"Old" Procedure is Found Most Effective for Treating Stress Incontinence

MORE THAN 15 MILLION WOMEN SUFFER FROM STRESS INCONTI-nence, the involuntary leakage of urine during physical stress such as laughing, coughing, or heavy lifting. While childbirth or aging can cause stress incontinence, in some women the condition is the result of urinary sphincter weakness or other anatomical problems. Now, P&S researchers say that a surgical procedure, the "vaginal sling," is simpler and more effective than other more invasive techniques for treating the problem.
The vaginal sling is essentially a hammock of tissue, the vaginal wall, which is secured under the bladder to help support it, according to Dr. Steven Kaplan, the Given Foundation Professor of Urology and co-director of the Center for Bladder and Prostate Health.
"The vaginal sling procedure is the most effective surgical option and has longer lasting results than other procedures," says Dr. Kimberly Cooper, assistant professor of urology and center co-director. The operation, which can be performed on an outpatient basis or require as little as a 24-hour hospital stay, requires only a vaginal incision, making for faster surgery and lower morbidity than other procedures.
Other surgical options for stress incontinence include supporting the bladder by inserting devices and synthetic materials (such as collagen) and the Marshall-Marchetti-Krantz procedure done via an abdominal approach, in which the bladder neck and urethra are stitched to help the patient gain control over urine flow. Another common surgical procedure is the transplantation of connective tissue webs, or fascia, from other parts of the body to the front abdominal wall or pubic bone to form a supportive brace for the bladder.
Dr. Kaplan and colleagues from Columbia, New York-Presbyterian Hospital, and Maimonides Medical Center in Brooklyn have found the vaginal sling procedure simpler and more effective than the other procedures. Research results were published in a 2000 issue of the Journal of Urology.
Though the vaginal sling technique has been around for about 100 years, Dr. Cooper says it has gained popularity recently because of its efficacy. Calling the procedure the "gold standard" treatment for all types of stress incontinence, Drs. Cooper and Kaplan say they anticipate that this method of treatment will be used increasingly.
"This technique is becoming more popular since the procedure, which requires less dissection and better instruments than the other procedures, has become easier to perform," Dr. Kaplan says. He adds that many doctors now are performing the sling procedure on an outpatient basis, and some are even using a minimally invasive approach.
Drs. Kaplan and Cooper can be contacted at the Center for Bladder and Prostate Health, 212-305-0140 or 212-305-0144.

Help for Troubled Babies and Their Parents

A MEDICAL CENTER SERVICE PROVIDES AN ARRAY OF FREE, individualized consultations to parents concerned about the psychological well-being of their infants. Parents who have a child who has experienced trauma or who are simply frazzled and overwhelmed by parenthood can find help at the parent-infant consultation service at the Columbia University Center for Psychoanalytic Training and Research.
Clinicians address problems such as mother-infant bonding, sleep and eating disorders, excessive crying, sibling conflict, aggression and temper tantrums, and developmental disorders.
The parent-infant program also has a training program and research component. "The program's mission is to enhance professionals' training in the observational, diagnostic, and technical skills that are essential to working with infants and toddlers in the context of their families," says Dr. Christine Anzieu-Premmereur, lecturer in psychiatry and director of the Psychoanalytic Center's parent-infant program.
After receiving a call from a parent, a child psychoanalyst meets first with the parents alone and then with the parents and their child. The psychoanalyst may encourage the family to join a parent-baby group — led by a child psychologist specializing in early childhood development — that provides a forum for parents to learn from each other's experiences. Specialists may further refer parents or families for family or individual counseling where they can receive guidance on how to better interact with their baby or read his or her emotions and receive support to enable them to cope better with troubled babies.
So far, 16 clinicians are involved in the program, which receives up to 10 calls from parents each week. Families consult with clinicians practicing in areas closest to them, including the five boroughs, Long Island, and New Jersey. The first three evaluations are free; fees for additional meetings are arranged on a case by case basis.
With a grant from the Mortimer D. Sackler Foundation, the Department of Psychiatry at P&S established an annual award in developmental psychobiology in 1997. The first award went to the Columbia Center for Psychoanalytic Training and Research to help fund the parent-infant program, says its first and former director, Dr. Susan Coates, associate professor of clinical psychiatry. Compelling evidence suggests that intervention at an early age can help prevent infants from developing problems with attachment and security.
"There is growing evidence that in just five or six sessions, you can improve the attachment and security between mothers and babies," Dr. Coates says. "Preventive psychiatry can really work with this age group. It's quite stunning to see that emotional issues that are not attended to can cause problems later on."
"We'd like parents to know they can find support or help when confronted with symptoms in their babies," says Dr. Anzieu-Premmereur, who would like to increase the services to parents even further by working directly with day care programs, nurses, and teachers in charge of young children.
More information is available from Dr. Christine Anzieu-Premmereur at 212-828-8422.

Lung Center Poised to Become National Leader
COLUMBIA UNIVERSITY MEDICAL CENTER'S CENTER FOR LUNG Disease and Transplantation has achieved an important milestone — its transplant patients now have one of the highest one-year survival rates in the country. "We're at 90 percent," say Dr. Joshua Sonett and Dr. Selim Arcasoy, the center's program directors. "Most centers are at 75 to 80 percent."
Begun in 1985, just two years after the world's first successful lung transplant was performed at Stanford University, the center has, in the past two years, grown larger and busier than ever with the recruitment of several physicians. Already the premier center of its kind in the New York area, the transplant center is on the cusp of becoming a national leader in the field.
Since the arrival in 2001 of Dr. Sonett, associate professor of clinical surgery and the center's surgical director, and Dr. Selim Arcasoy, associate professor of clinical medicine and the center's medical director, the center has performed nearly 60 of the 335 transplants recorded since 1985.
Dr. Sonett and Dr. Arcasoy attribute the increasing survival rate to several key factors: the ability to identify and treat organ rejection early; new surgical, medical, and lung preservation techniques; and standardized follow-up protocols that help doctors diagnose and manage postoperative complications. But perhaps the most significant factor, Dr. Arcasoy says, is the cohesive and multidisciplinary team effort within the transplant program.
"Early surgical outcomes are very important," he says, "but in addition to the initial success of surgery, long-term success is really dependent on a combined medical and surgical team effort. It is the multidisciplinary team management that helps improve patients' life span and quality of life."
For example, a patient referred to the center would not only see a surgeon and a pulmonologist, but also might consult with a psychiatrist, physical therapist, social worker, and even a financial counselor for guidance on how to deal with insurance companies and costs incurred for the transplant. The specialists and referring physician remain involved throughout the transplant process to ensure that the patient continues to receive proper care; this enhances both the quality of treatment and quality of life post-surgically.
Dr. Sonett and Dr. Arcasoy have ambitious plans. By bringing on an additional transplant surgeon — and with the support of transplant pulmonogists, Drs. Steven Kawut, an Irving Assistant Professor of Clinical Medicine, and Jessie Wilt, assistant professor of clinical medicine — they hope to double their patient volume. They also would like to expand the portion of the program that helps patients with cystic fibrosis — now about 20 percent of the program's patients.
In addition to the clinical aspect, the center is involved in several important research projects. In continuing studies, the researchers are looking to identify blood markers that can play a role in determining which patients suffer from graft injury; determine more effective treatment strategies post-transplantation to prevent rejection and infections; and identify various pre-transplant prognostic markers, such as cardiopulmonary exercise parameters, to predict optimal timing of transplantation and surgical outcomes.
Dr. Sonett believes that the transplant program draws strength from the medical center's resources and clinical and research staff. "The hospital and university enable us to draw all of those elements together," he says. "This really is an institution with a lot of depth."
More information is available from Dr. Joshua Sonett at 212-305-8086.

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