Prolapse Publications

    1. BMJ Surg Interv Health Technol. 2022 Nov 11;4(Suppl 1):e000076. doi:
    10.1136/bmjsit-2020-000076. eCollection 2022. Development of a coordinated registry network for pelvic organ prolapse technologies. Baird CE(1)(2), Chughtai B(3), Bradley CS(4), Kobashi K(5), Jung M(6), Sedrakyan A(2), Andrews S(6), Ferriter A(6), Cornelison T(6), Marinac-Dabic D(6). Author information: (1)Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA. (2)Population Health Sciences, Weill Cornell Medicine, New York, New York, USA. (3)Department of Urology, Weill Cornell Medicine, New York, New York, USA. (4)Department of Obstetrics and Gynecology, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA. (5)Department of Urology, Houston Methodist Hospital, Houston, Texas, USA. (6)Center for Devices and Radiological Health (CDRH), US Food and Drug Administration, Silver Spring, Maryland, USA. OBJECTIVES: The accumulation of data through a prospective, multicenter Coordinated Registry Network (CRN) could be a robust and cost-effective way to gather real-world evidence on the performance of pelvic organ prolapse (POP) technologies for device-based and intervention-based studies. To develop the CRN, a group of POP experts consisting of representatives from professional societies, the Food and Drug Administration, academia, industry, and the patient community, was convened to discuss the role and feasibility of the CRN and to identify the core data elements important to assess POP technologies. DESIGN: A Delphi method approach was employed to achieve consensus on a core minimum dataset for the CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated, and analyzed by the study design team from Weill Cornell Medicine. Questions for the next round were based on the analysis process and discussed with group members via conference call. This process was repeated twice over a 6-month time period during which consensus was achieved. RESULTS: Twenty-one experts participated in the effort and proposed 120 data elements. Participation rates in the first and second round of the Delphi survey were 95.2% and 71.4%, respectively. The working group reached final consensus among responders on 90 data elements capturing relevant general medical and surgical history, procedure and discharge, short-term and long-term follow-up, device factors, and surgery and surgeon factors. CONCLUSIONS: The CRN successfully developed a set of core data elements to support the study of POP technologies through convening an expert panel on POP technologies and using the Delphi method. These standardized data elements have the potential to influence patient and provider decisions about treatments and include important outcomes related to efficacy and safety. © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. DOI: 10.1136/bmjsit-2020-000076 PMCID: PMC9660621 PMID: 36393893 Conflict of interest statement: Competing interests: None declared.
    1. BJUI Compass. 2022 Jul 5;3(6):415-423. doi: 10.1002/bco2.174. eCollection 2022
    Nov. Rare complications of pessary use: A systematic review of case reports. Dabic S(1), Sze C(1), Sansone S(1), Chughtai B(1). Author information: (1)Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA. INTRODUCTION: Pessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events. METHODS: We performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient-level data were extracted from case reports to further describe complications on an individual level. RESULTS: Overall median age of the patients was 82 years (range 62-98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non-surgical treatment of the complications. CONCLUSION: Pessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self-care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow-up that is required. © 2022 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company. DOI: 10.1002/bco2.174 PMCID: PMC9579882 PMID: 36267197
    1. Obstet Gynecol. 2022 Oct 1;140(4):613-622. doi: 10.1097/AOG.0000000000004931.
    Epub 2022 Sep 7. Role of Pessaries in the Treatment of Pelvic Organ Prolapse: A Systematic Review and Meta-analysis. Sansone S(1), Sze C, Eidelberg A, Stoddard M, Cho A, Asdjodi S, Mao J, Elterman DS, Zorn KC, Chughtai B. Author information: (1)Department of Urology and the Department of Obstetrics & Gynecology, Weill Cornell Medicine/NewYork-Presbyterian, New York, New York; the Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; the Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; the Georgetown University School of Medicine, Washington, DC; the Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York; and the Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, and the Division of Urology, Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montréal, Québec, Canada. OBJECTIVE: To evaluate the existing evidence on the efficacy of pessaries in improving quality of life when used for the treatment of pelvic organ prolapse (POP). DATA SOURCES: We searched for the terms “pelvic organ prolapse” and “pessar/y/ies/ium or vaginal support device,” and “safety or safe or outcome or complication or efficacy or effective or effectiveness” in PubMed, EMBASE, and CINAHL on March 16, 2020. A search was also performed on ClinicalTrials.gov , with no studies fitting our strict inclusion and exclusion criteria. METHODS OF STUDY SELECTION: Studies that reported pretreatment and posttreatment mean scores and SDs after pessary treatment for standardized questionnaires were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for prolapse were excluded. Three reviewers independently screened studies. TABULATION, INTEGRATION, AND RESULTS: Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were pooled for meta-analysis when reported by at least three studies. The primary study outcome was change in mean pretreatment and posttreatment questionnaire scores, which included those for the PFDI-20 (Pelvic Floor Distress Inventory- Short Form 20), PFIQ-7 (Pelvic Floor Impact Questionnaire – Short Form 7), and subscale POPIQ (Pelvic Organ Prolapse Impact Questionnaire Long Form). A random-effects model was used to combine estimates and capture between-study heterogeneity using the I 2 -statistic. Eight studies including 627 patients were included for systematic review. The mean (SD) age was 63.0±12.2 years, and the majority of patients had stage III prolapse (48.1%) followed by stage II prolapse (43.2%) when reported. Although variable, the majority of studies conducted 3-month follow-up. A negative change in pretreatment and posttreatment scores was noted, signifying improvement after pessary use: PFDI-20 mean change -46.1 (95% CI -65.4 to -26.8); PFIQ-7 mean change -36.0 (95% CI -46.0 to -26.0); POPIQ-7 (Pelvic Organ Prolapse Impact Questionnaire-7) mean change -16.3 (95% CI -26.8 to -5.7). No significant heterogeneity was found. CONCLUSION: Based on improvements in standardized questionnaire scores, pessaries are effective treatment options for POP. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020172618. Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/AOG.0000000000004931 PMID: 36075076 [Indexed for MEDLINE] Conflict of interest statement: Financial Disclosure The authors did not report any potential conflicts of interest.
    1. Female Pelvic Med Reconstr Surg. 2022 May 1;28(5):332-335. doi:
    10.1097/SPV.0000000000001177. Epub 2022 Apr 15. Manufacturer and User Facility Device Experience Reporting of Events Related to Transvaginal Mesh: Understanding the Data. Dallas K(1), Souders CP(1), Caron A(1), Clark K(1), Obi N(1), McClelland L(2), Chughtai B(3), Eilber KS(1), Anger JT(4). Author information: (1)From the Urology, Cedars-Sinai Medical Center. (2)Hugh & Hazel Darling Law Library at UCLA School of Law, Los Angeles, CA. (3)Weill-Cornell Medical Center, New York, NY. (4)Department of Urology, Research Gender Affirming Surgery, Urologic Reconstruction, and Female Pelvic Medicine, San Diego, CA. OBJECTIVE: The aim of this study was to examine potential bias in reports to the Manufacturer and User Facility Device Experience (MAUDE) database involving vaginal mesh by identifying the party submitting the report, the nature of the complaints, and whether the reports were edited. METHODS: All reports submitted to the MAUDE database involving synthetic transvaginal mesh from January 2000 through December 2017 (40,266 safety reports) were identified. A random 2% sample (900) of these reports was reviewed in depth to determine the specific relevant details, including reporter type (patient, manufacturer, lawyer) and details of the complaint/injury. RESULTS: Of the 40,226 reports to MAUDE identified, 28,473 (70.7%) were sling reports, and 11,793 (29.3%) described mesh products augmenting pelvic organ prolapse repair. Of the 900 reports reviewed in depth, 46%, 41%, 10%, and 2% of entries were reported by the manufacturer, attorney, health care provider, and patients, respectively. In the 4 years after submission, 18.6% of reports were modified at least once. CONCLUSIONS: The MAUDE database allows physicians, manufacturers, and patients to immediately report adverse events experienced due to medical devices. While this database is an important means to identify potential danger to patients, any individual can file a report and, thus, it should not be the sole source of evidence to consider when assessing device safety. Further, the MAUDE database provides no information into the total number of cases performed without complication. Copyright © 2022 American Urogynecologic Society. All rights reserved. DOI: 10.1097/SPV.0000000000001177 PMID: 35421039 [Indexed for MEDLINE] Conflict of interest statement: The authors have declared they have no conflicts of interest.
    1. JAMA Surg. 2022 Jun 1;157(6):542-543. doi: 10.1001/jamasurg.2022.0663.
    Patterns in Transvaginal Mesh Surgery After Government Regulation in the United States. Lewicki P(1), Brant A(1), Basourakos SP(1), Qiu Y(2), Chughtai B(1), Shoag JE(1)(3)(4). Author information: (1)Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York. (2)Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York. (3)Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, Ohio. (4)Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio. This case series examines whether the rate of transvaginal mesh repair of pelvic organ prolapse changed after US Food and Drug Administration prohibitions on the sale and distribution of the mesh. DOI: 10.1001/jamasurg.2022.0663 PMCID: PMC9008563 PMID: 35416946 [Indexed for MEDLINE] Conflict of interest statement: Conflict of Interest Disclosures: Dr Shoag reported receiving grants from the Bristol Myers Squibb Foundation and the Damon Runyon Cancer Research Foundation during the conduct of the study and receiving support from the Frederick J. and Theresa Dow Foundation of the New York Community Trust, Vinney Scholars Award, and a Damon Runyon Cancer Research Foundation Physician Scientist Training Award. No other disclosures were reported.
    1. Female Pelvic Med Reconstr Surg. 2022 Mar 1;28(3):160-164. doi:
    10.1097/SPV.0000000000001148. Can Women Accurately Predict Their Voided Volumes? Drangsholt S(1), Sansone S(2), Donnelly M(3), Chughtai B(2). Author information: (1)From the Department of Urology and Ob/Gyn, Westchester Medical Center/New York Medical College, Valhalla. (2)Division of Urology, Weill Cornell Medicine, New York, NY. (3)Department of Surgery, University of California Irvine Medical School, Irvine, CA. IMPORTANCE: Voiding diaries can be onerous, we sought to investigate if some women can predict their voided volumes. OBJECTIVES: The objective of this study is to determine the accuracy of estimated voided volumes and characteristics most predictive of accuracy. STUDY DESIGN: We prospectively collected data on 101 women undergoing urodynamics for lower urinary tract symptoms and/or prolapse at a tertiary care facility. Data collection included postvoid residual volume, urodynamic diagnosis, flow time and rate, and a 1-time measurement of voided volume into a blinded uroflow. Linear and logistic regression analyses were performed to examine predictors of estimated voided volume (mL). RESULTS: Mean age was 58.2 years (standard deviation, 12.8 years). The median estimated voided volume and actual voided volume were 240 and 215 mL, respectively. The average percent error was 15% (63% of patients being within a 30% margin of error and 32.7% being within a 20% margin of error). On linear regression analysis, smaller voids of 101 to 200 mL were associated with greater accuracy (R2 = 0.37 P = 0.001) and diagnosis of anxiety was associated with a higher voided volume percent error (P = 0.028). Logistic regression analysis revealed that for every 1 year increase in age, there was a 3% decrease in odds of predicting voiding volume within 30% (odds ratios, 0.97; P = 0.041). CONCLUSIONS: Nearly two-thirds of women estimated their voided volume within 30% of the actual void and one-third of women could predict within 20%. This should be taken into consideration when obtaining patient history, particularly with age and diagnosis of anxiety, and may substantiate use of voiding diaries for accurate measurement in specific populations. Copyright © 2022 American Urogynecologic Society. All rights reserved. DOI: 10.1097/SPV.0000000000001148 PMID: 35272323 [Indexed for MEDLINE] Conflict of interest statement: B.C. is a consultant for Medi-Tate Ltd, Olympus, Boston Scientific, and Medeon Bio. The remaining authors have declared they have no conflicts of interest.
    1. Pharmacoepidemiol Drug Saf. 2021 Aug;30(8):993-1002. doi: 10.1002/pds.5239. Epub
    2021 Apr 19. Opioid prescribing and risks among commercially insured women undergoing pelvic organ prolapse repair. Gressler LE(1), dosReis S(1), Chughtai B(2). Author information: (1)Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA. (2)Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, New York, USA. PURPOSE: Opioid use after surgical repair for pelvic organ prolapse (POP) is intended for short-term post-operative pain. This study compared the incidence of opioid prescribing in women undergoing POP transabdominal repair with mesh and transvaginal native tissue repair. METHODS: A retrospective cohort of women undergoing POP transabdominal repair with mesh or transvaginal native tissue repair, was derived from a 10% random sample of enrollees from 2007 to 2015 within the IQVIA PharMetrics® Plus Database. Primary outcomes were any prescription of opioids and cumulative days of opioids prescribed in the 14- 180 days following surgical intervention. Inverse probability of treatment weights controlled for observed baseline confounders. Any opioid prescription was estimated using logistic regression and generalized linear regression for cumulative days of opioids prescribed. RESULTS: The cohort of 49 052 women who underwent POP surgical repair included 46 813 women with transvaginal native tissue repair and 2239 women with transabdominal repair with mesh. Women with a transabdominal repair with mesh had a 1.19 (95%CI: 1.09-1.31) significantly higher odds of receiving an opioid prescription than women with transvaginal native tissue repair. Post-operatively, over 29% of women received opioid prescriptions. Mean cumulative days of post-surgical opioid prescribing was 32.2 (SD = 43.1), and was not statistically different between groups. Thirteen percent of women were prescribed opioids for 90 days or more. CONCLUSIONS: Women undergoing POP with transabdominal mesh are more likely to receive prescriptions for opioids after surgery compared to transvaginal native tissue repair. Treatment plans that address pain while mitigating the risks associated with prolonged opioid prescribing should be employed. © 2021 John Wiley & Sons Ltd. DOI: 10.1002/pds.5239 PMID: 33797822 [Indexed for MEDLINE]
    1. J Urol. 2021 Jan;205(1):183-190. doi: 10.1097/JU.0000000000001312. Epub 2020 Aug
    4. Long-Term Safety with Sling Mesh Implants for Stress Incontinence. Chughtai B(1), Mao J(2), Matheny ME(3)(4), Mauer E(2), Banerjee S(2), Sedrakyan A(2). Author information: (1)Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, New York. (2)Department of Healthcare Policy and Research, Weill Cornell Medical College-New York Presbyterian, New York, New York. (3)Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee. (4)Geriatric Research Education and Clinical Care (GRECC) Service, Tennessee Valley Healthcare System VA, Nashville, Tennessee. PURPOSE: We examined long-term risks and predictors of mesh erosion and reoperation following mid urethral sling procedure for stress urinary incontinence. MATERIALS AND METHODS: Women aged 18 years or older who received a mid urethral sling for stress urinary incontinence between 2008 and 2016 in outpatient surgical settings in New York State were included in our study. Those who underwent concomitant mesh pelvic organ prolapse repair were excluded. Primary outcomes were post-implantation time to erosion and reoperations. Kaplan-Meier analysis and Cox proportional hazard models were used to assess the risks of erosion diagnosis and reoperation. RESULTS: Our cohort included 36,195 women with a mean±SD age of 53.7±12.4 years. Estimated risks of erosions and reoperations at 7 years after sling procedures were 3.7% and 6.7%, respectively. Older age (≥65 vs <65: HR 0.83, 95% CI 0.70-0.99) and high volume facilities (high vs low: HR 0.79, 95% CI 0.68-0.92) were associated with a lower risk of erosion. History of hysterectomy was associated with a higher risk of erosion (HR 1.62, 95% CI 1.36-1.92). Predictors of reoperation included concurrent abdominal or native tissue transvaginal prolapse repair, previous hysterectomy and depression. CONCLUSIONS: One in 27 women had sling erosions and 1 in 15 had invasive reoperations at 7 years after sling procedures. The highest erosion cases were observed among younger White women treated at low volume facilities. Continued and vigilant surveillance of mesh in stress urinary incontinence repairs, the nature and burden of stress urinary incontinence recurrence, different types of re-treatment, patient reported outcomes and information about treating surgeons are crucial. DOI: 10.1097/JU.0000000000001312 PMID: 32749936 [Indexed for MEDLINE]
    1. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e133-e138. doi:
    10.1097/SPV.0000000000000863. Food and Drug Administration Safety Communication on the Use of Transvaginal Mesh in Pelvic Organ Prolapse Repair Surgery: The Impact of Social Determinants of Health. Mao J(1), Chughtai B(2), Ibrahim S(1), Sedrakyan A(1). Author information: (1)From the Department of Healthcare Policy and Research, Weill Cornell Medical College. (2)Department of Urology, Weill Cornell Medical College/NewYork-Presbyterian, New York, NY. OBJECTIVE: This study was to examine the impact of the July 2011 Food and Drug Administration (FDA) safety communication on the use of transvaginal mesh in pelvic organ prolapse (POP) repair by patients’ race and ethnicity. METHODS: We conducted an observational cohort study of women undergoing POP repairs in 2008 to 2015 in New York State. We examined the changes in transvaginal mesh use in POP repairs before and after the FDA communication by patients’ race and ethnicity. Piecewise logistic regression models were used to assess the trends of mesh use, adjusting for patient characteristics. We performed a subgroup analysis of the trends of transvaginal mesh use by racial groups, stratifying by patients’ neighborhood socioeconomic status. RESULTS: We included 49,848 women (78% white, 7% black, and 15% Hispanic) with an average ± SD age of 60.2 ± 13.0 years. After the safety communication, the use of transvaginal mesh in POP repairs decreased among white women (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.41-0.50) and African Americans (OR, 0.48; 95% CI, 0.35-0.67) but remained stable among Hispanic women (OR, 0.88; 95% CI, 0.70-1.11). Only in the subgroup of patients from high-income areas, there was a trend toward decreasing mesh use among Hispanic patients after 2011 (OR, 0.71; 95% CI, 0.49-1.04). CONCLUSIONS: The communications related to the safety of transvaginal mesh did not have an equal impact across racial groups. Mesh use decreased among white and African American women but not among Hispanic women after the 2011 FDA safety communication. Particular attention is warranted for patients from disadvantaged groups, especially low-income minorities, when disseminating medical device safety messages. Copyright © 2020 American Urogynecologic Society. All rights reserved. DOI: 10.1097/SPV.0000000000000863 PMCID: PMC7679269 PMID: 32453208 [Indexed for MEDLINE] Conflict of interest statement: The authors have declared they have no conflicts of interest.
    1. Obstet Gynecol. 2020 Mar;135(3):591-598. doi: 10.1097/AOG.0000000000003689.
    Long-term Device Outcomes of Mesh Implants in Pelvic Organ Prolapse Repairs. Chughtai B(1), Mao J, Asfaw TS, Heneghan C, Rardin CR, Sedrakyan A. Author information: (1)Departments of Urology, Healthcare Policy and Research, and Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian, New York, New York; the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; and the Division of Urogynecology, the Warren Alpert Medical School of Brown University, and Women & Infants Hospital, Providence, Rhode Island. OBJECTIVE: To evaluate the longer-term safety and reintervention outcomes of mesh implants in pelvic organ prolapse (POP) repairs. METHODS: We conducted a population-based cohort study of women undergoing POP repairs in inpatient and outpatient surgical settings between 2008 and 2016 in New York State. Multivariable logistic regression was used based on patient and procedural characteristics and hospital volume between mesh and nonmesh groups to obtain propensity scores for each individual. Long-term safety events and reinterventions were assessed using time-to-event analysis. RESULTS: We identified 54,194 women undergoing POP repairs (12,989 with mesh, and 41,205 without mesh). Mean age was 59.8 (±13.1) years, and median follow-up was 4.7 years (interquartile range, 2.4-6.8 years). In the propensity score-matched 12,284 pairs of women, POP repair with mesh was associated with a higher risk of reintervention when compared with POP repair without transvaginal mesh (hazard ratio 1.40, 95% CI 1.27-1.54, P<.001). The estimated risk of undergoing a reintervention at 5 years was 8.8% (95% CI 8.2-9.3%) in the mesh group and 6.3% (5.9-6.8%) in the nonmesh group. Among patients who had reinterventions, 18.5% of those operated with mesh had a reintervention related to mesh-related complications. CONCLUSION: Even though transvaginal mesh has been removed from the market, the risk of mesh complications did not diminish over time and these women warrant close follow-up. Continued surveillance of mesh in POP repairs is essential to ensure safety for the women who have already been implanted. DOI: 10.1097/AOG.0000000000003689 PMID: 32028486 [Indexed for MEDLINE]
    1. J Urol. 2017 Oct;198(4):884-889. doi: 10.1016/j.juro.2017.04.099. Epub 2017 May
    4. Challenging the Myth: Transvaginal Mesh is Not Associated with Carcinogenesis. Chughtai B(1), Sedrakyan A(2), Mao J(2), Thomas D(3), Eilber KS(4), Clemens JQ(5), Anger JT(4). Author information: (1)Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, New York. Electronic address: bic9008@med.cornell.edu. (2)Department of Healthcare Policy and Research, Weill Cornell Medicine/New York-Presbyterian, New York, New York. (3)Department of Urology, Weill Cornell Medicine/New York-Presbyterian, New York, New York; Department of Surgery, Weill Cornell Medicine/New York-Presbyterian, New York, New York. (4)Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Beverly Hills, California. (5)Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan. Comment in J Urol. 2017 Oct;198(4):755-756. doi: 10.1016/j.juro.2017.07.045. PURPOSE: We sought to determine if there was a potential link between synthetic polypropylene mesh implantation for transvaginal pelvic organ prolapse and stress urinary incontinence, and carcinogenesis using statewide administrative data. MATERIALS AND METHODS: Women who underwent transvaginal surgery for pelvic organ prolapse or stress urinary incontinence with mesh between January 2008 and December 2009 in New York State were identified using ICD-9-CM procedure codes and CPT-4 codes. Patients in the mesh cohort were individually matched to 2 control cohorts based on comorbidities and procedure date. Carcinogenesis was determined before and after matching at 1, 2 and 3 years, and during the entire followup time. RESULTS: A total of 2,229 patients who underwent mesh based pelvic organ prolapse surgery and 10,401 who underwent sling surgery for stress urinary incontinence between January 2008 and December 2009 were included in the study. Mean followup was 6 years (range 5 to 7). Exact matching between the mesh and control cohorts resulted in 1,870 pairs for pelvic organ prolapse mesh and cholecystectomy (1:2), 1,278 pairs for pelvic organ prolapse mesh and hysterectomy (1:1), 7,986 pairs for sling and cholecystectomy (1:1) and 3,810 pairs for sling and hysterectomy (1:1). Transvaginal mesh implantation was not associated with an increased risk of a cancer diagnosis (pelvic/local cancers or any cancer) at 1 year and during the entire followup of up to 7 years. CONCLUSIONS: Transvaginal surgery with implantation of mesh was not associated with the development of malignancy at a mean followup of 6 years. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.juro.2017.04.099 PMID: 28479238 [Indexed for MEDLINE]
    1. Int Urogynecol J. 2017 Aug;28(8):1263-1264. doi: 10.1007/s00192-017-3269-8. Epub
    2017 Feb 1. The feasibility of transvaginal robotic surgery in the repair of pelvic organ prolapse. Yaghnam I(1), Thomas D(1), Rosenblatt P(2), Chughtai B(3). Author information: (1)Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61st Street, 12th Floor, New York, NY, 10056, USA. (2)Mount Auburn Hospital, Cambridge, MA, 02138, USA. (3)Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61st Street, 12th Floor, New York, NY, 10056, USA. bic9008@med.cornell.edu. INTRODUCTION AND HYPOTHESIS: Pelvic organ prolapse (POP), the descent of one or more pelvic organs, occurs in an estimated 40 to 60% of parous women. Conventional transvaginal surgery for POP has been plagued with high failure rates. The purpose was to determine the safety and feasibility of robotic transvaginal POP surgery. METHODS: The da Vinci Surgical Robot, SI was used in the POP surgical procedures. There were two cadavers (aged 18 and 78 years of age; BMI 17.2 and 19.2 respectively). POP-Q scores before intervention were stage 1 for both cadavers. RESULTS: The visualization of anatomical landmarks and the placement of sutures at these locations were successful. CONCLUSION: Robotic transvaginal POP is a feasible option for POP surgery. Further studies are warranted to determine the role of robotic transvaginal POP repair. DOI: 10.1007/s00192-017-3269-8 PMID: 28150031 [Indexed for MEDLINE]
    1. Int Urogynecol J. 2017 Aug;28(8):1183-1195. doi: 10.1007/s00192-016-3244-9. Epub
    2017 Jan 13. Role of concurrent vaginal hysterectomy in the outcomes of mesh-based vaginal pelvic organ prolapse surgery. Forde JC(1), Chughtai B(2), Anger JT(3), Mao J(4), Sedrakyan A(4). Author information: (1)Beaumont Hospital, Dublin, Ireland, D09 V2N0. (2)Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA. bic9008@med.cornell.edu. (3)Department of Urologic Reconstruction, Urodynamics, and Female Urology, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. (4)Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA. INTRODUCTION AND HYPOTHESIS: Hysterectomy is often performed at the time of pelvic organ prolapse (POP) surgery; yet, there is insufficient evidence regarding the specific effect of hysterectomy on outcomes. We sought to determine the outcomes and associated short-term complications of mesh-based POP surgery with and without concurrent hysterectomy. METHODS: We utilized the New York Statewide Planning and Research Cooperation System (SPARCS) database to identify patients under 55 years of age undergoing surgeries for POP with mesh between 2009 and 2014. Patients who had a hysterectomy at the time of mesh-based POP surgery were compared with those who underwent mesh-based POP surgery without hysterectomy. Outcome measures of the patient groups before and after propensity score matching were compared. We assessed the difference Chi-squared tests and log-rank tests in the entire cohort and Mantel-Haenszel stratified Chi-squared tests and Prentice-Wilcoxon tests in the matched cohort. RESULTS: A total of 1,601 women underwent mesh-based POP surgery. 921 patients underwent concurrent hysterectomy, whereas 680 had mesh-based uterine-preserving POP surgery. After propensity score matching, there was no difference in reintervention rates between groups for up to 3 years. Concurrent hysterectomy with mesh-based POP repair was consistently associated with longer hospitalization (20.0% vs 12.8% stayed longer than 2 days) and higher charges (median charges were $22,689 vs $19,273). CONCLUSIONS: Concurrent hysterectomy during mesh-based POP surgery in patients under 55 years led to more expensive charges and a longer stay compared with uterine-preserving mesh surgery. There was no difference in reintervention rates between groups for up to 3 years. DOI: 10.1007/s00192-016-3244-9 PMID: 28091710 [Indexed for MEDLINE]
    1. Am J Obstet Gynecol. 2017 May;216(5):495.e1-495.e7. doi:
    10.1016/j.ajog.2016.12.021. Epub 2016 Dec 26. Is vaginal mesh a stimulus of autoimmune disease? Chughtai B(1), Sedrakyan A(2), Mao J(2), Eilber KS(3), Anger JT(3), Clemens JQ(4). Author information: (1)Department of Urology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY. Electronic address: bic9008@med.cornell.edu. (2)Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY. (3)Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA. (4)Department of Urology, University of Michigan, Ann Arbor, MI. BACKGROUND: Polypropylene mesh has been used as a means of reinforcing weak tissues in women with pelvic organ prolapse and stress urinary incontinence. OBJECTIVE: We sought to investigate a potential link between the development of systemic/autoimmune disorders and synthetic polypropylene mesh repairs. STUDY DESIGN: New York State Department of Health Statewide Planning and Research Cooperative System data were utilized to conduct this retrospective cohort study. Adult women undergoing surgery for pelvic organ prolapse with vaginally implanted mesh from January 2008 through December 2009 in inpatient and ambulatory surgery settings in New York State were identified. Two separate control cohorts were created to compare outcomes, including a screening colonoscopy cohort and a vaginal hysterectomy cohort for benign gynecologic conditions (without pelvic organ prolapse repair or sling). Patients in the mesh cohort were individually matched to the control cohorts based on demographics, comorbidities, and procedure date. The development of systemic/autoimmune disease was determined before and after matching for 1-year, 2-year, 3-year, and entire follow-up (up to 6 years until December 2014) and differences between groups were evaluated. RESULTS: A total of 2102 patients underwent mesh-based pelvic organ prolapse surgery from January 2008 through December 2009. In the control cohorts, 37,298 patients underwent colonoscopy and 7338 underwent vaginal hysterectomy. When patients were matched based on demographics, comorbidities, and procedure time, mesh-based surgery was not associated with an increased risk of developing autoimmune disease at any of the evaluated time periods. CONCLUSION: Mesh-based vaginal surgery was not associated with the development of systemic/autoimmune diseases. These data refute claims against mesh as a cause of systemic disease. Copyright © 2016 Elsevier Inc. All rights reserved. DOI: 10.1016/j.ajog.2016.12.021 PMID: 28034649 [Indexed for MEDLINE]
    1. JAMA Surg. 2017 Mar 1;152(3):257-263. doi: 10.1001/jamasurg.2016.4200.
    Association Between the Amount of Vaginal Mesh Used With Mesh Erosions and Repeated Surgery After Repairing Pelvic Organ Prolapse and Stress Urinary Incontinence. Chughtai B(1), Barber MD(2), Mao J(3), Forde JC(1), Normand ST(4), Sedrakyan A(3). Author information: (1)Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York. (2)Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio. (3)Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York. (4)Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts5Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. Comment in JAMA Surg. 2017 Mar 1;152(3):263-264. doi: 10.1001/jamasurg.2016.4201. Eur Urol. 2019 Jan;75(1):196-197. doi: 10.1016/j.eururo.2018.10.048. IMPORTANCE: Mesh, a synthetic graft, has been used in pelvic organ prolapse (POP) repair and stress urinary incontinence (SUI) to augment and strengthen weakened tissue. Polypropylene mesh has come under scrutiny by the US Food and Drug Administration. OBJECTIVE: To examine the rates of mesh complications and invasive reintervention after the placement of vaginal mesh for POP repair or SUI surgery. DESIGN, SETTING, AND PARTICIPANTS: This investigation was an observational cohort study at inpatient and ambulatory surgery settings in New York State. Participants were women who underwent transvaginal repair for POP or SUI with mesh between January 1, 2008, and December 31, 2012, and were followed up through December 31, 2013. They were divided into the following 4 groups based on the amount of mesh exposure: transvaginal POP repair surgery with mesh and concurrent sling use (vaginal mesh plus sling group), transvaginal POP repair with mesh and no concurrent sling use (vaginal mesh group), transvaginal POP repair without mesh but concurrent sling use for SUI (POP sling group), and sling for SUI alone (SUI sling group). MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of mesh complications and repeated invasive intervention within 1 year after the initial mesh implantation. A time-to-event analysis was performed to examine the occurrence of mesh erosions and subsequent reintervention. Secondary analyses of an age association (<65 vs ≥65 years) were conducted. RESULTS: The study identified 41 604 women who underwent 1 of the 4 procedures. The mean (SD) age of women at their initial mesh implantation was 56.2 (13.0) years. The highest risk of erosions was found in the vaginal mesh plus sling group (2.72%; 95% CI, 2.31%-3.21%) and the lowest in the SUI sling group (1.57%; 95% CI, 1.41%-1.74%). The risk of repeated surgery with concomitant erosion diagnosis was also the highest in the vaginal mesh plus sling group (2.13%; 95% CI, 1.76%-2.56%) and the lowest in the SUI sling group (1.16%; 95% CI, 1.03%-1.31%). CONCLUSIONS AND RELEVANCE: The combined use of POP mesh and SUI mesh sling was associated with the highest erosion and repeated intervention risk, while mesh sling alone had the lowest erosion and repeated intervention risk. There is evidence for a dose-response relationship between the amount of mesh used and subsequent mesh erosions, complications, and invasive repeated intervention. DOI: 10.1001/jamasurg.2016.4200 PMID: 27902825 [Indexed for MEDLINE]
    1. Int Urogynecol J. 2016 Nov;27(11):1761-1766. doi: 10.1007/s00192-016-3040-6.
    Epub 2016 May 21. Trends in internet search activity, media coverage, and patient-centered health information after the FDA safety communications on surgical mesh for pelvic organ prolapse. Stone BV(1), Forde JC(1), Levit VB(1), Lee RK(1), Te AE(1), Chughtai B(2). Author information: (1)Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 425 E 61st Street, 12th floor, New York, NY, 10065, USA. (2)Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, 425 E 61st Street, 12th floor, New York, NY, 10065, USA. bic9008@med.cornell.edu. INTRODUCTION: In July 2011, the US Food and Drug Administration (FDA) issued a safety communication regarding serious complications associated with surgical mesh for pelvic organ prolapse, prompting increased media and public attention. This study sought to analyze internet search activity and news article volume after this FDA warning and to evaluate the quality of websites providing patient-centered information. METHODS: Google Trends™ was utilized to evaluate search engine trends for the term “pelvic organ prolapse” and associated terms between 1 January 2004 and 31 December 2014. Google News™ was utilized to quantify the number of news articles annually under the term “pelvic organ prolapse.” The search results for the term “pelvic organ prolapse” were assessed for quality using the Health On the Net Foundation (HON) certification. RESULTS: There was a significant increase in search activity from 37.42 in 2010 to 57.75 in 2011, at the time of the FDA communication (p = 0.021). No other annual interval had a statistically significant increase in search activity. The single highest monthly search activity, given the value of 100, was August 2011, immediately following the July 2011 notification, with the next highest value being 98 in July 2011. Linear regression analysis of news articles per year since the FDA communication revealed r2 = 0.88, with a coefficient of 186. Quality assessment demonstrated that 42 % of websites were HON-certified, with .gov sites providing the highest quality information. CONCLUSIONS: Although the 2011 FDA safety communication on surgical mesh was associated with increased public and media attention, the quality of relevant health information on the internet remains of poor quality. Future quality assurance measures may be critical in enabling patients to play active roles in their own healthcare. DOI: 10.1007/s00192-016-3040-6 PMID: 27209310 [Indexed for MEDLINE]
    1. JAMA Intern Med. 2016 Feb;176(2):275-7. doi: 10.1001/jamainternmed.2015.6595.
    Regulatory Warnings and Use of Surgical Mesh in Pelvic Organ Prolapse. Sedrakyan A(1), Chughtai B(2), Mao J(1). Author information: (1)Department of Healthcare Policy and Research, Weill Medical College of Cornell University, New York, New York. (2)Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York. Comment in JAMA Intern Med. 2016 Feb;176(2):277-8. doi: 10.1001/jamainternmed.2015.7155. DOI: 10.1001/jamainternmed.2015.6595 PMID: 26713426 [Indexed for MEDLINE]
    1. Urology. 2015 Nov;86(5):885-91. doi: 10.1016/j.urology.2015.08.022. Epub 2015
    Sep 4. Trends in Mesh Use for Pelvic Organ Prolapse Repair From the Medicare Database. Wang LC(1), Al Hussein Al Awamlh B(1), Hu JC(1), Laudano MA(1), Davison WL(1), Schulster ML(1), Zhao F(2), Chughtai B(1), Lee RK(3). Author information: (1)Department of Urology, Weill Medical College of Cornell University, New York, NY. (2)Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China. (3)Department of Urology, Weill Medical College of Cornell University, New York,
    1. Electronic address: ril9010@med.cornell.edu.
    Comment in J Urol. 2017 Feb;197(2):481-482. doi: 10.1016/j.juro.2016.11.012. OBJECTIVE: To investigate recent trends in mesh use for pelvic organ prolapse (POP)-related reconstruction procedures. MATERIALS AND METHODS: Using the 2001-2011 5% Medicare claims database, we identified POP diagnoses and related procedures. Transvaginal mesh use and sacrocolpopexy were first reported in 2005 and 2004, respectively. RESULTS: A total of 613,160 cases of vaginal and abdominal POP repair procedures were identified. The majority of procedures involved multiple compartments. The rate of mesh use increased dramatically from 2% of repairs in 2005 to 35% by
    1. After the Food and Drug Administration warning in 2008, mesh use plateaued
    and then decreased in 2011. Mesh was used more commonly in younger (odds ratio [OR] 0.722, P < .001), white (OR 0.712-0.791 for other races, P < .001) women in the South (OR 0.741-0.848 for non-South regions, P < .001). Starting in 2008, the rate of sacrocolpopexy procedures almost doubled yearly until 2011. Sacrocolpopexy was more common in younger patients (49% in women <70 years) and in white women (88%); the majority of sacrocolpopexies were performed in the South (60%) and laparoscopically (83%-98%). CONCLUSION: The treatment of POP has changed over time. The use of mesh increased significantly until 2008, after which it plateaued following the Food and Drug Administration warning regarding mesh-related complications. Concurrently, the number of sacrocolpopexy procedures increased significantly starting in 2008 as the use of laparoscopic and/or robotic technique and concern regarding transvaginal mesh increased. Copyright © 2015 Elsevier Inc. All rights reserved. DOI: 10.1016/j.urology.2015.08.022 PMID: 26344153 [Indexed for MEDLINE]
    1. BMJ. 2015 Jun 2;350:h2685. doi: 10.1136/bmj.h2685.
    Use and risks of surgical mesh for pelvic organ prolapse surgery in women in New York state: population based cohort study. Chughtai B(1), Mao J(2), Buck J(1), Kaplan S(1), Sedrakyan A(3). Author information: (1)Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY, USA. (2)Patient-Centered Comparative Effectiveness Program and MDEpiNet Science and Infrastructure Centre, Department of Healthcare Policy and Research at Weill Cornell Medical College and New York Presbyterian, New York, NY 10065, USA. (3)Patient-Centered Comparative Effectiveness Program and MDEpiNet Science and Infrastructure Centre, Department of Healthcare Policy and Research at Weill Cornell Medical College and New York Presbyterian, New York, NY 10065, USA ars2013@med.cornell.edu. Erratum in BMJ. 2015 Jun 03;350:h3060. doi: 10.1136/bmj.h3060. Comment in BMJ. 2015 Jun 02;350:h2910. doi: 10.1136/bmj.h2910. Evid Based Med. 2015 Dec;20(6):220. doi: 10.1136/ebmed-2015-110254. OBJECTIVE: To assess the use of mesh in pelvic organ prolapse surgery, and compare short term outcomes between procedures using and not using mesh. DESIGN: All inclusive, population based cohort study. SETTING: Statewide surgical care captured in the New York Statewide Planning and Research Cooperative System. PARTICIPANTS: Women who underwent prolapse repair procedures in New York state from 2008 to 2011. MAIN OUTCOMES MEASURES: 90 day safety events and reinterventions within one year, after propensity score matching. Categorical, time to event, and subgroup analyses (<65 and ≥ 65 year age groups) were conducted. RESULTS: Of 27,991 patients in total, 7338 and 20, 653 underwent prolapse repair procedures with and without mesh, respectively. Mesh use increased by 44.7%, from 1461 procedures in 2008 to 2114 procedures in 2011. Most patients in the cohort were younger than 65 years (62.3% (n=17,424/27, 991)). However, more patients were aged 65 years and older in the mesh group than in the non-mesh group (44.3% (n=3249) v 35.4% (n=7318)). Complications after surgery were not common, irrespective of the use or non-use of mesh. After propensity score matching, patients who received the surgery with mesh had a higher chance of having a reintervention within one year (mesh 3.3% v no mesh 2.2%, hazard ratio 1.47 (95% confidence interval 1.21 to 1.79)) and were more likely to have urinary retention within 90 days (mesh 7.5% v no mesh 5.6%, risk ratio 1.33 (95% confidence interval 1.18 to 1.51)), compared with those who received surgery without mesh. In subgroup analyses based on age, mesh use was associated with an increased risk of reintervention within one year in patients under age 65 years, and increased risk of urinary retention in patients aged 65 years and over. CONCLUSIONS: Despite multiple warnings released by the US Food and Drug Administration since 2008, use of mesh in pelvic organ prolapse surgery continues to grow. In this statewide comprehensive study, mesh procedures were associated with an increased risk of reinterventions within one year and urinary retention after surgery. © Chughtai et al 2015. DOI: 10.1136/bmj.h2685 PMCID: PMC4451585 PMID: 26037077 [Indexed for MEDLINE] Conflict of interest statement: Competing interests: All authors completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the US National Institutes of Health and the FDA for the submitted work; AS received funding from the FDA for establishing the MDEpiNet Science and Infrastructure Centre, and is director of the FDA’s Medical Device Epidemiology Network’s (MDEpiNet) Science and Infrastructure Centre; BC is a senior investigator and JM is an analyst within the Weill Cornell Medical College’s Patient Centered Comparative Effectiveness Program; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
    1. Rev Urol. 2015;17(2):78-83. doi: 10.3909/riu0653.
    Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women. Chughtai B(1), Laor L(1), Dunphy C(1), Lee R(1), Te A(1), Kaplan S(1). Author information: (1)Department of Urology, Weill Cornell Medical College, New York, NY. Mixed urinary incontinence (MUI) is a common clinical problem in the community and hospital setting. The broad definition of the term makes it difficult to diagnose, as well as determine effective treatment strategies. There are no current guidelines recommended for physicians. The estimated prevalence of this condition is approximately 30% in all women with incontinence. It has also been suggested that patients with MUI report more bothersome symptoms than either stress or urge incontinence; approximately 32% of 40- to 64-year-olds with MUI report symptoms of depression. The authors examine the diagnosis, evaluation, and treatment of patients with MUI. DOI: 10.3909/riu0653 PMCID: PMC4857898 PMID: 27222643
    1. Can J Urol. 2014 Oct;21(5):7460-4.
    Urodynamic characterization of lower urinary tract symptoms in women less than 40 years of age. Jamzadeh AE(1), Xie D, Laudano MA, Elterman DS, Seklehner S, Shtromvaser L, Lee R, Kaplan SA, Te AE, Tyagi R, Chughtai B. Author information: (1)Weill Cornell Medical College of Cornell University, New York, New York, USA. INTRODUCTION: Lower urinary tract symptoms (LUTS) in young women is becoming a more recognized urologic issue that can arise from many causes, each with their own management strategy. The purpose of this study was to determine the rates of various etiologies for LUTS in women under 40 years of age. MATERIALS AND METHODS: Video urodynamic studies (VUDS) were performed in 70 women age 40 years or less with LUTS for greater than 6 months between March 2005 and June 2012 at Weill Cornell Medical College. Patients with culture-proven bacterial urinary tract infections, pelvic organ prolapse greater than grade I, symptoms for less than 6 months, a history of neurologic disease, or previous urological surgery affecting voiding function, were excluded from the analysis. RESULTS: The mean age of the patients was 31.95 ± 5.57. There were 48 patients that presented with more than one urinary symptom (68.57%). The most frequent complaints included: urinary frequency (n = 42, 34.15%), incontinence (n = 26, 21.14%), and urinary urgency (n = 22, 17.89%). The most common urodynamic abnormality was dysfunctional voiding (n = 25, 28.74%), detrusor overactivity (n = 15, 20.00%), bladder outlet obstruction (n = 8, 11.43%). There were no significant differences seen in complaints or AUA symptom and quality of life scores across diagnosis groups. CONCLUSIONS: Persistent LUTS can present in younger women with an unclear etiology, which may be characterized using VUDS. The most common etiology found is dysfunctional voiding followed by detrusor overactivity. This study shows that the etiology can be more accurately determined using VUDs, which can assist in management. PMID: 25347371 [Indexed for MEDLINE]
    1. J Urol. 2014 Apr;191(4):1022-7. doi: 10.1016/j.juro.2013.10.076. Epub 2013 Oct
    25. Changes in pelvic organ prolapse surgery in the last decade among United States urologists. Elterman DS(1), Chughtai BI(2), Vertosick E(3), Maschino A(3), Eastham JA(4), Sandhu JS(5). Author information: (1)Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. (2)Brady Department of Urology, Weill Cornell Medical College, New York, New York. (3)Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York. (4)Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. (5)Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: sandhuj@mskcc.org. PURPOSE: Surgical correction of pelvic organ prolapse underwent transformation in the last decade. Training in pelvic organ prolapse surgery, the ease of mesh kit use, and Food and Drug Administration warnings about mesh have influenced practice patterns. We investigated trends in pelvic organ prolapse procedures. MATERIALS AND METHODS: Case logs of pelvic organ prolapse procedures, mesh use and pessary placement were obtained from the American Board of Urology for 2003 to 2012. We evaluated associations between surgeon characteristics and the use of pelvic organ prolapse procedures. RESULTS: Of 6,355 nonpediatric urologists applying for certification or recertification 2,192, representing a 10% annual sample of all urologists, reported performing pelvic organ prolapse procedures during the study period. The number of procedures increased steadily from 930 in 2003 to 6,978 in 2012. The number of colporrhaphies increased from 806 to 2,670 and the number of colpopexies increased from 32 to 1,414 between 2003 and 2012. The number of vaginal colpopexies increased from 24 to 1,016 during the study period. The number of sacrocolpopexies increased from 8 to 398 with exponential increases in laparoscopic sacrocolpopexy (282 cases by 2012). Mesh insertion increased from 10 cases reported by applicants in 2005 to 1,552 reported in 2012 (p <0.0005). Mesh revision, first reported in 2007 with 52 performed, consistently increased to 214 in 2012. Urologists trained in female urology performed a median of 16 pelvic organ prolapse procedures, double the number reported by surgeons trained in other urological fellowships. Urologists of the female gender also reported performing approximately 8 more procedures annually than male urologists. CONCLUSIONS: The number of pelvic organ prolapse operations done by urologists increased dramatically in the last decade with a similar increase in mesh use. More colpopexies are now performed with laparoscopic sacrocolpopexy showing an exponential increase. The recent trend of mesh revision is notable with a much faster rate of increase than mesh insertion. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.juro.2013.10.076 PMID: 24513165 [Indexed for MEDLINE]
    1. Obstet Gynecol Int. 2012;2012:392027. doi: 10.1155/2012/392027. Epub 2011 Sep
    22. Ambulatory pessary trial unmasks occult stress urinary incontinence. Chughtai B(1), Spettel S, Kurman J, De E. Author information: (1)Continence Center, Urological Institute of Northeast New York and Division of Urology, Albany Medical College, Albany, NY 12208, USA. Objective. We evaluated the use of a one-week ambulatory pessary trial in predicting patients’ postoperative outcomes for occult stress incontinence. Methods. Patients with anterior vaginal wall prolapse were offered a pessary trial to predict response to reconstruction. We performed a retrospective review of 4 years of cases. All patients underwent a detailed evaluation including videourodynamics with and without pessary reduction. Results. Twenty-six patients completed the 1-week pessary trial. Ten (38%) women showing no evidence of stress urinary incontinence (SUI) underwent surgical repair of prolapse without anti-incontinence procedure. None of these patients had SUI postoperatively. Sixteen women (61%) had occult stress urinary incontinence on evaluation and underwent concurrent sling procedure. Three (19%) of these patients were identified by the pessary trial alone. Twenty-five of the 26 patients were without clinical stress incontinence at a mean follow up of 12 months (range 4-37 months). The pessary trial correctly predicted persistent urgency in six patients and persistent frequency in five. No patients with SUI or persistent voiding difficult were missed in a pessary trial. Conclusion. An ambulatory pessary trial is an effective, easy, and inexpensive method to approximate anatomic results achieved by surgery under real-life conditions. In our series, 20% of patients with occult SUI were identified by pessary trial alone. DOI: 10.1155/2012/392027 PMCID: PMC3178112 PMID: 21949665

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