Obstetrician & Gynecologist (OB/GYN)
23 years of experience
Video profile
Accepting new patients
1000 Courtyard 3400 Spruce St
Department of Gynecology
Philadelphia, PA 19104
Locations and availability (7)

Education ?

Medical School
Calcutta Medical College (1987)
Foreign school

Awards & Distinctions ?

Castle Connolly's Top Doctors™ (2013)
University of Pennsylvania
Assistant Professor of Obstetrics and Gynecology Chief, Division of Urogynecology and Pelvic Reconstructive Surgery
American Urogynecologic Society

Affiliations ?

Dr. Arya is affiliated with 5 hospitals.

Hospital Affilations



  • Hospital of the University of PA *
    3400 Spruce St, Philadelphia, PA 19104
    • Currently 4 of 4 crosses
    Top 25%
  • Pennsylvania Hospital University PA Health System
    800 Spruce St, Philadelphia, PA 19107
    • Currently 4 of 4 crosses
    Top 25%
  • University of PA Medical Center/Presbyterian
    51 N 39th St, Philadelphia, PA 19104
    • Currently 3 of 4 crosses
    Top 50%
  • Graduate Hospital
    1800 Lombard St, Philadelphia, PA 19146
    • Currently 1 of 4 crosses
  • Clinical Practices of the University of Pennsylvania
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Arya has contributed to 22 publications.
    Title Is Pelvic Pain Associated with Defecatory Symptoms in Women with Pelvic Organ Prolapse?
    Date January 2012
    Journal Neurourology and Urodynamics

    To investigate the significance of pelvic pain and its association with defecatory symptoms in women with pelvic organ prolapse (POP).

    Title Acute Colonic Inflammation Triggers Detrusor Instability Via Activation of Trpv1 Receptors in a Rat Model of Pelvic Organ Cross-sensitization.
    Date September 2011
    Journal American Journal of Physiology. Regulatory, Integrative and Comparative Physiology

    Chronic pelvic pain of unknown etiology is a common clinical condition and may develop as a result of cross-sensitization in the pelvis when pathological changes in one of the pelvic organs result in functional alterations in an adjacent structure. The aim of the current study was to compare transient receptor potential vanilloid 1 (TRPV1) activated pathways on detrusor contractility in vivo and in vitro using a rat model of pelvic organ cross-sensitization. Four groups of male Sprague-Dawley rats (N = 56) were included in the study. Animals received intracolonic saline (control), resiniferatoxin (RTX, TRPV1 agonist, 10(-7) M), 2,4,6-trinitrobenzene sulfonic acid (TNBS, colonic irritant), or double treatment (RTX followed by TNBS). Detrusor muscle contractility was assessed under in vitro and in vivo conditions. Intracolonic RTX increased the contractility of the isolated detrusor in response to electric field stimulation (EFS) by twofold (P ≤ 0.001) and enhanced the contractile response of the bladder smooth muscle to carbachol (CCh). Acute colonic inflammation reduced detrusor contractility upon application of CCh in vitro, decreased bladder capacity by 28.1% (P ≤ 0.001), and reduced micturition volume by 60% (P ≤ 0.001). These changes were accompanied by an increased number of nonmicturition contractions from 3.7 ± 0.7 to 15 ± 2.7 (N = 6 in both groups, P ≤ 0.001 vs. control). Desensitization of intracolonic TRPV1 receptors before the induction of acute colitis restored the response of isolated detrusor strips to CCh but not to EFS stimulation. Cystometric parameters were significantly improved in animals with double treatment and approximated the control values. Our data suggest that acute colonic inflammation triggers the occurrence of detrusor instability via activation of TRPV1-related pathways. Comparison of the results obtained under in vitro vs. in vivo conditions provides evidence that intact neural pathways are critical for the development of an overactive bladder resulting from pelvic organ cross talk.

    Title Severe Atrophic Vaginitis Causing Vaginal Synechiae and Hematocolpos at Menopause.
    Date June 2011
    Journal Menopause (new York, N.y.)

    Vaginal atrophy caused by decreased levels of ovarian estrogen production is common at menopause. Atrophic vaginitis severe enough to result in vaginal stricture of the upper two thirds of the vagina and subsequent hematocolpos is unusual.

    Title Interstitial Cystitis is an Etiology of Chronic Pelvic Pain in Young Women.
    Date October 2009
    Journal Journal of Pediatric and Adolescent Gynecology

    The prevalence of interstitial cystitis (IC) in young women, especially in those 18 years old or younger, is not well defined. This case series was performed to investigate IC as a cause of chronic pelvic pain (CPP) in young women.

    Title Association of Change in Estradiol to Lower Urinary Tract Symptoms During the Menopausal Transition.
    Date December 2008
    Journal Obstetrics and Gynecology

    OBJECTIVE: To estimate the relationship between changes in estradiol (E2) levels over time and lower urinary tract symptoms in premenopausal women as they transition to menopause. METHODS: A self-administered validated questionnaire to measure lower urinary tract symptoms was administered to 300 women at the 11th assessment period on an ongoing longitudinal Penn Ovarian Aging cohort study. The association between the change in E2 over time through the menopausal transition and lower urinary tract symptoms (urinary incontinence, filling symptoms, voiding dysfunction) was determined. Risk factors associated with lower urinary tract symptoms were determined by univariable analysis and multivariable linear regression. RESULTS: Estradiol levels and menopausal stage at one point in time were not associated with lower urinary tract symptoms. Women with a sharp decline in E2 levels over time had significantly lower urinary incontinence scores in comparison with women without a change in E2 levels through the study period (mean+/-standard deviation 3.11+/-2.86 compared with 2.08+/-2.43, adjusted mean difference -0.93, 95% confidence interval [CI] -1.8 to -0.02). Women between the ages of 45 years to 49 years had significantly higher urinary incontinence scores than women woman age older than 55 years (1.59+/-1.86 compared with 3.04+/-2.93, adjusted mean difference 1.0, 95% CI 0.01-2.1). Women with a body mass index greater than 35 also had significantly higher urinary incontinence scores than women in the normal weight range, (3.53+/-3.16 compared with 1.98+/-2.52, adjusted mean difference 1.5, 95% CI 0.59-2.3) after adjusting for changes of E2 through the menopausal transition. High anxiety was associated with worsening scores in all three lower urinary tract symptoms domains (incontinence, filling, voiding). CONCLUSION: Women with a sharp decline in E2 through the menopausal transition have significantly lower urinary incontinence scores. Urinary filling symptoms and voiding dysfunction were not associated with changes in E2 through the menopausal transition. LEVEL OF EVIDENCE: II.

    Title Development and Testing of a New Instrument to Measure Fluid Intake, Output, and Urinary Symptoms: the Questionnaire-based Voiding Diary.
    Date May 2008
    Journal American Journal of Obstetrics and Gynecology

    OBJECTIVE: The purpose of this study was to develop a validated self-administered questionnaire to measure fluid intake, output, behavior, and urinary symptoms. STUDY DESIGN: Factor analysis identified 4 subscales in the new questionnaire. Ninety-two women completed the questionnaire, comprised of a 48-hour voiding diary and the Bristol Female Lower Urinary Tract Symptom-Scored form. The questionnaire was readministered after a 2-week period with no change in treatment and 2-3 months later after treatment of urinary symptoms. RESULTS: Correlation of items of the questionnaire with the 48-hour voiding diary in the 4 subscales was high (r = 0.55, 0.74. 0.68, and 0.47; P < .01). Subscale scores also correlated with the Bristol Lower Urinary Tract Symptom score (r = 0.68 and =0.87; P < .001). Comparisons of scores before and after treatment showed the ability of the questionnaire to respond to change. CONCLUSION: The new questionnaire is a valid and reliable means to assess fluid intake, output, behavior, and urinary symptoms.

    Title Sexual Function in Women After Rectocele Repair with Acellular Porcine Dermis Graft Vs Site-specific Rectovaginal Fascia Repair.
    Date January 2008
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction

    The objective of the study was to compare preoperative and postoperative sexual function between women undergoing rectocele repair with porcine dermis graft and women undergoing site-specific repair of rectovaginal fascia. A standardized, validated questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire [PISQ]) was used to collect preoperative sexual function data from 100 patients with rectocele pelvic organ prolapse quantification stage 2 or greater. Fifty women underwent rectocele repair utilizing porcine dermis graft (group 1) and 50 women underwent a site-specific repair of the rectovaginal fascia (group 2). The same questionnaire was administered to all subjects 6 months after surgery. The two groups were similar in age, race, parity, prior hysterectomy, and postmenopausal hormone use. Preoperative sexual function scores were similar in the two groups (group 1 81.4+/-7.3 and group 2: 83.6+/-8.2, p=1.0). Six months after surgery, PISQ scores in group 1 significantly increased (score increase 19.9+/-2.2, p=0.01). The mean increase in PISQ scores for group 2 was 6.9+/-3.1 (p=0.08). When compared with group 2, subjects undergoing rectocele repair with porcine dermis graft scored significantly higher on the PISQ 6 months after surgery (group 1 101.3+/-6.4 and group 2 89.7+/-7.1, p=0.01). We conclude that rectocele repair using porcine dermis graft is associated with improved sexual functioning when compared with site-specific rectovaginal fascia repair.

    Title Risk of Irritable Bowel Syndrome and Depression in Women with Interstitial Cystitis: a Case-control Study.
    Date September 2005
    Journal The Journal of Urology

    PURPOSE: We determined the risk of irritable bowel syndrome and depression in women with interstitial cystitis. MATERIALS AND METHODS: Cases consisted of 46 women with newly diagnosed interstitial cystitis. The control group consisted of 46 women presenting for an annual gynecologic examination. Data were collected using standardized, validated questionnaires. RESULTS: The 2 groups were similar with respect to age, race, parity, previous pelvic surgery and postmenopausal hormone use. Compared with controls patients with interstitial cystitis were more likely to be diagnosed with irritable bowel syndrome (OR 11, 95% CI 2.7 to 52, p <0.001) and depression (OR 3.97, 95% CI 1.17 to 14.1, p <0.05). In the interstitial cystitis group when we compared women with and without depression, we noted that women with depression were significantly more likely to complain of bladder pain, nocturia, abdominal pain and other bowel symptoms. CONCLUSIONS: The association of irritable bowel syndrome and depression appears to be greater in women with interstitial cystitis than in controls. Additionally, it appears that pain of bladder or bowel origin is a significant cause of depression in women with interstitial cystitis.

    Title Pelvic Organ Prolapse, Constipation, and Dietary Fiber Intake in Women: a Case-control Study.
    Date June 2005
    Journal American Journal of Obstetrics and Gynecology

    OBJECTIVE: This study was undertaken to determine whether there is an association among pelvic organ prolapse, constipation, and dietary fiber intake. STUDY DESIGN: Sixty consecutive women with prolapse were compared with 30 control women without prolapse. All women completed 2 validated questionnaires to assess constipation and dietary fiber intake. Multivariate analysis was performed. RESULTS: The risk for constipation was greater in women with prolapse than controls (odds ratio 4.03, 95% CI 1.5-11.4). Median insoluble fiber intake was significantly lower in women with prolapse (2.4 g) than controls (5.8 g, P < .01). The increased risk for constipation was reduced but remained significant after controlling for age and insoluble dietary fiber intake (odds ratio 2.9, 95% CI 1.1-13.5). CONCLUSION: Women with pelvic organ prolapse are at a higher risk for constipation than controls. This increased risk for constipation is partially explained by lower intake of dietary insoluble fiber by women with prolapse than controls.

    Title Sexual Function in Women with Pelvic Organ Prolapse Compared to Women Without Pelvic Organ Prolapse.
    Date May 2005
    Journal The Journal of Urology

    PURPOSE: We compared sexual function in women with pelvic organ prolapse to that in women without prolapse. MATERIALS AND METHODS: We collected sexual function data using a standardized, validated, condition specific questionnaire. The study group consisted of 30 women with pelvic organ prolapse and it was compared with 30 unmatched controls without evidence of prolapse. RESULTS: The 2 groups were similar in age, race, parity and postmenopausal hormone use. Subjects in the study group were more likely to have undergone previous pelvic surgery. Mean total Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire scores +/- SD were lower in the study group compared with controls (81.4 +/- 7.3 vs 106.4 +/- 15.5, p <0.001). In the study group total questionnaire scores in women with prior pelvic surgery were similar to those in women without prior pelvic surgery (79.3 +/- 14.9 vs 82.9 +/- 10.2, p = 0.61). CONCLUSIONS: Pelvic organ prolapse appears to have a significant negative impact on sexual function.

    Title A New Questionnaire for Urinary Incontinence Diagnosis in Women: Development and Testing.
    Date March 2005
    Journal American Journal of Obstetrics and Gynecology

    OBJECTIVE: The purpose of this study was to develop a questionnaire for urinary incontinence diagnosis in women and to test its reliability and validity, with incontinence specialists' clinical evaluations as the gold standard. STUDY DESIGN: One hundred seventeen urogynecology outpatients with urinary incontinence symptoms completed the Questionnaire for Urinary Incontinence Diagnosis at enrollment and 1 week and 9 months later. Baseline clinical diagnoses were compared with Questionnaire for Urinary Incontinence Diagnosis diagnoses (criterion validity). Nine-month Questionnaire for Urinary Incontinence Diagnosis change scores were compared across treatment groups (responsiveness). RESULTS: Clinical diagnoses included stress (n = 15), urge (n = 26), and mixed urinary incontinence (n = 72). Internal consistency and test-retest reliability estimates were good. Sensitivity and specificity were 85% (95% CI, 75%, 91%) and 71% (95% CI, 51%, 87%), respectively, for stress urinary incontinence and 79% (95% CI, 69%, 86%) and 79% (95% CI, 54%, 94%), respectively, for urge urinary incontinence. The Questionnaire for Urinary Incontinence Diagnosis correctly diagnosed urinary incontinence type in 80% of subjects. Questionnaire for Urinary Incontinence Diagnosis Stress and Urge scores decreased significantly in treated subjects. CONCLUSION: The Questionnaire for Urinary Incontinence Diagnosis, a new 6-item questionnaire for female urinary incontinence type diagnosis, is reliable and able to diagnose stress urinary incontinence and urge urinary incontinence in a referral urogynecology patient population with accuracy.

    Title Exercise and Urinary Incontinence in Women.
    Date December 2004
    Journal Obstetrical & Gynecological Survey

    Urinary incontinence is a common problem in women and may significantly impair their quality of life. Although women often report stress urinary incontinence during exercise, current data indicates that most types of exercise are not a risk factor for the development of urinary incontinence. However, certain extreme high-impact sports such as parachute jumping may cause pelvic organ support defects that result in stress urinary incontinence. Eating disorders also increase the risk of urinary incontinence in athletes. Overall, women should be encouraged to pursue physical activity that will benefit their general health without the risk of development of urinary incontinence later in life. Women athletes should be counseled about the increased risk of urinary incontinence with ultra high-impact sports and eating disorders.

    Title Urethral Resistance Measurement: a New Method for Evaluation of Stress Urinary Incontinence in Women.
    Date September 2004
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction

    The aim of this study was to evaluate a new method to measure urethral resistance among 66 women with urinary incontinence. A stainless steel sphere attached to a guide wire was developed. The sphere is inserted into the bladder and withdrawn through the urethra at a steady rate. Serial measurements with spheres of 5, 6 and 7 mm were performed. The mean urethral resistance as measured by the largest sphere (0.07+/-0.03) was significantly greater than that measured by the medium sphere (0.06+/-0.02, p<0.0001), which was significantly larger than that measured by the smallest sphere (0.04+/-0.01, p<0.0001). There was good correlation of urethral resistance with maximum urethral closure pressure (MUCP) by this technique, but no correlation with Valsalva leak point pressure (VLPP).

    Title Vaginal Paravaginal Repair with an Alloderm Graft.
    Date January 2004
    Journal American Journal of Obstetrics and Gynecology

    OBJECTIVE: This study was undertaken to describe outcomes of a technique of vaginal paravaginal repair that used AlloDerm graft (LifeCell, Branchburg, NJ) in women with recurrent stage II or with primary or recurrent stage III/IV anterior vaginal wall prolapse. STUDY DESIGN: This was an observational study. Thirty-three women underwent a vaginal paravaginal repair using AlloDerm graft. Anterior vaginal wall prolapse was staged using the pelvic organ prolapse quantification system preoperatively and every 6 months after surgery. Recurrence of prolapse, changes in functional status (urinary symptoms, prolapse symptoms, and sexual activity), and complications were recorded. Objective failure was defined as recurrent anterior vaginal wall prolapse, stage II or greater, and subjective failure as symptomatic recurrent anterior vaginal wall prolapse. Life-table analysis evaluated objective and subjective failure. Risk factors for recurrent anterior vaginal wall prolapse were evaluated. RESULTS: The mean age was 65.2 years and 93% of the women were white. Preoperatively, 6 women had recurrent stage II, 24 women had stage III, and 3 women had stage IV anterior vaginal wall prolapse. The median length of follow-up was 18 months. Postoperatively, 12 women had asymptomatic stage II anterior vaginal wall prolapse (not beyond the hymen) develop, and 1 woman had symptomatic stage II prolapse develop. Thus, there were 13 (41%) objective failures and 1 (3%) subjective failure. Life-table analysis demonstrated the cumulative probability of an objective failure was 0.24 at 1 year and 0.50 at 2, 3, and 4 years. The cumulative probability of a subjective failure was 0.00 at 1 and 2 years and 0.11 at 3 and 4 years. No risk factors for objective failure were identified. Voiding complaints resolved in 11 of 14 (79%) women (P=.004), incontinence symptoms resolved in 17 of 19 (89%) women (P<.001), and urgency symptoms resolved in 20 of 23 (87%) women (P<.001) (all two-tailed Fisher exact test). Twenty-one women (64%) were sexually active, and none complained of postoperative dyspareunia. Complications included 1 case of febrile morbidity, 1 cystotomy, and 1 anterior wall breakdown secondary to hematoma formation caused by heparin therapy. No other erosions or rejections were seen. CONCLUSION: Vaginal paravaginal repair with AlloDerm graft in women with recurrent stage II or stage III/IV anterior vaginal wall prolapse is safe and has good subjective but only fair objective success within the first 2 years.

    Title Vaginal Erosion After Pubovaginal Sling Procedures Using Dermal Allografts.
    Date January 2003
    Journal The Journal of Urology
    Title Diagnosing Interstitial Cystitis in Women with Chronic Pelvic Pain.
    Date August 2002
    Journal Obstetrics and Gynecology

    OBJECTIVE: To evaluate the Interstitial Cystitis Symptom Index and Problem Index as a screening tool for interstitial cystitis, and to estimate the prevalence and risk factors for interstitial cystitis in women with chronic pelvic pain. METHODS: Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. Women were questioned about lower urinary tract symptoms, administered the Interstitial Cystitis Symptom Index and Problem Index, and rated pain symptoms on a 0-10 visual analogue scale. Cystoscopy with hydrodistension and bladder biopsy was performed at the time of laparoscopy. Interstitial cystitis was diagnosed if women had a combination of: 1) urgency, 2) frequency or nocturia, and 3) positive cystoscopic findings. RESULTS: Seventeen women (38%) were diagnosed with interstitial cystitis. A score of 5 or more on the Symptom Index had 94% sensitivity (95% confidence interval [CI] 71%, 99.8%) and 93% negative predictive value (95% CI 68%, 99.8%) in diagnosing interstitial cystitis. On multivariable analysis, an elevated Symptom Index score of 5 or more (odds ratio [OR] 9.4; 95% CI 1.01, 88.1) and an elevated dyspareunia score of 7 or more (OR 5.5; 95% CI 1.10, 27.1) were risk factors for interstitial cystitis. CONCLUSION: In our sample of women with chronic pelvic pain, the prevalence of interstitial cystitis was 38%. The Interstitial Cystitis Symptom Index was a useful screening tool. Independent risk factors for the diagnosis of interstitial cystitis were an elevated Symptom Index score and an elevated dyspareunia pain score. For women with chronic pelvic pain, screening for interstitial cystitis should be performed.

    Title Risk of New-onset Urinary Incontinence After Forceps and Vacuum Delivery in Primiparous Women.
    Date January 2002
    Journal American Journal of Obstetrics and Gynecology

    OBJECTIVE: We sought to determine the incidence of new-onset urinary incontinence after forceps and vacuum delivery compared with spontaneous vaginal delivery. STUDY DESIGN: We performed a prospective study in primiparous women delivered by forceps (n = 90), vacuum (n = 75), or spontaneous vaginal delivery (n = 150). Follow-up for urinary incontinence was at 2 weeks, 3 months, and 1 year after delivery. RESULTS: The incidence of urinary incontinence was similar in the 3 groups at 2 weeks after delivery. The proportion of women developing new-onset urinary incontinence decreased significantly over time in the spontaneous vaginal (P =.003) and vacuum delivery groups (P =.009) but not in the forceps group (P =.2). No relationship of urinary incontinence with vaginal lacerations, epidural anesthesia, length of second stage of labor, or infant birth weight was seen. CONCLUSIONS: In primiparous women, urinary incontinence after forceps delivery is more likely to persist compared with spontaneous vaginal or vacuum delivery.

    Title Office Screening Test for Intrinsic Urethral Sphincter Deficiency: Pediatric Foley Catheter Test.
    Date June 2001
    Journal Obstetrics and Gynecology

    OBJECTIVE: To evaluate an office-based test as a screening method for intrinsic sphincter deficiency. METHODS: One hundred seventy-three women with urinary incontinence were evaluated prospectively by complete urodynamic studies. After catheterization, the pediatric Foley catheter test was performed on an empty bladder by withdrawing the inflated bulb of an 8-French Foley catheter through the urethra. The test was considered positive if the inflated catheter bulb could be withdrawn completely through the urethra. Women with grade 3 genital prolapse or higher were excluded. Intrinsic sphincter deficiency was defined as the presence of genuine stress incontinence and low maximum urethral closure pressure (at most 20 cm H(2)O). RESULTS: Seventy-six of 173 women (44%) had positive tests and 97 (56%) had negative tests. Seventy-six percent of those with positive tests were diagnosed with intrinsic sphincter deficiency, compared with 19% in women with negative tests (P <.001). All women with positive tests and negative cotton swab tests had intrinsic sphincter deficiency. The sensitivity, specificity, and positive and negative predictive values for diagnosing intrinsic sphincter deficiency were 76, 81, 76, and 81%, respectively. CONCLUSION: A positive pediatric Foley catheter test in the absence of urethral mobility strongly suggests intrinsic sphincter deficiency. The pediatric Foley catheter test may be useful in screening for intrinsic sphincter deficiency.

    Title Pelvic Anatomy for Obstetrics and Gynecology Residents: an Experimental Study Using Clay Models.
    Date March 2001
    Journal Obstetrics and Gynecology

    OBJECTIVE: To determine whether clay modeling with lecture is more effective than lecture alone in teaching female pelvic anatomy. METHODS: A pretest preceded a lecture on female pelvic anatomy in the following five groups of obstetrics and gynecology residents: postgraduate year 1 (PGY-1) residents at Women and Infants Hospital of Rhode Island (RI), PGY-1 residents at University of Connecticut (CT), and PGY-2, -3, and -4 residents at RI. The study group (PGY-1 RI) also participated in a clay modeling session. Both groups of PGY-1 residents were tested immediately (posttest 1) and then 8 weeks later (posttest 2). The PGY-2, -3, and -4 residents had only posttest 2. Data were analyzed with parametric, nonparametric, and repeated measures analyses. RESULTS: There was no significant difference between the mean pretest scores of the five groups. The study group showed significant improvement in mean scores at posttest 1 (29.7 +/- 0.9, P <.001) and at posttest 2 (24.1 +/- 4.6, P =.03) compared with the mean pretest score (17.4 +/- 3.7). The CT residents demonstrated significant improvement in mean scores at posttest 1 (25.2 +/- 4.4, P =.02) but not at posttest 2 (19 +/- 3.7, P =.2) compared with their mean pretest score (15.2 +/- 2.9). There was no significant improvement in the mean scores at posttest 2 for PGY-2, -3, and -4 resident groups compared with their pretest scores. CONCLUSION: Clay modeling with lecture was more effective than lecture alone for teaching pelvic anatomy.

    Title Dietary Caffeine Intake and the Risk for Detrusor Instability: a Case-control Study.
    Date August 2000
    Journal Obstetrics and Gynecology

    OBJECTIVE: To determine whether there is an association in women between caffeine intake and risk for detrusor instability. METHODS: Women were included if they had symptoms of urinary incontinence, completed a 48-hour voiding diary detailing fluid and caffeine intake, and had undergone standardized multichannel urodynamics. The study group had 131 women with detrusor instability on provocative cystometry and maximum urethral closure pressure greater than 20 cm of water. The control group had 128 women without detrusor instability on provocative cystometry and maximum urethral closure pressure greater than 20 cm of water. For statistical comparison, women were divided into the following three groups on the basis of caffeine intake: minimal (< 100 mg/day), moderate (100-400 mg/day), and high (> 400 mg/day). RESULTS: The mean caffeine intake of women with detrusor instability (484 +/- 123 mg/day) was significantly higher than that of controls (194 +/- 84 mg/day, P =.002). On univariate analysis, significant risk factors for detrusor instability were age, smoking status, and caffeine intake. On multivariate analysis, the statistically significant association between high caffeine intake and detrusor instability persisted after controlling for age and smoking (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.1, 6.5, P =.018). When women with moderate caffeine intake were compared with those with minimal caffeine intake, the risk for detrusor instability was lower and did not reach significant levels (OR 1.5, 95% CI 0.1, 7.2, P =.093). CONCLUSION: An association between high caffeine intake and detrusor instability was seen in this population. Larger studies are required to determine whether the association is causal.

    Title Is Urinary Incontinence Different in Women with Parkinson's Disease?
    Date September 1999
    Journal International Urogynecology Journal and Pelvic Floor Dysfunction

    The purpose of this study was to determine the risk of detrusor hyperreflexia in women with Parkinson's disease. Fourteen women with Parkinson's disease and urinary complaints were compared with 28 age-matched women who had urinary complaints and no neurologic disease (controls). Demographic data, symptomatology, multichannel urodynamic indices and rates of diagnoses were compared between the two groups using the Mantel-Haenszel matched odds ratio (OR) and the Kruskal-Wallis test. The mean age of the women was 73.3 years. Those with Parkinson's disease had an increased rate of detrusor hyperreflexia (92.8% vs. 50.0%, OR 13, 95% confidence interval 1.6,228, P=0.02) which occurred at lower volumes (150.0 ml vs. 225.0 ml, P=0.01), and a lower maximum cystometric capacity (240.0 ml vs. 335.0 ml, P=0.02) compared to the control group. It was concluded that women with Parkinson's disease and lower urinary tract complaints have a lower maximum cystometric capacity and a higher rate of detrusor hyperreflexia at lower bladder volumes.

    Title Discontinuation Rates of Anticholinergic Medications Used for the Treatment of Lower Urinary Tract Symptoms.
    Journal Obstetrics and Gynecology

    OBJECTIVE: To estimate the discontinuation rates of anticholinergic medications used for the treatment of lower urinary tract symptoms in women. METHODS: A large administrative database was used for this study. Women aged 18 years and older who were prescribed anticholinergic medications were included. An overall and drug-specific discontinuation rate for nine different anticholinergic medications was estimated. Covariates examined included number of prior drug classes used, number of switches performed, number of prior drug episodes, year of initiation, age, and history of smoking. The Kaplan-Meier method was used to estimate an overall discontinuation rate. A Cox multivariable regression was performed for the drug-specific analysis. RESULTS: There were 49,419 episodes of anticholinergic therapy available for analysis from 29,369 women. The average number of treatment episodes and number of drug classes prescribed per patient were 1.65+/-1.31 and 1.54+/-0.57, respectively. The median time for overall anticholinergic drug discontinuation was 4.76 months. The 6-month unadjusted cumulative incidence of discontinuation was 58.8% (95% confidence interval [CI] 58.4-59.3). The percentage of episodes in which women switched to another medication was 15.8% (95% CI 15.4-16.1). At 6 months, the adjusted cumulative incidence of discontinuation was as follows: oxybutynin 71% (95% CI 68.4-73.5), tolterodine tartrate 61% (59.4,64.3), extended-release oxybutynin 57% (95% CI 55.1-59.4), and extended-release tolterodine tartrate 54% (95% CI 52.3-57.7). CONCLUSION: Discontinuation rates for anticholinergic medications are high regardless of the class of medication used. LEVEL OF EVIDENCE: II.

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