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Exploring stress urinary incontinence outcomes after sling excision for perforation or exposure

Syan, Raveen; Peyronnet, Benoit; Drain, Alice; Enemchukwu, Ekene; Malacarne, Dominique R; Rosenblum, Nirit; Nitti, Victor W; Brucker, Benjamin M
OBJECTIVE:This study assessed stress urinary incontinence (SUI) outcomes after sling excision for urinary tract perforation or vaginal exposure, and compared the outcomes of concomitant versus staged autologous fascia pubovaginal sling (AFPVS). METHODS:A retrospective chart review of all patients who underwent midurethral sling (MUS) excision for urinary tract perforation or vaginal exposure at a tertiary referral center between 2010 and 2015 was performed. Therapeutic strategies were categorized as concomitant AFPVS, staged AFPVS, and no anti-incontinence procedure. RESULTS:In all, 32 patients were included for analysis: 13 with vaginal tape exposure (40.6%) and 19 with urinary tract tape exposure (59.4%). In patients who had SUI prior to sling excision (43.8%), the rate of resolved or improved SUI postoperatively was higher in the concomitant AFPVS group than in those who underwent sling excision alone (83.3% vs 12.5%, respectively; P = 0.03). Of 18 patients with no SUI prior to sling excision, 12 experienced recurrent SUI after sling removal (66.7%). The rate of recurrent SUI was lower in patients with vaginal MUS exposure than urinary tract MUS perforation, but this did not reach statistical significance (57.1% vs 72.7%, respectively; P = 0.63). The rates of resolved SUI after AFPVS were comparable in patients with concomitant and staged AFPVS (66.7% vs 71.4%, respectively; P = 0.99). CONCLUSIONS:Many patients with MUS perforations or exposures will have SUI at initial presentation or develop SUI after removal of the synthetic sling. The decision to perform a concomitant AFPVS or to stage the surgical management of SUI can be individualized.
PMID: 30900401
ISSN: 1757-5672
CID: 3735312

Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease

Vurture, Gregory; Peyronnet, Benoit; Palma, Jose-Alberto; Sussman, Rachael D; Malacarne, Dominique R; Feigin, Andrew; Palmerola, Ricardo; Rosenblum, Nirit; Frucht, Steven; Kaufmann, Horacio; Nitti, Victor W; Brucker, Benjamin M
PURPOSE/OBJECTIVE:To assess the urodynamic findings in patients with Parkinson disease (PD) with overactive bladder symptoms. METHODS:We performed a retrospective chart review of all PD patients who were seen in an outpatient clinic for lower urinary tract symptoms (LUTS) between 2010 and 2017 in a single-institution. Only patients who complained of overactive bladder (OAB) symptoms and underwent a video-urodynamic study for these symptoms were included. We excluded patients with neurological disorders other than PD and patients with voiding LUTS but without OAB symptoms. RESULTS:We included 42 patients (29 men, 13 women, 74.5±8.1 years old). Seven patients (16.7%) had a postvoid residual (PVR) bladder volume >100 mL and only one reported incomplete bladder emptying. Detrusor overactivity (DO) was found in all 42 patients (100%) and was terminal in 19 (45.2%) and phasic in 22 patients (52.4%). Eighteen patients had detrusor underactivity (DU) (42.3%). Later age of PD diagnosis was the only parameter associated with DU (P=0.02). Patients with bladder outlet obstruction (BOO) were younger than patients without BOO (70.1 years vs. 76.5 years, P=0.004), had later first sensation of bladder filling (173.5 mL vs. 120.3 mL, P=0.02) and first involuntary detrusor contraction (226.4 mL vs. 130.4 mL, P=0.009). CONCLUSION/CONCLUSIONS:DO is almost universal in all patients with PD complaining of OAB symptoms (97.1%). However, a significant percentage of patients also had BOO (36.8%), DU (47%), and increased PVR (16.7%) indicating that neurogenic DO may not be the only cause of OAB symptoms in PD patients.
PMID: 31607100
ISSN: 2093-4777
CID: 4136172

Teaching Vaginal Hysterectomy via Simulation: Creation and Validation of the Objective Skills Assessment Tool for Simulated Vaginal Hysterectomy on a Task Trainer and Performance Among Different Levels of Trainees

Malacarne, D R; Escobar, C M; Lam, C J; Ferrante, K L; Szyld, D; Lerner, Veronica T
OBJECTIVES:The use of simulation-based education to train surgeons is widely accepted. Although many authors describe the use of an Objective Skills Assessment Test (OSAT) to assess performance of various surgical procedures, there is a paucity of research on use of this modality to evaluate vaginal surgery skills. We created a vaginal hysterectomy procedure-specific checklist (PSC) to complete the OSAT (which is composed of a PSC and a global rating scale [GRS]). The primary objective of this study is to evaluate the performance of a novel evaluation strategy for vaginal hysterectomy using an OSAT combining PSC and GRS. METHODS:This is a descriptive prospective study from a single institution. After orientation to the model, participants were filmed performing vaginal hysterectomy. A blinded grader scored each subject using the PSC and GRS. RESULTS:Medical students, residents, fellows, and attendings performed vaginal hysterectomy on a simulated model. Mean PSC and GRS scores increased significantly with surgeon level of experience (P < 0.001). Procedure-specific checklist scores significantly correlated with GRS scores (P < 0.001). CONCLUSIONS:The vaginal hysterectomy model and PSC have been studied across different surgeon levels using OSATs. Training programs should consider using this low-cost task trainer as a teaching tool.
PMID: 29443815
ISSN: 2154-4212
CID: 4007762

Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort

Peyronnet, Benoit; Vurture, Gregory; Palma, Jose-Alberto; Malacarne, Dominique R; Feigin, Andrew; Sussman, Rachael D; Biagioni, Milton C; Palmerola, Ricardo; Gilbert, Rebecca; Rosenblum, Nirit; Frucht, Steven; Kaufmann, Horacio; Nitti, Victor W; Brucker, Benjamin M
INTRODUCTION/BACKGROUND:This study aimed to assess the outcomes of mirabegron for the treatment of overactive bladder (OAB) symptoms in patients with Parkinson disease (PD). METHODS:A retrospective study was conducted including patients with PD who received mirabegron 50 mg once daily for OAB symptoms between 2012 and 2017. The primary endpoint was clinical success defined as any improvement in overactive bladder symptoms self-assessed by the patients 6 weeks after mirabegron initiation. Secondary endpoints included number of pads per day, number of nocturia episodes and adverse events. RESULTS:Fifty patients (mean 74 years old) were included. Before being treated with mirabegron, 56% had failed prior anticholinergic therapy. After 6 weeks of mirabegron 50 mg, five patients (11.4%) had a complete resolution of their OAB symptoms; 25 patients (50%) reported improvement, 23 (46%) reported no change and 2(4%) reported worsening of their OAB symptoms. The number of pads per day decreased from 1.5 to 0.9 (p = 0.01) and so did the number of nocturia episodes (from 3 to 2.6/night; p = 0.02). Only 2 adverse events were reported during mirabegron treatment (4%): one dizziness and one diaphoresis, that disappeared after mirabegron discontinuation. After a median follow-up of 19 months, 23 patients (46%) persisted on mirabegron. Persistence rates were 51.5%, 44.6% and 36.4% at 1, 2 and 3 years respectively. CONCLUSION/CONCLUSIONS:Mirabegron has an excellent safety profile and appears to be an effective treatment for overactive bladder symptoms in patients with PD. Further prospective randomized trials are needed to properly assess mirabegron in PD patients.
PMID: 30037689
ISSN: 1873-5126
CID: 3216322

DOES RECORDING PATIENT PERCEPTION OF URGENCY IMPROVE INTER-READER RELIABILITY FOR IDENTIFYING DETRUSOR OVERACTIVITY ON URODYNAMIC TRACINGS? [Meeting Abstract]

Glass, Dianne; Drangsholt, Siri; Malacarne, Dominique; Nitti, Victor; Brucker, Benjamin
ISI:000427016100232
ISSN: 0733-2467
CID: 3008812

TRENDS IN POST-PERCUTANEOUS TIBIAL NERVE STIMULATION FOLLOW-UP TREATMENT [Meeting Abstract]

Brandon, Caroline; Malacarne, Dominique; Ringel, Nancy; Rosenblum, Nirit; Brucker, Benjamin; Smilen, Scott; Nitti, Victor; Ferrante, Kimberly
ISI:000427016100216
ISSN: 0733-2467
CID: 3008822

"Best practices in risk reducing bilateral salpingo-oophorectomy: the influence of surgical specialty"

Malacarne, Dominique R; Boyd, Leslie R; Long, Yang; Blank, Stephanie V
BACKGROUND/BACKGROUND:Risk-reducing bilateral salpingo-oophorectomy (RRBSO) increases survival in patients at high risk of developing ovarian cancer. While many general gynecologists perform this procedure, some argue it should be performed exclusively by specialists. In this retrospective observational study, we identified how often optimal techniques were used and whether surgeons' training impacted implementation. METHODS/METHODS:We used the ACOG guidelines highlighting various aspects of the procedure to determine which elements were consistent with best practices to maximize surgical prophylaxis. All cases of RRBSO from 2006 to 2010 were identified. We abstracted data from the operative and pathology reports to review the techniques employed. Fisher's exact test and chi-square were utilized to compare differences between groups (InStat, La Jolla, CA). RESULTS/RESULTS:Among 263 RRBSOs, 22 were performed by general gynecologists and 241 by gynecologic oncologists. Gynecologic oncologists were more likely to perform pelvic washings-217/241 vs. 10/22 (p < .0001). They were more likely to include a description of the upper abdomen-220/241 vs. 12/22 (p < .0001). Oncologists were more likely to utilize a retroperitoneal approach to skeletonize the infundibulopelvic ligaments-157/241 vs. 3/22 (p < .0001). When operations were performed by oncologists, the specimens were more often completely sectioned-217/241 vs. 16/22 (p = .003). The use of a retroperitoneal approach among gynecologic oncologists increased over the study period (chi-square for trend, p < .0001). There was no visible trend in performance improvement in any other area when looking at either group. CONCLUSION/CONCLUSIONS:Gynecologic oncologists are more likely to adhere to best practice techniques when performing RRBSO, though there was room for improvement for both groups.
PMCID:5725804
PMID: 29228967
ISSN: 1477-7819
CID: 2837492

Urologic and Gynecologic Sources of Pelvic Pain

Malacarne, Dominique R; Ferrante, Kimberly L; Brucker, Benjamin M
Gynecologic and urologic etiologies are the sources of pelvic pain for many individuals. This article aims to provide a comprehensive review of the various genitourinary sources of pelvic pain. It is important to recognize that although these disorders predominantly affect women, there are various conditions that affect both men and women, and these should be considered in the differential diagnosis of patients presenting with pelvic pain. Providers who encounter patients with pelvic pain should attempt to localize these symptoms and obtain a comprehensive history from the patient to help direct diagnostic evaluation.
PMID: 28676365
ISSN: 1558-1381
CID: 2616902

THE IMPACT OF CONCOMITANT SUI SURGERY ON PATIENTS UNDERGOING VAGINAL PROLAPSE REPAIR: ANALYSIS OF HOSPITAL SURGICAL QUALITY MEASURES. [Meeting Abstract]

Malacarne, Dominique R; Brucker, Benjamin M
ISI:000394664900102
ISSN: 1520-6777
CID: 2506872

Post-Sling Urinary Retention in Women

Malacarne, Dominique R; Nitti, Victor W
As many as 80 % of all women who complain of urine leakage will be diagnosed with stress urinary incontinence (SUI). As the population ages and SUI becomes more widespread, it is imperative to understand how to manage potential complications of the therapies used to treat this condition. As the mid-urethral sling has become the "gold standard" of SUI treatment, it is important to be aware of post-operative complications associated with this procedure. One significant complication of the MUS is subsequent urinary retention. In this review, we discuss the potential etiologies of post-sling urinary retention and outline the various modalities for achieving a timely and accurate diagnosis. We also emphasize the applications of various diagnostic tools, such as urodynamics, when evaluating patients with post-sling urinary retention. Lastly, various treatments for this complication are discussed. This chapter serves as a comprehensive overview of how to approach post-sling urinary retention, underlining the recent academic research contributions that have enhanced our understanding of how to manage this condition.
PMID: 27678391
ISSN: 1534-6285
CID: 2262572