Our Urogynecologic Research

Vatche Minassian, MD, MPH

Urinary Incontinence

Working with researchers from the Channing Laboratory of Brigham and Women’s Hospital to understand the natural history of urinary incontinence in women. To achieve their goal, Dr Minassian and his collaborators are using data from two large cohorts including Nurses Health Study (NHS) and Nurses Health Study II (NHS II). The original NHS was initiated in 1976 when over 120,000 female nurses aged 30 to 55 years responded to a mailed questionnaire about their medical history and lifestyle. The NHS II was initiated in 1989 when over 110,000 female nurses aged 25 to 42 years completed and returned a similar questionnaire. These nurses have been followed every two years. Questions about urinary incontinence were included on the questionnaires beginning in 2000. Understanding the natural history of urinary incontinence will allow Dr Minassian and other researchers to develop prevention modalities that limit the onset and progression of disease over time.

Urinary Incontinence Subtypes

Dr. Minassian continues to collaborate with his colleagues on his NIH RO1-funded research work that he obtained while at Geisinger in Danville, PA. This research utilizes data obtained from the Bladder Health Survey, a 6-monthly questionnaire administered to over 7,000 women over the age of 40 from the primary care patient population served by the Geisinger Clinic in rural Pennsylvania. The goal of this research to understand the natural history of urinary incontinence subtypes. In particular, Dr Minassian and his research collaborators are trying to decipher the paradox of why the observed prevalence of mixed (co-existing stress and urgency) urinary incontinence is much higher than expected. Gaining an in-depth knowledge of the epidemiology of stress, urgency and mixed urinary incontinence will lead to a better understanding of the pathophysiology of the different UI subtypes. This, in turn, will lead to the development of better treatment modalities.

INTRAOPERATIVE AND IMMEDIATE POSTOPERATIVE PAIN CONTROL AFTER VAGINAL HYSTERECTOMY AND VAGINAL VAULT SUSPENSION VERSUS LAPAROSCOPIC HYSTERECTOMY WITH SACROCOLPOPEXY

Pelvic organ prolapse (POP) is a prevalent condition worldwide and the demand for reconstructive surgery for POP will increase by 45% over the next three decades, exceeding 1 billion dollars per year. Although the use of pain medication after different surgical procedures is widely investigated, including for pelvic reconstructive procedures, it is yet not well understood if the route of apical vault suspension (vaginal versus laparoscopic) has an impact on requirements for pain medication after surgery. Both approaches are considered to be minimally invasive.

The goal of this retrospective chart review study is to assess the type, amount and predictors of pain medication use during and immediately after (while the patient is still in the hospital) these two distinct vault suspension techniques (sacrospinous (or uterosacral) vaginal vault suspension vs. laparoscopic sacropexy with mesh).

The role of urinary microbiome in urinary incontinence

Urinary incontinence is a common condition among women of all ages, with a prevalence ranging from 30-60% in middle-aged and older women. Several risk factors are known to be related with urinary incontinence including menopausal status, age, body mass index (BMI), and parity. However, it is still not clear how to prevent new onset or progression of UI, and how to promote lower urinary tract health. Recent studies have detected bacteria in the bladder of healthy women known as the urinary microbiome. Other studies have shown that urinary urgency (overactive bladder) may be related to changes in the diversity and concentration of bacteria in the urinary microbiome. These findings are novel and require confirmation in prospective studies. Our goal is to investigate the variation in urinary bacteria in correlation with bothersome lower urinary tract symptoms such as urgency, frequency and nocturia to improve our understanding of the pathogenesis of urinary incontinence and its subtypes.

Jeannine M. Miranne, MD, MS

Pain Control with Oxycodone after Hysterectomy

In the United States, opioid addiction and overdose have reached epidemic levels. Opioids include oxycodone, hydrocodone, and morphine. Oxycodone is a short-acting opioid taken every 4 to 6 hours, prescribed for patients with acute, short term pain. Hysterectomy is the most frequent, non-pregnancy related major surgery performed in women in the United States. Approximately 10% of U.S. women, ages 40-44 have had a hysterectomy. Two OB/GYN divisions at Brigham and Women’s Hospital that perform hysterectomies are Urogynecology and Minimally Invasive Gynecologic Surgery (MIGS). Between these two divisions, over 250 hysterectomies are performed annually. Dr. Miranne and her colleagues from Urogynecology and MIGS are conducting this study to develop a better understanding of the number of oxycodone tablets taken by patients after a hysterectomy. The goal of the study is to determine if there is a difference in the number of oxycodone tablets taken depending on the route of hysterectomy. The two study groups are:

  • Urogynecology: the vaginal group – vaginal hysterectomy performed for benign indications
  • MIGS: the laparoscopic group – laparoscopic hysterectomy performed for benign indications

Cranberry Tablets to Prevent Urinary Tract Infections after Urogynecologic Surgery

Urinary tract infections (UTIs) account for more than 8.5 million visits to health care providers in the United States every year. UTIs are also one of the most common hospital-acquired infections. Treatment for UTIs is an economic burden on the U.S. healthcare system accounting for $2.6 billion in annual costs. One of the most common complications of urogynecologic surgery is UTI and the risk of UTI with transurethral catheterization is well known. In patients undergoing urogynecologic surgery, the risk of UTI ranges from 10 to 64%. Different strategies to lower this risk include antibiotic prophylaxis, or using antibiotic medicine to prevent an infection before it occurs, and the use of cranberry products. Several studies have been conducted investigating the use of antibiotic prophylaxis and cranberry products for UTI risk reduction after urogynecologic surgery.

The results from these studies are conflicting. Dr. Miranne and The Brigham Urogynecology Group are conducting this study to compare the effectiveness of cranberry capsules versus nitrofurantoin (antibiotic) prophylaxis in women who require transurethral catheterization after urogynecologic surgery. We are conducting this study to hopefully reduce the number of UTIs women have after urogynecologic surgery. Reducing the risk of UTIs can have a significant impact on surgical recovery and quality of life. This can also help decrease or reduce health care costs.

Development of a Patient-Centered Pelvic Floor Complication Scale

Through this Multi-Center Collaborative Pilot Project, we plan to construct a new scale for evaluating complications associated with pelvic reconstructive surgery (PRS). Once a simplified patient-centered PFCS is created, future research will be necessary to validate this scale in a large prospective surgical trial.

Pelvic floor disorders, like pelvic organ prolapse urinary incontinence, and fecal incontinence often impair a woman’s quality-of-life but rarely result in significant morbidity. The surgical procedures used to correct these conditions, however, impart some inherent risk of short and long-term complications. The PFCS was designed for all routes of pelvic surgery including vaginal, laparoscopic with or without robotic assistance, and open abdominal procedures. The PFCS characterizes complications unique to prolapse and incontinence procedures including mesh/graft related complications, urinary retention and others.

Women who have undergone PRS will be recruited and consented by the Urogynecology team. An online survey will be sent to the participant’s email address and they will fill out the PFCS. All data will be statistically analyzed at the end of the study period.

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