIV.
- Published
- 2020
- Full Text
- View/download PDF
44. Apical Suspension Utilization at the Time of Vaginal Hysterectomy for Pelvic Organ Prolapse Varies With Surgeon Specialty.
- Author
-
Sheyn D, El-Nashar S, Mahajan ST, Mangel JM, Chapman GC, and Hijaz AK
- Subjects
- Aged, Databases, Factual, Female, Humans, Hysterectomy, Vaginal statistics & numerical data, Middle Aged, Operative Time, Pelvic Organ Prolapse epidemiology, Postoperative Complications epidemiology, Postoperative Complications etiology, Propensity Score, Retrospective Studies, Specialization, Hysterectomy, Vaginal methods, Pelvic Organ Prolapse surgery, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Objective: To evaluate whether utilization of apical suspension procedures at the time of vaginal hysterectomy for pelvic organ prolapse varies with surgeon specialty., Methods: This was a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2016. International Classification of Diseases, Ninth Revision, Clinical Modification with a diagnosis of pelvic organ prolapse who underwent vaginal hysterectomy with any combination of pelvic reconstructive procedures. Propensity score matching using available preoperative clinical data was used to ameliorate selection bias by specialty at a ratio of 1 female pelvic reconstructive surgeon (FPMRS) surgeon to 2 obstetrician-gynecologists (OBG). Descriptive statistics were reported as means with standard deviations. Pairwise analysis using Student t test and Fisher exact test was performed where appropriate., Results: After propensity score matching, there were 901 cases performed by FPMRS and 1802 performed by OBG. The overall utilization rate of apical suspension in the matched cohort was 81.7% for FPMRS and 19.8% for OBG (P < 0.001). Obstetrician-gynecologists were more likely to perform vaginal hysterectomy without apical suspension compared with FPMRS (44.3% vs 5.8%; P < 0.001) and were also more likely to perform nonapical vaginal repair without also performing an apical suspension, (17.7% vs 9.3%, P < 0.001), compared to urogynecologists. On multivariable logistic regression, having surgery performed by FPMRS was the only significant variable associated with an increased likelihood of undergoing apical suspension (adjusted odds ratio, 5.34; 95% confidence interval, 4.48-6.36)., Conclusions: The FPMRS physicians are more likely to perform apical suspension with vaginal hysterectomy for prolapse repair compared with OBG.
- Published
- 2020
- Full Text
- View/download PDF
45. Response to Letter.
- Author
-
Sheyn D, Hijaz A, Mahajan S, El-Nashar S, Ray S, and Mangel J
- Subjects
- Algorithms, Cholinergic Antagonists, Humans, Machine Learning, Urinary Bladder, Overactive
- Published
- 2020
- Full Text
- View/download PDF
46. Adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse.
- Author
-
Slopnick EA, Sheyn DD, Chapman GC, Mahajan ST, El-Nashar S, and Hijaz AK
- Subjects
- Aged, Female, Humans, Middle Aged, Combined Modality Therapy, Databases, Factual, Logistic Models, Propensity Score, Treatment Outcome, United States, Hysterectomy, Vaginal methods, Hysterectomy, Vaginal statistics & numerical data, Pelvic Organ Prolapse surgery, Practice Patterns, Physicians' statistics & numerical data, Salpingectomy methods, Salpingectomy statistics & numerical data
- Abstract
Introduction and Hypothesis: Preoperative counseling about salpingectomy with pelvic surgery is recommended by the American College of Obstetrics and Gynecology for ovarian cancer risk reduction. Our objective was to determine recent practice patterns and patient factors associated with salpingectomy with vaginal hysterectomy (VH) for pelvic organ prolapse (POP) in the USA. We hypothesize that salpingectomy might have become more common in recent years., Methods: We queried the 2014-2016 National Surgical Quality Improvement Program database for women with a postoperative diagnosis of POP who underwent VH with any combination of pelvic reconstructive procedures. CPT codes do not differentiate salpingectomy from salpingo-oophorectomy, so subjects were stratified by whether concurrent adnexectomy was performed. Chi-squared and multivariate logistic regression analyses were used to evaluate characteristics associated with adnexectomy. Propensity score matching was utilized when evaluating postoperative complication rates., Results: Of 5,344 women who underwent VH, 2019 (37.8%) had adnexectomy. Adnexectomy rate increased from 34.4% in 2014 to 46.8% in 2016 (p < 0.001). Adnexectomy rates of fellowship-trained urogynecologists and general gynecologists were similar (36.0% vs 38.8%, p = 0.197). On logistic regression analysis, patients more likely to undergo adnexectomy were < 65 years old (OR 0.844, CI 0.75-0.95, p = 0.004), had BMI <30 (OR 0.76, CI 0.68-0.86, p < 0.001), and were non-smokers (OR 0.78, CI 0.64-0.95, p = 0.016). Mean operative time was 17 min longer with adnexectomy (145 vs 128 min, p < 0.001). There were no differences in postoperative complications or reoperation rates between groups., Conclusions: Adnexectomy during VH for POP is safe and increasingly utilized by gynecology surgeons in the USA.
- Published
- 2020
- Full Text
- View/download PDF
47. Development and Validation of a Machine Learning Algorithm for Predicting Response to Anticholinergic Medications for Overactive Bladder Syndrome.
- Author
-
Sheyn D, Ju M, Zhang S, Anyaeche C, Hijaz A, Mangel J, Mahajan S, Conroy B, El-Nashar S, and Ray S
- Subjects
- Adult, Aged, Algorithms, Area Under Curve, Cholinergic Antagonists administration & dosage, Cholinergic Antagonists adverse effects, Female, Humans, Middle Aged, Predictive Value of Tests, Prognosis, Reproducibility of Results, Machine Learning standards, Urinary Bladder, Overactive diagnosis, Urinary Bladder, Overactive drug therapy, Urinary Bladder, Overactive physiopathology, Urinary Incontinence drug therapy, Urinary Incontinence etiology
- Abstract
Objective: To develop and externally validate a prediction model for anticholinergic response in patients with overactive bladder (OAB)., Methods: A machine learning model to predict the likelihood of anticholinergic treatment failure was constructed using a retrospective data set (n=559) of female patients with OAB who were treated with anticholinergic medications between January 2010 and December 2017. Treatment failure was defined as less than 50% improvement in frequency, urgency, incontinence episodes, and nocturia, and the patient's subjective impression of symptomatic relief. Patients were stratified by age (younger than 40 years, 40-60 years, and older than 60 years), and number of previously failed medications. K-fold stratified cross-validation was performed on each stratum using machine learning algorithms. Of these, the random forest model was the most accurate. This model was refined using internal cross validation within each stratum. The area under the curve (AUC) was calculated for each stratum and used to identify the optimal operating points for prediction of treatment failure. The random forest model was then externally validated using a prospectively collected data set (n=82) of women treated with anticholinergic medications at a different clinical site between January 2018 and December 2018., Results: The global accuracy of the final model was 80.3% (95% CI 79.1-81.3), and the AUC was 0.77 (95% CI 0.74-0.79). Using the external validation data set, the model's sensitivity and specificity was 80.4% (95% CI 66.5-89.7%) and 77.4% (95% CI 58.6-89.7%), respectively. The model performed best in women aged younger than 40 years (AUC 0.84, 95% CI 0.81-0.84) and worst in women aged older than 60 years who had previously failed medication (AUC 0.71, 95% CI 0.67-0.75)., Conclusion: Our externally validated machine learning prediction model can predict anticholinergic treatment failure during the standard 3-month treatment trial period with greater than 80% accuracy. The model can be accessed at https://oabweb.herokuapp.com/app/pre/.
- Published
- 2019
- Full Text
- View/download PDF
48. Cerebral White Matter Disease and Response to Anti-Cholinergic Medication for Overactive Bladder in an Age-Matched Cohort.
- Author
-
Sheyn D, Mahajan ST, Hijaz A, Slopnick E, Chapman G, El-Nashar S, and Mangel JM
- Subjects
- Aged, Female, Humans, Middle Aged, Retrospective Studies, Treatment Failure, Urinary Bladder, Overactive complications, Leukoencephalopathies complications, Muscarinic Antagonists therapeutic use, Urinary Bladder, Overactive drug therapy
- Abstract
Objective: To determine if the presence of cerebral white matter disease (WMD) affects the response to anti-cholinergic medications., Materials and Methods: This was a retrospective cohort of age-matched patients treated for OAB with anti-cholinergic medications between January 2010 and December 2017. Inclusion criteria were a chief complaint of OAB, never evaluated by a urogynecologist for OAB, treated with a maximum dose for a minimum of 4 weeks, and underwent head computed tomography (CT) within 12 months of starting therapy. Patients with WMD were matched 1:1 by age and number of prior failed antimuscarinics to controls with normal head CTs. Exclusion criteria included incomplete documentation of therapeutic response, non-WMD CT abnormalities, and non-idiopathic OAB. The primary outcome was anti-cholinergic treatment failure. Pairwise analysis between groups was performed using Wilcoxon rank-sum and Fisher's exact test where appropriate. Univariate logistic regression was performed, and any variable that was associated with treatment failure and a p value ≤ 0.2 was included in the multivariable regression analysis., Results: Sixty-eight cases were matched with 68 controls. Patients with WMD were more likely to have undergone hysterectomy (57.4% vs. 41.2%, p = 0.04) and to use diuretics (31.1% vs. 19.1%, p = 0.04). Patients with WMD were more likely to fail treatment compared with controls (60.7% vs. 29.4%, p = 0.004). After adjusting for confounders, WMD was strongly associated with an increased probability of failure (aOR = 7.31, 95% CI: 1.49-12.20). Additional significant risk factors for treatment failure were the previous number of failed medications (aOR = 3.65 per medication, 95% CI: 1.48-9.01) and a rising HbA1c (aOR: 1.39 per 1.0% increase, 95% CI: 1.0-1.91)., Conclusion: WMD is independently associated with anti-muscarinic treatment failure in women with overactive bladder symptoms.
- Published
- 2019
- Full Text
- View/download PDF
49. Comparison of 30-day Complication Rates between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy for the Treatment of Uterine Leiomyoma in Women Older Than Age 40.
- Author
-
Sheyn D, Bretschnieder CE, Mahajan ST, El-Nashar S, Billow M, and Ninivaggio CS
- Subjects
- Adult, Age Factors, Female, Humans, Hysterectomy methods, Hysterectomy mortality, Hysterectomy statistics & numerical data, Laparoscopy adverse effects, Laparoscopy methods, Laparoscopy mortality, Laparoscopy statistics & numerical data, Leiomyoma epidemiology, Leiomyoma pathology, Length of Stay statistics & numerical data, Middle Aged, Morbidity, Mortality, Operative Time, Patient Readmission statistics & numerical data, Postoperative Complications etiology, Postoperative Complications mortality, Retrospective Studies, Risk Factors, Time Factors, Uterine Myomectomy methods, Uterine Myomectomy mortality, Uterine Myomectomy statistics & numerical data, Uterine Neoplasms epidemiology, Uterine Neoplasms pathology, Hysterectomy adverse effects, Leiomyoma surgery, Postoperative Complications epidemiology, Uterine Myomectomy adverse effects, Uterine Neoplasms surgery
- Abstract
Study Objective: To evaluate whether there are differences in complication rates between laparoscopic myomectomy (LM) and total laparoscopic hysterectomy (TLH) for the treatment of uterine leiomyoma in perimenopausal women., Design: A retrospective cohort study using 1:2 propensity score matching (Canadian Task Force classification II-2)., Setting: American College of Surgeons National Surgical Quality Improvement Program database., Patients: Women between the ages of 40 and 60 years undergoing surgical laparoscopic surgery for uterine leiomyoma between the years 2010 and 2016., Interventions: Women were stratified to either LM or TLH at a ratio of 1:2 using propensity score matching. Descriptive statistics were reported as means with standard deviations. Pairwise analysis using the Student t test and chi-square test was performed where appropriate. Multivariable logistic regression was used to identify factors associated with the presence of a complication., Measurements and Main Results: After propensity score matching, there were 631 myomectomies and 1262 hysterectomies. The operating time was slightly longer for LM compared with TLH (166.8 ± 90.3 minutes vs 157.9 ± 70.9 minutes, p = .03). The overall complication rate was 6.3%. There were no differences in complications between the LM and TLH groups (5.9% vs 6.6%, p = .54). Urinary tract infections were more common in the TLH group (2.3% vs 0.6%, p = .01). There were no other differences in the rates of specific complications between the 2 groups. On logistic regression, wound class greater than 3 was most strongly associated with a risk of complications (adjusted odds ratio [aOR] = 8.89; 95% confidence interval [CI], 1.28-15.87). Other variables associated with an increased risk of complications were conversion to hysterectomy (aOR = 5.91; 95% CI, 1.7-9.63), total operating time (aOR = 1.05; 95% CI, 1.02-1.07), and length of stay over 1 day (aOR = 3.67; 95% CI, 2.31-5.8)., Conclusion: LM is not associated with an increased risk of complications compared with TLH in women over the age of 40 years undergoing treatment for uterine leiomyomata., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2019
- Full Text
- View/download PDF
50. Survey of pelvic reconstructive surgeons on performance of opportunistic salpingectomy at the time of pelvic organ prolapse repair.
- Author
-
Hassani DB, Mangel JM, Mahajan ST, Hijaz AK, El-Nashar S, and Sheyn D
- Subjects
- Aged, Fellowships and Scholarships statistics & numerical data, Female, Health Knowledge, Attitudes, Practice, Humans, Hysterectomy statistics & numerical data, Laparoscopy statistics & numerical data, Middle Aged, Plastic Surgery Procedures statistics & numerical data, Robotic Surgical Procedures statistics & numerical data, Surveys and Questionnaires, Ovarian Neoplasms prevention & control, Pelvic Organ Prolapse surgery, Practice Patterns, Physicians' statistics & numerical data, Prophylactic Surgical Procedures statistics & numerical data, Salpingectomy statistics & numerical data
- Abstract
Introduction and Hypothesis: Opportunistic salpingectomy (OS) at the time of benign hysterectomy has recently emerged as a potential primary preventive modality for ovarian cancer. Our objective was to determine whether the reported rate of OS at the time of prolapse surgery is similar to the rate of OS at the time of gynecologic surgery for non-prolapse indications., Methods: An anonymous online survey was sent to the Society of Gynecologic Surgery members. Responses were divided into surgeons who did and did not perform OS at the time of prolapse repair. Differences between surgeons who did and did not perform OS were evaluated using the chi-square test. Multivariable logistic regression was used to identify which responses related to increased odds of performing OS., Results: There were 117 (33.1%) completed responses; of these, 98 (83.8%) reported performing OS at the time of prolapse repair, which was similar to the reported rate of OS at the time of hysterectomy for non-prolapse indications, 82.1%. After multivariable logistic regression, performance of salpingectomy at the time of hysterectomy for a non-prolapse indication (aOR: 17.9, 95% CI: 3.11-42.01), use of a laparoscopic or robotic surgical approach (aOR 14.1, 95% CI: 1.81-32.21) and completion of an FPMRS fellowship (aOR: 3.47, 95% CI: 1.20-10.02) were associated with a higher likelihood of performing OS at the time of prolapse repair., Conclusions: OS at the time prolapse repair is performed more frequently with concomitant hysterectomy compared with OS at the time of post-hysterectomy prolapse repair and is similar to rates of OS performed at the time of hysterectomy for non-prolapse indications.
- Published
- 2019
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.