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.

  • Prevalence of post-operative vaginal vault prolapse after hysterectomy – Based on the National Health and Nutrition Examination Survey across the United States, the self-reported prevalence of pelvic organ prolapse (POP) is 2.9% in the general population. By 2050, POP prevalence is predicted to increase by 46% resulting in increased bother and worsening quality of life in women with these conditions. Hysterectomy is the most common major gynecological surgery in the United States and is a significant risk factor for POP. It is not known whether different hysterectomy techniques or approaches have a different risk factor profile with respect to subsequent vaginal vault prolapse.

    This study is designed as a retrospective study of all women who underwent hysterectomy between 2001 to 2010 at the Brigham & Women’s Hospital. The aim of the study is to compare the rate of post-operative vaginal vault prolapse following abdominal, vaginal or laparoscopic/robotic hysterectomies. Based on our study we anticipate to better understand the risk of prolapse following hysterectomy and factors associated with (or protective of) subsequent vaginal vault prolapse, and whether this risk varies by type or route of hysterectomy.

  • 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.

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