Adam Gafni-Kane, M.D.

Adam Gafni-Kane, M.D.

Adam Gafni-Kane, M.D.

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Conditions & Procedures


Female Reproductive Health, Incontinence, Overactive Bladder, Pelvic Floor Disorders, Pelvic Pain, Pelvic Prolapse, Urinary Infections, Urogynecology


Minimally Invasive Approach, Pelvic Reconstruction Surgery

General Information




NorthShore Medical Group



Academic Rank

Clinical Assistant Professor



Board Certified

Female Pelvic Medicine and Reconstructive Surgery, Obstetrics & Gynecology

Clinical Service

Education, Training & Fellowships

Medical School

Yale University School of Medicine, 2005


Yale University School of Medicine, 2006


Yale-New Haven Hospital, 2009


University of Chicago - NorthShore



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  • Does physician specialty affect persistence to pharmacotherapy among patients with overactive bladder syndrome?

    International urogynecology journal 2016 Aug 18

    Authors: Tran AM, Sand PK, Seitz MJ, Gafni-Kane A, Zhou Y, Botros SM
    We compared persistence on overactive bladder (OAB) pharmacotherapy in patients treated in the Female Pelvic Medicine and Reconstructive Surgery (FPMRS) department compared with patients treated in the Internal Medicine (IM) and General Urology (GU) departments within an integrated health-care system. We hypothesized that persistence would be higher among FPMRS patients.
    This was a retrospective cohort study. Patients with at least one prescription for OAB between January 2003 and July 2014 were identified. Demographic, prescription and treatment specialty data and data on the use of third-line therapies were collected. The primary outcome was persistence, defined as days on continuous pharmacotherapy. Discontinuation was defined as a treatment gap of ≥45 days. Discontinuation-free probabilities were calculated using the Kaplan-Meier method and compared among the specialties. Predictors of persistence were estimated using logistic regression with adjustment for covariates. Pearson correlation coefficients were calculated to identify risk associations.
    A total of 252 subjects were identified. At 12 weeks, 6 months and 1 year, FPMRS patients had the highest persistence rates of 93 %, 87 % and 79 % in contrast to 72 %, 68 % and 50 % in GU patients, and 83 %, 71 % and 63 % in IM patients (p = 0.006, p = 0.007, p = 0.001, respectively). The median persistence in FPMRS patients was 738 days, in GU patients 313 days and in IM patients 486 days (p = 0.006). Of the FPMRS patients, 61 % switched to at least a second medication, as compared to 27 % of IM patients and 14 % of GU patients (p < 0.0001).
    Persistence on OAB pharmacotherapy was higher among FPMRS patients than among GU and IM patients in this community setting. These results suggest that persistence is higher under subspecialist supervision.
    PMID: 27539566 [PubMed - as supplied by publisher]
  • Predictive modeling and threshold scores for care seeking among women with urinary incontinence: The short forms of the Pelvic Floor Distress Inventory and Urogenital Distress Inventory.

    Neurourology and urodynamics 2015 Jul 24

    Authors: Gafni-Kane A, Zhou Y, Botros SM
    To further the interpretability of the Pelvic Floor Distress Inventory (PFDI-20) and Urogenital Distress Inventory (UDI-6) by (i) evaluating the ability of these measures to distinguish between women with urinary incontinence who do and do not seek care, (ii) defining PFDI-20 and UDI-6 threshold scores above which women with urinary incontinence seek care, and (iii) developing a predictive model for incontinence care seeking.
    An observational study was conducted with two groups of women with urinary incontinence: 256 who had not sought care and 90 seeking initial care at a tertiary center. Sample sizes were based upon the prevalence of care seeking for urinary incontinence and the number of potential predictors for care seeking. Wilcoxon rank-sum tests, receiver operating characteristics, and multivariable logistic regression were use to achieve the study aims.
    Women with urinary incontinence who sought care had higher median PFDI-20 and UDI-6 scores compared to non-care seekers (73.96 vs. 16.67, P < 0.0001, and 41.67 vs. 8.33, P < 0.0001). A PFDI-20 score of 33.33 (83.33% sensitivity and 79.30% specificity) had very good discriminatory accuracy in distinguishing care and non-care seekers (AUC 0.886 ± 0.019 [95%CI 0.8518, 0.9254] P < 0.0001). A UDI-6 score of 25.00 (83.33% sensitivity and 83.59% specificity) had excellent discriminatory accuracy in distinguishing care and non-care seekers (AUC 0.9025 ± 0.0190 [95%CI 0.8653, 0.9398] P < 0.0001). A multivariable predictive model accurately identified 82.4% of care and non-care seekers.
    A PFDI-20 score of 33.33 and UDI-6 score of 25.00 provide meaningful benchmarks for care seeking among women with urinary incontinence.
    PMID: 26207922 [PubMed - as supplied by publisher]
  • An automatic female pelvic medicine and reconstructive surgery registry and complications manager developed in an electronic medical record.

    Female pelvic medicine & reconstructive surgery

    Authors: Goldberg RP, Gafni-Kane A, Jirschele K, Silver R, Maurer D, Solomonides T, Simmons A, Silverstein J
    The aim of this study is to incorporate a structured clinical documentation system (SCDS) into the electronic medical record (EMR), allowing for automatic flow of clinical data into an enterprise data warehouse (EDW) and clinical registry.
    The SCDS programming was developed within inpatient and ambulatory EMR domains, allowing routine documentation in these settings to trigger data flow into an EDW. An extensive set of clinical outcomes was included, focusing on data points likely to exist in the forthcoming American Urogynecologic Society Pelvic Floor Disorders Registry. An electronic complications manager was developed to link immediate and/or delayed complications to the index surgery, allowing for accurate morbidity tracking.
    All aspects of EMR documentation were successfully reconfigured for charting in both inpatient and office settings. Clinicians transitioned to clinical documentation such that no additional data entry beyond routine charting was required, and this resulted in data flow into the EDW. Physician feedback led to the refinement of SCDS entry fields.
    This SCDS system allows for automatic flow of a comprehensive data set from our EMR into an EDW and registry. It also provides the ability to systematically track complications and longitudinal clinical outcomes. Integrated systems may eliminate barriers associated with free-standing registries including those relating to cost, maintenance, data integrity, and consistent clinician participation. In addition, it should improve ascertainment of a complete patient population in comparison to voluntary registries.
    PMID: 25185625 [PubMed - as supplied by publisher]
  • Vesico-ureteral reflux in women with idiopathic high-pressure detrusor overactivity: prevalence, bladder function, and effect on the upper urinary tract.

    International urogynecology journal 2014 Oct

    Authors: Gafni-Kane A, Sand PK
    To assess the prevalence of vesico-ureteral reflux (VUR) and upper urinary tract damage in women with idiopathic high-pressure detrusor overactivity (IHPDO) and to characterize their bladder function.
    A retrospective chart review of women diagnosed with IHPDO (detrusor pressures > 40 cm H2O during involuntary bladder contractions) from 2007 to 2010 was conducted. Women were assessed for VUR by X-ray voiding cysto-urethrogram. Renal ultrasound or CT urogram, serum BUN/creatinine, and urinalyses were performed if reflux reached the renal pelvices. Cystometric and voiding pressure study data were reviewed for detrusor overactivity pressure and volume, voiding dysfunction, urethral relaxation, compliance, and bladder outlet obstruction.
    Sixty-five women were diagnosed with IHPDO, and 50 completed an X-ray voiding cysto-urethrogram. The median (range) detrusor overactivity pressure was 65 (41-251) cm H2O. Four (8.0%) women had IHPDO; none had upper urinary tract deterioration. The majority of women exhibited urethral relaxation with voiding, impaired compliance, and bladder outlet obstruction.
    Women with IHPDO are at risk of low-grade vesico-ureteral reflux. However, most women with IHPDO are likely protected from reflux by intermittent exposure to high detrusor pressures and the ability to decompress the bladder by urethral relaxation.
    PMID: 24803214 [PubMed - as supplied by publisher]
  • Measuring the success of combined intravesical dimethyl sulfoxide and triamcinolone for treatment of bladder pain syndrome/interstitial cystitis.

    International urogynecology journal 2013 Feb

    Authors: Gafni-Kane A, Botros SM, Du H, Sand RI, Sand PK
    The purpose of this study was to investigate change in bladder capacity as a measure of response to combined intravesical dimethyl sulfoxide (DMSO) and triamcinolone instillations for the treatment of newly diagnosed bladder pain syndrome/interstitial cystitis (BPS/IC).
    141 newly diagnosed women were identified retrospectively. 79 were treated with weekly DMSO/triamcinolone instillations. Change in bladder capacity with bladder retrofill, daytime urinary frequency, nocturia episodes per night, and Likert scale symptom scores were reviewed. Wilcoxon signed-rank tests, Wilcoxon rank-sum tests, Spearman's rank correlations, COX regression analysis, and a Kaplan-Meier survival curve were performed.
    Significant changes (median (25(th)-percentile to 75(th)-percentile) were noted for bladder capacity (75 mL (25 to 130 mL), p < 0.0001), inter-void interval (0 hrs (0 to 1 hour), p < 0.0001), nocturia episodes per night (-1 (-2 to 0), p < 0.0001), and aggregate Likert symptom scores (-2 points (-5 to 0), p < 0.0001). Percent change in bladder capacity correlated positively with percent change in inter-void interval (p = 0.03) and negatively with percent changes in nocturia (p = 0.17) and symptom scores (p = 0.01). Women without detrusor overactivity (DO) had greater percent changes in capacity than women with DO (62.5 % vs. 16.5 %, p = 0.02). 61.3 % of patients were retreated with a 36 weeks median time to retreatment and no difference in time to retreatment based upon DO. Greater capacity was protective against retreatment (hazard ratio = 0.997 [95 % CI 0.994,0.999], p = 0.02).
    Percent change in bladder capacity is a useful objective measure of response to intravesical DMSO/triamcinolone for newly diagnosed BPS/IC. Clinical outcomes do not differ based upon presence of DO.
    PMID: 22699887 [PubMed - as supplied by publisher]
  • Enhanced interpretability of the PFDI-20 with establishment of reference scores among women in the general population.

    Neurourology and urodynamics 2012 Nov

    Authors: Gafni-Kane A, Goldberg RP, Sand PK, Botros SM
    To enhance the interpretability of the PFDI-20 by establishing a score distribution for women in the general population and to determine whether scores correspond with urinary and anal incontinence (UI and AI).
    Subjects recruited during Twins Day Festivals from 2004 to 2009 completed a survey assessing for stress and urgency urinary incontinence (SUI and UUI) and AI of flatus and stool. Score distributions for the PFDI-20 and each of its subscales were determined for all subjects and for women with isolated forms of incontinence. Scores were compared between continent and incontinent women and between incontinent subtypes by Wilcoxon rank-sum tests.
    One thousand three hundred seventy-six women completed the survey with PFDI-20 (Median = 8.9, IQR 31.3), POPDI-6 (Median = 0, IQR = 8.3), CRADI-8 (Median = 0, IQR = 10.7), and UDI-6 (Median = 0, IQR = 16.7). PFDI-20, POPDI-6, CRADI-8, and UDI-6 scores were significantly greater among women reporting isolated SUI (P < 0.0001, P = 0.04, P < 0.0001, P < 0.0001, respectively), UUI (P < 0.0001, P = 0.02, P < 0.0001, P < 0.0001, respectively), mixed UI (P < 0.0001 each), AI flatus (P < 0.0001 each), and AI stool (P < 0.0001 each) compared to those denying incontinence. Women with mixed UI had significantly greater PFDI-20 and UDI-6 scores compare to those with SUI (P < 0.0001) or UUI (P < 0.0001). Subjects with AI stool had significantly greater PFDI-20 and CRADI-8 scores compared to those with AI flatus (P = 0.01).
    PFDI-20 scores from a sample of the general population correspond with the presence or absence of UI and AI. These normative and symptom-specific score distributions for the PFDI-20 provide reference points to gauge the effect of disease and intervention on quality of life for women with incontinence.
    PMID: 22532248 [PubMed - as supplied by publisher]
  • Minimal mesh repair for apical and anterior prolapse: initial anatomical and subjective outcomes.

    International urogynecology journal 2012 Dec

    Authors: Vu MK, Letko J, Jirschele K, Gafni-Kane A, Nguyen A, Du H, Goldberg RP
    Here we describe anatomic and quality of life (QOL) outcomes of an anterior and apical compartment prolapse repair involving a reduced mesh implant size and apex-only fixation.
    One hundred and fifteen patients undergoing the repair at a single urogynecology center were assessed using the Pelvic Organ Prolapse Quantification (POP-Q) and inpatient chart reviews. A horizontal incision eliminated overlap with the mesh, and each sacrospinous ligament was approached anteriorly by blunt dissection. Recurrence was defined as apical (C), or anterior (Aa or Ba) ≥0, and secondary analyses were performed using POP-Q ≥ -1 as the anatomic threshold. Pelvic Floor Distress Inventory (PFDI), Surgical Satisfaction Questionnaires (SSQ) and a dyspareunia symptom scale were analyzed pre- and postoperatively.
    Fifty-three women with uterus in situ demonstrated a combined anterior-apical recurrence rate of 1.89 %, including no anterior (Ba ≥ -1) and one apical (C ≥ -1) recurrence. Forty-seven women undergoing repair for vault prolapse had recurrence rates ranging from 0 % in those with prior hysterectomy to 4.2 % in those undergoing concurrent hysterectomy. The rate of mesh exposure was 3/115 (2.6 %), including two in women with concurrent hysterectomy. Self-reported dyspareunia was more common preoperatively (13.4 %) than postoperatively (9.3 %). PFDI scores improved in all domains, and 93 % completing the SSQ reported they were satisfied and would choose the surgery again.
    This technique resulted in successful outcomes within both anterior and apical compartments with a low rate of mesh complication, and no cases required mesh removal or hospital readmission. High rates of satisfaction and improved condition-specific QOL were observed.
    PMID: 22531956 [PubMed - as supplied by publisher]
  • Factors influencing women's participation in urogynecology research in the UK and USA.

    Neurourology and urodynamics 2011 Nov

    Authors: Bakali E, Gafni-Kane A, Botros S, Tincello DG
    To explore factors influencing willingness to participate in urogynecology trials and explore associations between demographics, quality of life score (ICIQ-SF), and willingness to participate.
    The Bladder Clinic Questionnaire (BCQ) was developed, piloted, and validated. The BCQ and ICIQ-SF were distributed to women attending urogynecologists in tertiary referral centers in the UK and USA. The BCQ collected demographic data and data on previous involvement in research and posed eight research scenarios. Women were asked to record their willingness to participate on a Likert scale, collapsed for analysis into "any yes," "unsure," or "any no," giving a BCQ score between 0 and 16 (higher scores indicating greater willingness).
    Two hundred sixty-seven UK women and 200 US women returned completed questionnaires. Median BCQ score differed between UK and US women (11 [0-16] vs. 10 [0-16]; P = 0.004); median ICIQ score was similar (9 [0-21] vs. 9 [0-20]). ICIQ score was higher in UK women willing to participate in two scenarios: standard operation versus new operation (P = 0.007), and new operation versus new operation (P = 0.001). UK women were uniformly more willing to take part in all scenarios involving established treatments.
    We identified cultural differences in willingness to participate and differences depending on type of intervention proposed which supports the growing evidence that detailed pilot work is required during planning of intervention studies.
    PMID: 21780172 [PubMed - as supplied by publisher]
  • Foreign-body granuloma after injection of calcium hydroxylapatite for type III stress urinary incontinence.

    Obstetrics and gynecology 2011 Aug

    Authors: Gafni-Kane A, Sand PK
    Foreign-body granuloma is a potential complication of periurethral injection of calcium hydroxylapatite for the treatment of type III stress urinary incontinence.
    We present two cases of foreign-body granuloma formation after periurethral injection of calcium hydroxylapatite for type III stress urinary incontinence. Excision of the lesion resulted in cessation of pain in a symptomatic patient; however, it led to the resumption of stress urinary incontinence in both cases.
    Foreign-body granuloma is not the normative response to periurethral bulking with calcium hydroxylapatite. However, granuloma should be considered when a periurethral mass is encountered after injection of calcium hydroxylapatite for type III stress urinary incontinence.
    PMID: 21768839 [PubMed - as supplied by publisher]
  • Extrasphincteric perianal fistulae after sacrospinous fixation for apical prolapse.

    Obstetrics and gynecology 2011 Feb

    Authors: Gafni-Kane A, Goldberg RP, Spitz JS, Sand PK
    Delayed extrasphincteric perianal fistulae may be encountered after sacrospinous vaginal vault suspension or hysteropexy with permanent sutures.
    We report two cases of extrasphincteric perianal fistulae: one after a sacrospinous vaginal vault suspension and one after a sacropsinous hysteropexy. Reproduction of the vaginal dissection performed to place the sacrospinous fixation sutures failed to expose the sutures, and the fistulae persisted. Perianal fistulotomy and fistulectomy, however, resulted in identification and excision of the sutures.
    Perianal fistulotomy or fistulectomy offers the most successful approach to identifying the inciting sutures.
    PMID: 21252781 [PubMed - as supplied by publisher]