Publications by authors named "Eric Jelovsek"
Introduction And Hypothesis: The objective was to externally validate and recalibrate a previously developed model for predicting postoperative surgical-site infection (SSI) after pelvic organ prolapse (POP) surgery.
Methods: This study utilized a previously validated model for predicting post-POP surgery SSI within 90 days of surgery using a Medicare population. For this study, the model was externally validated and recalibrated using the Premier Healthcare Database (PHD) and the National Surgical Quality Improvement Project (NSQIP) database.
Aims: Men with lower urinary tract symptoms (LUTS) represent a heterogeneous group, and treatment decisions are often based on severity of symptoms and physical examination findings. Identification of clinically meaningful subtypes could allow for more personalized care. This study advances phenotyping efforts from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) by adding data domains to previous phenotyping using urologic symptoms alone.
View Article and Find Full Text PDFIntroduction And Hypothesis: Standardized digital rectal examination (DRE) correlates with anorectal manometry (ARM) measures. However, less is known about the relationship between DRE/ARM measures and patient-reported outcomes (PROs), especially among women with fecal incontinence (FI). Our aims were to evaluate associations between DRE and ARM measures and compare PROs with diagnostic evaluation measures for women with FI.
View Article and Find Full Text PDFArticle Synopsis
- - The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is starting a new study (LURN II) to investigate urinary urgency and incontinence by comparing cases and controls.
- - The study aims to improve the understanding of these difficult-to-treat symptoms by enhancing the phenotyping process.
- - The paper will discuss the reasons for this new research initiative and identify existing knowledge gaps related to the treatment of lower urinary tract symptoms, particularly urinary urgency.
Article Synopsis
- - Ectopic prostatic tissue in females is uncommon and may originate from remnants of male developmental structures or hormonal changes in areas like the uterus and Skene's gland.
- - This case study discusses a female patient with ectopic prostatic tissue found in a urethral diverticulum who had undergone testosterone hormone therapy.
- - The findings suggest that ectopic prostatic tissue could be a possible cause of anterior vaginal cysts, particularly in women receiving testosterone supplementation.
Purpose: We compared fluctuations in treatment response after onabotulinumtoxinA and sacral neuromodulation for urgency incontinence using Markov models.
Materials And Methods: We fit data from a randomized trial to Markov models to compare transitions of success/failure over 6 months between 200 U onabotulinumtoxinA and sacral neuromodulation. Objective failure was <50% reduction in urgency incontinence episodes from baseline; subjective failure "strongly disagree" to "neutral" to the Patient Global Symptom Control questionnaire.
Objective: The objective of this study was to describe adherence to behavioral and pelvic floor muscle training in women undergoing vaginal reconstructive surgery for organ prolapse and to examine whether adherence was associated with 24-month outcomes.
Methods: Participants were women ≥18 years of age, with vaginal bulge and stress urinary incontinence symptoms, planning to undergo vaginal reconstructive surgery for stages 2 to 4 vaginal or uterine prolapse. They were randomized to either sacrospinous ligament fixation or uterosacral ligament suspension and to perioperative behavioral and pelvic floor muscle training or usual care.
Objective: To develop a model for predicting postpartum readmission for hypertension and pre-eclampsia at delivery discharge and assess external validation or model transportability across clinical sites.
Design: Prediction model using data available in the electronic health record from two clinical sites.
Setting: Two tertiary care health systems from the Southern (2014-2015) and Northeastern USA (2017-2019).
Purpose: We determined the utility of intraoperative data in predicting sacral neuromodulation outcomes in urgency urinary incontinence.
Materials And Methods: Intraoperative details of sacral neuromodulation stage 1 were recorded during the prospective, randomized, multicenter ROSETTA trial, including responsive electrodes, amplitudes, and response strengths (motor and sensory Likert scales). Stage 2 implant was performed for stage 1 success on 3-day diary with 24-month follow-up.
Natural history of lower urinary tract symptoms in treatment-seeking women with pelvic organ prolapse; the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN).
Am J Obstet Gynecol
December 2022
Background: The association of pelvic organ prolapse with overactive bladder and other lower urinary tract symptoms, and the natural history of those symptoms are not well characterized. Previous cross-sectional studies demonstrated conflicting relationships between prolapse and lower urinary tract symptoms.
Objective: This study primarily aimed to determine the baseline association between lower urinary tract symptoms and prolapse and to assess longitudinal differences in symptoms over 12 months in women with and without prolapse.
Importance: Overprescription of opioid medications following surgery is well documented. Current prescribing models have been proposed in narrow patient populations, which limits their generalizability.
Objective: To develop and validate a model for predicting outpatient opioid use following a range of gynecological surgical procedures.
Importance: Surgical site infection (SSI) is a common and costly complication. Targeted interventions in high-risk patients may lead to a reduction in SSI; at present, there is no method to consistently identify patients at increased risk of SSI.
Objective: The aim of this study was to develop and validate a model for predicting risk of SSI after pelvic organ prolapse surgery.
Article Synopsis
- - The study introduces a new method to categorize women with lower urinary tract symptoms (LUTS) by combining different types of data, such as personal health reports and bladder diaries, to better understand their diverse symptoms and causes.
- - Using data from a multi-center study involving 545 women, the researchers employed advanced techniques to handle complex data sets, leading to the identification of five distinct symptom clusters, none defined by a single symptom alone.
- - The findings reveal that each cluster shows unique patterns in symptoms and associated proteins, highlighting the clinical significance and potential for improved evaluation methods for LUTS, rather than conventional approaches.
Artificial intelligence/machine learning models are being rapidly developed and used in clinical practice. However, many models are deployed without a clear understanding of clinical or operational impact and frequently lack monitoring plans that can detect potential safety signals. There is a lack of consensus in establishing governance to deploy, pilot, and monitor algorithms within operational healthcare delivery workflows.
View Article and Find Full Text PDFImportance: There are no publications on national trends in performance of concomitant stress urinary incontinence (SUI) treatment with pelvic organ prolapse surgery over the past decade.
Objectives: The objective of this study was to describe trends in the performance and type of concomitant SUI treatment from 2011 to 2019.
Study Design: Surgical procedures for pelvic organ prolapse and coding for prolapse repair were identified from the American College of Surgeons National Surgical Quality Improvement Program database.
Importance: Although frailty is predictive of adverse outcomes in predominantly male general and orthopedic surgical populations, the utility of American College of Surgeons National Surgical Quality Improvement Program-based frailty measurement for hysterectomy is unclear.
Objectives: The objective of this study was to measure the added contribution of the modified frailty index (mFI) and Risk Analysis Index (RAI) for predicting adverse outcomes after hysterectomy.
Study Design: A secondary analysis of the 2011 to 2014 American College of Surgeons National Surgical Quality Improvement database was conducted.
Objectives: To assess the association of publication of the American Urogynecologic Society (AUGS)/American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin on pelvic organ prolapse and performance of an apical suspension at the time of surgery for pelvic organ prolapse.
Methods: Surgical procedures performed with a primary diagnosis of uterovaginal or female genital prolapse, cystocele, or enterocele were isolated from the 2011 to 2019 American College of Surgeons National Surgical Quality Improvement Program Database. An autoregressive interrupted time series regression estimated the overall temporal trend in performance of an apical suspension and assessed for a change in trend associated with publication of the AUGS/ACOG Practice Bulletin in April 2017.
Objective: A recent study leveraging machine learning methods found that postpartum hemorrhage (PPH) can be predicted accurately at the time of labor admission in the U.S. Consortium for Safe Labor (CSL) dataset, with a C-statistic as high as 0.
View Article and Find Full Text PDFAims: Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI).
Methods: Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months.
Background: Treatment outcomes after pelvic organ prolapse surgery are often presented as dichotomous "success or failure" based on anatomic and symptom criteria. However, clinical experience suggests that some women with outcome "failures" are asymptomatic and perceive their surgery to be successful and that other women have anatomic resolution but continue to report symptoms. Characterizing failure types could be a useful step to clarify definitions of success, understand mechanisms of failure, and identify individuals who may benefit from specific therapies.
View Article and Find Full Text PDFObjectives: High-level evidence for second-line noninvasive treatments for fecal incontinence in women is limited. We present the rationale for and design of the NeuromOdulaTion for Accidental Bowel Leakage trial, a randomized controlled trial of percutaneous tibial nerve stimulation (PTNS) and validated sham stimulation in women with refractory accidental bowel leakage.
Methods: The rationale and goals for a 2-part study with a run-in phase, use of a generic pulse generator for PTNS and sham stimulation, masking, participant inclusion, primary and secondary outcome measures, and adverse event collection are described.
Objectives: The objective of this study was to compare efficacy and adverse events between 100 U and 200 U of onabotulinumtoxinA for 6 months in women with nonneurogenic urgency incontinence.
Methods: This is a secondary analysis of 2 multicenter randomized controlled trials assessing efficacy of onabotulinumtoxinA in women with nonneurogenic urgency incontinence; one compared 100 U to anticholinergics and the other 200 U to sacral neuromodulation. Of 307 women who received onabotulinumtoxinA injections, 118 received 100 U, and 189 received 200 U.