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Our Urogynecologic Research

Vatche Minassian, MD, MPH

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.

The Effect of Preoperative Scopolamine Patch Use on Postoperative Urinary Retention in Urogynecological Surgeries

Postoperative urinary retention is a common and potentially serious medical condition that affects a patient’s ability to urinate freely after a surgery. Particularly in urogynecological surgeries, this is an unfavorable outcome that is associated with frequent visits to the hospital and patient dissatisfaction. Postoperative nausea and vomiting is a common outcome of surgery that doctors will often try to prevent with the application of a scopolamine patch. A scopolamine patch is an anticholinergic medication that works to prevent postoperative nausea and vomiting.

Recent studies have found an association between the use of a scopolamine patch before surgery and postoperative urinary retention. Dr. Minassian and his study staff are conducting a retrospective chart review comparing the outcomes of patients who were given a scopolamine patch and those who were not. They hope to determine if there is an increased risk of postoperative urinary retention when using a scopolamine patch across all urogynecological surgeries. The results from this study will hopefully be used to guide prescription practices to best prevent urinary retention in populations undergoing urogynecological surgery.

Jeannine M. Miranne, MD, MS

Incidence of Interstitial Cystitis/Bladder Pain Syndrome Before the COVID-19 Pandemic vs During the COVID-19 Pandemic

Interstitial cystitis (IC) is a chronic pain syndrome that affects between 3 and 8 million American women. Causes of interstitial cystitis are not well known, however diet, caffeine and alcohol intake, urinary tract infections, and stress have all been associated with flares of IC. Stress is particularly of interest to Dr. Miranne and her team in the context of the COVID-19 pandemic. Since the beginning of 2020, the COVID-19 pandemic has affected everyone’s daily lives and likely raised stress levels in many individuals.

The COVID-19 pandemic has prompted new research questions in all areas of medicine, and Dr. Miranne and her team will conduct a retrospective research study to compare incidence rates of IC the year before and during the first year of the pandemic. They hypothesize that the life stressors associated with the COVID-19 pandemic caused an increased amount of new cases of IC and flares in patients with existing IC.

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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