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Adam Gafni-Kane, M.D.

Adam Gafni-Kane, M.D.

Adam Gafni-Kane, M.D.

Urogynecology
  • Locations
    Locations
    A

    NorthShore Medical Group - Skokie

    Urogynecology
    9650 Gross Point Rd.
    Suite 3900
    Skokie, IL 60076
    224.251.2374 847.933.3531 fax Get Directions This location is wheelchair accessible.
    B

    NorthShore Medical Group

    225 N. Milwaukee Ave.
    Suite 1500
    Vernon Hills, IL 60061
    224.251.2374 847.933.3531 fax Get Directions This location is wheelchair accessible.
    C

    NorthShore Medical Group

    757 Park Ave. West
    Suite 3870
    Highland Park, IL 60035
    224.251.2374 847.933.3531 fax Get Directions This location is wheelchair accessible.
    D

    NorthShore Medical Group

    15 Tower Ct.
    Suite 300
    Gurnee, IL 60031
    224.251.2374 847.933.3531 fax Get Directions This location is wheelchair accessible.
  • Publications
    Publications
    • Subjective and objective responses to PTNS and predictors for success: a retrospective cohort study of percutaneous tibial nerve stimulation for overactive bladder.

      International urogynecology journal 2018 Nov 22

      Authors: Iyer S
      Abstract
      We investigated the objective improvements in overactive bladder (OAB) symptoms in patients undergoing percutaneous tibial nerve stimulation (PTNS) and predictive factors of patient satisfaction.
      In this single-center retrospective cohort study at a tertiary urogynecology center, we identified all female patients who underwent PTNS therapy from 1 October 2007 - 1 January 2016 and followed them from their initial visit through medication therapy and PTNS treatments. Patients who tried at least one medication prior to starting PTNS therapy and completed at least one PTNS visit were included. Baseline demographic data, urinary data, and details of medication and PTNS therapy sessions were collected from records through chart review. Paired or two-sample t-tests were used to compare changes over time or groups. Bivariate and multivariable logistic regression were performed.
      Two hundred thirteen patients underwent PTNS therapy and 183 patients met the criteria. Overall patients were able to decrease voiding frequency by 1 h, decrease nocturia episodes by 0.8, and decrease urge incontinence episodes with PTNS therapy by ten episodes per week (p = 0.02). Patients who continued OAB medications did not have additional improvements compared with patients who did not continue OAB medications during PTNS. Overall, 25.4% (43/169) patients reported ≥ 75% improvement during PTNS therapy, and 61.5% (104/169) reported ≥ 50% improvement. When evaluating predictive factors of ≥ 50% overall improvement, the number of PTNS sessions increased odds of subjective success (OR = 1.8, p = 0.004). Other factors were not significant predictors of subjective PTNS success.
      PTNS can provide both objective and subjective improvements for patients who do not respond to OAB medication therapy.
      PMID: 30467763 [PubMed - as supplied by publisher]
    • A Comparison of Sacrospinous Hysteropexy Augmented With Polypropylene Mesh Versus Human Dermis at 12-Month Follow-up: An Ambidirectional Study.

      Female pelvic medicine & reconstructive surgery 2018 Oct 17

      Authors: Seitz M, Jirschele K, Tran A, Iyer S, Gafni-Kane A, Tomezsko J, Botros SM, Sand PK
      Abstract
      Suture-based hysteropexy is performed for pelvic organ prolapse with varying results. Graft augmentation may improve outcomes.
      The aim of this study was to determine whether vaginal hysteropexy with mesh reduces recurrence at 1-year postoperative examination compared with hysteropexy with allograft.
      Data were collected for patients who underwent vaginal hysteropexy with either mesh "Uphold" (referred to as "mesh") or a cadaveric allograft "Axis or Repliform" (referred to as "dermal"). The primary outcome was anatomic success defined as no prolapse Pelvic Organ Prolapse Quantification System stage II or less at 12 months postoperative. The secondary outcomes were recurrence to the hymen and a composite score (any positive response to the 20-item Pelvic Floor Distress Inventory question 3 and cervix ≥ -1/2 total vaginal length at rest or as reference point 3 cm proximal to or above the hymenal ring anteriorly [Ba] ≥0) measured at 12 months.
      Two hundred seventy-four patients returned for their 1-year postoperative examination: 93.5% of the mesh group (231/247 subjects) and 95.5% of the dermal group (43/45 subjects). The mesh group had fewer recurrences to or beyond Pelvic Organ Prolapse Quantification System stage II (mesh 18% vs dermal 29%, P = 0.03), to the hymen (2.6% vs 9.3%, P = 0.007), or based on composite score (19 vs 33%, P = 0.007). Questionnaire data improved more in the mesh group (P < 0.0001). The exposure rate was 5.75% (13/247) in the mesh group. Reoperation rate was greater in the dermal group (mesh 4.3%vs dermal 7.3%, P = 02).
      Hysteropexy augmented with mesh reduced the recurrence at 1 year compared with hysteropexy with allograft. Fewer patients in the mesh group felt a bulge at 1 year (4.5% vs 20.9%, P < 0.0001). These findings need to be weighed against the mesh exposure rate of 5.75%.
      PMID: 30335649 [PubMed - as supplied by publisher]
    • Anterior Colporrhaphy With and Without Dermal Allograft: A Randomized Control Trial With Long-Term Follow-Up.

      Female pelvic medicine & reconstructive surgery 2018 Jan 03

      Authors: Iyer S, Seitz M, Tran A, Scalabrin Reis R, Botros C, Lozo S, Botros S, Sand P, Tomezsko J, Wang C, Gafni-Kane A
      Abstract
      The objective of this study was to determine whether anterior colporrhaphy plus insertion of anterior dermal allograft reduces anterior prolapse recurrence at 1 and 7 to 10 years postoperatively compared with anterior colporrhaphy alone.
      We present a nonblinded randomized controlled trial with 1- and 7- to 10-year follow-up. Subjects were randomized between 2005 and 2008 to anterior colporrhaphy or ultralateral anterior colporrhaphy plus insertion of a dermal allograft spanning the anterior compartment between the arcus tendineus fascia pelvis on each side. Eligible subjects had anterior prolapse to the hymen or beyond, were bothered by their prolapse, and were planning to undergo surgical correction. Subjects completed a pelvic organ prolapse quantification system (POPQ) examination and Pelvic Floor Distress Inventory (PFDI)/PFDI-20 before surgery; a POPQ, PFDI, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire at 1 year postoperatively; and a POPQ, PFDI-20, Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, Revised, and Patient-reported Global Impression of Improvement Inventory at 7 to 10 years postoperatively. Our primary outcome was anatomic anterior prolapse recurrence at 1 or 7 to 10 years defined as Aa or Ba greater than or equal to -1. Our secondary outcome was a composite score of anterior prolapse recurrence at 1 or 7 to 10 years defined as anatomic recurrence (Aa or Ba ≥ 0), retreatment for cystocele, or answering yes to PFDI-20 question 3 (subjective report of vaginal bulge).
      A total of 114 subjects were randomized, 70 to anterior colporrhaphy and 44 to anterior colporrhaphy plus dermal allograft. About 92% of subjects underwent concomitant apical suspension, 98% in the graft group and 89% in the nongraft group. Eighty-nine subjects (32 graft [73%], 57 nongraft [81%]) returned for 1-year follow-up. Fifty-three patients (19 graft [48%], 34 nongraft [49%]) returned for 7- to 10-year follow-up. The primary outcome was met by 8 (18%) graft and 22 (31%) nongraft subjects at 1 year postoperatively (P = 0.26) and by 10 (23%) graft and 24 (34%) nongraft subjects at 7 to 10 years postoperatively (P = 0.37). The secondary outcome was met by 8 (18%) graft and 15 (21%) nongraft subjects at 1 year postoperatively (P = 0.74) and by 13 (30%) graft and 21 (30.0%) nongraft subjects at 7 to 10 years postoperatively (P = 0.99).
      We cannot conclude whether there is a difference in anterior recurrence for anterior colporrhaphy with and without dermal allograft and do not recommend changes in clinical practice based on these results.
      PMID: 29300253 [PubMed - as supplied by publisher]
    • Postoperative pain and perceptions of recuperation after suture- and mesh-based apical sacrospinous ligament suspension.

      International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2017 Oct

      Authors: Botros C, Letko J, Gafni-Kane A, Botros S, Lozo S, Sand P
      Abstract
      To compare the incidence of postoperative pain after suture- or mesh-based sacrospinous ligament suspension (SSLS).
      In a retrospective study, data were reviewed from patients who underwent suture- or mesh-based SSLS at a center in Skokie, IL, USA, between 2006 and 2011. The primary outcome was self-reported postoperative pain scores (range 0-10) on the day of surgery (day 0) and 1 day later (day 1).
      Overall, 90 women were included in the study: 66 underwent mesh-based SSLS and 24 underwent suture-based SSLS. Day-0 mean pain score was 4.65 ± 1.57 in the mesh group and 5.24 ± 1.44 in the suture group (adjusted P=0.159). Day-1 mean pain score was 4.06 ± 1.78 in the mesh group and 4.31 ± 1.21 in the suture group (adjusted P=0.596).
      Postoperative pain did not differ between patients undergoing suture-based and those undergoing mesh-based SSLS. These observations should be considered in preoperative counseling of patients.
      PMID: 28643369 [PubMed - as supplied by publisher]
    • Which bladder instillations are more effective? DMSO vs. bupivacaine/heparin/triamcinolone: a retrospective study.

      International urogynecology journal 2017 Sep

      Authors: Iyer S
      Abstract
      Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic and debilitating condition. Our objective was to compare two different bladder instillation treatments in patients with BPS/IC: dimethyl sulfoxide with triamcinolone (DMSO) vs. bupivacaine with heparin and triamcinolone (B/H/T). Our hypothesis was that both treatments are equally effective.
      A retrospective cohort study of instillation-naïve patients was conducted comparing responses to either DMSO or B/H/T at our tertiary urogynecology center from 2012 to 2014. The primary outcome was patient-reported percent of overall improvement from baseline. Secondary outcomes were change in patient-reported daytime voiding frequency (hours) and change in number of nighttime voiding episodes. Variables analyzed as potential confounders included pelvic pain, cystoscopy findings, levator spasm, and fibromyalgia. The two-sided Student's t test, chi-squared test, Poisson regression, and repeated-measure analysis of variance (ANOVA) were used for analyses.
      One hundred and ninety-three eligible patients were identified (45 receiving DMSO, 146 receiving B/H/T). Compared with baseline, DMSO patients reported 63% improvement (p < 0.0001), increased time between daytime voids by 1.5 h (p < 0.00), and a 40% reduction in nocturia episodes (p < 0.00). B/H/T patients reported 51% improvement (p < 0.00), increased time between daytime voids by 1.4 h (p < 0.00), and an 8% reduction in nocturia episodes (p = 0.26). When comparing the two treatments, DMSO resulted in a greater percentage of overall improvement (p = 0.02) and a significant decrease in nocturia episodes when compared with B/H/T (p = 0.02). There was no significant difference between treatments for daytime voiding frequency (p = 0.50).
      Bladder instillations with DMSO or B/H/T provide overall symptomatic improvement and improved frequency and nocturia. DMSO appears to provide greater improvement in nocturia and overall.
      PMID: 28150028 [PubMed - as supplied by publisher]
    • Does physician specialty affect persistence to pharmacotherapy among patients with overactive bladder syndrome?

      International urogynecology journal 2017 Mar

      Authors: Tran AM, Sand PK, Seitz MJ, Gafni-Kane A, Zhou Y, Botros SM
      Abstract
      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 2016 11

      Authors: Gafni-Kane A, Zhou Y, Botros SM
      Abstract
      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. Neurourol. Urodynam. 35:949-954, 2016. © 2015 Wiley Periodicals, Inc.
      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
      Abstract
      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
      Abstract
      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
      Abstract
      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]