49 results on '"John Eric Jelovsek"'
Search Results
2. A framework for the oversight and local deployment of safe and high-quality prediction models.
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Armando Bedoya, Nicoleta J. Economou-Zavlanos, Benjamin Alan Goldstein, Allison Young, John Eric Jelovsek, Cara O'Brien, Amanda B. Parrish, Scott Elengold, Kay Lytle, Suresh Balu, Erich Huang, Eric G. Poon, and Michael J. Pencina
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- 2022
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3. Automated problem list generation and physicians perspective from a pilot study.
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Murthy V. Devarakonda, Neil Mehta, Ching-Huei Tsou, Jennifer J. Liang, Amy S. Nowacki, and John Eric Jelovsek
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- 2017
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4. Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study
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Carol Emi, Bretschneider, Qian, Liu, Abigail R, Smith, Ziya, Kirkali, Cindy L, Amundsen, Henry, Lai, Juila, Geynisman-Tan, Anna, Kirby, Anne P, Cameron, Margaret E, Helmuth, James W, Griffith, and John Eric, Jelovsek
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Adult ,Cohort Studies ,Urinary Incontinence ,Urinary Bladder, Overactive ,Humans ,Female ,Urinary Incontinence, Urge ,Urinary Tract - Abstract
Limited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation.To describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year.The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up.Among 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score.Treatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated.
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- 2022
5. Risk of obstetric anal sphincter injuries at the time of admission for delivery: A clinical prediction model
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Douglas Luchristt, Ana Rebecca Meekins, Congwen Zhao, Chad Grotegut, Nazema Y. Siddiqui, Brooke Alhanti, and John Eric Jelovsek
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Parity ,Models, Statistical ,Pregnancy ,Risk Factors ,Obstetrics and Gynecology ,Anal Canal ,Humans ,Female ,Delivery, Obstetric ,Prognosis ,Lacerations ,Obstetric Labor Complications ,Retrospective Studies - Abstract
To develop and validate a model to predict obstetric anal sphincter injuries (OASIS) using only information available at the time of admission for labour.A clinical predictive model using a retrospective cohort.A US health system containing one community and one tertiary hospital.A total of 22 873 pregnancy episodes with in-hospital delivery at or beyond 21 weeks of gestation.Thirty antepartum risk factors were identified as candidate variables, and a prediction model was built using logistic regression predicting OASIS versus no OASIS. Models were fit using the overall study population and separately using hospital-specific cohorts. Bootstrapping was used for internal validation and external cross-validation was performed between the two hospital cohorts.Model performance was estimated using the bias-corrected concordance index (c-index), calibration plots and decision curves.Fifteen risk factors were retained in the final model. Decreasing parity, previous caesarean birth and cardiovascular disease increased risk of OASIS, whereas tobacco use and black race decreased risk. The final model from the total study population had good discrimination (c-index 0.77, 95% confidence interval [CI] 0.75-0.78) and was able to accurately predict risks between 0 and 35%, where average risk for OASIS was 3%. The site-specific model fit using patients only from the tertiary hospital had c-stat 0.74 (95% CI 0.72-0.77) on community hospital patients, and the community hospital model was 0.77 (95%CI 0.76-0.80) on the tertiary hospital patients.OASIS can be accurately predicted based on variables known at the time of admission for labour. These predictions could be useful for selectively implementing OASIS prevention strategies.
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- 2022
6. Controlling faecal incontinence in women by performing anal exercises with biofeedback or loperamide: a randomised clinical trial
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J Eric Jelovsek, Alayne D Markland, William E Whitehead, Matthew D Barber, Diane K Newman, Rebecca G Rogers, Keisha Dyer, Anthony G Visco, Gary Sutkin, Halina M Zyczynski, Benjamin Carper, Susan F Meikle, Vivian W Sung, Marie G Gantz, John Eric Jelovsek, Mathew D. Barber, Marie Fidela R. Paraiso, Mark D. Walters, Beri Ridgeway, Brooke Gurland, Massarat Zutshi, Geetha Krishnan, Ly Pung, Annette Graham, Vivian W. Sung, Deborah L. Myers, Charles R. Rardin, Cassandra Carberry, B. Star Hampton, Kyle Wohlrab, Ann S. Meers, Anthony Visco, Cindy Amundsen, Alison Weidner, Nazema Siddiqui, Amie Kawasaki, Shantae McLean, Nicole Longoria, Jessica Carrington, Niti Mehta, Ingrid Harm-Ernandes, Jennifer Maddocks, Amy Pannullo, Alayne Markland, Holly E. Richter, R. Edward Varner, Robert Holley, L. Keith Lloyd, Tracy S. Wilson, Alicia Ballard, Jeannine McCormick, Velria Willis, Nancy Saxon, Kathy Carter, Susan Meikle, Charles Nager, Michael Albo, Emily Lukacz, Cindy Furey, Patricia Riley, JoAnn Columbo, Sherella Johnson, Shawn Menefee, Karl Luber, Gouri Diwadkar, Jasmine Tan-Kim, Rebecca G. Rogers, Yuko Komesu, Gena Dunivan, Peter Jeppson, Sara Cichowski, Christy Miller, Erin Yane, Julia Middendorf, Risela Nava, Marie G. Gantz, Dennis Wallace, Amanda Shaffer, Poonam Pande, Kelly Roney, Ryan E. Whitworth, Lauren Klein Warren, Kevin A. Wilson, Brenda Hair, Kendra Glass, Daryl Matthews, James W. Pickett, Yan Tang, Tamara L. Terry, Lynda Tatum, Barbara Bibb, Jutta Thornberry, Kristin Zaterka-Baxter, Lindsay Morris, Lily Arya, Ariana Smith, Heidi Harve, Uduak Umoh Andy, Pamela Levin, Diane K. Newman, Mary Wang, Donna Thompson, Teresa Carney, Michelle Kingslee, Lorraine Flick, Halina M. Zyczynski, Pam Moalli, Jonathan Shepherd, Michael Bonidie, Steven Abo, Janet Harrison, Christopher Chermansky, Lori Geraci, Judy Gruss, Karen Mislanovich, Ellen Eline, Beth Klump, Susan E. George, William E. Whitehead, Kay Dickersin, Luohua Jiang, Missy Lavender, Kate O'Dell, Kate Ryan, Paul Tulikangas, Lan Kong, Donna McClish, Leslie Rickey, David Shade, Ashok Tuteja, and Susan Yount
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Loperamide ,medicine.medical_specialty ,Constipation ,medicine.medical_treatment ,Anal Canal ,Biofeedback ,Placebo ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Severity of illness ,medicine ,Clinical endpoint ,Humans ,Hepatology ,business.industry ,digestive, oral, and skin physiology ,Gastroenterology ,Biofeedback, Psychology ,Exercise Therapy ,Clinical trial ,030220 oncology & carcinogenesis ,Physical therapy ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Fecal Incontinence ,medicine.drug - Abstract
Summary Background Well designed, large comparative effectiveness trials assessing the efficacy of primary interventions for faecal incontinence are few in number. The objectives of this study were to compare different combinations of anorectal manometry-assisted biofeedback, loperamide, education, and oral placebo. Methods In this randomised factorial trial, participants were recruited from eight clinical sites in the USA. Women with at least one episode of faecal incontinence per month in the past 3 months were randomly assigned 0·5:1:1:1 to one of four groups: oral placebo plus education only, placebo plus anorectal manometry-assisted biofeedback, loperamide plus education only, and loperamide plus anorectal manometry-assisted biofeedback. Participants received 2 mg per day of loperamide or oral placebo with the option of dose escalation or reduction. Women assigned to biofeedback received six visits, including strength and sensory biofeedback training. All participants received a standardised faecal incontinence patient education pamphlet and were followed for 24 weeks after starting treatment. The primary endpoint was change in St Mark's (Vaizey) faecal incontinence severity score between baseline and 24 weeks, analysed by intention-to-treat using general linear mixed modelling. Investigators, interviewers, and outcome evaluators were masked to biofeedback assignment. Participants and all study staff other than the research pharmacist were masked to medication assignment. Randomisation took place within the electronic data capture system, was stratified by site using randomly permuted blocks (block size 7), and the sizes of the blocks and the allocation sequence were known only to the data coordinating centre. This trial is registered with ClinicalTrials.gov, number NCT02008565. Findings Between April 1, 2014, and Sept 30, 2015, 377 women were enrolled, of whom 300 were randomly assigned to placebo plus education (n=42), placebo plus biofeedback (n=84), loperamide plus education (n=88), and the combined intervention of loperamide plus biofeedback (n=86). At 24 weeks, there were no differences between loperamide versus placebo (model estimated score change −1·5 points, 95% CI −3·4 to 0·4, p=0·12), biofeedback versus education (−0·7 points, −2·6 to 1·2, p=0·47), and loperamide and biofeedback versus placebo and biofeedback (−1·9 points, −4·1 to 0·3, p=0·092) or versus loperamide plus education (−1·1 points, −3·4 to 1·1, p=0·33). Constipation was the most common grade 3 or higher adverse event and was reported by two (2%) of 86 participants in the loperamide and biofeedback group and two (2%) of 88 in the loperamide plus education group. The percentage of participants with any serious adverse events did not differ between the treatment groups. Only one serious adverse event was considered related to treatment (small bowel obstruction in the placebo and biofeedback group). Interpretation In women with normal stool consistency and faecal incontinence bothersome enough to seek treatment, we were unable to find evidence against the null hypotheses that loperamide is equivalent to placebo, that anal exercises with biofeedback is equivalent to an educational pamphlet, and that loperamide and biofeedback are equivalent to oral placebo and biofeedback or loperamide plus an educational pamphlet. Because these are common first-line treatments for faecal incontinence, clinicians could consider combining loperamide, anal manometry-assisted biofeedback, and a standard educational pamphlet, but this is likely to result in only negligible improvement over individual therapies and patients should be counselled regarding possible constipation. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institutes of Health Office of Research on Women's Health
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- 2019
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7. Correction to: Characteristics Associated With Clinically Important Treatment Responses in Women Undergoing Non-Surgical Therapy for Fecal Incontinence
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Keisha Y. Dyer, John Eric Jelovsek, P Iyer, Diane K. Newman, Megan S. Bradley, Holly E. Richter, Isuzu Meyer, I Harm-Ernandes, Kyle Wohlrab, Donna Mazloomdoost, Rebecca G. Rogers, and Marie G. Gantz
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medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,MEDLINE ,Article ,Clinical trial ,Surgical therapy ,Text mining ,Internal medicine ,medicine ,Fecal incontinence ,medicine.symptom ,business - Abstract
OBJECTIVE: To identify baseline clinical and demographic characteristics associated with clinically important treatment responses in a randomized trial of non-surgical therapies for fecal incontinence (FI). METHODS: Women (N=296) with FI were randomized to loperamide or placebo and manometry-assisted biofeedback exercises or educational pamphlet in a 2×2 factorial design. Treatment response was defined in 3 ways: minimally clinically important difference (MID) of −5 points in St. Mark’s score, ≥50% reduction in FI episodes and combined St. Mark’s MID and ≥50% reduction FI episodes, from baseline to 24 weeks. Multivariable logistic regression models included baseline characteristics and treatment group with and without controlling for drug and exercise adherence. RESULTS: Treatment response defined by St. Mark’s MID was associated with higher symptom severity (adjusted Odds Ratio [aOR] 1.20, 95%CI 1.11 – 1.28) and being overweight vs normal/underweight (aOR 2.15, 95%CI 1.07 – 4.34); these predictors remained controlling for adherence. 50% reduction in FI episodes was associated with combined loperamide/biofeedback group compared to placebo/pamphlet (aOR 4.04, 95%CI 1.36 – 11.98), St. Mark’s score in the placebo/pamphlet group (aOR 1.29, 95%CI 1.01–1.65), FI subtype of urge vs urge plus passive FI (aOR 2.39, 95%CI 1.09–5.25) and passive vs urge plus passive FI, (aOR 3.26, 95% CI 1.48–7.17). Controlling for adherence, associations remained, except St. Mark’s score. CONCLUSION: Higher severity of FI symptoms, being overweight, drug adherence, FI subtype, and combined biofeedback and medication treatment were associated with clinically important treatment responses. This information may assist in counseling patients regarding efficacy and expectations of non-surgical treatments of FI.
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- 2021
8. Clinical prediction is at the heart of preventing birth trauma and pelvic floor disorders for individual women
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John Eric Jelovsek
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medicine.medical_specialty ,Birth trauma ,Urology ,030232 urology & nephrology ,Context (language use) ,Pelvic Floor Disorders ,03 medical and health sciences ,Observational evidence ,0302 clinical medicine ,Pregnancy ,Risk Factors ,medicine ,Childbirth ,Humans ,Intensive care medicine ,030219 obstetrics & reproductive medicine ,Pelvic floor ,business.industry ,Parturition ,Obstetrics and Gynecology ,medicine.disease ,Delivery, Obstetric ,medicine.anatomical_structure ,Observational study ,Female ,business - Abstract
The purpose of this article is to understand that the majority of studies investigating the role of risk factors for maternal birth trauma and pelvic floor disorders are designed using causal inferential statistical methods and have not been designed to investigate the more useful goal of clinical prediction. A review of the literature was conducted to describe notable causal and predictive associations between risk factors and maternal birth trauma outcomes. Examples were obtained to illustrate and contrast differences in clinical usefulness between causal and predictive models. Effects of pregnancy and childbirth on the risk of maternal birth trauma outcomes and subsequent pelvic floor disorders are an area of profound investigation. Numerous observational studies provide evidence that pregnancy and childbirth play a causal role in the increasing prevalence of these outcomes, and clinicians must rely on this observational evidence to guide decisions about preventing maternal birth trauma and pelvic floor disorders. However, there are important differences between the design and evaluation of models for a predictive context including: study design goals, inclusion or exclusion of candidate risk factors, model evaluation and the additional need to assess model error. This article contrasts how causal and predictive modeling approaches are different and argues that indiscriminately modeling risk factors for birth trauma and pelvic floor disorder outcomes is costly to women.
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- 2021
9. LBA01-04 INTRAOPERATIVE PREDICTORS OF SACRAL NEUROMODULATION IMPLANTATION & TREATMENT RESPONSE - RESULTS FROM THE ROSETTA TRIAL
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Lindsey Barden, Cindy L. Amundsen, Ariana Smith, John Eric Jelovsek, Yuko M. Komesu, Bradley C. Gill, and Sonia Thomas
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Treatment response ,medicine.medical_specialty ,Sacral nerve stimulation ,business.industry ,Urology ,Medicine ,business ,Surgery - Published
- 2020
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10. Predicting urinary incontinence after surgery for pelvic organ prolapse
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John Eric Jelovsek
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Risk ,medicine.medical_specialty ,Sling (implant) ,Urinary Incontinence, Stress ,medicine.medical_treatment ,MEDLINE ,Urinary incontinence ,Hysterectomy ,Urologic Surgical Procedure ,Pelvic Organ Prolapse ,Article ,03 medical and health sciences ,Gynecologic Surgical Procedures ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,Adverse effect ,Aged ,Suburethral Slings ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,Surgical Mesh ,Surgery ,Neck of urinary bladder ,Urinary Incontinence ,Surgical mesh ,Urologic Surgical Procedures ,Female ,medicine.symptom ,business - Abstract
Purpose of review Many women choosing to have surgery for pelvic organ prolapse also choose to undergo continence surgery. This review focuses on available evidence that clinicians may use to counsel patients when choosing whether to perform continence surgery and how predictive analytic tools improve this decision-making process. Recent findings Midurethral sling, Burch cystourethropexy and bladder neck sling are highly effective for the surgical treatment of stress urinary incontinence. Trials demonstrate that continence surgery may be routinely performed to reduce the risk of postoperative incontinence in women undergoing surgery for pelvic organ prolapse with or without preoperative stress urinary incontinence. Although these procedures are effective and well tolerated on average, media concerns, regulatory warnings and litigation reinforce the need for a balanced discussion regarding efficacy and potential adverse events directed at the individual patient during the preoperative visit. Advances in predictive analytics allow surgeons to quantitate individual risk using algorithms that tailor estimates for the individual patient and facilitate shared understanding of risks and benefits. These models are less prone to cognitive biases and frequently outperform experienced clinicians. Summary This review discusses how predictive analytic tools can be used to improve decisions about continence surgery in the woman planning to undergo prolapse surgery.
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- 2016
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11. Characteristics Associated With Treatment Response and Satisfaction in Women Undergoing OnabotulinumtoxinA and Sacral Neuromodulation for Refractory Urgency Urinary Incontinence
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Deborah L. Myers, Yuko M. Komesu, Michael E. Albo, Stephen W. Erickson, Holly E. Richter, John Eric Jelovsek, W.T. Gregory, Cindy L. Amundsen, Dennis Wallace, Christopher Chermansky, and Heidi S. Harvie
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medicine.medical_specialty ,Urology ,Lumbosacral Plexus ,030232 urology & nephrology ,Urinary incontinence ,Comorbidity ,Injections, Intramuscular ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Quality of life ,Internal medicine ,medicine ,Humans ,Botulinum Toxins, Type A ,Aged ,030219 obstetrics & reproductive medicine ,Urinary bladder ,business.industry ,Age Factors ,Obstetrics and Gynecology ,Urinary Incontinence, Urge ,General Medicine ,Middle Aged ,medicine.disease ,Botulinum toxin ,Lumbosacral plexus ,Treatment Outcome ,medicine.anatomical_structure ,Overactive bladder ,Patient Satisfaction ,Quality of Life ,Transcutaneous Electric Nerve Stimulation ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
We sought to identify clinical and demographic characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation therapies.We analyzed data from the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation versus BoTulinum Toxin Assessment) trial. Baseline participant characteristics and clinical variables were associated with 2 definitions of treatment response, including 1) a reduction in mean daily urgency incontinence episodes during 6 months and 2) a 50% or greater decrease in urgency incontinence episodes across 6 months. The OAB-S (Overactive Bladder-Satisfaction) questionnaire was used to assess satisfaction.A greater reduction in mean daily urgency incontinence episodes was associated with higher HUI-3 (Health Utility Index-3) scores in the onabotulinumtoxinA group and higher baseline incontinence episodes (each p0.001) in the 2 groups. Increased age was associated with a lesser decrease in incontinence episodes in the 2 groups (p0.001). Increasing body mass index (adjusted OR 0.82/5 points, 95% CI 0.70-0.96) was associated with reduced achievement of a 50% or greater decrease in incontinence episodes after each treatment. Greater age (adjusted OR 0.44/10 years, 95% CI 0.30-0.65) and a higher functional comorbidity index (adjusted OR 0.84/1 point, 95% CI 0.71-0.99) were associated with reduced achievement of a 50% or greater decrease in urgency incontinence episodes in the onabotulinumtoxinA group only (p0.001 and 0.041, respectively). In the onabotulinumtoxinA group increased satisfaction was noted with higher HUI-3 score (p = 0.002) but there was less satisfaction with higher age (p = 0.001).Older women with multiple comorbidities, and decreased functional and health related quality of life had decreased treatment response and satisfaction with onabotulinumtoxinA compared to sacral neuromodulation for refractory urgency incontinence.
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- 2017
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12. 03: Posterior repair does not affect the success of transvaginal repair of apical prolapse
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Isuzu Meyer, Marie G. Gantz, John N. Nguyen, Donna Mazloomdoost, Amaanti Sridhar, Halina M. Zyczynski, U. U. Andy, John Eric Jelovsek, Charles R. Rardin, David D. Rahn, and Gary Sutkin
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medicine.medical_specialty ,Apical prolapse ,business.industry ,medicine ,Obstetrics and Gynecology ,business ,Affect (psychology) ,Surgery - Published
- 2019
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13. Incidence and Predictors of Anal Incontinence After Obstetric Anal Sphincter Injury in Primiparous Women
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Ryan Whitworth, Cathie Spino, Charles W. Nager, Marie G. Gantz, Susan Meikle, John Eric Jelovsek, Halina M. Zyczynski, Holly E. Richter, Alison C. Weidner, Scott Graziano, Joseph I. Schaffer, Kathryn L. Burgio, Peggy Norton, and Linda Brubaker
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Adult ,medicine.medical_specialty ,Time Factors ,Urology ,Anal Canal ,Logistic regression ,White People ,Article ,Young Adult ,Pregnancy ,medicine ,Humans ,Fecal incontinence ,Young adult ,Labor, Obstetric ,business.industry ,Obstetrics ,Incidence ,Obstetrics and Gynecology ,Odds ratio ,Delivery, Obstetric ,medicine.disease ,Confidence interval ,Parity ,medicine.anatomical_structure ,Sphincter ,Female ,Surgery ,medicine.symptom ,Anal sphincter ,business ,Fecal Incontinence ,Forecasting - Abstract
Objective This study aimed to describe the incidence of fecal incontinence (FI) at 6, 12, and 24 weeks postpartum; anal incontinence (AI) and fecal urgency at 24 weeks; and identify predictors of AI in women with obstetric anal sphincter injury (OASI). Methods Primiparous women sustaining OASIs were identified at 8 clinical sites. Third-degree OASIs were characterized using World Health Organization criteria, 3a ( 50%) tear through the sphincter. Fecal incontinence was defined as leakage of liquid/solid stool and/or mucus in the past month; AI was defined as leakage of liquid/solid stool and/or mucus and/or gas in the past month and was assessed at 6, 12, and 24 weeks postpartum using the Fecal Incontinence Severity Index. Logistic regression identified variables associated with AI. Results Three hundred forty-three women participated: 297 subjects sustained a third-degree OASI, 168 type 3a, 98 type 3b and 31 indeterminant; 45 had a fourth-degree OASI. Overall FI incidence at 6, 12, and 24 weeks was 7% [23/326; 95% confidence interval (CI), 4%-10%], 4% (6/145; 95% CI, 2%-9%), and 9% (13/138; 95% CI, 5%-16%), respectively. At 24 weeks, AI incidence was 24% (95% CI, 17%-32%) and fecal urgency 21% (95% CI, 15%-29%). No significant differences in FI and AI rates were noted by third-degree type or between groups with third and fourth OASI. Flatal incontinence was greater in women sustaining a fourth-degree tear (35% vs 16%, P = 0.04). White race (adjusted odds ratio, 4.64; 95% CI, 1.35-16.02) and shorter duration of second stage (adjusted odds ratio, 1.47 per 30 minute decrease; 95% CI, 1.12-1.92) were associated with AI at 24 weeks. Conclusions Overall 24-week incidence of FI is 9% (95% CI, 5%-16%) and AI is 24% (95% CI, 17%-32%). In women with OASI, white race and shorter second-stage labor were associated with postpartum AI. Clinical trial registration NCT01166399 (http://clinicaltrials.gov).
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- 2015
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14. Automated problem list generation and physicians perspective from a pilot study
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Amy S. Nowacki, Ching-Huei Tsou, Neil Mehta, John Eric Jelovsek, Jennifer J. Liang, and Murthy V. Devarakonda
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020205 medical informatics ,Computer science ,media_common.quotation_subject ,Cognitive computing ,Problem list ,Health Informatics ,Pilot Projects ,02 engineering and technology ,Clinical decision support system ,Machine Learning ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Medical Records, Problem-Oriented ,Electronic Health Records ,Humans ,Quality (business) ,030212 general & internal medicine ,Practice Patterns, Physicians' ,media_common ,Natural Language Processing ,Watson ,medicine.disease ,Data science ,Automatic summarization ,Patient Care Management ,Scale (social sciences) ,Pairwise comparison ,Medical emergency - Abstract
Objective An accurate, comprehensive and up-to-date problem list can help clinicians provide patient-centered care. Unfortunately, problem lists created and maintained in electronic health records by providers tend to be inaccurate, duplicative and out of date. With advances in machine learning and natural language processing, it is possible to automatically generate a problem list from the data in the EHR and keep it current. In this paper, we describe an automated problem list generation method and report on insights from a pilot study of physicians’ assessment of the generated problem lists compared to existing providers-curated problem lists in an institution’s EHR system. Materials and methods The natural language processing and machine learning-based Watson 1 method models clinical thinking in identifying a patient’s problem list using clinical notes and structured data. This pilot study assessed the Watson method and included 15 randomly selected, de-identified patient records from a large healthcare system that were each planned to be reviewed by at least two internal medicine physicians. The physicians created their own problem lists, and then evaluated the overall usefulness of their own problem lists (P), Watson generated problem lists (W), and the existing EHR problem lists (E) on a 10-point scale. The primary outcome was pairwise comparisons of P, W, and E. Results Six out of the 10 invited physicians completed 27 assessments of P, W, and E, and in process evaluated 732 Watson generated problems and 444 problems in the EHR system. As expected, physicians rated their own lists, P, highest. However, W was rated higher than E. Among 89% of assessments, Watson identified at least one important problem that physicians missed. Conclusion Cognitive computing systems like this Watson system hold the potential for accurate, problem-list-centered summarization of patient records, potentially leading to increased efficiency, better clinical decision support, and improved quality of patient care.
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- 2016
15. Bladder Pain Syndrome/Interstitial Cystitis in Twin Sisters
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B. Nutter, Peter C. Jeppson, John Eric Jelovsek, Matthew D. Barber, Elena Tunitsky, and Beri Ridgeway
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Adult ,medicine.medical_specialty ,Urinary bladder ,Cross-sectional study ,Bladder Pain Syndrome ,business.industry ,Urology ,Cystitis, Interstitial ,Interstitial cystitis ,Mean age ,Environment ,medicine.disease ,Index score ,Cross-Sectional Studies ,medicine.anatomical_structure ,Diseases in Twins ,medicine ,Humans ,Female ,Bladder Pain ,business ,Irritable bowel syndrome - Abstract
We determined the genetic contribution of and associated factors for bladder pain syndrome using an identical twin model.Multiple questionnaires were administered to adult identical twin sister pairs. The O'Leary-Sant Interstitial Cystitis Symptom and Problem Index was administered to identify individuals at risk for bladder pain syndrome. Potential associated factors were modeled against the bladder pain syndrome score with the twin pair as a random effect of the factor on the bladder pain syndrome score. Variables that showed a significant relationship with the bladder pain syndrome score were entered into a multivariable model.In this study 246 identical twin sister pairs (total 492) participated with a mean age (± SD) of 40.3 ± 17 years. Of these women 45 (9%) were identified as having a moderate or high risk of bladder pain syndrome (index score greater than 13). There were 5 twin sets (2%) in which both twins met the criteria. Correlation of bladder pain syndrome scores within twin pairs was estimated at 0.35, suggesting a genetic contribution to bladder pain syndrome. Multivariable analysis revealed that increasing age (estimate 0.46 [95% CI 0.2, 0.7]), irritable bowel syndrome (1.8 [0.6, 3.7]), physical abuse (2.5 [0.5, 4.1]), frequent headaches (1.6 [0.6, 2.8]), multiple drug allergies (1.5 [0.5, 2.7]) and number of self-reported urinary tract infections in the last year (8.2 [4.7, 10.9]) were significantly associated with bladder pain syndrome.Bladder pain syndrome scores within twin pairs were moderately correlated, implying some genetic component. Increasing age, irritable bowel syndrome, frequent headaches, drug allergies, self-reported urinary tract infections and physical abuse were factors associated with higher bladder pain syndrome scores.
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- 2012
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16. Functional Bowel Disorders and Pelvic Organ Prolapse
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John Eric Jelovsek, Mark D. Walters, Matthew D. Barber, and Marie Fidela R. Paraiso
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medicine.medical_specialty ,Constipation ,business.industry ,Urology ,Case-control study ,Obstetrics and Gynecology ,Odds ratio ,medicine.disease ,Gastroenterology ,Urogynecology ,medicine.anatomical_structure ,Internal medicine ,medicine ,Defecation ,Functional constipation ,Abdomen ,Surgery ,medicine.symptom ,business ,Irritable bowel syndrome - Abstract
OBJECTIVES : To compare the relative frequencies of constipation and other functional bowel disorders between patients with and without pelvic organ prolapse (POP). METHODS : This was a case-control study design. Cases were patients with stage 3-4 POP presenting to a urogynecology clinic and controls were patients presenting to a general gynecology or women's health clinic for annual examinations with stage 0-1 vaginal support. Constipation disorders were defined using responses to the Rome II Modular Questionnaire for functional bowel disorders as well as predefined defecatory disorders. RESULTS : 128 cases and 127 controls were enrolled. After controlling for race, education, and comorbidities, women with POP were more likely to report symptoms consistent with outlet constipation, including straining during a bowel movement (odds ratio [OR] 3.9, confidence interval [CI] 2.1-7.3), feeling of incomplete rectal emptying (OR 4.0, CI 2.1-7.7), a sensation that stool cannot be passed (OR 3.4, CI 1.7-6.7), and splinting (OR 2.7, CI 1.3-5.7). In spite of this, cases were just as likely to meet the criteria for functional constipation or irritable bowel syndrome (IBS) with constipation as controls but more likely to meet the criteria for IBS-any type (OR 3.8, CI 1.6-9.1) as women with POP reported more discomfort or pain in the abdomen (OR 3.4 CI 1.6-7.1) and >3 bowel movements per day (OR 2.9, CI 1.3-6.3). CONCLUSIONS : Patients with POP are more likely to have symptoms of outlet constipation and other functional bowel disorders compared with patients without POP. The Rome II criteria may not be an appropriate classification system for functional bowel disorders in patients with advanced POP.
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- 2010
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17. Randomised trial of laparoscopic Burch colposuspension versus tension-free vaginal tape: long-term follow up
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Barber, John Eric Jelovsek, Walters, M.F.R. Paraiso, and Mickey M. Karram
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Reoperation ,medicine.medical_specialty ,Stress incontinence ,Urinary incontinence ,law.invention ,Patient satisfaction ,Randomized controlled trial ,Recurrence ,law ,medicine ,Humans ,Prospective Studies ,Laparoscopy ,Prospective cohort study ,Suburethral Slings ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Surgery ,Clinical trial ,Urodynamics ,Treatment Outcome ,Urinary Incontinence ,Colposcopy ,Patient Satisfaction ,Relative risk ,Quality of Life ,Female ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Objective To compare the long-term efficacy of laparoscopic Burch colposuspension with tension-free vaginal tape (TVT) for the treatment of urodynamic stress urinary incontinence (SUI). Design Long-term follow up from a prospective randomised trial. Setting Academic tertiary referral centre. Sample Seventy-two women with urodynamic SUI from two institutions. Methods Subjects were randomised to either laparoscopic Burch or TVT from August 1999 to August 2002. Follow-up evaluations occurred 6 months, 1 year, 2 years, and 4–8 years after surgery. Main outcome measures Subjects completed the Incontinence Severity Index, Urogenital Distress Inventory 6 (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient Global Impression of Improvement (PGI-I) scales. Results Median follow-up duration was 65 months (range 12–88 months) with 92% completing at least one follow-up visit. Seventy-four percent of subjects had long-term (4–8 years) follow up. Fifty-eight percent of subjects receiving laparoscopic Burch compared with 48% of TVT subjects reported any urinary incontinence 4–8 years after surgery (Relative Risk (RR):1.19; 95% CI: 0.71–2.0) with no significant difference between groups. Bothersome SUI symptoms were seen in 11 and 8%, respectively, 4–8 years after surgery (P= 0.26). There was significant improvement in the postoperative UDI-6 and IIQ-7 scores in both groups at 1–2 years that were maintained throughout follow up with no significant differences between the groups. Conclusions TVT has similar long-term efficacy to laparoscopic Burch for the treatment of SUI. A substantial proportion of subjects have some degree of urinary incontinence 4–8 years after surgery; however, the majority of incontinence is not bothersome.
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- 2007
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18. Functional bowel and anorectal disorders in patients with pelvic organ prolapse and incontinence
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Mark D. Walters, Matthew D. Barber, Marie Fidela R. Paraiso, and John Eric Jelovsek
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Diarrhea ,medicine.medical_specialty ,Constipation ,Rectum ,Urinary incontinence ,Colonic Diseases, Functional ,Irritable Bowel Syndrome ,Uterine Prolapse ,Internal medicine ,Prevalence ,medicine ,Humans ,Fecal incontinence ,Irritable bowel syndrome ,Aged ,Gynecology ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,Pelvic cavity ,medicine.disease ,Anus ,Cross-Sectional Studies ,Rectal Diseases ,Urinary Incontinence ,medicine.anatomical_structure ,Functional constipation ,Female ,medicine.symptom ,business ,Fecal Incontinence - Abstract
The purpose of this study was 1) to determine the prevalence of functional bowel and anorectal disorders as defined by the Rome II criteria in patients with advanced pelvic organ prolapse (POP) and urinary incontinence (UI), and (2) to determine if the extent of prolapse on gynecologic examination is related to the subtypes of constipation or any functional anorectal pain disorder.Three hundred and two consecutive female subjects presenting to a tertiary urogynecology clinic were enrolled. Demographic, general medical, and physical examination information, including POPQ measurements and a standardized sacral neurologic evaluation, were collected. The prevalence of functional disorders of the bowel, rectum, and anus as defined by the Rome II criteria were collected using the Rome II Modular questionnaire. Relationships of functional disorders to various components of the vaginal examination were reviewed.Thirty-six percent (108/302) met the criteria for constipation, including the following subtypes: 19% outlet constipation, 5% functional constipation, 5% constipation predominant irritable bowel syndrome (IBS), and 7% IBS-outlet. Nineteen percent (56/302) of subjects had IBS or 1 of its subtypes. Functional diarrhea was seen in 6% (17/302), fecal incontinence in 19% (58/302), and anorectal pain disorders in 25% (77/302). After controlling for age, parity, diabetes, constipating medications, and previous pelvic surgery, there were no differences in the prevalence of constipation or any of its subtypes between patients with UI and those with stage 3 or 4 POP. Fecal incontinence was independently associated with UI (adjusted odds ratio [OR] 6.3; 95% CI 2.6-19.1), but not advanced POP. Neither overall stage of POP nor stage of posterior vaginal prolapse was significantly associated with any of the functional bowel disorders, including constipation and its subtypes. Perineal body measurement was significantly longer in patients with outlet type constipation (mean 3.5 +/- 0.6 cm vs 3.1 +/- 0.9 cm, P.01) and in those with proctalgia fugax (mean 3.4 +/- 1.0 vs 3.1 +/- 0.8, P.05).There is a high prevalence of constipation and anorectal pain disorders in women with urinary incontinence and pelvic organ prolapse. However, patients with stage 3 or 4 pelvic organ prolapse have similar rates of constipation compared with those with urinary incontinence. Constipation and its subtypes are not related to the stage of pelvic organ prolapse. It appears that either constipation is not a significant contributor to prolapse, or constipation contributes equally to the development of both urinary incontinence and pelvic organ prolapse.
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- 2005
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19. Sacrocolpopexy (ASC) and Vaginal Native Tissue Apical Repair (VAR): A Retrospective Comparison of Success and Serious Adverse Events (SAE) among Participants from Multiple Randomized Trials
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Tracy L. Nolen, Jonathan P. Shepherd, Dennis Wallace, Rebecca G. Rogers, Deborah L. Myers, Linda Brubaker, John Eric Jelovsek, Susie Meikle, Yvonne Hsu, Alison C. Weidner, Holly E. Richter, Shawn A. Menefee, Joseph I. Schaffer, and Heidi S. Harvie
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medicine.medical_specialty ,Randomized controlled trial ,law ,business.industry ,Native tissue ,medicine ,Obstetrics and Gynecology ,business ,Adverse effect ,Surgery ,law.invention - Published
- 2015
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20. MINIMUM IMPORTANT DIFFERENCES FOR SCALES ASSESSING SYMPTOM SEVERITY AND QUALITY OF LIFE IN PATIENTS WITH FECAL INCONTINENCE
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Linda Brubaker, Susie Meikle, Alayne D. Markland, Matthew D. Barber, Zhen Chen, David D. Rahn, Nazeema Y. Siddiqui, Ashok K. Tuteja, Keisha Y. Dyer, and John Eric Jelovsek
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medicine.medical_specialty ,Urology ,Anxiety ,Severity of Illness Index ,Article ,Patient satisfaction ,Quality of life ,Surveys and Questionnaires ,Severity of illness ,Medicine ,Fecal incontinence ,Humans ,Prospective Studies ,Prospective cohort study ,Pelvic floor ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,Distress ,medicine.anatomical_structure ,Patient Satisfaction ,Physical therapy ,Quality of Life ,Surgery ,Female ,medicine.symptom ,business ,Fecal Incontinence - Abstract
Objectives The objective of this study was to estimate the minimum important difference (MID) for the Fecal Incontinence Severity Index (FISI), the Colorectal-Anal Distress Inventory (CRADI) scale of the Pelvic Floor Distress Inventory, the Colorectal-Anal Impact Questionnaire (CRAIQ) scale of the Pelvic Floor Impact Questionnaire, and the Modified Manchester Health Questionnaire (MMHQ). Methods We calculated the MIDs using anchor-based and distribution-based approaches from a multicenter prospective cohort study investigating adaptive behaviors among women receiving nonsurgical and surgical management for fecal incontinence (FI). Patient responses were primarily anchored using a Global Impression of Change scale. The MID was defined as the difference in mean change from baseline between those who indicated they were "a little better" and those who reported "no change" on the Global Impression of Change scale 3 months after treatment. The effect size and SE of measurement were the distribution methods used. Results The mean changes (SD) in FISI, CRADI, CRAIQ, and MMHQ scores from baseline to 3 months after treatment were -8.8 (12.0), -52.7 (70.0), -60.6 (90.0), and -12.6 (19.2), respectively. The anchor-based MID estimates suggested by an improvement from no change to a little better were -3.6, -11.4 and -4.7, -18.1 and -8.0, and -3.2 for the FISI, CRADI (long and short version), CRAIQ (long and short version), and MMHQ, respectively. These data were supported by 2 distribution-based estimates. Conclusions The MID values for the FISI are -4, CRADI (full version, -11; short version, -5), CRAIQ (full version, -18; short version, -8), and MMHQ -3. Statistically significant improvements that meet these thresholds are likely to be clinically important.
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- 2014
21. What happens to the posterior compartment and bowel symptoms after sacrocolpopexy?: Evaluation of 5-year outcomes from E-CARE
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Holly E. Richter, John Eric Jelovsek, Anthony G. Visco, Marie G. Gantz, Linda Brubaker, Halina M. Zyczynski, Lauren Klein Warren, Susan Meikle, Geoffrey W. Cundiff, Min Zhang, Paul Fine, Emily S. Lukacz, and Cara L. Grimes
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Reoperation ,medicine.medical_specialty ,Urology ,Urinary system ,Article ,Pelvic Organ Prolapse ,Pelvic Floor Disorders ,Paediatrics and Reproductive Medicine ,Gynecologic Surgical Procedures ,Clinical Research ,medicine ,Humans ,Defecation ,Obstetrics & Reproductive Medicine ,Posterior colporrhaphy ,Aged ,Pelvic organ ,Abdominal sacrocolpopexy ,business.industry ,Sacrococcygeal Region ,Contraception/Reproduction ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,Surgery ,Treatment Outcome ,Colposcopy ,Concomitant ,Female ,Obstructed defecation ,medicine.symptom ,business - Abstract
Author(s): Grimes, Cara L; Lukacz, Emily S; Gantz, Marie G; Warren, Lauren Klein; Brubaker, Linda; Zyczynski, Halina M; Richter, Holly E; Jelovsek, J Eric; Cundiff, Geoffrey; Fine, Paul; Visco, Anthony G; Zhang, Min; Meikle, Susan; NICHD Pelvic Floor Disorders Network | Abstract: ObjectivesThe objective of this study was to describe posterior prolapse (pPOP) and obstructed defecation (OD) symptoms 5 years after open abdominal sacrocolpopexy (ASC).MethodsWe grouped the extended colpopexy and urinary reduction efforts trial participants with baseline and 5-year outcomes into 3 groups using baseline posterior Pelvic Organ Prolapse Quantification (POP-Q) points and concomitant posterior repair (PR) (no PR, Ap l0; no PR, Ap ≥0; and +PR). Posterior colporrhaphy, perineorrhaphy, or sacrocolpoperineopexy were included as PR, which was performed at surgeon's discretion. Outcomes were dichotomized into presence/absence of pPOP (Ap ≥0) and OD symptoms (≥2 on 1 or more questions about digital assistance, excessive straining, or incomplete evacuation). Composite failure was defined by both pPOP and OD symptoms or pPOP reoperation.ResultsNinety participants completed baseline and 5-year outcomes or were retreated with mean follow-up of 7.1 ± 1.0 years. Of those with no PR (Ap l0), 2 women (2/36; 9%) developed new pPOP with OD symptoms; 1 underwent subsequent PR. Nearly all (23/24; 96%) with no PR (Ap ≥0) demonstrated sustained resolution of pPOP, and none underwent PR. Fourteen percent (4/29) of +PR underwent repeat PR within 5 years, and 12% had recurrent pPOP. Regardless of PR, OD symptoms improved in all groups after ASC, although OD symptoms were still present in 17% to 19% at 5 years.ConclusionsSymptomatic pPOP is common 5 years after ASC regardless of concomitant PR. Obstructed defecation symptoms may improve after ASC regardless of PR. Recurrent pPOP and/or reoperation was highest among those who received concomitant PR at ASC. Further studies identifying criteria for concomitant PR at the time of ASC are warranted.
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- 2014
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22. Perioperative adverse events after minimally invasive abdominal sacrocolpopexy
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John Eric Jelovsek, Cecile A. Unger, Matthew D. Barber, Marie Fidela R. Paraiso, and Beri Ridgeway
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Reoperation ,medicine.medical_specialty ,Sacrum ,Abdominal Abscess ,medicine.medical_treatment ,Urinary Bladder ,Blood Loss, Surgical ,Hysterectomy ,Pelvic Organ Prolapse ,Cohort Studies ,Gynecologic Surgical Procedures ,Robotic Surgical Procedures ,Uterine Prolapse ,medicine ,Humans ,Blood Transfusion ,Aged ,Retrospective Studies ,Urinary bladder ,business.industry ,Rectum ,Obstetrics and Gynecology ,Uterine prolapse ,Retrospective cohort study ,Osteomyelitis ,Perioperative ,Middle Aged ,Surgical Mesh ,medicine.disease ,Abscess ,Surgery ,Surgical mesh ,medicine.anatomical_structure ,Concomitant ,Vagina ,Female ,Laparoscopy ,business ,Cohort study - Abstract
Our first objective was to compare peri- and postoperative adverse events between robotic-assisted laparoscopic sacrocolpopexy (RSC) and conventional laparoscopic sacrocolpopexy (LSC) in a cohort of women who underwent these procedures at a tertiary care center. Our second objective was to explore whether hysterectomy and rectopexy at the time of sacrocolpopexy were associated with these adverse events.This was a retrospective cohort study of women who underwent either RSC or LSC with or without concomitant hysterectomy and/or rectopexy from 2006-2012. Once patients were identified as either having undergone RSC or LSC, the electronic medical record was queried for demographic, peri-, and postoperative data.Four hundred six women met study inclusion criteria. Mean age and body mass index of all the women were 58 ± 10 years and 27.9 ± 4.9 kg/m(2). The women who underwent RSC were older (60 ± 9 vs 57 ± 10 years, respectively; P = .009) and more likely to be postmenopausal (90.9% vs 79.1%, respectively; P = .05). RSC cases were associated with a higher intraoperative bladder injury rate (3.3% vs 0.4%, respectively; P = .04), a higher rate of estimated blood loss of ≥500 mL (2.5% vs 0, respectively; P = .01), and reoperation rate for pelvic organ prolapse (4.9% vs 1.1%, respectively; P = .02) compared with LSC. Concomitant rectopexy was associated with a higher risk of transfusion (2.8% vs 0.3%, respectively; P = .04), pelvic/abdominal abscess formation (11.1% vs 0.8%, respectively; P.001), and osteomyelitis (5.6% vs 0, respectively; P.001). The mesh erosion rate for all the women was 2.7% and was not statistically different between LSC and RSC and for patients who underwent concomitant hysterectomy and those who did not.Peri- and postoperative outcomes after RSC and LSC are favorable, with few adverse outcomes. RSC is associated with a higher rate of bladder injury, estimated blood loss ≥500 mL, and reoperation for recurrent pelvic organ prolapse; otherwise, the rate of adverse events is similar between the 2 modalities. Concomitant rectopexy is associated with a higher rate of postoperative abscess and osteomyelitis complications.
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- 2013
23. Ureterovaginal fistula: a case series
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J. Shaw, John Eric Jelovsek, Matthew D. Barber, and Elena Tunitsky-Bitton
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Surgical repair ,Adult ,medicine.medical_specialty ,Hysterectomy ,business.industry ,Urinary Fistula ,Urology ,medicine.medical_treatment ,Fistula ,Vaginal Fistula ,Obstetrics and Gynecology ,Stent ,Urinary incontinence ,medicine.disease ,Surgery ,Genitourinary Fistula ,Laparotomy ,Medicine ,Humans ,Ureteral Diseases ,Female ,medicine.symptom ,business ,Gynecological surgery ,Retrospective Studies - Abstract
We describe the presentation, diagnosis, and management of ureterovaginal fistula over a 7-year period at a tertiary care center. A retrospective review of ureterovaginal fistula cases between 2003 and 2011 was performed. Demographic information, antecedent event, symptoms, diagnostic modalities, and management strategies were reviewed. Nineteen ureterovaginal fistulas were identified during the 7-year study period. One fistula followed a repeat cesarean section and 18 fistulas followed a hysterectomy (9 total abdominal, 6 total laparoscopic, 3 vaginal hysterectomies). Ureteral injuries were not recognized in any of the patients at the time of index surgery. Computed tomography (CT) urography was the most commonly utilized diagnostic modality (58 %). Primary non-surgical management with ureteral stents was attempted and successful in 5 out of 7 cases (71 %). There were 14 total surgical repairs, including 2 cases in which stents were successfully placed, but the fistula persisted, and 6 additional cases where attempted stent placement failed. Surgical repair consisted of 10 ureteroneocystostomies performed via laparotomy and 4 performed laparoscopically, 3 of which were robotically assisted. Despite being uncommon, ureterovaginal fistula should remain in the differential diagnosis of new post-operative urinary incontinence after gynecological surgery. Conservative management with ureteral stent appears to be the best initial approach in selected patients, with a success rate of 71 %. Minimally invasive approaches to performing ureteroneocystostomy have high success rates, comparable to those of open surgical repair.
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- 2013
24. Endometriosis of the liver containing mullerian adenosarcoma: Case report
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John Eric Jelovsek, Jennifer Brainard, Tommaso Falcone, and Charles Winans
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Gynecology ,medicine.medical_specialty ,Mixed tumor ,Adenosarcoma ,business.industry ,Liver Neoplasms ,Endometriosis ,Mixed Tumor, Mullerian ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Diagnosis, Differential ,Postmenopause ,Rare case ,medicine ,Endometriosis surgery ,Humans ,Mullerian Adenosarcoma ,Female ,Differential diagnosis ,business - Abstract
We present a case of a liver endometrioma in a postmenopausal woman. After failed management with leuprolide acetate, the mass was resected and contained focal areas of mullerian adenosarcoma. This is a rare case of mullerian adenosarcoma that appeared to arise within an endometrioma of the liver.
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- 2004
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25. Attitudes toward hysterectomy in women undergoing evaluation for uterovaginal prolapse
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John Eric Jelovsek, Marie Fidela R. Paraiso, Mark D. Walters, Anna C. Frick, Beri Ridgeway, and Matthew D. Barber
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Adult ,medicine.medical_specialty ,Urology ,Risk of malignancy ,medicine.medical_treatment ,Decision Making ,Uterovaginal prolapse ,Hysterectomy ,Pelvic Organ Prolapse ,Social life ,Medicine ,Humans ,Aged ,Aged, 80 and over ,Pelvic organ ,Prolapse repair ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Sacrohysteropexy ,Middle Aged ,Distress ,Surgery ,Female ,business ,Attitude to Health - Abstract
OBJECTIVES To investigate attitudes toward hysterectomy in women seeking care for pelvic organ prolapse. METHODS Two hundred twenty women referred for evaluation of prolapse without evidence of previous hysterectomy were surveyed with the Pelvic Organ Prolapse Distress Inventory; the Control Preferences Scale; and questions regarding patients' perception of the impact of hysterectomy on health, social life, and emotional well-being. Additional items presented hypothetical scenarios. Surveys were distributed in small batches until 100 responses were obtained from patients who met inclusion criteria. RESULTS One hundred women with an intact uterus responded. Sixty percent indicated they would decline hysterectomy if presented with an equally efficacious alternative to a hysterectomy-based prolapse repair. The doctor's opinion, risk of surgical complications, and risk of malignancy were the most important factors in surgical decision making. CONCLUSIONS Many women with prolapse prefer to retain their uterus at the time of surgery in the absence of a substantial benefit to hysterectomy. These findings should provide further impetus to investigate the efficacy of uterine-sparing procedures to help women make informed decisions regarding prolapse surgery.
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- 2013
26. Adherence to Behavioral Interventions for Stress Incontinence: Rates, Barriers, and Predictors
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Patricia S. Goode, Diane Borello-France, John Eric Jelovsek, Wen Ye, Catherine S. Bradley, Emily S. Lukacz, Joseph I. Schaffer, Yvonne Hsu, Alison C. Weidner, Kimberly Kenton, Kathryn L. Burgio, and Cathie Spino
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Pessary ,medicine.medical_specialty ,Stress incontinence ,Urinary Incontinence, Stress ,MEDLINE ,Physical Therapy, Sports Therapy and Rehabilitation ,Urinary incontinence ,law.invention ,Randomized controlled trial ,Quality of life ,law ,Behavior Therapy ,Intervention (counseling) ,medicine ,Humans ,Behavioral interventions ,business.industry ,Research Reports ,Middle Aged ,Pessaries ,medicine.disease ,Exercise Therapy ,Logistic Models ,Physical therapy ,Quality of Life ,Patient Compliance ,Female ,medicine.symptom ,business - Abstract
BackgroundFirst-line conservative treatment for stress urinary incontinence (SUI) in women is behavioral intervention, including pelvic-floor muscle (PFM) exercise and bladder control strategies.ObjectiveThe purposes of this study were: (1) to describe adherence and barriers to exercise and bladder control strategy adherence and (2) to identify predictors of exercise adherence.DesignThis study was a planned secondary analysis of data from a multisite, randomized trial comparing intravaginal continence pessary, multicomponent behavioral therapy, and combined therapy in women with stress-predominant urinary incontinence (UI).MethodsData were analyzed from the groups who received behavioral intervention alone (n=146) or combined with continence pessary therapy (n=150). Adherence was measured during supervised treatment and at 3, 6, and 12 months post-randomization. Barriers to adherence were surveyed during treatment and at the 3-month time point. Regression analyses were performed to identify predictors of exercise adherence during supervised treatment and at the 3- and 12-month time points.ResultsDuring supervised treatment, ≥86% of the women exercised ≥5 days a week, and ≥80% performed at least 30 contractions on days they exercised. At 3, 6, and 12 months post-randomization, 95%, 88%, and 80% of women, respectively, indicated they were still performing PFM exercises. During supervised treatment and at 3 months post-randomization, ≥87% of the women reported using learned bladder control strategies to prevent SUI. In addition, the majority endorsed at least one barrier to PFM exercise, most commonly “trouble remembering to do exercises.” Predictors of exercise adherence changed over time. During supervised intervention, less frequent baseline UI and higher baseline 36-Item Short-Form Health Survey (SF-36) mental scores predicted exercise adherence. At 3 months post-randomization, women who dropped out of the study had weaker PFMs at baseline. At 12 months post-randomization, only “trouble remembering” was associated with exercise adherence.LimitationsAdherence and barrier questionnaires were not validated.ConclusionsAdherence to PFM exercises and bladder control strategies for SUI can be high and sustained over time. However, behavioral interventions to help women link exercise to environmental and behavioral cues may only be beneficial over the short term.
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- 2013
27. Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol
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Alayne D. Markland, Charles R. Rardin, John Eric Jelovsek, Uduak U. Andy, Diane K. Newman, Keisha Y. Dyer, Sara B. Cichowski, William E. Whitehead, Gary Sutkin, Amanda Shaffer, I. Harm-Ernandes, Susan Meikle, and J. McCormick
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medicine.medical_specialty ,Manometry ,Physiology ,medicine.medical_treatment ,Certification ,Audit ,030230 surgery ,Biofeedback ,Article ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Humans ,Medicine ,Fecal incontinence ,Protocol (science) ,Pelvic floor ,Cognitive Behavioral Therapy ,Endocrine and Autonomic Systems ,business.industry ,Anorectal manometry ,Gastroenterology ,Biofeedback, Psychology ,Treatment Outcome ,medicine.anatomical_structure ,Physical therapy ,Female ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Fecal Incontinence - Abstract
Background Standardized training and clinical protocols using biofeedback for the treatment of fecal incontinence (FI) are important for clinical care. Our primary aims were to develop, implement, and evaluate adherence to a standardized protocol for manometric biofeedback to treat FI. Methods In a Pelvic Floor Disorders Network (PFDN) trial, participants were enrolled from eight PFDN clinical centers across the United States. A team of clinical and equipment experts developed biofeedback software on a novel tablet computer platform for conducting standardized anorectal manometry with separate manometric biofeedback protocols for improving anorectal muscle strength, sensation, and urge resistance. The training protocol also included education on bowel function, anal sphincter exercises, and bowel diary monitoring. Study interventionists completed online training prior to attending a centralized, standardized certification course. For the certification, expert trainers assessed the ability of the interventionists to perform the protocol components for a paid volunteer who acted as a standardized patient. Postcertification, the trainers audited interventionists during trial implementation to improve protocol adherence. Key Results Twenty-four interventionists attended the in-person training and certification, including 46% advanced practice registered nurses (11/24), 50% (12/24) physical therapists, and 4% physician assistants (1/24). Trainers performed audio audits for 88% (21/24), representing 84 audited visits. All certified interventionists met or exceeded the prespecified 80% pass rate for the audit process, with an average passing rate of 93%. Conclusions & Inferences A biofeedback protocol can be successfully imparted to experienced pelvic floor health care providers from various disciplines. Our process promoted high adherence to a standard protocol and is applicable to many clinical settings.
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- 2016
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28. A Model to Predict Risk of Infection After Cesarean Delivery [16J]
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Kevin Chagin, Mark Lachiewicz, Laura J. Moulton, John Eric Jelovsek, and Oluwatosin Goje
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0301 basic medicine ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Obstetrics ,business.industry ,Risk of infection ,030106 microbiology ,medicine ,Obstetrics and Gynecology ,030212 general & internal medicine ,Cesarean delivery ,business - Published
- 2016
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29. Peri- and Postoperative Outcomes after Robotic-Assisted and Conventional Laparoscopic Sacrocolpopexy
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Cecile A. Unger, John Eric Jelovsek, Beri Ridgeway, M.F.R. Paraiso, and Matthew D. Barber
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medicine.medical_specialty ,business.industry ,Robotic assisted ,Peri ,Obstetrics and Gynecology ,Medicine ,Laparoscopic sacrocolpopexy ,business ,Surgery - Published
- 2014
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30. Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review
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John Eric Jelovsek, B Feiner, and Christopher G. Maher
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Gynecology ,medicine.medical_specialty ,Suburethral Slings ,business.industry ,Treatment outcome ,Suburethral Sling ,Obstetrics and Gynecology ,Surgical Mesh ,Vaginal mesh ,Surgery ,Intravaginal slingplasty ,Prosthesis Failure ,medicine.anatomical_structure ,Gynecologic Surgical Procedures ,Treatment Outcome ,Apical prolapse ,Uterine Prolapse ,medicine ,Vagina ,Humans ,Female ,Vaginal apex ,business ,Randomized Controlled Trials as Topic - Abstract
Vaginal mesh kits are being used to surgically treat apical vaginal prolapse; however, their safety and efficacy are currently unknown.To summarise success and complication rates for commonly used vaginal mesh kits in the treatment of apical prolapse.MEDLINE and other scientific databases were queried for primary research addressing the use of vaginal mesh kits for apical prolapse published between 1950 and 2007, including abstracts presented in major scientific meetings.Studies describing the use of mesh to support either the anterior or posterior compartment alone, for incontinence or fistula repair or not addressing the vaginal apex were excluded.Identified studies were grouped by the mesh kit and complications categorised using the Dindo classification system. Weighted averages and confidence intervals were calculated on objective success, follow-up length and complications.Thirty studies totalling 2653 women met inclusion criteria. Objective success rates (95% CI) were Apogee (American Medical Systems Inc., Minnetonka, MN, USA) 95% (95-96), Prolift (Ethicon Women's Health and Urology, Somerville, NJ, USA) 87% (86-87) and posterior intravaginal slingplasty 88% (87-89). Reoperations not requiring anaesthesia (Dindo IIIa) occurred in 0.4-2.3% and requiring anaesthesia (Dindo IIIb) in 1.5-6.0%, with a follow up between 26 and 78 weeks. Mesh erosion was the most commonly reported complication occurring in 4.6-10.7%.Overall objective success using transvaginal mesh kits in restoring apical vaginal prolapse is high. However, an increasing number of women require surgical intervention for mesh-related complications based on limited data quality and short follow up. Further research addressing functional outcomes and the impact of these procedures on women's symptoms and quality of life is mandatory.
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- 2008
31. Seven years after laparoscopic radical nephrectomy: oncologic and renal functional outcomes
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Georges-Pascal Haber, Brian R. Lane, Jose R. Colombo, John Eric Jelovsek, Inderbir S. Gill, and Andrew C. Novick
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Nephrology ,Male ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Urinary system ,Renal function ,Kidney ,Nephrectomy ,chemistry.chemical_compound ,Renal cell carcinoma ,Internal medicine ,medicine ,Carcinoma ,Humans ,Carcinoma, Renal Cell ,Creatinine ,business.industry ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,chemistry ,Female ,Laparoscopy ,business ,Follow-Up Studies - Abstract
OBJECTIVES To compare the long-term oncologic and renal function outcomes in patients undergoing laparoscopic (LRN) versus open radical nephrectomy (ORN). METHODS The medical records of 116 patients undergoing radical nephrectomy for pathologically confirmed renal cell carcinoma before January 2000 were reviewed. Of these 116 patients, 63 underwent LRN and 53 ORN. The oncologic and renal functional data were obtained from the patient charts, radiographic reports, and direct telephone calls to the patients or their families. RESULTS The median follow-up was 65 months (range 19 to 92) in the LRN group and 76 months (range 8 to 105) in the ORN group. LRN was successfully completed in all patients without open conversion. The mean tumor size was 5.4 cm in the LRN group and 6.4 cm in the ORN group (P = 0.007). The 5-year overall survival (78% versus 84%, respectively; P = 0.24), cancer-specific survival (91% versus 93%, respectively; P = 0.75), and recurrence-free survival (91% versus 93%, respectively; P = 0.75) rates were similar between the LRN and ORN groups. At 7 years, the overall survival (72% versus 84%; P = 0.24), cancer-specific survival (91% versus 93%; P = 0.75), and recurrence-free survival (91% versus 93%; P = 0.75) rates were also comparable. No port site recurrence was noted in the laparoscopic group. The long-term renal function outcomes were similar in the LRN and ORN groups, with serum creatinine increasing by 33% and 25%, and the estimated creatinine clearance decreasing by 31% and 23% from baseline, respectively. Chronic renal insufficiency developed in 4% of patients in each group. CONCLUSIONS The results of our study have shown that LRN and ORN have comparable long-term oncologic and renal functional outcomes.
- Published
- 2007
32. Anatomic relationships of the tension-free vaginal mesh trocars
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Marie Fidela R. Paraiso, John Eric Jelovsek, Arlan Marcus Gustilo-Ashby, and Chi Chiung Grace Chen
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Suburethral Slings ,business.industry ,Dissection ,Suburethral Sling ,Urinary Bladder ,Rectum ,Obstetrics and Gynecology ,Anatomy ,Vaginal mesh ,Surgical Instruments ,medicine.anatomical_structure ,Gynecologic Surgical Procedures ,Cadaver ,Uterine Prolapse ,Vagina ,medicine ,Fresh frozen ,Cadaver dissection ,Humans ,Female ,business ,Aged - Abstract
Objective The objective of the study was to describe the distances between the major anatomic structures to the path of the tension-free vaginal mesh (TVM) trocars. Study Design Four anterior transobturator and 2 posterior ischiorectal TVM trocars were inserted bilaterally into 8 fresh frozen cadavers. Dissections were performed and mean distances (95% confidence interval) were measured between the closest points along the trocar's path and significant anatomic structures. Results The mean distances between both anterior transobturator trocars and the medial branch of the obturator vessels were 0.8 cm (range, 0.6 to 1.0) and 0.7 cm (range, 0.4 to 1.1), and bladder were 0.7 cm (range, 0.5 to 0.9) and 1.3 cm (range, 0.8 to 1.9), respectively. The mean distances between the posterior trocar and the rectum and inferior rectal vessels were 0.8 cm (range, 0.6 to 1.0) and 0.9 cm (range, 0.7 to 1.1), respectively. Conclusion The bladder and medial branch of the obturator vessel may be at risk of injury during the passage of the anterior trocars, whereas the rectum and inferior rectal vessels may be at risk during the passage of the posterior trocar.
- Published
- 2007
33. GYNECOLOGIC INJURIES INVOLVING THE URINARY SYSTEM ■
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Tommaso Falcone, John Eric Jelovsek, and Paul K. Tulikangas
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medicine.medical_specialty ,business.industry ,Urinary system ,Urology ,medicine ,business - Published
- 2006
- Full Text
- View/download PDF
34. Bowel symptoms 1 year after surgery for prolapse: further analysis of a randomized trial of rectocele repair
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A. Marcus Gustilo-Ashby, Mark D. Walters, Matthew D. Barber, John Eric Jelovsek, and Marie Fidela R. Paraiso
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medicine.medical_specialty ,Time Factors ,law.invention ,Gynecologic Surgical Procedures ,Randomized controlled trial ,Rectocele repair ,law ,Uterine Prolapse ,Surveys and Questionnaires ,medicine ,Fecal incontinence ,Humans ,Stage (cooking) ,Defecation ,Pelvic examination ,Digestive System Surgical Procedures ,Posterior colporrhaphy ,medicine.diagnostic_test ,business.industry ,Rectocele ,Obstetrics and Gynecology ,Rectal Prolapse ,Surgery ,Treatment Outcome ,Concomitant ,Female ,medicine.symptom ,business ,Fecal Incontinence - Abstract
Objective The purpose of this study was to analyze change in bowel function and its relationship to vaginal anatomy 1 year after rectocele repair and pelvic reconstruction in a randomized trial of 3 techniques of rectocele repair. Study Design The study is an ancillary analysis of data from a randomized trial of 3 techniques of rectocele repair: posterior colporrhaphy, site-specific repair, and site-specific repair with Fortagen graft augmentation. Pelvic examination and validated questionnaires were obtained at baseline, 6 months, and 1 year after surgery. Bowel symptoms included straining, splinting, incomplete emptying, painful defecation, fecal urgency, and fecal incontinence. Logistic regression was used to identify predictors of bothersome postoperative symptoms. Results One hundred six women with Stage ≥ 2 POP, which included a rectocele, were enrolled in the study. Nintey-nine underwent prolapse surgery that included a rectocele repair and completed at least 1 follow-up visit. Ninety-six percent of subjects underwent concomitant prolapse surgery. No differences in change in bowel symptoms were noted between treatment groups. On average, all bowel symptoms evaluated were significantly improved 1 year after surgery. The development of new “bothersome” bowel symptoms after surgery was uncommon (11%). After controlling for age, treatment group, comorbidities, and preoperative bowel symptoms, corrected postoperative vaginal support (Stage 0/1) was associated with a reduced risk of postoperative straining (adj. OR 0.17 95% CI 0.03 to 0.9) and feeling of incomplete emptying (adj. OR 0.1 95% CI 0.01 to 0.52). Normal support of the posterior vaginal wall (Bp ≤ −2) was associated with a reduced risk of bothersome incomplete emptying (OR 0.08 95% CI 0.004 to 0.58) but not with other symptoms. Conclusion Resolution or improvement in bowel symptoms can be expected in the majority of women after rectocele repair and pelvic reconstruction. While all symptoms improved after surgery, a reduction in bothersome postoperative straining and incomplete emptying were specifically associated with cure of posterior vaginal wall prolapse.
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- 2006
35. Incidence and predictors of prolonged urinary retention after TVT with and without concurrent prolapse surgery
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Marie Fidela R. Paraiso, Andrew I. Sokol, John Eric Jelovsek, Mark D. Walters, and Matthew D. Barber
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Adult ,medicine.medical_specialty ,Time Factors ,Urinary Incontinence, Stress ,Urology ,Urination ,Logistic regression ,Catheterization ,Uterine Prolapse ,Epidemiology ,Laparoscopically Assisted Vaginal Hysterectomy ,Postoperative urinary tract infection ,medicine ,Hysterectomy, Vaginal ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Urinary retention ,business.industry ,Prolapse surgery ,Medical record ,Incidence ,Obstetrics and Gynecology ,Odds ratio ,Middle Aged ,Urinary Retention ,Dilatation ,Surgery ,Treatment Outcome ,Urologic Surgical Procedures ,Female ,medicine.symptom ,business - Abstract
Objectives The purpose of this study was to describe the time to adequate voiding, incidence of urinary retention, and predictors of voiding efficiency and urinary retention after tension-free vaginal tape (TVT) with and without concurrent prolapse surgery. Study design Medical records of patients who underwent TVT between August 1999 and July 2003 were reviewed. Urinary retention was defined as the need for urethrolysis, urethral dilation, or postoperative catheterization for >6 weeks. Linear and logistic regression models were used to determine predictors of time to adequate voiding and urinary retention. Results Two hundred sixty-seven patients were available for analysis; 66% had concurrent prolapse repair, 4% had concurrent laparoscopically assisted vaginal hysterectomy (LAVH), and 30% had an isolated TVT. TVT with and without concurrent prolapse repair or LAVH were statistically similar with respect to median days to voiding (8 vs 5) and the rate of urinary retention (11.2% vs 11.3%). Overall, 4.9% underwent urethrolysis, 1.9% received urethral dilation, and 4.1% required prolonged catheterization. Increasing age, decreasing BMI, and postoperative urinary tract infection were independent predictors of time to adequate voiding. Previous history of incontinence surgery was the only independent predictor of urinary retention (Adjusted odds ratio [AOR] 2.96, 95%CI [1.17-7.06]). Conclusion Concurrent prolapse surgery does not appear to significantly alter postoperative voiding efficiency or increase the risk of prolonged urinary retention compared with TVT alone.
- Published
- 2005
36. Anatomic relationships of infracoccygeal sacropexy (posterior intravaginal slingplasty) trocar insertion
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Andrew I. Sokol, John Eric Jelovsek, Matthew D. Barber, Mark D. Walters, and Marie Fidela R. Paraiso
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Sacrum ,Ischial spine ,Dissection (medical) ,Pelvis ,medicine.muscle ,Cadaver ,Uterine Prolapse ,medicine ,Humans ,Ischiorectal Fossa ,Ligaments ,business.industry ,Obstetrics and Gynecology ,Muscle, Smooth ,Anatomy ,Pelvic cavity ,Surgical Mesh ,medicine.disease ,Neurovascular bundle ,Surgical Instruments ,medicine.anatomical_structure ,Vagina ,Iliococcygeus muscle ,Female ,business - Abstract
Objective The purpose of this study was to describe the distances of the major bony, vascular, neurologic, and visceral structures to the path of the infracoccygeal sacropexy trocar and to determine the point of trocar entry into the vagina. Study design Infracoccygeal sacropexy trocars were inserted bilaterally into 6 fresh frozen cadavers. Dissection was performed and the maximal length of the vagina, ischiorectal fossa, and pararectal spaces were measured bilaterally. Mean distances with 95% CIs to important anatomic structures were made from fixed points along the trocar's path. Results The path of the trocar began dorsal and lateral to the anus, passed through the ischiorectal fossa, iliococcygeus muscle, into the pararectal space, and into the posteriolateral vagina. Along this course, the mean distance (95% CI) to the pudendal vessels at the exit of Alcock's canal was 2.8 cm (2.1 to 3.4 cm) and rectum was 0.5 cm (0.2 to 0.9 cm). The closest inferior rectal vessel was 0.1 cm (0 to 0.3 cm). In the pararectal space, the mean distance to the ischial spine was 2.6 cm (1.7 to 3.5 cm). In 12 of 12 trocar passages, the inferior rectal branches of the pudendal artery and the rectum were within 1 cm or less of the trocar. The mean distance of trocar entry into the vagina was only 4.8 cm (4.3 to 5.4 cm) proximal to the hymenal ring compared with a mean total vaginal length of 8.7 cm (8.0 to 9.3 cm). Conclusion This anatomic study suggests that the rectum and the inferior rectal branches of the pudendal neurovascular bundle may be at risk of injury during infracoccygeal sacropexy trocar placement. Additionally, this procedure appears to provide support to the mid-posterior vaginal wall, not the vaginal apex.
- Published
- 2005
37. Reply
- Author
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Tommaso Falcone, Barber, Paraiso Mf, John Eric Jelovsek, Jon I. Einarsson, Beri Ridgeway, and Amy J. Park
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medicine.medical_specialty ,Hysterectomy ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General surgery ,MEDLINE ,Obstetrics and Gynecology ,Medicine ,business ,Laparoscopy - Published
- 2013
- Full Text
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38. Vestibulectomy: A Review of Technique
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Nathan Kow, Cecile A. Unger, and John Eric Jelovsek
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medicine.medical_specialty ,business.industry ,Obstetrics and Gynecology ,Medicine ,Medical physics ,business - Published
- 2014
- Full Text
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39. Tip/Trick 1
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A. C. Frick, C. Taylor, G. Diwadkar, and John Eric Jelovsek
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Medical education ,Multimedia ,business.industry ,Urology ,Verbal feedback ,Autodidacticism ,Obstetrics and Gynecology ,Medicine ,Surgery ,business ,computer.software_genre ,computer - Published
- 2010
- Full Text
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40. Transvaginal Mesh Excision for Complications Following Transvaginal Mesh Placement
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Amy J. Park, Chi Chiung Grace Chen, John Eric Jelovsek, and Mark D. Walters
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medicine.medical_specialty ,business.industry ,medicine ,Obstetrics and Gynecology ,business ,Surgery - Published
- 2008
- Full Text
- View/download PDF
41. Randomized Trial of Laparoscopic Burch Colposuspension Versus Tension-Free Vaginal Tape: Long-Term Follow Up
- Author
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Marie Fidela R. Paraiso, John Eric Jelovsek, Matthew D. Barber, Mark D. Walters, and Mickey Karram
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Laparoscopic surgery ,medicine.medical_specialty ,business.industry ,Genitourinary system ,medicine.medical_treatment ,Obstetrics and Gynecology ,Urinary incontinence ,General Medicine ,Confidence interval ,Surgery ,law.invention ,Randomized controlled trial ,Quality of life ,law ,Relative risk ,Very Much Worse ,medicine ,medicine.symptom ,business - Abstract
A recent Cochrane review found that women with stress urinary incontinence (SUI) were less likely to leak on objective testing following the mid-urethral tension-free vaginal tape (TVT) procedure than after the laparoscopic Burch colposuspension operation. Subjective cure rates were similar, however, and postoperative follow-up was limited to 18 months. The present prospective randomized trial, carried out at an academic tertiary referral center, followed 72 women with urodynamic SUI who were randomly assigned to have the Burch operation or TVT procedure for a median of 65 months. Nearly three-fourths of the women were followed for 4 to 8 years. Patients completed the Incontinence Severity Index, Urogenital Distress Inventory, Incontinence Impact Questionnaire, and Patient Global Impression of Improvement scales. Somewhat more women having laparoscopic surgery (57% vs. 48%) reported any degree of urinary incontinence 4 to 8 years after surgery, for a relative risk of 1.19 (95% confidence interval, 0.71-2.0); the difference was not significant. Only 11% of women in the Burch group and 8% of those in the TVT group reported having bothersome incontinence after surgery. The group difference in rates of moderate to severe incontinence 4 to 8 years after surgery was not statistically significant. More than 65% of women in both groups reported being better or very much better than before surgery. Only 7% and 4%, respectively, felt that they were much worse or very much worse. In all, 4% of women were reoperated on for SUI. Comparable numbers of patients in the 2 groups were using pads or taking anticholinergic medication. Quality of life had improved significantly in both groups within 1 to 2 years after surgery, and this continued throughout follow-up. The investigators believe that the TVT procedure is about as effective as the laparoscopic Burch colposuspension operation in women with SUI. Although a substantial number of women has some degree of incontinence 4 to 8 years postoperatively, this is not bothersome to a majority of those affected.
- Published
- 2008
- Full Text
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42. Development and Validation of a Ureteral Surgery Simulation Model for Surgical Training
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M.N. Simmons, John Eric Jelovsek, Matthew D. Barber, Elena Tunitsky-Bitton, and Alana M. Murphy
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Obstetrics and Gynecology ,business ,Surgical training ,Surgery - Published
- 2012
- Full Text
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43. Assessment of long term bowel symptoms after segmental resection for deeply infiltrating endometriosis
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Carrie Bedient, Benjamin Nutter, T. Falcone, Michelle Catenacci, and John Eric Jelovsek
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medicine.medical_specialty ,Reproductive Medicine ,business.industry ,medicine ,Endometriosis ,Obstetrics and Gynecology ,Segmental resection ,medicine.disease ,business ,Surgery ,Term (time) - Published
- 2012
- Full Text
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44. Surgical Management of Ureteral Injury: A Simulation Training Model
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John Eric Jelovsek, Elena Tunitsky-Bitton, and Alana M. Murphy
- Subjects
medicine.medical_specialty ,business.industry ,Ureteral injury ,medicine ,Obstetrics and Gynecology ,business ,Surgery ,Simulation training - Published
- 2011
- Full Text
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45. Laparoscopic Versus Robotic Hysterectomy: A Randomized Controlled Trial
- Author
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John Eric Jelovsek, Matthew D. Barber, Amy J. Park, Jon I. Einarsson, Beri Ridgeway, Tommaso Falcone, and M.F. Paraiso
- Subjects
Robotic hysterectomy ,medicine.medical_specialty ,Randomized controlled trial ,law ,business.industry ,medicine ,Obstetrics and Gynecology ,business ,Surgery ,law.invention - Published
- 2011
- Full Text
- View/download PDF
46. Long-Term Symptom Improvement in Women After Fecal Incontinence Treatments: A Multicenter Cohort Study of the Pelvic Floor Disorders Network
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John T. Wei, Marlene M. Corton, Alison C. Weidner, Lu Wang, Ashok K. Tuteja, Susan Meikle, Holly E. Richter, Andelka LoSavio, John Eric Jelovsek, Alayne D. Markland, and Linda Brubaker
- Subjects
Pediatrics ,medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Urology ,Pelvic Floor Disorders ,Term (time) ,Symptom improvement ,medicine ,Fecal incontinence ,medicine.symptom ,business ,Cohort study - Published
- 2011
- Full Text
- View/download PDF
47. Conventional Laparoscopic Versus Robotic-Assisted Laparoscopic Sacral Colpopexy: A Randomized Controlled Trial
- Author
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Anna C. Frick, C.C.G. Chen, John Eric Jelovsek, Matthew D. Barber, and M.F.R. Paraiso
- Subjects
medicine.medical_specialty ,Randomized controlled trial ,business.industry ,Robotic assisted ,law ,Obstetrics and Gynecology ,Medicine ,business ,law.invention ,Surgery - Published
- 2010
- Full Text
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48. 1231: Complications of Laparoscopic Surgery for Urological Cancer
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Robert J. Stein, Monish Aron, Jihad H. Kaouk, Georges-Pascal Haber, Jason Hafron, Mike M. Nguyen, Jose R. Colombo, John Eric Jelovsek, Inderbir S. Gill, Troy Gianduzzo, and Mihir M. Desai
- Subjects
Laparoscopic surgery ,medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,General surgery ,Urological cancer ,Medicine ,business - Published
- 2007
- Full Text
- View/download PDF
49. Psychosocial Impact of Chronic Vulvovaginal Disorders
- Author
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Mark D. Walters, Matthew D. Barber, and John Eric Jelovsek
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medicine.medical_specialty ,business.industry ,medicine ,Obstetrics and Gynecology ,Psychiatry ,business ,Psychosocial - Published
- 2006
- Full Text
- View/download PDF
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