Papers by Ridwan Shabsigh
The Journal of Urology, Mar 1, 2000
Purpose: Female sexual dysfunction is highly prevalent but not well defined or understood. We eva... more Purpose: Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. Materials and Methods: An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. Results: Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. Conclusions: We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.
The Journal of Urology, Apr 1, 2008
A randomized, blinded, multicenter, controlled study was undertaken to assess the impact of a mul... more A randomized, blinded, multicenter, controlled study was undertaken to assess the impact of a multiyear continuing medical education (CME) initiative on physician knowledge and behavior in the treatment of erectile dysfunction (ED). The objective of this study was to assess the efficacy of CME and compare applied knowledge and attitude scores of participants in the Consortium for Improvement in Erectile Function (CIEF), to non-CIEF participants. Subjects were selected randomly and contacted anonymously, by mail, email and fax and requested to enroll in this study. A blinded, validated questionnaire and series of standardized patient (SP) case studies and attitude questions were given to CIEF participants, defined as those who showed an interest in learning more about ED and who took at least one CME-certified program on ED from the CIEF website and non-CIEF participants, defined as those who showed interest in learning more about ED and who took at least one CME-certified program on ED from any organization other than CIEF. The primary outcome was a comparison of subjects' scores who participated in at least one CIEF program to non-participants in CIEF programs. Subjects were also compared based on SP case scores, attitude scores, specialty, years in practice, age and gender. Answers were ranked from best to worst and assigned a corresponding value of 10y3, 2, 1 and 0 (10 being the best), assuming that there may be more than one correct answer to each question in clinical practice. SAS version 9.1 analysis of variance model was used by an independent consultant. A total of 120 physicians completed the questionnaire: 87 urologists (UROs) and 33 primary care physicians (PCPs). UROs scored higher on SP cases compared with PCPs (P ¼ 0.0039); however, as a result of participating in CIEF programs, PCPs trended toward more comparable scores to UROs; P ¼ 0.23 for SP case 2 that was clinically less complex and P ¼ 0.19 for SP case 3 that was more complex. In the other two cases, the gap was reduced; however, UROs scored better than PCPs. PCPs in CIEF (n ¼ 23) had significantly higher SP case scores compared with non-CIEF PCPs (n ¼ 10); 216.6 vs 191.0, respectively (P ¼ 0.0437). PCPs in CIEF also showed a significantly greater level in mean attitude scores compared with UROs, 10.82 vs 8.15, respectively (Po0.0001). Both PCPs and UROs scored higher after participating in CIEF ED educational programs than those clinicians who participated in non-CIEF ED educational programs. In addition, clinicians participating in more CIEF programs scored higher than those participating in fewer CIEF programs. As expected, UROs consistently scored better than PCPs, indicating a higher baseline level of knowledge base about ED. However, this educational gap was significantly reduced in PCPs who participated in CIEF programs. The study demonstrated that PCPs who took more CIEF courses were almost as knowledgeable as UROs on the subject of ED. Longitudinal, disease-specific CME initiatives are valuable in that they positively impact the knowledge and thus the behavior of participating physicians, potentially conferring clinical benefits toward patient outcomes.
The Journal of Urology, Apr 1, 2006
Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular... more Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular disease. In particular, the role of endothelial dysfunction and nitric oxide in ED and atherosclerotic disease has been elucidated. Given the large number of men receiving medical treatment for ED, concerns regarding the risk for sexual activity triggering acute cardiovascular events and potential risks of adverse or unanticipated drug interactions need to be addressed. A risk stratification algorithm was developed by the First Princeton Consensus Panel to evaluate the degree of cardiovascular risk associated with sexual activity for men with varying degrees of cardiovascular disease. Patients were assigned to 3 categories: low, intermediate (including those requiring further evaluation), and high risk. This consensus study from the Second Princeton Consensus Conference corroborates and clarifies the algorithm and emphasizes the importance of risk factor evaluation and management for all patients with ED. The panel reviewed recent safety and drug interaction data for 3 phosphodiesterase (PDE)-5 inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. Increasing evidence supports the role of lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease. Special management recommendations for patients taking PDE-5 inhibitors who present at the emergency department and other emergency medical situations are described. Finally, further research on the role of PDE-5 inhibition in treating patients with other medical or cardiovascular disorders is recommended.
International Journal of Impotence Research, Oct 1, 2000
The Journal of Urology, Apr 1, 2006
The Journal of Urology, Jun 1, 1993
A case is reported in which ejaculatory duct obstruction causing perineal pain following transure... more A case is reported in which ejaculatory duct obstruction causing perineal pain following transurethral resection of the prostate was diagnosed by transrectal ultrasound and treated successfully by transurethral resection of the ejaculatory ducts.
Journal of Endourology, 1988
To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and... more To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly high in the patients having a JJ stent. The cost of the treatment doubled in the stented group which is an important factor in our country. JJ stenting does not prove to be a cost effective procedure when compared to the reduction in complications.
The Journal of Urology, Oct 1, 1998
PurposeA retrospective analysis of the MUSE**VIVUS, Inc., Menlo Park, California. clinical trial ... more PurposeA retrospective analysis of the MUSE**VIVUS, Inc., Menlo Park, California. clinical trial was performed to evaluate the efficacy and safety of transurethral alprostadil in patients with erectile dysfunction after radical prostatectomy.
Gerontology and Geriatric Medicine, 2019
Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integra... more Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (–67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation an...
Journal of Men's Health, 2019
GoalTo provide a state-of-the-art literature review on veno-occlusive diseases as a pathomechanis... more GoalTo provide a state-of-the-art literature review on veno-occlusive diseases as a pathomechanism of vascu-logenic erectile dysfunction (ED).MethodsA comprehensive systematic literature search was conducted followed by sorting, review, and summarizing. ResultsThe systematic review of the literature reveals a significant number of recent studies dealing with new minimally invasive methods to provide a potential solution of caverno-venous leakage. Even the long-term results reported demonstrate considerable improvement of ED caused by this condition. Furthermore, 3-D computed tomography cavernosography (CT-cavernosography) is a new technology, which can provide high-resolution images of venous drainage from any angle and shows to be very helpful for both the diagnosis of corporal veno-occlusive dysfunction and the anatomical study of the human penile venous system. The application of this technology may also lead to better strategies in venous leak treatment. Over 30 published studie...
The Journal of Urology, 2007
The Journal of Urology, 2005
European Journal of Trauma and Emergency Surgery, 2018
Objectives Thoracostomy tube (TT) connection to drainage device (DD) may be unintentionally disco... more Objectives Thoracostomy tube (TT) connection to drainage device (DD) may be unintentionally disconnected, potentiating complications. Tape may strengthen this connection despite minimal data informing optimal practice. Our goal was to analyze the utility of cable ties for TT to DD connection. Methods On April 1, 2015, our trauma center supplanted use of tape or nothing with cable ties for securing TT to DD connection. We abstracted trauma registry patients with TTs placed from March 1, 2014 to May 31, 2016 and dichotomized as prior ("BEFORE") and subsequent ("AFTER") to the cable tie practice pattern change. We analyzed demographics, TT-specific details and outcomes. Primary outcome was TT to DD disconnection. Secondary outcomes included TT dislodgement from the chest, complications, length of stay (LOS), mortality, number of TTs placed and TT days. Results 121 (83.4% of abstracted) patients were analyzed. Demographics, indications for TT and operative rate were similar for BEFORE and AFTER cohorts. ISS was lower BEFORE (14.12 ± 2.35 vs 18.21 ± 2.71, p = 0.022); however, RTS and AIS for chest were similar (p = 0.155 and 0.409, respectively). TT to DD disconnections per TT days were significantly higher in the BEFORE cohort [6 (2.8%) vs. 1 (0.19%), p = 0.003], and dislodgements were statistically similar [0 vs 3 (0.57%), p = 0.36]. LOS, initial TTs placed and days per TT were similar, and median and mode of days per TT were the same. Conclusions Cable ties secure connections between TT and DDs with higher fidelity compared to tape or nothing but may increase rates of TT dislodgement from the chest.
Journal of Urology, 1986
The charts and x-rays of 120 neurogenic bladder patients who underwent artificial sphincter impla... more The charts and x-rays of 120 neurogenic bladder patients who underwent artificial sphincter implantation for treatment of urinary incontinence between 1973 and 1984 were reviewed retrospectively. Patients were followed for 3 to 130 months (average 36.8 months). The upper urinary tracts remained unchanged in 108 patients (90 per cent). Renal growth in children was undisturbed. Transient hydroureteronephrosis occurred in 8 patients (6.7 per cent) and progressive hydroureteronephrosis occurred in 4 (3.3 per cent). A total of 26 patients with vesicoureteral reflux (39 ureters) underwent ureteral reimplantation. Our results indicate that 1) implantation of the artificial urinary sphincter in neurogenic bladder patients has minimal adverse impact on the upper urinary tracts, 2) followup should be long-term and should include an IVP, 3) outflow obstruction should be eliminated preoperatively by means of external sphincterotomy in male patients and bladder flap urethroplasty in female patients, 4) similarly, adequate emptying of the bladder always must be assured during followup, 5) if hydroureteronephrosis is detected early appropriate treatment can restore normal upper tracts, 6) the presence of previously damaged upper tracts without evidence of obstruction is not a contraindication for artificial sphincter implantation and 7) an antireflux operation in combination with artifici~l sphincter implantation is feasible.
Journal of Urology, 1987
A total of 63 combined transrectal ultrasonographic and urodynamic studies was performed to evalu... more A total of 63 combined transrectal ultrasonographic and urodynamic studies was performed to evaluate the voiding dysfunction in 49 spinal cord injury patients and 7 other patients. Ultrasonography provided excellent real-time imaging of the bladder neck, prostatic urethra, prostate and external sphincter, and allowed for accurate diagnosis of detrusor-sphincter dyssynergia, detrusorbladder neck dyssynergia, prostatic hypertrophy and bladder neck strictures. In addition to offering these capabilities, ultrasonography is less expensive than x-ray and it does not involve exposure of either the patient or examiner to radiation. However, it does not provide a means to detect vesicoureteral reflux.
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Papers by Ridwan Shabsigh