Papers by John Heesakkers
Supplemental material, sj-pdf-1-tau-10.1177_17562872211041470 for Real-life patient experiences o... more Supplemental material, sj-pdf-1-tau-10.1177_17562872211041470 for Real-life patient experiences of TTNS in the treatment of overactive bladder syndrome by Manon te Dorsthorst, Michael van Balken, Dick Janssen, John Heesakkers and Frank Martens in Therapeutic Advances in Urology
Obstetrics & Gynecology, May 1, 2013
To estimate whether a strategy of immediate surgery was noninferior to a strategy based on discor... more 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). 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. 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 -∞ to 5). There were no differences with respect to cure or complication rate. In women with uncomplicated SUI, an immediate midurethral sling operation is not inferior to individually tailored treatment based on urodynamic findings. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00814749. I.
International Journal of Technology Assessment in Health Care, 2004
Objectives: The observed posterior probability distributions regarding the benefits of surgery fo... more Objectives: The observed posterior probability distributions regarding the benefits of surgery for otitis media with effusion (OME) with expected probability distributions, using Bayes' theorem are compared.Methods: Postal questionnaires were used to assess prior and posterior probability distributions among ear-nose-throat (ENT) surgeons in the Netherlands.Results: In their prior probability estimates, ENT surgeons were quite optimistic with respect to the effectiveness of tube insertion in the treatment of OME. The trial showed no meaningful benefit of tubes on hearing and language development. Posterior probabilities calculated on the basis of prior probability estimates and trial results differed widely from those, elicited empirically 1 year after completion of the trial and dissemination of the results.Conclusions: ENT surgeons did not adjust their opinion about the benefits of surgical treatment of glue ears to the extent that they should have done according to Bayes'...
CRC Press eBooks, May 15, 2023
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Aug 19, 2013
Neurourology and Urodynamics, Mar 1, 2012
This ICI-RS report aims to analyze morphological or functional complications of the lower or uppe... more This ICI-RS report aims to analyze morphological or functional complications of the lower or upper urinary tract in elderly men, clarify the association between complications and benign prostatic obstruction (BPO) and define men who will develop these complications. Research proposals to further enlighten these associations were to be defined. A think-tank discussion was held on the annual ICI-RS meeting in 2011. The published literature between 1966 and 2011 was reviewed and research proposals were defined with all congress participants. Post-void residual, bladder diverticula or calculi, vesico-ureteral reflux, hydronephrosis, renal insufficiency, and urinary retention appear with greater prevalence in patients with symptoms or signs of benign prostatic hyperplasia. BPO may directly or indirectly be responsible for these complications but conclusive evidence for BPO as the primary cause does not exist. Many of the complications have a multifactorial etiology and BPO is only partially responsible. It is currently impossible to define men who will develop complications. In contrast to the widespread belief of urologist, there is only rudimentary data available showing no convincing association between urinary tract complications and BPO. The ICI-RS proposes that prospective trials are conducted to demonstrate the association between complications and BPO by using cystometry, pressure-flow (P/F) studies, and other commonly used BPO parameters in men with complications and comparing those with a cohort of age-matched men without complications. Non-invasive proxy parameters of BPO, for example, ultrasonic measurement of detrusor wall thickness, can be used instead of P/F studies especially in longitudinal trials.
Life, May 17, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European Urology, 1997
To study the feasibility of bladder autoaugmentation in patients with motor urge incontinence. Th... more To study the feasibility of bladder autoaugmentation in patients with motor urge incontinence. The clinical and urodynamic data of 5 patients were analyzed before and after treatment. All patients suffered from unstable bladders with a variable bladder capacity. All patients had urodynamic evaluation after 3 months. Three months after autoaugmentation 1 patient was continent while 4 were still incontinent. The continent patient had a stable bladder, whereas the others still suffered from unstable bladder contractions despite increased bladder capacity and leak point pressure. We did not succeed in abolishing bladder instability. Although our experience is limited, we cannot recommend vesicomyotomy as a routine procedure for motor urge incontinence at this time.
Continence reports, Mar 1, 2022
Neurourology and Urodynamics, 2012
Conclusions To investigate cell junction formation in the urogenital tract of humans and in TRPV4... more Conclusions To investigate cell junction formation in the urogenital tract of humans and in TRPV4 knockout mice.
European Urology Supplements, Mar 1, 2005
Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Sep 3, 2013
Medical Devices : Evidence and Research, Jun 1, 2017
Objectives: This review describes the evidence from established and experimental therapies that u... more Objectives: This review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction. Methods: Clinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated. Results: SNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidencebased efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy. Conclusion: Neurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies. Significance: Refinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.
Türk üroloji dergisi, Jun 20, 2014
Urodynamic tests are the standard diagnostic method for lower urinary tract dysfunctions (LUTD). ... more Urodynamic tests are the standard diagnostic method for lower urinary tract dysfunctions (LUTD). However, these tests are invasive. The current review describes the noninvasive imaging techniques that have been used to monitor LUTD. The main imaging technologies that have been applied in diagnosing LUTD were 2D ultrasonography, Doppler ultrasonography, and near-infrared spectroscopy (NIRS). Ultrasonographic parameters, such as bladder wall thickness (BWT), detrusor wall thickness (DWT), and ultrasound-estimated bladder weight (UEBW), have been proposed as surrogates for bladder outlet obstruction (BOO) or detrusor overactivity (DO). Few studies have reported diagnostic cutoffs in diagnosing BOO or DO; thus, there is still a need to standardize the measurement method. NIRS can detect the hemodynamic changes related to DO and BOO in real-time, which could be advantageous in clinical practice , but the liability of NIRS to motion artefacts is a limitation. Bladder strain imaging in real-time using 2D ultrasound enables noninvasive estimation of the dynamic changes in the bladder wall during voiding. Many imaging techniques have been used to monitor the urinary bladder during the storage and voiding phases of the micturition cycle. These techniques were either static [i.e., measuring fixed parameters, such as BWT, DWT, UEBW, and intravesical prostatic protrusion (IVPP)] or dynamic (monitoring the structural and hemodynamic changes in the bladder wall in real-time). These techniques are currently being developed and standardized for potential use in diagnosing LUTD in clinical practice.
European Urology, Oct 1, 2007
e u r o p e a n u r o l o g y 5 2 (2 0 0 7) 1 2 1 3-1 2 2 2 a v a i l a b l e a t w w w. s c i e ... more e u r o p e a n u r o l o g y 5 2 (2 0 0 7) 1 2 1 3-1 2 2 2 a v a i l a b l e a t w w w. s c i e n c e d i r e c t. c o m j o u r n a l h o m e p a g e : w w w. e u r o p e a n u r o l o g y. c o m
European urology open science, Apr 1, 2023
Bohn Stafleu van Loghum eBooks, 2008
Urologia Internationalis, Sep 28, 2021
Introduction: The aim of this study is to determine the outcome of surgically treated vesico-vagi... more Introduction: The aim of this study is to determine the outcome of surgically treated vesico-vaginal fistulae (VVaFs) using a transvaginal approach with a Latzko technique. Methods: A retrospective chart study was conducted at the Department of Urology, Radboud University Medical Centre. Surgical approaches to repair VVaF, from 2014 to September 2020, were selected. Patients who underwent a transvaginal approach were included. The primary objective was fistula closure. Secondary objectives were predictive factors for the outcome of the surgical procedure, for example, patient characteristics, leakage on cystography 2 weeks postoperative, and surgery time. Results: Thirty-one patients had surgery for VVaF. Twenty-five procedures (81%) were performed transvaginally. Thirteen of these (52%) had successful transvaginal closure after the first attempt. Seven out of 12 had their second attempt at the time of analysis, of which 4 (57%) were successfully closed thereafter. After either 1 or 2 attempts with the transvaginal approach, 17 (68%) of the VVaFs were successfully closed, but 79% if patients who did not yet had a second attempt were taken into account with the current success extrapolated. Only few minor complications were observed. Conclusion: Transvaginal closure of VVaFs with a Latzko technique is successful in about 79% in either 1 or 2 attempts, with few minor complications. A second attempt in closing the fistula with a transvaginal approach is useful, and a previous transvaginal attempt is not a contraindication for a second transvaginal attempt in closing the VVaF surgically.
Neurourology and Urodynamics, 2017
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Papers by John Heesakkers