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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
Parkinson's Disease and Its Effect on the Lower Urinary Tract: Evaluation of Complications and Treatment Strategies
Brucker, Benjamin M; Kalra, Sidhartha
Parkinson's disease (PD) and atypical Parkinsonism are the second most common neurodegenerative movement disorders. Lower urinary tract dysfunction is among the most common types of associated autonomic dysfunctions. Differentiating the subtypes of PD is important for symptom management and understanding prognosis, because Lower urinary tract symptoms (LUTS) can evolve differently depending on the primary disease. LUTS are caused by storage and/or voiding dysfunctions. Urodynamics is a key investigative tool. The complex pathophysiology of this bladder dysfunction is not responsive to levodopa, and add-on therapy is necessary. Newer interventions hold promise as therapy to improve bladder dysfunction.
PMID: 28716322
ISSN: 1558-318x
CID: 2639942
Barriers experienced by patients with multiple sclerosis in seeking care for lower urinary tract symptoms
Brucker, Benjamin M; Nitti, Victor W; Kalra, Sidhartha; Herbert, Joseph; Sadiq, Areeba; Utomo, Puspa; Aponte, Margarita M
AIM: The Actionable Bladder Symptom and Screening Tool (ABSST) is used to identify multiple sclerosis (MS) patients in possible need of evaluation for urinary symptoms. The primary objective of this study was to identify barriers experienced by MS patients in seeking evaluation for urinary symptoms. We also assessed the utility of ABSST tool in identifying patients that will follow up with urologic evaluation. METHODS: This was a prospective observational study where 100 patients with MS were enrolled from an MS center. Patients completed demographic information, questions to assess barriers to care, a short form of the ABSST, and incontinence questionnaires. An ABSST score >3 met criteria for referral and evaluation. One year after enrollment, follow up calls assessed whether patients had seen a urinary specialist. RESULTS: The most common barriers to seeking care included "Doctor never referred" (16%) and "Doctor never asked" (13%). Thirty-eight percent (n = 8/21) of men stated "Doctor never referred" compared to 10% (n = 8/79) of women (P = 0.002). Twenty-seven patients had an ABSST Score >/=3 and were more interested in seeing a specialist compared to those scoring <3 (88.9%, n = 24/27 vs. 26%, n = 19/73; P = <0.001). After 1 year, 70 patients were reached for follow up. A total of 57.9% (n = 11/19) patients who followed up for evaluation screened positive on the ABSST. CONCLUSIONS: The ABSST is a valuable tool to identify MS patients with urinary symptoms who will likely follow up for genitourinary evaluation. However, other barriers beyond awareness exist and prevent patients from being evaluated.
PMID: 27548624
ISSN: 1520-6777
CID: 2221412
Use of Concomitant Stress Incontinence Surgery at Time of Pelvic Organ Prolapse Surgery since Release of the 2011 FDA Health Notification on Serious Complications Associated with Transvaginal Mesh
Drain, Alice; Khan, Aqsa; Ohmann, Erin L; Brucker, Benjamin M; Smilen, Scott; Rosenblum, Nirit; Nitti, Victor W
PURPOSE: There is controversy regarding performing concomitant anti-incontinence procedures at the time of pelvic organ prolapse (POP) repair. Data supports improvement in stress urinary incontinence (SUI) with concomitant sling, but increased adverse events. We assessed trends in preoperative SUI evaluation, concomitant anti-incontinence procedure at POP surgery, and post-operative anti-incontinence procedures at our institution before and after the 2011 FDA Public Health Notification pertaining to vaginal mesh. MATERIALS AND METHODS: A retrospective review was performed on patients who underwent POP surgery from 2009-2015. Preoperative workup included assessment of subjective SUI and/or evaluation for leakage with reduction of POP on physical exam, urodynamics or pessary trial. Percentage of concomitant and post-operative anti-incontinence procedures were compared before and after the 2011 FDA notification. RESULTS: 775 women underwent POP repair. The percentage of anti-incontinence procedures at POP repair decreased from 54.8% to 38.0% after the FDA notification (p = 0.002) while the incidence of pre-operative objective SUI on exam, urodynamics and pessary trials remained constant. The incidence of post-operative anti-incontinence procedures within one year of the index surgery remained low. CONCLUSIONS: We found a decrease in incidence of concomitant anti-incontinence procedures at the time of POP repair following the 2011 FDA notification despite no significant decline in subjective SUI or demonstrable SUI on preoperative evaluation. Further analysis is warranted to assess the impact of the FDA notification on management patterns of women with POP and SUI.
PMID: 27866958
ISSN: 1527-3792
CID: 2314302
Best practice policy statement on urodynamic antibiotic prophylaxis in the non-index patient
Cameron, Anne P; Campeau, Lysanne; Brucker, Benjamin M; Clemens, J Quentin; Bales, Gregory T; Albo, Michael E; Kennelly, Michael J
AIMS: Antibiotic prophylaxis before urodynamic testing (UDS) is widely utilized to prevent urinary tract infection (UTI) with only limited guidance. The Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) convened a Best Practice Policy Panel to formulate recommendations on the urodynamic antibiotic prophylaxis in the non-index patient. METHODS: Recommendations are based on a literature review and the Panel's expert opinion, with all recommendations graded using the Oxford grading system. RESULTS: All patients should be screened for symptoms of UTI and undergo dipstick urinalysis. If the clinician suspects a UTI, the UDS should be postponed until it has been treated. The first choice for prophylaxis is a single oral dose of trimethoprim-sulfamethoxazole before UDS, with alternative antibiotics chosen in case of allergy or intolerance. Individuals who do NOT require routine antibiotic prophylaxis include those without known relevant genitourinary anomalies, diabetics, those with prior genitourinary surgery, a history of recurrent UTI, post-menopausal women, recently hospitalized patients, patients with cardiac valvular disease, nutritional deficiencies or obesity. Identified risk factors that increase the potential for UTI following UDS and for which the panel recommends peri-procedure antibiotics include: known relevant neurogenic lower urinary tract dysfunction, elevated PVR, asymptomatic bacteriuria, immunosuppression, age over 70, and patients with any indwelling catheter, external urinary collection device, or performing intermittent catheterization. Patients with orthopedic implants have a separate risk stratification. CONCLUSIONS: These recommendations can assist urodynamic providers in the appropriate use of antibiotics for UDS testing. Clinical judgment of the provider must always be considered.
PMID: 28345769
ISSN: 1520-6777
CID: 2508832
THE EFFECT OF MIXED URINARY INCONTINENCE ON CATHETERIZATION RATE AFTER INTRADETRUSOR ONABOTULINUMTOXINA: IS STRESS INCONTINENCE PROTECTIVE? [Meeting Abstract]
Glass, Dianne; Hoffman, Daniel S; Enemchukwu, Ekene A; Brucker, Benjamin M; Nitti, Victor W
ISI:000394664900282
ISSN: 1520-6777
CID: 2506882
EFFICACY AND SAFETY OF ONABOTULINUMTOXINA 100U FOR TREATMENT OF URINARY INCONTINENCE DUE TO NEUROGENIC DETRUSOR OVERACTIVITY IN NONCATHETERIZING MULTIPLE SCLEROSIS PATIENTS [Meeting Abstract]
Kohan, Alfred D; Cruz, Francisco; Denys, Pierre; Egerdie, Blair; Chartier-Kastler, Emmanuel; Magyar, Andrew; Nicandro, JP; Jenkins, Brenda; Brucker, Benjamin M
ISI:000394664900288
ISSN: 1520-6777
CID: 2506892
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
Best of the 2017 AUA Annual Meeting: Highlights From the 2017 American Urological Association Annual Meeting, May 12-16, 2017, Boston, MA
Arcila-Ruiz, Maria J; Assimos, Dean G; Brucker, Benjamin M; Chancellor, Michael B; Druskin, Sasha C; Curtis Nickel, J; Partin, Alan W; Shapiro, Ellen
PMCID:5737344
PMID: 29302240
ISSN: 1523-6161
CID: 2898382
Consistent and durable improvements in quality of life with long-term onabotulinum toxin A treatment in patients with overactive bladder [Meeting Abstract]
Brucker, B; Nitti, V; Radomski, S; Gousse, A; Drake, M; Kaufmann, A; Magyar, A; Nicandro, J P; Ginsberg, D
Background: Overactive bladder (OAB) is a chronic condition that can cause significant burden and have a negative effect on patients' daily lives. There is a need to offer patients with OAB who are inadequately managed by an anticholingergic alternative therapies that are effective and improve quality of life (QOL) over the long-term. A long-term extension study involving patients with OAB and urinary incontinence (UI) who were inadequately managed by an anticholinergic (ACH) demonstrated that onabotulinum toxin A 100U provides consistent, long-term improvement of OAB symptoms. Here we evaluated the long-term effects of onabotulinum toxin A 100U on QOL in this extension study. Methods: Eligible patients who completed either of two phase 3 trials could enter a three-year extension study to receive onabotulinum toxin A treatment "as needed" for control of symptoms. Results are reported for up to six treatments. Assessments included change from baseline in Incontinence-QOL (I-QOL) total score and proportions of patients who achieved/exceeded the minimally important difference (MID) in I-QOL score (+10 points) after each treatment. Consistency of response over repeat treatments was evaluated by determining whether patients achieved >=MID after the first treatment, and then analyzing the proportion who achieved >=MID for all subsequent treatments. Results: Of 829 patients enrolled, discontinuations due to lack of efficacy/ adverse events were 5.7%/5.1%. After onabotulinum toxin A treatments 1-6, QOL improvements were consistently maintained at 2-3X MID across treatment cycles, with most patients achieving >=MID (range 65.2-76.1%). 72.9% of patients who achieved >=MID after treatment 1 maintained I-QOL improvements >=MID in all subsequent treatments. Over one-third (38.3%) of patients not achieving >=MID after treatment 1 achieved improvements >=MID in all subsequent treatments. No new safety signals were observed. Conclusions: Consistent improvements in OAB symptoms after long-term treatment with onabotulinum toxin A corresponded with durable QOL improvements, with no new safety signals. Patients with clinically meaningful QOL improvements after treatment 1 had similar improvements in subsequent treatments, while lack of response to treatment 1 did not preclude positive response(s) in subsequent treatments. These results help set treatment expectations of patients and clinicians for onabotulinum toxin A and support persistence of its use over the long-term. Additional analyses may further characterize the long-term effects of treatment with onabotulinum toxin A in patients with OAB inadequately managed by an ACH
EMBASE:617744064
ISSN: 1920-1214
CID: 2671482