Heidi A. Stephany

Bio: Heidi A. Stephany is an academic researcher from University of California, Irvine. The author has contributed to research in topics: Medicine & Hydronephrosis. The author has an hindex of 11, co-authored 41 publications receiving 351 citations. Previous affiliations of Heidi A. Stephany include Monroe Carell Jr. Children's Hospital at Vanderbilt & Boston Children's Hospital.

Validation of the Clavien–Dindo Grading System in Urology by the European Association of Urology Guidelines Ad Hoc Panel

Abstract: Context Since 2012 uniformed reporting of complications after urological procedures has been advocated by the European Association of Urology (EAU) guidelines. The Clavien–Dindo grading system was recommended to report the outcomes of urologic procedures. Objective To validate the Clavien–Dindo grading system in urology. Design, setting, and participants Members of the EAU working group compiled a list of case scenarios including those with minor and major complications. A survey was administered online via Survey Monkey to the members of EAU committees for the appropriate grading according to the Clavien–Dindo classification of surgical complications. Scenarios with intraoperative complications were intentionally included to assess respondents' awareness of the Clavien–Dindo applicability. Outcome measurements and statistical analysis Survey data collected were used to calculate agreement rates and to estimate the overall inter-rater agreement on all cases using Fleiss' kappa ( κ ). Differences in agreement rates for each scenario among groups with different criteria about the system were estimated using the chi-square test. Results and limitations Evaluable responses were received from 81 out of 174 invited raters (46.5%). Of them 56.9% believed that the Clavien–Dindo system was adequate for grading postoperative complications. The agreement rate was over a score of ≥80% in nine cases, 60–79% in 10 cases, 40–59% in 14 cases, and κ =0.147). Being a resident rather than a specialist affected only the distribution of agreement rates in case 1 (ie, score IIIb: 83.3% vs 94.1%). Being an academic or having affiliation did not have any impact on the distribution of agreement rates in all cases but one. Conclusions The Clavien–Dindo classification is a standardised approach to grade and report postoperative complications in urology and should be used systematically. However, it does not apply for intraoperative complications, and there is a need for an additional tool. Patient summary A rigorous methodology is mandatory when surgeons report about complications after surgery. In this study, the European Association of Urology Guidelines Panel has validated the use of the Clavien–Dindo grading system in urology.

International Continence Society best practice statement for use of sacral neuromodulation

Abstract: Aims Sacral neuromodulation (SNM) is an accepted therapy for a variety of conditions. However, despite over 20 years of experience, it remains a specialized procedure with a number of subtleties. Here we present the recommendations issued from the International Continence Society (ICS) SNM Consensus Panel. Methods Under the auspices of the ICS, eight urologists, three colorectal surgeons and two urogynecologists, covering a wide breadth of geographic and specialty interest representation, met in January 2017 to discuss best practices for neuromodulation. Suggestions for statements were submitted in advance and specific topics were assigned to committee members, who prepared and presented supporting data to the group, at which time each topic was discussed in depth. Best practice statements were formulated based on available data. This document was then circulated to multiple external reviewers after which final edits were made and approved by the group. Results The present recommendations, based on the most relevant data available in the literature, as well as expert opinion, address a variety of specific and at times problematic issues associated with SNM. These include the use of SNM for a variety of underlying conditions, need for pre-procedural testing, use of staged versus single-stage procedures, screening for success during the trial phase, ideal anesthesia, device implantation, post-procedural management, trouble-shooting loss of device function, and future directions for research. Conclusions These guidelines undoubtedly constitute a reference document, which will help urologists, gynecologists, and colorectal surgeons optimize their use of SNM for refractory urinary urgency and frequency, UUI, NOR, and FI.