To Our Study Participants

On behalf of the Department of Urogynecology at Hartford Hospital, we would like to thank all of our patients that have participated in any of our research studies. We have performed many retrospective studies (review of charts) and prospective studies (actively recruiting patient participation). These studies have been presented at national conferences, published in multiple journals, and have increased the general body of medical knowledge. Below is a list of studies that we have actively recruited patient involvement for, completed, and published. This has only been possible due to your willingness to participate, and we appreciate your involvement.

Sincerely thankful,
The Urogynecology Team at Hartford HealthCare Medical Group

Disclaimer: This is not a comprehensive list of all of our research or publications.

Pending Publication:

Title: Inflammatory response in women with vaginal epithelial abnormalities after pessary use
Authors: Aparna Ramaseshan, Colleen Mellen, David O’Sullivan, Paul Tulikangas, Chris Nold
Aims: To see if there is an increase in inflammatory markers associated with pessary use and pelvic examination abnormalities among women who use pessaries.
Findings: There is an increase in inflammatory markers in women who wear pessaries and have abnormalities on their pelvic examination.
Bottom Line: Women who use pessaries and have any abrasions in the vagina also are likely to have findings associated with inflammation.

Title: A model for pain management in patients undergoing pelvic reconstructive surgery: A prospective clinical practice study
Authors: Aparna Ramaseshan, David O’Sullivan, Adam Steinberg, Elena Tunitsky-Bitton
Aims: To evaluate a practical protocol for pain management for surgical patients with utilization of secure electronic prescribing system to minimize postoperative opioid consumption without compromising patient satisfaction
Findings: When implementing multimodal pain approach pre-operatively and an enhanced recovery after surgery (ERAS) protocol, our patients used fewer than four 5mg oxycodone tablets after pelvic reconstructive surgery. Activity level was not limited by pain and patients were highly satisfied with their pain management.
Bottom Line: By providing non-narcotic medications immediately prior to the surgery and implementing a protocol after surgery, we have successfully reduced the number of narcotic medications our patients need after the surgery. In addition, while rarely needed, patients are able to obtain a refill via the electronic prescribing system without coming in to the office.

Published Studies:

Title: Timing of Office-Based Pessary Care: A Randomized Trial
Authors: Katie Propst, Colleen Mellen, David O’Sullivan, Paul Tulikangas
Journal: Obstetrics and Gynecology Date: 2020
Aims: To evaluate the influence of pessary visit intervals on development of vaginal epithelial abnormalities.
Findings: 6 month pessary visits did not demonstrate more pelvic examination abnormalities.
Bottom Line: It is safe to change a pessary every 6 months without increasing the risk of infection of abrasions in the vagina.

Title: A Comparison of Two Methods of Catheter Management after Pelvic Reconstructive Surgery: A Randomized Controlled trial.
Authors: Sarah Boyd, David O’Sullivan, Elena Tunitsky-Bitton
Journal: Obstetrics and Gynecology Date: 2019
Aims: To evaluate how patient activity after surgery was affected by plugging and unplugging catheters compared to having a catheter connected to a leg bag if the patient was discharged from the hospital with a catheter due to failing their day of discharge voiding trial.
Findings: Patient activity after surgery was not different if discharged with a catheter managed by plugging and unplugging or managed by a leg bag. Additionally, activity after surgery was not different if patients were discharged with a catheter or if they were discharged without a catheter. Those discharged with a plug-unplug catheter did report it was easier to manage and allowed better performance of their daily activities compared to those discharged with a leg bag. The majority of patients underwent successful catheter removal by 7 days after surgery.
Bottom Line: A lot of patients worry about having a catheter after surgery. While 1 in 4 women may need a catheter after surgery they are unlikely to need it beyond 7 days. Our method of managing a catheter by plugging and unplugging it (as opposed to having it connected to a bag) is safe, not restrictive to the everyday activities and patients are generally more satisfied with this method.

Title: Decreasing postoperative narcotics in reconstructive surgery: a randomized controlled trial.
Authors: Krista Reagan, David O’Sullivan, Rich Gannon, Adam Steinberg
Journal: American Journal of Obstetrics and Gynecology Date: 2017
Aims: To see if a multimodal pain regimen (Tylenol, Celebrex, and Gabapentin) with pelvic reconstructive surgery reduced narcotic use, pain, nausea, and constipation.
Findings: Use of a multimodal pain regimen decreased patient total narcotic use (in the operating room, hospital and at home). There was no difference in pain scores, anti-nausea medication use, and constipation.
Bottom Line: We have successfully implemented and tested a protocol for pain management that has allowed patients to have a better pain control and decrease the amount of narcotic medications they need after surgery.

Title: Phenazopyridine for Evaluation of Ureteral Patency: A Randomized Controlled Trial
Authors: Katie Propst, Elena Tunitsky-Bitton, David O’Sullivan, Adam Steinberg, Christine LaSala
Journal: Obstetrics and Gynecology Date: 2016
Aims: To see if taking phenazopyridine (Azo) prior to surgery would help surgeons visualize flow from the ureters faster.
Findings: Time to visualization of flow from the ureters did not differ with the use of phenazopyridine (Azo). However, surgeons preferred use of phenazopyridine (Azo).
Bottom Line: We now give phenazopyridine (pyridium/AZO) to all our patients preoperatively and this helps us visualize the urine flow from the kidneys at the time of the surgery ensuring that no injury occurred.

Title: The effect of a Decision Aid on Decision Making for Treatment of Pelvic Organ Prolapse.
Authors: Hema Brazell, David O’Sullivan, Allison Forrest, John Greene
Journal: Female Pelvic Medicine and Reconstructive Surgery Date: 2015
Aims: To evaluate the impact of the addition of a decision aid for women presenting for the management of pelvic organ prolapse.
Findings: The addition of a decisional aid to standard counselling did not significantly decrease the level of patient decisional conflict in making treatment-related decisions.
Bottom Line: We use a decisional aid on an individual basis when discussing treatment-related decisions.

Title: The effect of pessaries on the vaginal microenvironment
Authors: Sarah Collins, Richard Beigi, Colleen Mellen, David O’Sullivan, and Paul Tulikangas.
Journal: American Journal of Obstetrics and Gynecology Date: 2015
Aims: The aim of this cross sectional study was to identify the differences in the bacteria that live in the vagina between women who wear pessaries and women who do not.
Findings: There are few differences in the vaginal bacteria among women who wear pessaries and those who do not when looking at microscope slides with gram stain. There is evidence of inflammation among women with vaginal discharge from pessary use.
Bottom Line: While there are differences in the bacteria and inflammation between women who use a pessary and those who do not, these bacteria are not a sign of infection as most of the bacteria is a part of a normal vagina.

Title: The impact of pessary use on bowel symptoms: one year outcomes.
Authors: Hema Brazell, Minita Patel, David O’Sullivan, Colleen Mellen, Christine LaSala.
Journal: Female Pelvic Medicine and Reconstructive Surgery Date: 2014
Aims: To evaluate if there is a change in bowel symptoms in patients with prolapse treated with a vaginal pessary.
Findings: Findings suggested that use of a vaginal pessary is associated with improvement in bowel related symptoms from prolapse at one year (need to strain, feeling like the rectum isn’t empty, accidentally bowel leakage of stool/gas, urgency to pass bowel movement, and bulge of the rectum).
Bottom Line: Using a pessary appears to help with bowel function related to prolapse

Title: Pessary use and impact on quality of life and body image
Authors: Minita Patel, Colleen Mellen, David O’Sullivan, Christine LaSala
Journal: Female Pelvic Medicine and Reconstructive Surgery Date: 2010/2011
Aims: To see if vaginal pessary use impacted vaginal prolapse symptoms and body image after 3 months and 1 year.
Findings: The use of a pessary for 3 months and then for more than 1-year improved symptoms of vaginal prolapse, quality of life and improved women’s perception of their body image.
Bottom Line: Patients find that using a pessary has greatly helped them with symptoms, quality of life and their self-image.