The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Victor W. Nitti - One of the best experts on this subject based on the ideXlab platform.
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Urodynamics for clinically suspected obstruction after anti incontinence surgery in women
The Journal of Urology, 2013Co-Authors: Margarita Aponte, Benjamin M. Brucker, Sagar Shah, Nirit Rosenblum, Duane Hickling, Victor W. NittiAbstract:Purpose: We determined the usefulness of Urodynamics in patients with obstruction secondary to anti-incontinence surgery.Materials and Methods: We retrospectively reviewed the records of all procedures performed from January 2001 to June 2011 to relieve obstruction due to anti-incontinence surgery. Patients were excluded from study if they underwent prior procedures to relieve obstruction, followup data were missing or a neurological disorder was present. Patients were grouped into categories before intervention, including Urodynamics diagnostic of obstruction vs nondiagnostic Urodynamics vs no Urodynamics testing. We also separated patients with predominantly storage symptoms and those with incomplete emptying.Results: A total of 71 women were included in analysis. Of 54 women who presented with increased post-void residual urine volume 33 (61%) were diagnosed with obstruction on Urodynamics, Urodynamics was not diagnostic in 4 (7.4%) and 17 (32%) did not undergo Urodynamics preoperatively. All 18 patien...
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Urodynamic findings in women with insensible incontinence
International Journal of Urology, 2012Co-Authors: Benjamin M. Brucker, Eva Fong, Daniela Kaefer, Sagar Shah, Nirit Rosenblum, Victor W. NittiAbstract:Objectives To define the urodynamic study findings among women with insensible urinary incontinence. Methods Women complaining of insensible incontinence who underwent Urodynamics at our center were identified. Coexisting symptoms of stress incontinence, urgency incontinence and/or mixed incontinence were recorded. The primary outcome was the urodynamic study finding. Urodynamic stress incontinence, detrusor overactivity incontinence, combination of both or neither (no incontinence) were the possible diagnoses. Results A total of 58% of patients had insensible incontinence alone and 42% had insensible incontinence combined with other urinary incontinence symptoms. Of the patients with insensible incontinence alone, 37% had no incontinence on Urodynamics, whereas urodynamic stress incontinence was diagnosed in 52%. Isolated urodynamic stress incontinence was found in 73% of patients with insensible and stress incontinence symptoms. In patients with insensible plus urgency incontinence, isolated detrusor overactivity incontinence and detrusor overactivity incontinence with urodynamic stress incontinence were found in the same percentage of women (40% each). In patients with symptoms including stress urinary incontinence, stress incontinence was the predominant urodynamic finding. Conclusions In patients who have incontinence symptoms in addition to insensible incontinence, these symptoms are highly predictive of urodynamic findings. In particular, women with insensible incontinence, concomitant stress incontinence symptoms are most predictive of urodynamic findings (i.e. urodynamic stress urinary incontinence). In contrast, where insensible incontinence represents the only symptom, urodynamic findings vary widely, with a significant proportion having non-diagnostic studies.
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treatment of post prostatectomy incontinence with male slings in patients with impaired detrusor contractility on Urodynamics and or who perform valsalva voiding
The Journal of Urology, 2011Co-Authors: Benjamin M. Brucker, Eva Fong, Abdullah Demirtas, Victor W. NittiAbstract:Purpose: Male slings have emerged as a popular and efficacious treatment for men with post-prostatectomy stress urinary incontinence. Traditionally slings have been used with caution or avoided in men with impaired detrusor contractility or Valsalva voiding because of concern that patients will not be able to overcome the fixed resistance of a sling during micturition. We propose that men with post-prostatectomy urinary incontinence who have impaired contractility and/or void with abdominal straining for Urodynamics can be safely treated with slings.Materials and Methods: A retrospective review of patients with post-prostatectomy urinary incontinence who underwent an initial sling procedure between January 2004 and January 2010 was conducted at a single institution. Preoperative urodynamic characteristics, and postoperative Patient Global Impression of Improvement, post-void residual and noninvasive uroflow data were examined. Patients were grouped by poor bladder contractility or Valsalva voiding status....
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a Urodynamics protocol to optimally assess men with post prostatectomy incontinence
Neurourology and Urodynamics, 2005Co-Authors: Chad Huckabay, Christian O Twiss, Aaron D Berger, Victor W. NittiAbstract:Aims To propose a urodynamic protocol to comprehensively assess all parameters of post prostatectomy incontinence (PPI). Methods Sixty men with a history of PPI after radical prostatectomy prospectively underwent a standardized video Urodynamics protocol. A 7F urethral catheter was used for standard cystometry, abdominal leak point pressure (ALPP), and pressure flow measurements. The International Continence Society nomogram classified obstruction and further classification of obstruction was based on fluoro voiding cystourethrography and non-invasive flow rates (free Qmax). Results Twenty-four (40%) men had detrusor overactivity with 8 (13%) also having detrusor overactivity incontinence. Only one patient had impaired compliance. All men had urodynamic stress incontinence, but 21 (35%) men demonstrated it only after removal of the urethral catheter. For men leaking with and without the urethral catheter, the respective ALPP was significantly different, 86.3 and 67 cmH2O, respectively (P = 0.002). The men who leaked only in the absence of the urethral catheter had significantly higher ALPP measurements, P < 0.001. After reclassification using the fluoroscopic images of the bladder outlet and free Qmax, only 13.3% patients were obstructed. Conclusions The proposed urodynamic protocol allows for an optimal assessment of bladder and sphincter dysfunction and outlet obstruction in men with PPI. © 2005 Wiley-Liss, Inc.
Sanne A L Van Leijsen - One of the best experts on this subject based on the ideXlab platform.
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value of Urodynamics before stress urinary incontinence surgery a randomized controlled trial
Obstetrics & Gynecology, 2013Co-Authors: Sanne A L Van Leijsen, Kirsten B Kluivers, Joanna In T Hout, Alfredo L Milani, Jan Paul W R Roovers, Jan Den Boon, Huub C Van Der Vaart, Paul H Langen, Francis E Hartog, Viviane DietzAbstract:OBJECTIVE: : To estimate whether a strategy of immediate surgery was noninferior to a strategy based on discordant urodynamic findings followed by individually tailored therapy in women with stress urinary incontinence (SUI). METHODS: : A multicenter diagnostic cohort study with an embedded noninferiority randomized controlled trial was conducted in six academic and 24 nonacademic Dutch hospitals. Women with predominant SUI eligible for surgical treatment based on clinical assessment were included between January 2009 and November 2010. All patients underwent Urodynamics. In patients in whom Urodynamics were discordant with clinical assessment, participants were randomly allocated to receive either immediate surgery or individually tailored therapy based on Urodynamics. The primary outcome was clinical improvement assessed by the Urogenital Distress Inventory 12 months after baseline. Analysis was by intention to treat; a difference in mean improvement of 5 points or less was considered noninferior. RESULTS: : Five hundred seventy-eight women with SUI were studied, of whom 268 (46%) had discordant findings. One hundred twenty-six patients gave informed consent for randomization and were allocated to receive immediate surgery (n=64) or individually tailored therapy (n=62). The mean improvement measured with the Urogenital Distress Inventory after 1 year was 44 points (+/-24) in the group receiving immediate surgery and 39 (+/-25) points in the group receiving individually tailored treatment. The difference in mean improvement was 5 points in favor of the group receiving immediate surgery (95% confidence interval -infinity to 5). There were no differences with respect to cure or complication rate. CONCLUSION: : In women with uncomplicated SUI, an immediate midurethral sling operation is not inferior to individually tailored treatment based on urodynamic findings. CLINICAL TRIAL REGISTRATION: : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00814749. LEVEL OF EVIDENCE: : I.
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protocol for the value of Urodynamics prior to stress incontinence surgery vusis study a multicenter randomized controlled trial to assess the cost effectiveness of Urodynamics in women with symptoms of stress urinary incontinence in whom surgical tr
BMC Women's Health, 2009Co-Authors: Sanne A L Van Leijsen, Kirsten B Kluivers, Jan Paul W R Roovers, Jan Den Boon, Huub C Van Der Vaart, Suzan R Broekhuis, Fred Milani, Marlies Y Bongers, Wilbert A Spaans, Jan Willem De LeeuwAbstract:Stress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform Urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting. The Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) study evaluates the positive and negative effects with regard to outcome, as well as the costs of Urodynamics, in women with symptoms of SUI in whom surgical treatment is considered. A multicentre diagnostic cohort study will be performed with an embedded randomized controlled trial among women presenting with symptoms of (predominant) SUI. Urinary incontinence has to be demonstrated on clinical examination and/or voiding diary. Physiotherapy must have failed and surgical treatment needs to be under consideration. Patients will be excluded in case of previous incontinence surgery, in case of pelvic organ prolapse more than 1 centimeter beyond the hymen and/or in case of residual bladder volume of more than 150 milliliter on ultrasound or catheterisation. Patients with discordant findings between the diagnosis based on urodynamic investigation and the diagnosis based on their history, clinical examination and/or micturition diary will be randomized to operative therapy or individually tailored therapy based on all available information. Patients will be followed for two years after treatment by their attending urologist or gynaecologist, in combination with the completion of questionnaires. Six hundred female patients will be recruited for registration from approximately twenty-seven hospitals in the Netherlands. We aspect that one hundred and two women with discordant findings will be randomized. The primary outcome of this study is clinical improvement of incontinence as measured with the validated Dutch version of the Urinary Distress Inventory (UDI). Secondary outcomes of this study include costs, cure of incontinence as measured by voiding diary parameters, complications related to the intervention, re-interventions, and generic quality of life changes. Clinical Trials NCT00814749.
Viviane Dietz - One of the best experts on this subject based on the ideXlab platform.
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value of Urodynamics before stress urinary incontinence surgery a randomized controlled trial
Obstetrics & Gynecology, 2013Co-Authors: Sanne A L Van Leijsen, Kirsten B Kluivers, Joanna In T Hout, Alfredo L Milani, Jan Paul W R Roovers, Jan Den Boon, Huub C Van Der Vaart, Paul H Langen, Francis E Hartog, Viviane DietzAbstract:OBJECTIVE: : To estimate whether a strategy of immediate surgery was noninferior to a strategy based on discordant urodynamic findings followed by individually tailored therapy in women with stress urinary incontinence (SUI). METHODS: : A multicenter diagnostic cohort study with an embedded noninferiority randomized controlled trial was conducted in six academic and 24 nonacademic Dutch hospitals. Women with predominant SUI eligible for surgical treatment based on clinical assessment were included between January 2009 and November 2010. All patients underwent Urodynamics. In patients in whom Urodynamics were discordant with clinical assessment, participants were randomly allocated to receive either immediate surgery or individually tailored therapy based on Urodynamics. The primary outcome was clinical improvement assessed by the Urogenital Distress Inventory 12 months after baseline. Analysis was by intention to treat; a difference in mean improvement of 5 points or less was considered noninferior. RESULTS: : Five hundred seventy-eight women with SUI were studied, of whom 268 (46%) had discordant findings. One hundred twenty-six patients gave informed consent for randomization and were allocated to receive immediate surgery (n=64) or individually tailored therapy (n=62). The mean improvement measured with the Urogenital Distress Inventory after 1 year was 44 points (+/-24) in the group receiving immediate surgery and 39 (+/-25) points in the group receiving individually tailored treatment. The difference in mean improvement was 5 points in favor of the group receiving immediate surgery (95% confidence interval -infinity to 5). There were no differences with respect to cure or complication rate. CONCLUSION: : In women with uncomplicated SUI, an immediate midurethral sling operation is not inferior to individually tailored treatment based on urodynamic findings. CLINICAL TRIAL REGISTRATION: : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00814749. LEVEL OF EVIDENCE: : I.
Kirsten B Kluivers - One of the best experts on this subject based on the ideXlab platform.
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value of Urodynamics before stress urinary incontinence surgery a randomized controlled trial
Obstetrics & Gynecology, 2013Co-Authors: Sanne A L Van Leijsen, Kirsten B Kluivers, Joanna In T Hout, Alfredo L Milani, Jan Paul W R Roovers, Jan Den Boon, Huub C Van Der Vaart, Paul H Langen, Francis E Hartog, Viviane DietzAbstract:OBJECTIVE: : To estimate whether a strategy of immediate surgery was noninferior to a strategy based on discordant urodynamic findings followed by individually tailored therapy in women with stress urinary incontinence (SUI). METHODS: : A multicenter diagnostic cohort study with an embedded noninferiority randomized controlled trial was conducted in six academic and 24 nonacademic Dutch hospitals. Women with predominant SUI eligible for surgical treatment based on clinical assessment were included between January 2009 and November 2010. All patients underwent Urodynamics. In patients in whom Urodynamics were discordant with clinical assessment, participants were randomly allocated to receive either immediate surgery or individually tailored therapy based on Urodynamics. The primary outcome was clinical improvement assessed by the Urogenital Distress Inventory 12 months after baseline. Analysis was by intention to treat; a difference in mean improvement of 5 points or less was considered noninferior. RESULTS: : Five hundred seventy-eight women with SUI were studied, of whom 268 (46%) had discordant findings. One hundred twenty-six patients gave informed consent for randomization and were allocated to receive immediate surgery (n=64) or individually tailored therapy (n=62). The mean improvement measured with the Urogenital Distress Inventory after 1 year was 44 points (+/-24) in the group receiving immediate surgery and 39 (+/-25) points in the group receiving individually tailored treatment. The difference in mean improvement was 5 points in favor of the group receiving immediate surgery (95% confidence interval -infinity to 5). There were no differences with respect to cure or complication rate. CONCLUSION: : In women with uncomplicated SUI, an immediate midurethral sling operation is not inferior to individually tailored treatment based on urodynamic findings. CLINICAL TRIAL REGISTRATION: : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00814749. LEVEL OF EVIDENCE: : I.
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protocol for the value of Urodynamics prior to stress incontinence surgery vusis study a multicenter randomized controlled trial to assess the cost effectiveness of Urodynamics in women with symptoms of stress urinary incontinence in whom surgical tr
BMC Women's Health, 2009Co-Authors: Sanne A L Van Leijsen, Kirsten B Kluivers, Jan Paul W R Roovers, Jan Den Boon, Huub C Van Der Vaart, Suzan R Broekhuis, Fred Milani, Marlies Y Bongers, Wilbert A Spaans, Jan Willem De LeeuwAbstract:Stress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform Urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting. The Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) study evaluates the positive and negative effects with regard to outcome, as well as the costs of Urodynamics, in women with symptoms of SUI in whom surgical treatment is considered. A multicentre diagnostic cohort study will be performed with an embedded randomized controlled trial among women presenting with symptoms of (predominant) SUI. Urinary incontinence has to be demonstrated on clinical examination and/or voiding diary. Physiotherapy must have failed and surgical treatment needs to be under consideration. Patients will be excluded in case of previous incontinence surgery, in case of pelvic organ prolapse more than 1 centimeter beyond the hymen and/or in case of residual bladder volume of more than 150 milliliter on ultrasound or catheterisation. Patients with discordant findings between the diagnosis based on urodynamic investigation and the diagnosis based on their history, clinical examination and/or micturition diary will be randomized to operative therapy or individually tailored therapy based on all available information. Patients will be followed for two years after treatment by their attending urologist or gynaecologist, in combination with the completion of questionnaires. Six hundred female patients will be recruited for registration from approximately twenty-seven hospitals in the Netherlands. We aspect that one hundred and two women with discordant findings will be randomized. The primary outcome of this study is clinical improvement of incontinence as measured with the validated Dutch version of the Urinary Distress Inventory (UDI). Secondary outcomes of this study include costs, cure of incontinence as measured by voiding diary parameters, complications related to the intervention, re-interventions, and generic quality of life changes. Clinical Trials NCT00814749.
Jan Paul W R Roovers - One of the best experts on this subject based on the ideXlab platform.
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value of Urodynamics before stress urinary incontinence surgery a randomized controlled trial
Obstetrics & Gynecology, 2013Co-Authors: Sanne A L Van Leijsen, Kirsten B Kluivers, Joanna In T Hout, Alfredo L Milani, Jan Paul W R Roovers, Jan Den Boon, Huub C Van Der Vaart, Paul H Langen, Francis E Hartog, Viviane DietzAbstract:OBJECTIVE: : To estimate whether a strategy of immediate surgery was noninferior to a strategy based on discordant urodynamic findings followed by individually tailored therapy in women with stress urinary incontinence (SUI). METHODS: : A multicenter diagnostic cohort study with an embedded noninferiority randomized controlled trial was conducted in six academic and 24 nonacademic Dutch hospitals. Women with predominant SUI eligible for surgical treatment based on clinical assessment were included between January 2009 and November 2010. All patients underwent Urodynamics. In patients in whom Urodynamics were discordant with clinical assessment, participants were randomly allocated to receive either immediate surgery or individually tailored therapy based on Urodynamics. The primary outcome was clinical improvement assessed by the Urogenital Distress Inventory 12 months after baseline. Analysis was by intention to treat; a difference in mean improvement of 5 points or less was considered noninferior. RESULTS: : Five hundred seventy-eight women with SUI were studied, of whom 268 (46%) had discordant findings. One hundred twenty-six patients gave informed consent for randomization and were allocated to receive immediate surgery (n=64) or individually tailored therapy (n=62). The mean improvement measured with the Urogenital Distress Inventory after 1 year was 44 points (+/-24) in the group receiving immediate surgery and 39 (+/-25) points in the group receiving individually tailored treatment. The difference in mean improvement was 5 points in favor of the group receiving immediate surgery (95% confidence interval -infinity to 5). There were no differences with respect to cure or complication rate. CONCLUSION: : In women with uncomplicated SUI, an immediate midurethral sling operation is not inferior to individually tailored treatment based on urodynamic findings. CLINICAL TRIAL REGISTRATION: : ClinicalTrials.gov, www.clinicaltrials.gov, NCT00814749. LEVEL OF EVIDENCE: : I.
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protocol for the value of Urodynamics prior to stress incontinence surgery vusis study a multicenter randomized controlled trial to assess the cost effectiveness of Urodynamics in women with symptoms of stress urinary incontinence in whom surgical tr
BMC Women's Health, 2009Co-Authors: Sanne A L Van Leijsen, Kirsten B Kluivers, Jan Paul W R Roovers, Jan Den Boon, Huub C Van Der Vaart, Suzan R Broekhuis, Fred Milani, Marlies Y Bongers, Wilbert A Spaans, Jan Willem De LeeuwAbstract:Stress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform Urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting. The Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) study evaluates the positive and negative effects with regard to outcome, as well as the costs of Urodynamics, in women with symptoms of SUI in whom surgical treatment is considered. A multicentre diagnostic cohort study will be performed with an embedded randomized controlled trial among women presenting with symptoms of (predominant) SUI. Urinary incontinence has to be demonstrated on clinical examination and/or voiding diary. Physiotherapy must have failed and surgical treatment needs to be under consideration. Patients will be excluded in case of previous incontinence surgery, in case of pelvic organ prolapse more than 1 centimeter beyond the hymen and/or in case of residual bladder volume of more than 150 milliliter on ultrasound or catheterisation. Patients with discordant findings between the diagnosis based on urodynamic investigation and the diagnosis based on their history, clinical examination and/or micturition diary will be randomized to operative therapy or individually tailored therapy based on all available information. Patients will be followed for two years after treatment by their attending urologist or gynaecologist, in combination with the completion of questionnaires. Six hundred female patients will be recruited for registration from approximately twenty-seven hospitals in the Netherlands. We aspect that one hundred and two women with discordant findings will be randomized. The primary outcome of this study is clinical improvement of incontinence as measured with the validated Dutch version of the Urinary Distress Inventory (UDI). Secondary outcomes of this study include costs, cure of incontinence as measured by voiding diary parameters, complications related to the intervention, re-interventions, and generic quality of life changes. Clinical Trials NCT00814749.
