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Obstetrician & Gynecologist (OB/GYN)
9 years of experience
Accepting new patients

Education ?

Medical School Score Rankings
The University of Texas Southwestern (2001)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Society of Gynecologic Surgeons
American Urogynecologic Society (AUGS) Foundation
Excellence in Medical Student Teaching Award
Rigoberto Santos Award for Excellence in Sonography
Associations
American Board of Obstetrics and Gynecology

Affiliations ?

Dr. Rahn is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • UT Southwestern University Hospital - Zale Lipshy
    5151 Harry Hines Blvd, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • UT Southwestern University Hospital - St. Paul
    5909 Harry Hines Blvd, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • Parkland Health & Hospital System
    5201 Harry Hines Blvd, Dallas, TX 75235
    • Currently 1 of 4 crosses
  • UT Southwestern St Paul Hospital
  • Publications & Research

    Dr. Rahn has contributed to 19 publications.
    Title The Questionnaire for Urinary Incontinence Diagnosis (quid): Validity and Responsiveness to Change in Women Undergoing Non-surgical Therapies for Treatment of Stress Predominant Urinary Incontinence.
    Date December 2010
    Journal Neurourology and Urodynamics
    Excerpt

    The Questionnaire for Urinary Incontinence Diagnosis (QUID), a 6-item urinary incontinence (UI) symptom questionnaire, was developed and validated to distinguish stress and urge UI. This study's objective was to evaluate QUID validity and responsiveness when used as a clinical trial outcome measure.

    Title Correlation Between Levator Ani Muscle Injuries on Magnetic Resonance Imaging and Fecal Incontinence, Pelvic Organ Prolapse, and Urinary Incontinence in Primiparous Women.
    Date May 2010
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    The objective of the study was to correlate the presence of major levator ani muscle (LAM) injuries on magnetic resonance imaging (MRI) with fecal incontinence (FI), pelvic organ prolapse (POP), and urinary incontinence (UI) in primiparous women 6-12 months postpartum.

    Title Pathophysiology of Urinary Incontinence, Voiding Dysfunction, and Overactive Bladder.
    Date April 2010
    Journal Obstetrics and Gynecology Clinics of North America
    Excerpt

    Urinary incontinence and voiding dysfunction are common forms of pelvic floor dysfunction affecting women. The complex interactions between the nervous system and lower urinary tract anatomy allow for the coordinated functions of urine storage and evacuation. A thorough understanding of these components and their interactions is the foundation for the diagnosis and treatment of pathologic conditions affecting urine storage or evacuation. These components include changes in neurologic or muscular function, alterations in anatomy, and the deleterious effects of many common comorbid conditions on the lower urinary tract.

    Title Anterior Abdominal Wall Nerve and Vessel Anatomy: Clinical Implications for Gynecologic Surgery.
    Date April 2010
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    We sought to describe relationships of clinically relevant nerves and vessels of the anterior abdominal wall.

    Title Quantification of Pelvic Organ Prolapse in Mice: Vaginal Protease Activity Precedes Increased Mopq Scores in Fibulin 5 Knockout Mice.
    Date June 2009
    Journal Biology of Reproduction
    Excerpt

    Two mouse models of pelvic organ prolapse have been generated recently, both of which have null mutations in genes involved in elastic fiber synthesis and assembly (fibulin 5 and lysyl oxidase-like 1). Interestingly, although these mice exhibit elastinopathies early in life, pelvic organ prolapse does not develop until later in life. In this investigation we developed and validated a tool to quantify the severity of pelvic organ prolapse in mice, and we used this tool prospectively to study the role of fibulin 5, aging, and vaginal proteases in the development of pelvic organ prolapse. The results indicate that >90% of Fbln5(-/-) mice develop prolapse by 6 mo of age, even in the absence of vaginal delivery, and that increased vaginal protease activity precedes the development of prolapse.

    Title Optimal Location and Orientation of Suture Placement in Abdominal Sacrocolpopexy.
    Date May 2009
    Journal Obstetrics and Gynecology
    Excerpt

    To estimate the strongest location and optimal orientation of suture placement in the anterior longitudinal ligament for abdominal sacrocolpopexy in female cadavers.

    Title Effects of Pregnancy, Parturition, and Anal Sphincter Transection on Function of the External Anal Sphincter in an Animal Model.
    Date May 2009
    Journal Obstetrics and Gynecology
    Excerpt

    To estimate the effects of pregnancy, parturition, and anal sphincter laceration (with repair) on external anal sphincter morphology and neurophysiology and to define the time course of these effects after injury.

    Title Abdominal Hysterectomy with or Without Angle Stitch: Correlation with Subsequent Vaginal Vault Prolapse.
    Date January 2009
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    The objective of the study was to assess whether cardinal-uterosacral ligament lateral vaginal cuff angle stitches at the time of total hysterectomy may assist in preventing subsequent apical vault prolapse.

    Title Recovery of External Anal Sphincter Contractile Function After Prolonged Vaginal Distention or Sphincter Transection in an Animal Model.
    Date July 2008
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To estimate the effect of prolonged vaginal distention and anal sphincter transection on contractile properties of the external anal sphincter as a function of time. METHODS: One hundred thirty-nine young female virginal rats were randomly assigned into four treatment groups (sham, vaginal distention, transection of anal sphincter plus repair, or combined distention and transection plus repair). After 3 days, 3 months, or 6 months, the anal sphincter complex was analyzed for peak force of twitch tension, peak tetanic force, fatigue, and maximal responses to electrical field stimulation. Statistical analysis was performed using analysis of variance (Student-Neuman-Keuls). RESULTS: After 3 days, vaginal balloon distention, anal sphincter transection with repair, and combined distention and transection plus repair resulted in compromise of maximal tetanic contraction and electrical field stimulated force generation. Twitch tension, and resistance to fatigue were also significantly decreased in animals with anal sphincter disruption and repair with and without vaginal distention at 3 days. Contractile function of the external anal sphincter, however, was fully recovered by 3 months and was sustained at 6 months in all treatment groups. The time course of repair was slower in animals with sphincter laceration. CONCLUSION: Anal sphincter transection with or without antecedent prolonged vaginal distention results in severe compromise of external anal sphincter function in the immediate period after injury. In this animal model, complete recovery of external anal sphincter function occurs 3 months after initial insult.

    Title Biomechanical Properties of the Vaginal Wall: Effect of Pregnancy, Elastic Fiber Deficiency, and Pelvic Organ Prolapse.
    Date May 2008
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The purpose of this study was to identify pregnancy-induced changes in biomechanical properties of the vaginal wall and to compare these with fibulin-5 knockout mice (Fbln5(-/-)) with and without prolapse. STUDY DESIGN: Mid-vaginal segments of nonpregnant and late-pregnant wild-type mice, Fbln5(-/-) with prolapse mice and Fbln5(-/-) mice without prolapse were studied. Tissue length at failure, maximal strain, maximal stress, and tissue stiffness were determined. RESULTS: Compared with nonpregnant mice, vaginas of pregnant and Fbln5(-/-) (with prolapse) mice exhibited decreased maximal stress, increased distensibility and strain, and decreased stiffness. Tissues from Fbln5(-/-) mice without prolapse were similar to nonpregnant wild-type animals. CONCLUSION: Pregnancy confers remarkable changes in the vaginal wall that include increased distensibility and decreased stiffness and maximal stress. Elastinopathy alone is insufficient to cause significant changes in these properties, but prolapse confers additional alterations in distensibility and stiffness that are similar to those changes that have been observed in pregnancy. These changes may contribute to the poor durability of many restorative surgical procedures for prolapse.

    Title Does Supracervical Hysterectomy Provide More Support to the Vaginal Apex Than Total Abdominal Hysterectomy?
    Date December 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to assess whether cervical preservation at the time of hysterectomy may help prevent subsequent apical vaginal vault prolapse. STUDY DESIGN: Supracervical hysterectomies were performed in 12 unembalmed cadavers. Successive hanging weights of 1, 2, 3, and 4 kg were loaded against the cervical stump and distances moved were recorded. The same process was repeated after completion of a total hysterectomy. RESULTS: Average distances pulled with 1, 2, 3, and 4 kg of traction against the cervical stump were 17.8 +/- 1.9, 24.1 +/- 2.5, 29.0 +/- 2.8, and 34.3 +/- 3.5 mm, respectively. After total hysterectomy, these distances were 17.5 +/- 2.5, 23.5 +/- 2.6, 29.3 +/- 3.1, and 34.5 +/- 3.6 mm, respectively. CONCLUSION: In unembalmed cadavers, it appears that total abdominal hysterectomy and supracervical hysterectomy provide equal resistance to forces applied to the vaginal apex.

    Title Posterior Division of the Internal Iliac Artery: Anatomic Variations and Clinical Applications.
    Date December 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to characterize the anatomy of the internal iliac artery (IIA) and its posterior division branches and to correlate these findings to IIA ligation. STUDY DESIGN: Dissections were performed in 54 female cadavers. RESULTS: Average length of IIA was 27.0 (range, 0-52) mm. Posterior division arteries arose from a common trunk in 62.3% (66 of 106) of pelvic halves. In the remaining specimens, branches arose independently from the IIA, with the iliolumbar noted as the first branch in 28.3%, lateral sacral in 5.7%, and superior gluteal in 3.8%. The average width of the first branch was 5.0 (range, 2-12) mm. In all dissections, posterior division branches arose from the dorsal and lateral aspect of IIA. The internal iliac vein was lateral to the artery in 70.6% (12 of 17) of specimens on the left and 93.3% (14 of 15) on the right. CONCLUSION: Ligation of the IIA 5 cm distal from the common iliac bifurcation would spare posterior division branches in the vast majority of cases. Understanding IIA anatomy is essential to minimize intra-operative blood loss and other complications.

    Title Anatomic Relationships of the Distal Third of the Pelvic Ureter, Trigone, and Urethra in Unembalmed Female Cadavers.
    Date December 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to examine the relationship of the ureter to paravaginal defect repair (PVDR) sutures and to evaluate the anatomy of distal ureter, trigone, and urethra relative to the anterior vaginal wall. STUDY DESIGN: Dissections of the retropubic space were performed in 24 unembalmed female cadavers following placement of PVDR sutures. Lengths of the vagina, urethra, and trigone were recorded. RESULTS: The mean distance between apical PVDR sutures and the ureter was 22.8 (range, 5-36) mm. The average lengths of the urethra, trigone, and vagina were 3 cm, 2.8 cm, and 8.4 cm, respectively. The trigone was positioned over the middle third of the anterior vaginal wall in all specimens and the distal ureters traversed the anterolateral vaginal fornices. CONCLUSION: The ureters may be injured during paravaginal defect repairs, anterior colporrhaphies, and other procedures involving dissection in the upper third of the vagina. Cystotomy during vaginal hysterectomies is most likely to occur 2-3 cm above the trigone.

    Title The Natural History of Posterior Vaginal Wall Support After Abdominal Sacrocolpopexy with and Without Posterior Colporrhaphy.
    Date May 2007
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to determine the degree of posterior vaginal wall support after abdominal sacrocolpopexy (ASC) with and without a posterior colporrhaphy as a function of time. STUDY DESIGN: Retrospective review was performed on women who underwent ASC between 1997 and 2004. Pelvic organ prolapse quantification (POP-Q) points Ap and Bp and stage of posterior compartment were collected at initial visit and at 1, 4, 10, 22, and 34 months after ASC. RESULTS: Significant improvement of POP-Q point Ap and Bp and stage of posterior compartment was initially seen after ASC with or without posterior colporrhaphy. With concomitant posterior colporrhaphy, the improvement in Ap persisted 34 months after surgery. Mean Bp and stage of the posterior compartment returned to preoperative values after 10 months, regardless of whether a concurrent posterior colporrhaphy had been performed. Fifty-one of 191 women (29%) had subsequent stage 2 posterior wall prolapse, 4 (2%) of whom underwent subsequent posterior colporrhaphy. CONCLUSIONS: For ASC with concomitant posterior colporrhaphy, POP-Q point Ap significantly improved and persisted at 34 months after surgery. Ten months after surgery, descent of POP-Q point Bp returned to preoperative levels and was the same regardless of whether a site-specific posterior colporrhaphy was performed at the time of an abdominal sacrocolpopexy.

    Title Vascular Anatomy of the Presacral Space in Unembalmed Female Cadavers.
    Date December 2006
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The purpose of this study was to characterize the vascular anatomy of the female presacral space (PSS) and to correlate findings to the abdominal sacrocolpopexy. STUDY DESIGN: Detailed dissections of the PSS were performed in 52 unembalmed female cadavers. RESULTS: The closest cephalad vessel to the mid sacral promontory (MSP) was the left common iliac vein (LCIV), mean distance 27 mm (9-52 mm). The closest vessel lateral to MSP was also the LCIV, mean distance 22 mm (9-35 mm). The average distance of the middle sacral artery and vein to the MSP was 4 mm (0-15 mm) and 7 mm (0-17 mm), respectively. The mean distance of the sacral venous plexuses to the MSP was 34 mm (4-86 mm). CONCLUSION: Anatomic location of the vascular boundaries and contents of the PSS is highly variable. Careful dissection and exposure of the anterior longitudinal ligament of the sacrum before suture placement should minimize potentially life-threatening vascular complications.

    Title Anatomical Path of the Tension-free Vaginal Tape: Reassessing Current Teachings.
    Date December 2006
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: The objective of the study was to revisit the anatomical path of the tension-free vaginal tape and better describe its relationship to the perineal membrane and other important anatomic landmarks. STUDY DESIGN: Dissections of the anterior perineal triangle, periurethral, and retropubic spaces were performed in 24 unembalmed female cadavers following placement of the tension-free vaginal tape to identify the sling's relationship to the perineal membrane, periurethral muscles, and the arcus tendineus fascia pelvis. RESULTS: In 100% of specimens, the device passed cephalad to the perineal membrane. The urethrovaginal sphincter muscle was perforated in 2 of the specimens. The sling passed lateral to the arcus tendineus and perforated the pubococcygeus muscle in 6 (25%) of the cadavers. In the remaining 18 (75%) specimens, the mesh was medial to the arcus tendineus and penetrated the periurethral connective tissue. CONCLUSION: The assertion that the tension-free vaginal tape perforates the perineal membrane is incorrect.

    Title Predicting Bacteriuria in Urogynecology Patients.
    Date June 2005
    Journal American Journal of Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: This study was undertaken to determine whether reagent strip testing can predict bacteriuria in urogynecology patients. STUDY DESIGN: All women undergoing urodynamic evaluations from June 1997 to October 2001 were identified by using a computerized database. Urine culture results were compared with reagent strip testing. Significant bacteriuria was defined as greater than 10(5) colony-forming units per milliliter. RESULTS: Bacteriuria prevalence was 8.6% (n = 51). Sensitivity and specificity of nitrites were 0.51, (95% CI, 0.31-0.66) and 0.991, (95% CI, 0.974-0.998), respectively. Blood had a lower sensitivity (0.35, 95% CI, 0.20-0.54) and specificity (0.80, 95% CI, 0.75-0.84). Leukocyte esterase was similar to blood with a sensitivity of 0.28 (95% CI, 0.14-0.45) and specificity of 0.83 (95% CI, 0.78-0.87). No combination of tests offered improved sensitivity or specificity over nitrites alone. CONCLUSION: Nitrite dipstick testing has excellent specificity for bacteriuria in urogynecologic patients. These results support the treatment of women with positive nitrites who are preparing to undergo urodynamics without obtaining culture.

    Title Graft Use in Transvaginal Pelvic Organ Prolapse Repair: a Systematic Review.
    Date
    Journal Obstetrics and Gynecology
    Excerpt

    OBJECTIVE: To estimate the anatomic and symptomatic efficacy of graft use in transvaginal prolapse repair and to estimate the rates and describe the spectrum of adverse events associated with graft use. DATA SOURCES: Eligible studies, published between 1950 and November 27, 2007, were retrieved through Medline and bibliography searches. METHODS OF STUDY SELECTION: To assess anatomic and symptomatic efficacy of graft use, we used transvaginal prolapse repair studies that compared graft use with either native tissue repair or repair with a different graft. To estimate rates of adverse events from graft use, all comparative studies and case series with at least 30 participants were included. For spectrum of adverse events, all study designs were included. TABULATION, INTEGRATION AND RESULTS: Eligible studies were extracted onto standardized forms by one reviewer and confirmed by a second reviewer. Comparative studies were classified by vaginal compartment (anterior, posterior, apical, or multiple), graft type (biologic, synthetic-absorbable, synthetic nonabsorbable) and outcome (anatomic, symptomatic). We found 16 comparative studies, including six randomized trials, 37 noncomparative studies with at least 30 women, 11 case series with fewer than 30 women, and 10 case reports of adverse events. One randomized trial and one prospective comparative study evaluating synthetic, nonabsorbable graft use in the anterior compartment reported favorable anatomic and symptomatic outcomes with graft use. Data regarding graft use for posterior and apical compartments or for biologic or synthetic absorbable graft use in the anterior compartment were insufficient to determine efficacy. Rates and spectrum of adverse events associated with graft use included bleeding (0-3%), visceral injury (1-4%), urinary infection (0-19%), graft erosion (0-30%), and fistula (1%). There were insufficient data regarding dyspareunia, sexual, voiding, or defecatory dysfunction. CONCLUSION: Overall, the existing evidence is limited to guide decisions regarding whether to use graft materials in transvaginal prolapse surgery. Adequately powered randomized trials evaluating anatomic and symptomatic efficacy as well as adverse events are needed.

    Title Systematic Review Highlights Difficulty Interpreting Diverse Clinical Outcomes in Abnormal Uterine Bleeding Trials.
    Date
    Journal Journal of Clinical Epidemiology
    Excerpt

    (1) To systematically collect and organize into clinical categories all outcomes reported in trials for abnormal uterine bleeding (AUB); (2) to rank the importance of outcomes for patient decision making; and (3) to improve future comparisons of effects in trials of AUB interventions.

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