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  1. Article: Characteristics of Nationwide Urinary Tract Infection (UTI) Visits by Age and Type II Diabetes Status in Women.

    Papp, Sara B / Christie, Alana L / Zimmern, Philippe E

    Cureus

    2023  Volume 15, Issue 9, Page(s) e46000

    Abstract: Background Through a national database search of office visits, we studied the contribution of two known risk factors for urinary tract infections (UTIs) in women: age and type 2 diabetes mellitus (T2DM). Methodology The National Ambulatory Medical Care ... ...

    Abstract Background Through a national database search of office visits, we studied the contribution of two known risk factors for urinary tract infections (UTIs) in women: age and type 2 diabetes mellitus (T2DM). Methodology The National Ambulatory Medical Care Survey (NAMCS) database was queried for visits including a UTI diagnosis and a urine culture order. Data were included for all visits involving adult women for available years, 2014-2016 and 2018. Data on demographics, reason for visit, T2DM status, UTI workup, and UTI treatment were collected. Patients with Alzheimer's disease or chronic kidney disease were excluded. Descriptive statistics were displayed as weighted means with standard errors for continuous variables. The effect of age was compared based on a 65-year-old cutoff. Results One hundred sixty-seven surveyed visits were analyzed for the years 2014-2016 and 2018, representing an estimated 7.4 million visits nationwide. Women ≥65 years were more likely to be white, non-Hispanic/non-Latino, from the Midwest or West, from metropolitan areas, and on Medicare/Medicaid than their younger counterparts. T2DM and urinalysis rates did not significantly vary between the two age groups (7.7% vs. 14.6%,
    Language English
    Publishing date 2023-09-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.46000
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  2. Article ; Online: Long-term Outcomes With Macroplastique in Women With Stress Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency.

    Kusin, Samuel B / Carroll, Timothy F / Alhalabi, Feras / Christie, Alana L / Zimmern, Philippe E

    Urology

    2024  Volume 185, Page(s) 36–43

    Abstract: Objective: To evaluate the long-term outcomes of polydimethylsiloxane (Macroplastique (MPQ)) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) using validated questionnaires.: Methods: Following IRB ... ...

    Abstract Objective: To evaluate the long-term outcomes of polydimethylsiloxane (Macroplastique (MPQ)) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) using validated questionnaires.
    Methods: Following IRB approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection were reviewed from a prospectively maintained database. ISD was defined as positive stress test with a well-supported urethra and low Valsalva leak point pressure when available. Excluded were women with follow-up <5years. Baseline data included validated questionnaire scores (UDI-6 question 3 (0-3), VAS Quality of Life, Incontinence Impact Questionnaire (IIQ-7)) and urodynamic study findings. Patients were followed with same questionnaires and three-dimensional ultrasound evaluating volume/configuration of MPQ. All three-dimensional ultrasound measurements were performed by the same imaging team blinded to clinical outcomes. Outcomes were evaluated in four groups based on prior SUI treatment. Success was defined as UDI-6 question 3 score of 0-1 and not requiring additional anti-incontinence therapy at the last visit after the last MPQ injection.
    Results: From April 2011-December 2016, 106 patients (median age 67) met study criteria. Median follow-up time was 7.4years. Median MPQ injected was 5 mL. Overall success was 43%, with 54% successful after one injection and 46% requiring ≥2 injections. Across all groups, patients had improvement in Quality of Life and IIQ-7 Question 7 (frustration). Among the failure group, 17% opted for a secondary autologous sling procedure.
    Conclusion: MPQ demonstrated long-term favorable outcomes in a subset of women with SUI secondary to ISD.
    MeSH term(s) Humans ; Female ; Aged ; Male ; Urinary Incontinence, Stress/therapy ; Quality of Life ; Urethral Diseases ; Dimethylpolysiloxanes ; Urinary Incontinence/drug therapy ; Treatment Outcome ; Suburethral Slings
    Chemical Substances baysilon (63148-62-9) ; Dimethylpolysiloxanes
    Language English
    Publishing date 2024-01-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2023.12.019
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  3. Article ; Online: A Deception Study to Avoid Recall Bias Confirms Similar Scores for 3 Validated Questionnaires in the Office or Over the Phone in Women With or Without Urinary Incontinence.

    Reddy, Meghana / Kusin, Samuel / Christie, Alana / Zimmern, Philippe

    The Journal of urology

    2022  Volume 208, Issue 6, Page(s) 1288–1294

    Abstract: Purpose: With increasing telehealth technology, confirming the validity of non-office administration of questionnaires intended for office use only is important. We studied 3 validated questionnaires: the Urinary Distress Inventory 6-Short Form, the ... ...

    Abstract Purpose: With increasing telehealth technology, confirming the validity of non-office administration of questionnaires intended for office use only is important. We studied 3 validated questionnaires: the Urinary Distress Inventory 6-Short Form, the International Incontinence 7-Short Form, and a quality of life survey using a deception model.
    Materials and methods: Following Institutional Review Board approval and power calculations, these 3 questionnaires were prospectively administered in women with and without incontinence by phone and then again in person about 2 weeks later. To avoid recall bias, participants were not informed of the study over the phone. After completing their office visit questionnaire scores, they were told about the study and invited to consent for comparison of their phone and in-person questionnaire scores. Non-English speakers and those with an active urinary tract infection, with impaired mental competency, or on a fluid diet were excluded.
    Results: From June to September 2021, 86 women, including 40 incontinent (30-85 years old) and 46 control (30-85 years old), with similar demographic parameters met all study criteria. Of the 14 questions studied, only 2, ie, Question 1 on the Urinary Distress Inventory 6-Short Form (P = .033) and Question 7 on the International Incontinence 7-Short Form (P = .036), showed rather minimal but statistically significant differences in scores. For incontinent women, only Question 7 on the International Incontinence 7-Short Form (P = .012) showed a significant score difference.
    Conclusions: The 3 questionnaire scores were overall comparable when obtained over the phone or during office visits. Women with incontinence, who may otherwise be lost to follow-up or only reachable by telehealth calls, can benefit from the remote administration of these 3 questionnaires.
    MeSH term(s) Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Quality of Life ; Urinary Incontinence/diagnosis ; Surveys and Questionnaires ; Bias ; Deception ; Urinary Incontinence, Stress
    Language English
    Publishing date 2022-08-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3176-8
    ISSN 1527-3792 ; 0022-5347
    ISSN (online) 1527-3792
    ISSN 0022-5347
    DOI 10.1097/JU.0000000000002891
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  4. Article: Cranberry Supplement, D-Mannose, and Other OTC Modalities for Prevention of Recurrent UTI in Women Post-Electrofulguration.

    Kenee, Parker R M / Christie, Alana L / Zimmern, Philippe E

    International journal of women's health

    2022  Volume 14, Page(s) 643–653

    Abstract: Purpose: To assess patient reliance on various over-the-counter (OTC) modalities used for prevention of recurrent urinary tract infection (RUTI) after electrofulguration (EF).: Patients and methods: Following IRB approval, qualifying women were ... ...

    Abstract Purpose: To assess patient reliance on various over-the-counter (OTC) modalities used for prevention of recurrent urinary tract infection (RUTI) after electrofulguration (EF).
    Patients and methods: Following IRB approval, qualifying women were offered a short survey over the phone by a medical researcher to collect information about their use of various OTC modalities for prophylaxis of RUTI. Data was compared between two cohorts, ≥70 years old and <70 years old, using chi-squared and Student's
    Results: From a database of 324 patients, 163 accepted the interview. 17% (28/163) reported current use of cranberry supplements, 10% (16/163) D-mannose supplements, and 42% (69/163) another non-prescription modality for RUTI prophylaxis. The non-geriatric (<70 years old) cohort spent, on average, $80 less annually on cranberry/D-mannose supplements (
    Conclusion: Continued use of non-prescription modalities for RUTI prophylaxis were common among women with an EF history, but varied based on age groups. Across both age cohorts, annual expenditure and perceived benefit also varied among different OTC prophylactic modalities. Awareness of type and method of OTC modality implementation by patients with RUTI is essential to aligning use with current field recommendations.
    Language English
    Publishing date 2022-05-03
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 2508161-5
    ISSN 1179-1411
    ISSN 1179-1411
    DOI 10.2147/IJWH.S355469
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  5. Article ; Online: Role of Flexible Cystoscopy in the Management of Postmenopausal Women With Recurrent Urinary Tract Infections.

    Ordonez, Janett / Christie, Alana L / Zimmern, Philippe E

    Urology

    2022  Volume 169, Page(s) 65–69

    Abstract: Objectives: To evaluate office flexible cystoscopy findings in the evaluation and management of postmenopausal women with recurrent urinary tract infections (RUTIs).: Methods: An IRB-approved, prospectively maintained database of women evaluated for ... ...

    Abstract Objectives: To evaluate office flexible cystoscopy findings in the evaluation and management of postmenopausal women with recurrent urinary tract infections (RUTIs).
    Methods: An IRB-approved, prospectively maintained database of women evaluated for RUTIs at a tertiary care center was retrospectively reviewed by an independent investigator for flexible cystoscopy (FC) findings and related treatment decisions over three consecutive years. Data reviewed in the electronic medical record (EMR) included demographics, UTI history, history of diabetes, hormone replacement therapy (HRT), prior urological surgeries, sexual activity, coital antibiotic prophylaxis use, urine culture findings, antibiotic resistance/allergies, cystoscopy, and treatment plan.
    Results: Between 2017 and 2019, 113 consecutive postmenopausal women, mostly Caucasian, underwent flexible office cystoscopy to complete their RUTI evaluation. Eighty-four women (74%) had abnormal cystoscopy findings. The rate of overall abnormal findings on cystoscopy increased yearly, including findings of trigonitis (p = 0.022). Other abnormal cystoscopy findings, as well as post-evaluation treatment plans, did not significantly differ over time. Trigonitis was the most common (67%) finding on cystoscopy. RUTI management included exposed urethral/bladder mesh removal and/or electrofulguration of chronic cystitis areas.
    Conclusions: Flexible cystoscopy, as an office diagnostic procedure, can provide valuable information of underlying etiology of RUTIs and allow directed management.
    MeSH term(s) Female ; Humans ; Cystoscopy/adverse effects ; Cystoscopy/methods ; Retrospective Studies ; Postmenopause ; Urinary Tract Infections/diagnosis ; Urinary Tract Infections/therapy ; Antibiotic Prophylaxis ; Cystitis
    Language English
    Publishing date 2022-08-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2022.07.040
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  6. Article ; Online: Fosfomycin Prevents Intravenous Antibiotic Therapy in Women With Recurrent Urinary Tract Infections: A Retrospective Review.

    Carroll, Timothy F / Christie, Alana L / Prokesch, Bonnie C / Zimmern, Philippe E

    Female pelvic medicine & reconstructive surgery

    2022  Volume 28, Issue 2, Page(s) 109–114

    Abstract: Objectives: The aim of this study was to evaluate the role of oral fosfomycin to prevent the use of intravenous (IV) antibiotic therapy in women with recurrent urinary tract infection (RUTI) complicated by antibiotic allergies and/or multidrug-resistant ...

    Abstract Objectives: The aim of this study was to evaluate the role of oral fosfomycin to prevent the use of intravenous (IV) antibiotic therapy in women with recurrent urinary tract infection (RUTI) complicated by antibiotic allergies and/or multidrug-resistant organisms.
    Methods: After institutional review board approval, a retrospective review of women prescribed fosfomycin for RUTI at our institution was performed. Excluded were patients who did not take fosfomycin. Data collected included demographics, baseline voiding function/urological anatomic abnormalities, need for IV antibiotic therapy for RUTI, RUTI-related surgery, antibiotic allergies, and urine culture results before and after taking fosfomycin. Success was defined as no subsequent IV antibiotic use for RUTI management after fosfomycin within the study follow-up. Secondary outcomes included time to next UTI after fosfomycin, time to next extended-spectrum beta-lactamase UTI, factors predicting failure, urine culture results after fosfomycin, and need for surgical intervention.
    Results: Between 2013 and 2019, 105 women met study criteria. At a median follow-up (including phone interviews) of 1.7 years (interquartile range, 0.3-5.8) after fosfomycin, the success rate was 74%. Twenty-seven patients had documented sterile urine cultures immediately after fosfomycin. Prior history of hospitalization for UTI and infection with resistant organisms were predictive of failure. After fosfomycin, 25 women underwent bladder electrofulguration, and 3 required cystectomy.
    Conclusions: Fosfomycin reduced the rate of IV antibiotic therapy in the management of RUTI in women with multidrug-resistant organisms and/or antibiotic allergies. Fosfomycin was less effective in those with prior hospitalization for UTI or infection with resistant organisms.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Female ; Fosfomycin ; Humans ; Retrospective Studies ; Urinary Bladder ; Urinary Tract Infections/drug therapy ; Urinary Tract Infections/prevention & control
    Chemical Substances Anti-Bacterial Agents ; Fosfomycin (2N81MY12TE)
    Language English
    Publishing date 2022-02-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2542707-6
    ISSN 2154-4212 ; 2151-8378
    ISSN (online) 2154-4212
    ISSN 2151-8378
    DOI 10.1097/SPV.0000000000001083
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  7. Article ; Online: Electro-fulguration for extensive inflammatory bladder lesions in post-menopausal women with antibiotic-recalcitrant recurrent urinary tract infections.

    Ma, Rosalind / Chavez, Jacqueline A / Christie, Alana L / Zimmern, Philippe E

    International urogynecology journal

    2022  Volume 34, Issue 7, Page(s) 1415–1422

    Abstract: Introduction and hypothesis: To evaluate how women with uncomplicated antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) and extensive inflammatory bladder lesions on office cystoscopy responded to electro-fulguration (EF) to eliminate ... ...

    Abstract Introduction and hypothesis: To evaluate how women with uncomplicated antibiotic-recalcitrant recurrent urinary tract infections (RUTIs) and extensive inflammatory bladder lesions on office cystoscopy responded to electro-fulguration (EF) to eliminate these chronic bladder sites.
    Methods: After IRB approval, a retrospective study of non-neurogenic women with RUTIs, inflammatory lesions on cystoscopy, and who underwent EF was performed. Lesions were classified through a simplified staging system based on the extent of bladder wall involvement. Only those with extensive bladder wall involvement (stages 3 and 4) at the time of EF were analyzed in this report. Six months after EF, an office cystoscopy was performed, with endoscopic success defined as no lesions seen. The primary clinical outcome was number of symptomatic UTIs after EF, defined as cure (0/year), improvement (1-2/year), and failure (≥3/year).
    Results: From 2007 to 2019, a total of 57 women met the study criteria, 30 stage 3 and 27 stage 4. Nineteen (63%) were endoscopically successful in stage 3 and 11 (41%) in stage 4. Mean follow-up was 2.9 years (stage 3) and 3.1 years (stage 4). All had at least a 6-month UTI follow-up after the 6 months of office cystoscopy, with 15 patients cured, 37 improved, and 5 failed (all stage 4).
    Conclusions: Although EF only resulted in 63% complete endoscopic resolution, the majority experienced a decrease in the frequency of UTIs, suggesting that EF can be durably effective even in women with very extensive cystitis lesions.
    MeSH term(s) Humans ; Female ; Urinary Bladder ; Postmenopause ; Retrospective Studies ; Urinary Tract Infections/drug therapy ; Anti-Bacterial Agents/therapeutic use
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-09-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 1050631-7
    ISSN 1433-3023 ; 0937-3462
    ISSN (online) 1433-3023
    ISSN 0937-3462
    DOI 10.1007/s00192-022-05360-w
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  8. Article: What morphology can teach us about renal cell carcinoma clonal evolution.

    Kapur, Payal / Christie, Alana / Rajaram, Satwik / Brugarolas, James

    Kidney cancer journal : official journal of the Kidney Cancer Association

    2021  Volume 18, Issue 3, Page(s) 68–76

    Abstract: While cancer is a clonal process, cumulative evidence suggest that tumors are rather heterogenous and are composed of multiple genetically-distinct subclones that arise at different times and either persist and co-exist, expand and evolve, or are ... ...

    Abstract While cancer is a clonal process, cumulative evidence suggest that tumors are rather heterogenous and are composed of multiple genetically-distinct subclones that arise at different times and either persist and co-exist, expand and evolve, or are eliminated. A paradigm of tumor heterogeneity is renal cell carcinoma (RCC). By exploiting morphological traits and building upon a framework around three axes (architecture, cytology and the microenvironment), we review recent advances in our understanding of RCC evolution leading to an integrated molecular genetic and morphologic evolutionary model with both prognostic and therapeutic implications. The ability to predict cancer evolution may have profound implications for clinical care and is central to oncology.
    Language English
    Publishing date 2021-06-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2244563-8
    ISSN 1933-0871 ; 1933-0863
    ISSN (online) 1933-0871
    ISSN 1933-0863
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  9. Article ; Online: Reply by Authors.

    Gaitonde, Shivani / Christie, Alana L / Garigipati, Priya / Alhalabi, Feras / Zimmern, Philippe E

    The Journal of urology

    2023  Volume 210, Issue 4, Page(s) 658

    Language English
    Publishing date 2023-07-25
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 3176-8
    ISSN 1527-3792 ; 0022-5347
    ISSN (online) 1527-3792
    ISSN 0022-5347
    DOI 10.1097/JU.0000000000003612.02
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  10. Article ; Online: Very Long-term Outcomes After Electrofulguration for Antibiotic-refractory Recurrent Urinary Tract Infections in a Predominantly Menopausal Cohort of Women.

    Gaitonde, Shivani / Christie, Alana L / Garigipati, Priya / Alhalabi, Feras / Zimmern, Philippe E

    The Journal of urology

    2023  Volume 210, Issue 4, Page(s) 649–658

    Abstract: Purpose: Antibiotic-refractory recurrent urinary tract infections are challenging to manage. Prior studies have shown that, in selected patients, electrofulguration of cystitis may disrupt potential nidus of recurrent urinary tract infections. We report ...

    Abstract Purpose: Antibiotic-refractory recurrent urinary tract infections are challenging to manage. Prior studies have shown that, in selected patients, electrofulguration of cystitis may disrupt potential nidus of recurrent urinary tract infections. We report on long-term outcomes of electrofulguration in women with at least 5 years of follow-up.
    Materials and methods: Following Institutional Review Board approval, we analyzed a cohort of nonneurogenic women with ≥3 symptomatic recurrent urinary tract infections/y and inflammatory lesions on cystoscopy who underwent electrofulguration, excluding those with alternate identifiable etiology for recurrent urinary tract infections or less than 5-year follow-up. Preoperative characteristics, antibiotic regimens, and annual urinary tract infections were reported. Primary outcome was clinical cure (0-1 urinary tract infection/y), improvement (>1 and <3/y) or failure (≥3/y) at last follow-up. Secondary outcomes included need for antibiotics or repeat electrofulguration. A subanalysis was performed for women with >10-year follow-up.
    Results: From 2006 to 2012, 96 women met study criteria with median age 64. Median follow-up was 11 years (IQR: 10-13.5); 71 women had >10-year follow-up. Prior to electrofulguration, 74% used daily antibiotic suppression, 5% used postcoital prophylaxis, 14% used self-start therapy, and 7% were not on prophylaxis. At last post-electrofulguration visit, 72% of women were cured, 22% improved, and 6% failed. Antibiotic usage decreased post-electrofulguration (
    Conclusions: In menopausal women with over 5-year follow-up after electrofulguration for antibiotic-refractory recurrent urinary tract infections, there appears to be durable clinical cure and improvement, with decreased need for long-term antibiotics.
    MeSH term(s) Humans ; Female ; Middle Aged ; Anti-Bacterial Agents/therapeutic use ; Urinary Tract Infections/drug therapy ; Urinary Tract Infections/prevention & control ; Antibiotic Prophylaxis ; Menopause ; Clinical Protocols
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-06-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3176-8
    ISSN 1527-3792 ; 0022-5347
    ISSN (online) 1527-3792
    ISSN 0022-5347
    DOI 10.1097/JU.0000000000003612
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