Papers by Sangeeta Mahajan
Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy
Journal of reproductive medicine
To determine the prevalence of myofascial pain and the outcome of transvaginal pelvic floor physi... more To determine the prevalence of myofascial pain and the outcome of transvaginal pelvic floor physical therapy for the treatment of chronic pelvic pain caused by myofascial pelvic pain in a tertiary care facility. A retrospective chart review was performed on all women who presented to our facility between January 2005 and December 2007. Those diagnosed with myofascial pelvic pain and referred for transvaginal pelvic floor physical therapy over this 3-year period were evaluated. Participants with an initial pain score of > or = 4, myofascial pelvic pain on examination, and who attended 2 or more physician visits were included in the analysis. Patient physical examination findings, symptoms, and verbal pain ratings were reviewed. In all, 146 (13.2%) of 1,106 initially screened patients were diagnosed with myofascial pain. Seventy-five (51%) of the 146 patients who were referred for physical therapy were included, and 75% had an initial pain score of > or = 7. Pain scores signific...
Management of Urgency and Mixed Urinary Incontinence
Clinical Obstetrics and Gynecology, 2021
Urinary incontinence (UI) is a prevalent disorder that significantly affects quality of life. Thi... more Urinary incontinence (UI) is a prevalent disorder that significantly affects quality of life. This article reviews management of urgency and mixed UI by breaking the management algorithm down into observation, lifestyle and behavioral changes, pharmacologic therapy, and procedural management. Stress UI is best managed with mid-urethral slings and is covered in other chapters. Behavioral and pharmacologic management are equally efficacious for urgency UI, but procedural therapy is superior. Mixed UI is conventionally treated by first managing whichever UI subtype is most bothersome. The management of overflow UI is directed at its underlying etiology: detrusor underactivity or bladder outlet obstruction.
International Urogynecology Journal
Introduction and hypothesis The primary aim of this study was to compare differences in complicat... more Introduction and hypothesis The primary aim of this study was to compare differences in complication rates across different types of vaginal colpopexy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Methods Patients who underwent intra-or extraperitoneal vaginal colpopexy with or without concurrent hysterectomy were identified in the 2014-2016 NSQIP database using Current Procedural Terminology codes. Patient demographics, preoperative comorbidities, American Society of Anesthesiologists (ASA) classification system scores, and total operating time were obtained. NSQIP-tracked 30-day codes were used to determine the complication, reoperation, and readmission rates. Results A total of 9546 colpopexies were performed during the study period. The mean age was 62 ± 12 years, and the mean body mass index (BMI) was 28 ± 6 kg/m 2. The majority of patients were white (73%) with an ASA class of 2 (65%). The overall rate of postoperative complications was 10.5%. The most common complications were urinary tract infections (UTI) (5.1%), transfusion (1.0%), and superficial surgical site infection (0.7%). Excluding UTI, the rate of postoperative complications was 5.4%. After performing multivariable logistic regression, higher ASA class (class 3: aOR 1.69, 95% CI 1.16-2.51; class 4: aOR 3.98, 95% CI 1.51, 9.30) and extraperitoneal colpopexy with hysterectomy were independently associated with a higher odds of experiencing a non-UTI postoperative complication (aOR1.43, 95% CI 1.10, 1.84). Minority race was also independently associated with higher odds of experiencing a non-UTI postoperative complication (aOR 1.33, 95% CI 1.15, 1.52). Conclusion One in ten women undergoing vaginal colpopexy experienced a postoperative complication. Minority race and extraperitoneal colpopexy with concurrent hysterectomy were independently associated with an increased risk of a non-UTI postoperative complication.
Medical Malpractice Litigation in Non–Mesh-Related Pelvic Organ Prolapse Surgery
Female Pelvic Medicine & Reconstructive Surgery
INTRODUCTION Malpractice litigations have significant implications for patients and physicians. S... more INTRODUCTION Malpractice litigations have significant implications for patients and physicians. Studies have investigated mesh litigations in female pelvic reconstructive surgery, but none on nonmesh pelvic organ prolapse (POP) surgery. Our purpose is to determine the reasons for and outcomes of medical malpractice after nonmesh POP surgery. METHODS Westlaw (Thompson Reuters, New York, New York) is a legal research database of US court records. We identified completed POP litigations from 1987 to 2018 using the following: "pelvic organ prolapse," "enterocele," "rectocele," "cystocele," "uterine prolapse," and "vaginal wall prolapse." Mesh-related cases were excluded. Outcomes included reasons for litigation, verdict, injury, and payments. Statistical analysis was performed with nonparametric tests and χ independence test. RESULTS Ninety-one litigations were included. The median plaintiff age was 53 years (range, 36-85 years). The leading allegation was negligence of surgery (n = 59; 65%). The jury sided with the defendant physician in 67% of cases (n = 61). There was no association between case verdict and patient age (P = 0.781), geographic region (P = 0.824), or allegation (P = 0.904). The primary complications were urinary tract injury (n = 24; 26%), need for additional surgery (n = 22; 24%), and new postoperative urinary symptoms (n = 22; 24%). The median payout was $280,000 (interquartile range, $137,250-$1,300,000), with no difference between plaintiff awards or settlements (P = 0.659). CONCLUSION The leading allegation of malpractice litigations for nonmesh POP surgery is negligence of surgery, whereas the most common complication was urinary tract injury. A verdict in favor of the physician defendant was the most likely outcome. Plaintiff awards and settlements were not statistically different with no variation by region or time.
Cover Image, Volume 38, Number 5, June 2019
Neurourology and Urodynamics
Neurourology and Urodynamics
Effective personalization of web experiences constitutes matching the intent and interest of a us... more Effective personalization of web experiences constitutes matching the intent and interest of a user (or a group of users) to content they consume, while optimizing a set of target engagement metrics. With improved content consumption tracking via web analytics, such personalization is not only feasible but also valuable for a content publisher/owner with large volumes of content to choose from. However the multitude of media (desktop, mobile, etc.) and the diversity of users' interests necessitates automation in this process of constructing personalized content experiences. In this paper, we propose a genetic algorithm based framework that chooses a subset of content items (from a large collection) that are relevant to a given user and determines their respective sizes and relative positions to construct a layout that is optimized for a chosen engagement metric. Comparisons against existing frameworks based on crowd-sourced annotations indicate improved prominence of key content (based on historic engagement metrics) by the proposed approach, while improving the information diversity of the content presented in the layout. • Human-centered computing → Human computer interaction (HCI); • Computing methodologies → Learning to rank.
Readmission Rates after Same-Day Discharge Compared with Postoperative Day 1 Discharge after Benign Laparoscopic Hysterectomy
Journal of minimally invasive gynecology, Jan 14, 2017
To determine if there is a difference in readmission rates after same-day discharge compared with... more To determine if there is a difference in readmission rates after same-day discharge compared with postoperative day 1 discharges after laparoscopic hysterectomy. A retrospective cohort study with 1:2 propensity score matching (Canadian Task Force classification II-2). American College of Surgeons National Surgical Quality Improvement Program database. Women undergoing benign laparoscopic total or supracervical hysterectomy or laparoscopic-assisted vaginal hysterectomy with or without adnexal surgery between the years 2010 to 2015. Three thousand thirty-two low-risk women discharged on postoperative day 0 and 6064 women discharged on postoperative day 1 were included in the analysis. The overall readmission rate was 1.8%; after same-day discharge, the readmission rate was 2.2%, and after postoperative day 1 discharge the readmission rate was 1.7% (p = .10). After logistic regression analysis, smoking (adjusted odds ratio [aOR] = 2.06; 95% confidence interval [CI], 1.49-2.88), nonwhit...
A Randomized Comparative Study Evaluating Various Cough Stress Tests and 24-Hour Pad Test with Urodynamics
The Journal of urology, Jan 23, 2017
The cough stress test (CST) is a common and accepted tool to evaluate stress urinary incontinence... more The cough stress test (CST) is a common and accepted tool to evaluate stress urinary incontinence but there is no agreement on how the test should be conducted. We assessed the diagnostic ability of different CSTs performed varying patient's position and bladder volumes using urodynamic stress urinary incontinence (USI) as the gold standard. The 24-hour pad test was also evaluated. Women presenting to specialty outpatient clinics with complaints of urinary incontinence and recommended to undergo urodynamic testing were recruited. 140 patients were randomized to four CST groups including: (A)comfortably full bladder, (B)empty bladder, (C)bladder infused with 200cc of saline, and (D)bladder filled to half-functional capacity. The sequence of standing and sitting was randomly assigned. Group comparisons were performed using one-way ANOVA or generalized Fisher exact test. The Kappa statistic was used to evaluate the agreement between the sitting and standing positions. Confidence in...
Prevalence and risk factors for cardiac arrest and myocardial infarction after pelvic reconstructive surgery: a national, multi-institutional, surgical database study
International Urogynecology Journal
Introduction and hypothesisThere is limited data available regarding the risk for perioperative c... more Introduction and hypothesisThere is limited data available regarding the risk for perioperative cardiac morbidity following pelvic reconstructive surgery (PRS). We sought to determine the incidence of cardiac arrest and myocardial infarction within 30 days of pelvic organ prolapse (POP) surgery and determine which factors may contribute to an increased risk of these complications.MethodsUsing the American College of Surgeons National Quality Improvement Program (NSQIP) database, we identified patients who underwent PRS procedures between 2010 to 2015 using Current Procedural Terminology (CPT) codes. Patient demographics and clinical and surgical factors were obtained. Patients who experienced myocardial infarction or cardiac arrest (MICA) were compared with patients without these complications. Differences between groups were calculated using the chi-square and Student’s t test. Stepwise backward multivariate logistic regression was used to identify factors associated with acute cardiac morbidity.ResultsA total of 46, 367 women were identified. The incidence of MICA was 0.11% and of death was 0.01% for the entire cohorot. Age >70 years [adjusted odds ratio (aOR) = 2.99, 95% confidence interval (CI) 1.56–5.73], length of stay >1 day (aOR = 3.34, 95% CI 1.70–6.40), dependent functional status (aOR = 5.99 95% CI 1.95–16.32), hypertension (aOR = 2.86, 95% CI 1.36–6.04), American Society of Anesthesiologists (ASA) class 3 (aOR = 2.01, 95% CI 1.10–3.64), and inpatient status (aOR = 4.35, 95% CI 1.78–10.49).ConclusionThe rate of MICA is low following PRS. Additional studies are necessary to determine whether more extensive preoperative cardiac evaluation is warranted in this patient population.
Sensory mapping of pelvic dermatomes in women with interstitial cystitis/bladder pain syndrome
Neurourology and Urodynamics
To describe a sensory map of pelvic dermatomes in women with Interstitial Cystitis/Bladder Pain S... more To describe a sensory map of pelvic dermatomes in women with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). We hypothesized that if IC/BPS involves changes in central processing, then women with IC/BPS will exhibit sensory abnormalities in neurologic pelvic dermatomes. Women with IC/BPS and healthy controls underwent neurologic examination that included evaluation of sharp pain sensitivity and vibration in dermatomes T12, L1, L2, S1-5. Peripheral nervous system sensitivity to pressure, vibration, and pinprick were scored using numeric rating scales (NRS). Bilateral comparisons were made with Wilcoxon signed-rank test and comparisons between groups were made by the Mann-Whitney U-test. Total of 74 women with IC/BPS and 36 healthy counterparts were included. IC/BPS and control groups had similar age (43.0 ± 14.1 and 38.6 ± 15.3 years, P = 0.14) and BMI (28.9 ± 8.0 kg/m and 26.9 ± 8.4 kg/m , P = 0.24), respectively. Women with IC/BPS reported hyperalgesia (elevated bilateral NRS pain intensity) in all pelvic dermatomes compared to healthy controls. S4-S5 region had the highest pain intensity in all participants. All IC/BPS participants exhibited vibration sensation hypoesthesia, at least unilaterally, in all of the pelvic dermatomes except L1 compared to healthy controls. This detailed map of neurologic pelvic dermatomes in women with IC/BPS found hyperalgesia in all pelvic dermatomes, and some evidence of vibration sensation hypoesthesia, compared to healthy controls. These findings support the hypothesis that IC/BPS may involve changes in central signal processing biased towards nociception.
Video: Cystoscopic Intradetrusor Botulinum A Toxin Injection for the Treatment of Detrusor Overactivity Incontinence
Journal of Pelvic Medicine and Surgery
Effect of Bilateral Salpingectomy on Total Hysterectomy Cost
Obstetrics & Gynecology
RESULTS: Among 1,075 women who underwent hysteroscopy for which antibiotics are not recommended, ... more RESULTS: Among 1,075 women who underwent hysteroscopy for which antibiotics are not recommended, 196 (18.23%) received antibiotics. 770 (71.62%) women had a hysteroscopy alone, and 305 (28.37%) women had additional procedure(s) that also did not warrant antibiotics per guidelines from the American College of Obstetricians and Gynecologists or SCIP. At a significance level of 0.05, age (P , .0045), primary procedure (P , .0022), primary diagnosis (P , .0019), admitted year (P , .0302) and length of stay (P , .0005) had statistically significant effects on the impact of having unproven antibiotics. Non-compliance with guidelines decreased with time from 19.2% in 2010 to 11.4% in 2015 (P5.0242). Compliance among providers was 100% for those in practice , 10 years, 11.9% for those in practice .10 years and 1.2% among subspecialists.
Trans-abdominal ultrasound shear wave elastographyfor quantitative assessment of female bladder neck elasticity
International Urogynecology Journal, 2016
Disorders of micturition result from a wide variety of conditions and evaluation often involves m... more Disorders of micturition result from a wide variety of conditions and evaluation often involves multiple diagnostic modalities. However, the sensitivity and specificity of these techniques are highly variable and may not always yield a diagnosis. Novel imaging techniques such as ultrasound shear wave elastography may help to improve diagnostic accuracy. Continent women were recruited from outpatient gynecology offices from a tertiary medical system. Participants underwent ultrasound evaluation with measurement of the shear wave velocity (SWV) of the bladder neck (BN). SWV was used to determine the Young's modulus of the bladder neck. The median bladder neck stiffness was calculated and univariate and step-wise and backward multivariate logistic regression analyses were used to identify significant patient characteristics associated with bladder neck stiffness above or below the median. Fifty-seven women underwent SWE of the bladder; 12 were excluded, and 45 were included in the analysis. The median bladder neck stiffness of the study population was 22 (17.1-28.2) kPa. Age greater than 45 years was associated with a bladder neck stiffness above the median, OR 8.39, p < 0.001. Having no vaginal deliveries was also associated with a bladder neck stiffness greater than 22 kPa, unadjusted OR 4.76 (95 % CI 1.41-20.0, p = 0.012). Bladder volume and bladder neck thickness were not significantly associated with bladder neck stiffness above or below the median. Trans-abdominal shear wave elastography can be used to quantitatively assess bladder neck stiffness. This technique may potentially be useful for evaluating chronic urinary retention.
Video: Cystoscopic Intradetrusor Botulinum A Toxin Injection for the Treatment of Detrusor Overactivity Incontinence
Journal of Pelvic Medicine and Surgery, 2005
The prevalence of urinary catheterization in women and men with multiple sclerosis
The journal of spinal cord medicine, 2013
To determine the prevalence of urinary catheterization in patients with multiple sclerosis (MS). ... more To determine the prevalence of urinary catheterization in patients with multiple sclerosis (MS). After obtaining Institutional Review Board exemption, results from the Fall 2005 North American Research Committee on Multiple Sclerosis (NARCOMS) survey were reviewed. Respondents to the fall 2005 NARCOMS survey. Responses to the Urogenital Distress Inventory (UDI-6), the Short Form-12 (SF-12), the Patient Determined Disease Steps measure of physical disability, and urologic history were analyzed using descriptive statistics, the χ(2) and Student's t-tests, and multivariable logistic and linear regression. Of 9702 (58%) responses were returned, excluding respondents with prior bladder surgery, 9676 participants were reviewed: primarily white (92.9%), women (75.3%), with average age of diagnosis of 30.2 (SD 10.0) years. Urinary catheterization was reported by 2514 (26%) respondents, with 1091 (11%) reporting current and 1423 (15%) past catheter use. Among all catheter types (possibly...
Minimally invasive surgery, 2013
Objective. Laparoscopic pelvic assessment is often performed in a nonstandardized fashion dependi... more Objective. Laparoscopic pelvic assessment is often performed in a nonstandardized fashion depending on the surgeon's discretion. Reporting anatomic findings is inconsistent and lesions in atypical locations may be missed. We propose a method for systematic pelvic assessment based on anatomical landmarks. Design. Retrospective analysis. Setting. Tertiary care academic medical center. Intervention. We applied this system to operative reports of 540 patients who underwent diagnostic or operative laparoscopy for unexplained infertility between 2006 and 2012. The pelvis was divided into 2 midline zones (zone I and II) and right and left lateral zones (zone III and IV). All reports were evaluated for the comprehensiveness of description with respect to normal findings or pathology for each zone. Results. Of 540 surgeries, all reports commented on the uterus, tubes, and ovaries (100%), but only 17% (n = 93, 95% CI: 13.8-20.2) commented on the dome of the bladder and the anterior cul-de...
History and Development of an Integrated Model of Care for Female Pelvic Medicine and Surgery
Urology, 2014
Urologists and gynecologists manage most of the patients with female pelvic floor disorders. Howe... more Urologists and gynecologists manage most of the patients with female pelvic floor disorders. However, lack of a single focused approach among these two disciplines and other related fields may hinder advances in clinical care and research. Herein, along with describing the background of birth of the new subspeciality, we present a practical approach by which we established an integrated model of care and discovery for FPFD at our institution. With the recent approval of this subspeciality by the Accreditation Council for Graduate Medical Education (ACGME), it is plausible that other institutions would wish to initiate similar steps toward establishment of an integrated model of care for FPFD, and hence move this new subspecialty to its new frontiers.
Medical & Biological Engineering & Computing, 2014
measurements corresponding to 79 trauma patient records generated over 110,000 feature sets, whic... more measurements corresponding to 79 trauma patient records generated over 110,000 feature sets, which were used to develop, train, and implement the system. Comparisons among several machine learning models proved that a multilayer perceptron would best implement the algorithm in a hybrid system consisting of a machine learning component and basic detection rules. additionally, 295,994 feature sets from 82 h of trauma patient data showed that the system can obtain 89.8 % accuracy within 5 min of recorded lSIs. Use of machine learning technologies combined with basic detection rules provides a potential approach for accurately assessing the need for lSIs in trauma patients. the performance of this system demonstrates that machine learning technology can be implemented in a real-time fashion and potentially used in a critical care environment.
The Journal of Urology, 2010
We describe the prevalence of overactive bladder symptoms in patients with multiple sclerosis as ... more We describe the prevalence of overactive bladder symptoms in patients with multiple sclerosis as well as the rates of evaluation and treatment of urinary complaints. Materials and Methods: Data from the fall 2005 North American Research Committee On Multiple Sclerosis survey were examined, including the Urogenital Distress Inventory plus a nocturia question, the SF-12, and inquiries regarding urological care and treatments. Data were analyzed using descriptive statistics, chi-square and Student's t tests, ANOVA and multivariable logistic regression. Results: Of 16,858 surveys distributed 9,702 (58%) were completed. Participants with a surgically altered bladder were excluded from analysis (21). At least 1 moderate to severe urinary symptom (score of 2 or greater) was reported by 6,263 (65%) respondents. Increasing overactive bladder symptoms were correlated with longer disease duration (r ϭ 0.135) and increasing physical disability (r ϭ 0.291) (both p Ͻ0.001). Decreased quality of life was associated with increasing disability (p Ͻ0.001) and overactive bladder symptom score (p Ͻ0.001). Of patients with moderate to severe overactive bladder symptoms only 2,710 (43.3%) were evaluated by urology and 2,361 (51%) were treated with an anticholinergic medication. Treated patients more frequently reported leakage (p Ͻ0.001) and newer treatments were significantly underused (less than 10% total use). Catheter use was reported by 2,309 (36.8%) respondents, and was associated with greater disability, higher overactive bladder symptom score and reduced quality of life (all p Ͻ0.001). Conclusions: This large scale study identified high rates of overactive bladder symptoms in patients with MS, and correlations with increasing disease duration and physical disability. Despite an increasing awareness of overactive bladder symptoms and the need for evaluation and treatment, many patients remain underserved.
Uploads
Papers by Sangeeta Mahajan