Imperial College London

Dr Alex Digesu

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3312 1752a.digesu CV

 
 
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Location

 

Urogynaecology DepartmentCambridge WingSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

156 results found

Asfour V, Nikolopoulos KI, Digesu GA, Emery S, Khan Zet al., 2021, Modified autologous fascial sling technique ('sling on a string') for stress incontinence, INTERNATIONAL UROGYNECOLOGY JOURNAL, ISSN: 0937-3462

Journal article

Asfour V, Gibbs K, Wertheim D, Digesu GA, Fernando R, Khullar Vet al., 2021, Anal canal to pubis angle: a novel clinical ultrasound technique for the assessment of the anorectal region, INTERNATIONAL UROGYNECOLOGY JOURNAL, ISSN: 0937-3462

Journal article

Patel M, Swift S, Digesu A, 2021, Mental health among clinicians: what do we know and what can we do?, INTERNATIONAL UROGYNECOLOGY JOURNAL, Vol: 32, Pages: 1055-1059, ISSN: 0937-3462

Journal article

Tailor VK, Morris E, Bhide AA, Fernando R, Digesu GA, Khullar Vet al., 2020, Does cystoscopy method affect the investigation of bladder pain syndrome/interstitial cystitis?, INTERNATIONAL UROGYNECOLOGY JOURNAL, Vol: 32, Pages: 1229-1235, ISSN: 0937-3462

Journal article

Asfour V, Khullar V, Digesu GA, 2020, Complex extensive urethral diverticulum on pelvic floor ultrasound and MRI, International Urogynecology Journal and Pelvic Floor Dysfunction, Vol: 31, Pages: 2687-2689, ISSN: 0937-3462

A urethral diverticulum most commonly presents with recurrent urinary tract infection (51%), stress incontinence (45.5%), a vaginal lump (45%), urethral discharge (21%), and “the 3Ds” (dysuria, dyspareunia, post-void dribbling; 9%) [1]. Diverticula are on average 26 mm in diameter (range 8–45 mm) [1], and are U-shaped or circumferential in 84% [1].

Journal article

Asfour V, Digesu GA, Fernando R, Khullar Vet al., 2020, Ultrasound imaging of the perineal body: a useful clinical tool, International Urogynecology Journal and Pelvic Floor Dysfunction, Vol: 31, Pages: 1197-1202, ISSN: 0937-3462

Introduction and hypothesisThe perineal body is a fibromuscular pyramidal structure located between the vagina and the anus. It has been difficult to image because of its small size and anatomical location. This study used 2D transperineal ultrasound to measure the perineal body and assess whether there is an association with prolapse.MethodsAn observational, cross-sectional study was carried out in a tertiary level Urogynaecology department and included prolapse patients and healthy nulliparous volunteers (control group). This was a clinical assessment, including POP-Q and trans-perineal 2D ultrasound measurement of the perineal body height, length, perimeter, and area. Parametric tests were used, as the data were normally distributed. Results are reported as mean and 95% confidence interval (±95% CI).ResultsA total of 101 participants were recruited of which 22 were nulliparous healthy volunteers. Mean perineal body measurements in controls were height 22.5 ± 3.3 mm, length 17.4 ± 2.7 mm, perimeter 7.5 ± 0.9 mm, and area 2.8 ± 0.38 cm2. Perineal body measurements in 79 prolapse patients: height 16.9 ± 1.7 mm, length 16.0 ± 1.4 mm, perimeter 6.5 ± 0.5 mm and area 2.1 ± 0.5 cm2. A small perineal body was strongly associated with posterior compartment prolapse (paired t test, p < 0.0001) and wider POP-Q GH (paired t test, p = 0.0003). Surprisingly, Pelvic Organ Prolapse Quantification Perineal Body (POP-Q PB) of the two groups was not significantly different. A perineal body mid-sagittal area of less than 2.4 cm2 has been shown to be associated strongly with posterior compartment prolapse.ConclusionsIt is possible to measure the perineal body on 2D ultrasound. This technique facilitates the objective diagnosis of perineal deficiency. POP-Q PB does not predict the length or area of the perineal body.

Journal article

Tailor VK, Bhide AA, Fernando R, Digesu GA, Khullar Vet al., 2020, Does size matter? Perineometer and digital examination of a model levator hiatus, NEUROUROLOGY AND URODYNAMICS, Vol: 39, Pages: 1338-1344, ISSN: 0733-2467

Journal article

Bhide AA, Tailor V, Fernando R, Khullar V, Digesu GAet al., 2020, Posterior tibial nerve stimulation for overactive bladder-techniques and efficacy, International Urogynecology Journal and Pelvic Floor Dysfunction, Vol: 31, Pages: 865-870, ISSN: 0937-3462

The ideal treatment for overactive bladder is still elusive. In those where medication fails to improve symptoms options include invasive treatments such as botulinum toxin-A, sacral neural stimulation or posterior tibial nerve stimulation. Scientific professional society guidelines advise percutaneous posterior tibial nerve stimulation as a third line treatment option only after multi-disciplinary team review as well as failure of both conservative and pharmacological management. The aim of this article is to review all techniques for tibial nerve stimulation and their efficacy.

Journal article

Digesu GA, Tailor V, Bhide AA, Khullar Vet al., 2020, The role of bladder instillation in the treatment of bladder pain syndrome: Is intravesical treatment an effective option for patients with bladder pain as well as LUTS?, International Urogynecology Journal and Pelvic Floor Dysfunction, Vol: 31, Pages: 1387-1392, ISSN: 0937-3462

The aetiology of bladder pain syndrome/interstitial cystitis is still unknown. Numerous mechanisms have been proposed and treatments targeting various aspects of these are used. This review looks at the existing evidence on bladder instillations and whether they could be used in the treatment of lower urinary tract symptoms as well.

Journal article

Khullar V, Digesu GA, Veit-Rubin N, Sahai A, Rahnama'i MS, Tarcan T, Chermansky C, Dmochowski Ret al., 2019, How can we improve the diagnosis and management of bladder pain syndrome? Part 2:ICI-RS 2018, NEUROUROLOGY AND URODYNAMICS, Vol: 38, Pages: S71-S81, ISSN: 0733-2467

Journal article

Khullar V, Chermansky C, Tarcan T, Rahmanai S, Digesu A, Sahai A, Veit-Rubin N, Dmochowski Ret al., 2019, How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI-RS 2018, NEUROUROLOGY AND URODYNAMICS, Vol: 38, Pages: S66-S70, ISSN: 0733-2467

Journal article

Ford AA, Tailor V, Ogah J, Veit-Rubin N, Khullar V, Digesu GAet al., 2019, Midurethral slings for treatment of stress urinary incontinence review (vol 38, pg S70, 2019), NEUROUROLOGY AND URODYNAMICS, Vol: 38, Pages: 2387-2387, ISSN: 0733-2467

Journal article

Asfour V, Gibbs K, DaSilva AS, Fernando R, Digesu GA, Khullar Vet al., 2019, Validation study of ultrasound bladder wall thickness measurements, INTERNATIONAL UROGYNECOLOGY JOURNAL, Vol: 30, Pages: 1575-1580, ISSN: 0937-3462

Journal article

Asfour V, Gibbs K, Digesu G, Fernando R, Khullar Vet al., 2019, AN ASSESSMENT OF OBSTRUCTED DEFAECATION AMONGST WOMEN UNDERGOING ROUTINE PROLAPSE SURGERY FOR A RECTOCOELE?, Publisher: SPRINGER LONDON LTD, Pages: S276-S276, ISSN: 0937-3462

Conference paper

Asfour V, Gibbs K, Digesu G, Fernando R, Khullar Vet al., 2019, ASSESSMENT OF THE PERINEAL BODY ANATOMY BEFORE AND AFTER POSTERIOR COLPORRHAPHY (WITH A PERINEORRHAPHY), Publisher: SPRINGER LONDON LTD, Pages: S270-S270, ISSN: 0937-3462

Conference paper

Mchayle A, Bhide AA, Morris ES, Tailor V, Fernando R, Digesu G, Khullar Vet al., 2019, RELATIONSHIP BETWEEN ANAL SPHINCTER COMPLEX THICKNESS AND SYMPTOMS OF ANAL INCONTINENCE IN WOMEN WHO HAVE SUFFERED A SINGLE OBSTETRIC ANAL SPHINCTER INJURY, Publisher: SPRINGER LONDON LTD, Pages: S353-S353, ISSN: 0937-3462

Conference paper

Tailor V, Bhide AA, Patel M, Rahim A, Gibbs K, Fernando R, Digesu G, Khullar Vet al., 2019, DOES THE SYMPTOM OF BLADDER PAIN INFLUENCE THE URODYNAMIC DIAGNOSIS?, Publisher: SPRINGER LONDON LTD, Pages: S297-S297, ISSN: 0937-3462

Conference paper

Patel M, Morris ES, Bhide AA, Tailor V, Rahim A, Digesu G, Fernando R, Khullar Vet al., 2019, SYSTEMATIC REVIEW OF THE ACCURACY OF ULTRASOUND AS THE METHOD OF MEASURING BLADDER WALL THICKNESS IN THE DIAGNOSIS OF DETRUSOR OVERACTIVITY, IUGA meeting, Publisher: SPRINGER LONDON LTD, Pages: S125-S125, ISSN: 0937-3462

Conference paper

Ford AA, Taylor V, Ogah J, Veit-Rubin N, Khullar V, Digesu GAet al., 2019, Midurethral slings for treatment of stress urinary incontinence review, NEUROUROLOGY AND URODYNAMICS, Vol: 38, Pages: S70-S75, ISSN: 0733-2467

Journal article

Purwar B, Cartwright R, Cavalcanti G, Digesu GA, Fernando R, Khullar Vet al., 2019, The impact of bariatric surgery on urinary incontinence: a systematic review and meta-analysis, INTERNATIONAL UROGYNECOLOGY JOURNAL, Vol: 30, Pages: 1225-1237, ISSN: 0937-3462

Journal article

Asfour V, Gibbs K, Franklin L, Digesu GA, Fernando R, Regan L, Khullar Vet al., 2019, Ultrasound technique for the assessment of urethral descent assessment technique (UDAT) in healthy volunteers, Journal of Obstetrics and Gynaecology, ISSN: 0144-3615

Bladder neck descent (BND) has been implicated in the pathophysiology of stress incontinence and prolapse. The aim of this study was to evaluate a novel 2D technique for the evaluation of BND, the Urethral Descent Assessment Technique (UDAT). UDAT involves measuring BND during dynamic manoeuvres in live 2D ultrasound, by using the geometrical properties of parallel lines. The internal urethral meatus and distal end of the urethra are used as reference points. Y1 is the urethral height at rest (also the urethral length when the urethra is straight). Y2 is the urethral height on Valsalva. Y1 and Y2 are parallel lines. Y1–Y2 = BND. A horizontal line (X) connecting Y1 and Y2 is the forward movement of the bladder neck.Y1 mean 30.4 mm (95% CI ± 1.36 mm). Y2 mean 24.2 mm (95% CI ± 2.58 mm). X mean 12.1 mm (95% CI ± 1.66 mm). BND mean 6.2 mm (95% CI ± 1.47 mm). Bland–Altman plots and linear regression showed that UDAT is repeatable and reliable.

Journal article

Bhide AA, Khullar V, Swift S, Digesu GAet al., 2019, The use of laser in urogynaecology, International Urogynecology Journal and Pelvic Floor Dysfunction, Vol: 30, Pages: 683-692, ISSN: 0937-3462

IntroductionThe use of lasers in urogynaecology has increased in recent years. Their use has been described in pelvic organ prolapse, urinary incontinence and genito-urinary symptoms of menopause. The aim of this study was to review the published literature on CO2 and erbium:YAG laser use in urogynaecological conditions.MethodsAn extensive search of literature databases (PubMed, EMBASE) was performed for publications (full text and abstracts) written in English up to July 2018. Relevant trials were selected and analysed by an independent reviewer. Twenty-five studies were identified in total.ResultsAll studies were either prospective cohort or case-control studies. The results of individual studies indicate that both CO2 and erbium lasers are effective in treating urogynaecological conditions. Most studies use a vaginal approach with only two investigations of intraurethral application.ConclusionThe use of lasers to treat these conditions may seem appealing; however, the lack of good-quality evidence in the form of multi-centre randomised placebo-controlled trials is concerning. The safety and effectiveness of these laser devices have not been established. Use of lasers may lead to serious adverse events such as vaginal burns, scarring, dyspareunia and chronic pain. Randomised placebo-controlled trials in addition to formal evaluation of the laser devices are required before this treatment modality can be recommended.

Journal article

Digesu GA, Tailor V, Preti M, Vieira-Baptista P, Tarcan T, Stockdale C, Mourad Set al., 2019, The energy based devices for vaginal "rejuvenation," urinary incontinence, vaginal cosmetic procedures, and other vulvo-vaginal disorders: An international multidisciplinary expert panel opinion, NEUROUROLOGY AND URODYNAMICS, Vol: 38, Pages: 1005-1008, ISSN: 0733-2467

Journal article

Preti M, Vieira-Baptista P, Digesu GA, Bretschneider CE, Damaser M, Demirkesen O, Heller DS, Mangir N, Marchitelli C, Mourad S, Moyal-Barracco M, Peremateu S, Tailor V, Tarcan T, De EJB, Stockdale CKet al., 2019, The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document, NEUROUROLOGY AND URODYNAMICS, Vol: 38, Pages: 1009-1023, ISSN: 0733-2467

Journal article

Da Silva AS, Asfour V, Digesu GA, Cartwright R, Fernando R, Khullar Vet al., 2019, Levator Ani avulsion: The histological composition of this site. A cadaveric study, NEUROUROLOGY AND URODYNAMICS, Vol: 38, Pages: 123-129, ISSN: 0733-2467

Journal article

Asfour V, Gargasole C, Fernando R, Digesu GG, Khullar Vet al., 2018, Urodynamics are necessary for patients with asymptomatic pelvic organ prolapse, NEUROUROLOGY AND URODYNAMICS, Vol: 37, Pages: 2841-2846, ISSN: 0733-2467

Journal article

Asfour V, Digesu GA, Ford A, Fernando R, Khullar Vet al., 2018, Re: Ultrasound bladder wall thickness and detrusor overactivity: a multicentre test accuracy study Is it fair to assess new imaging techniques against a poor gold standard?, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 125, Pages: 395-395, ISSN: 1470-0328

Journal article

Ali I, Swift S, Digesu GA, 2018, Surgical management of pelvic organ prolapse and stress urinary incontinence: where are we now?, International Urogynecology Journal, Vol: 29, Pages: 1-2, ISSN: 0937-3462

Journal article

Digesu GA, Swift S, Handley V, 2017, Informed consent checklists for midurethral slings: a common-sense approach., Int Urogynecol J, Vol: 28, Pages: 1639-1643

INTRODUCTION AND HYPOTHESIS: Following the US Food and Drug Administration's (FDA's) warning about the use of transvaginal mesh to treat pelvic organ prolapse (POP) and the use of single-incision slings to treat incontinence, the number of lawsuits for medical negligence regarding the use of any polypropylene mesh in the vagina has increased tremendously. METHODS: This same FDA document did not question the use of polypropylene midurethral slings and polypropylene for sacrocolpopexies. Surprisingly, despite all the evidence and recommendations from respected international scientific societies, we are constantly being called upon by our patients to defend the use of midurethral slings. The most common reasons for the new rash of medicolegal proceedings involving midurethral slings has to do with "breach of duties" resulting from undisclosed postoperative complications on the consent form and/or the lack of information in the medical records confirming that all possible alternative treatment options were presented to and discussed with the patient. RESULTS: One response to these lawsuits involves the addition of preoperative checklists when performing informed consent with patients electing surgical correction of stress urinary incontinence (SUI). CONCLUSIONS: This clinical opinion provides an expert clinician's perspectives and legal point of view on this controversial topic and discusses the role of a preoperative checklist supplementary to the standard informed consent form.

Journal article

Digesu GA, Swift S, 2017, Laser treatment in urogynaecology and the myth of the scientific evidence., Int Urogynecol J, Vol: 28, Pages: 1443-1444

Journal article

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