Imperial College London

DrVikKhullar

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Professor of Practice (Urogynaecology)
 
 
 
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Contact

 

+44 (0)20 3312 1959vik.khullar

 
 
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Location

 

Urogynaecology DeptCambridge WingSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

493 results found

Yu J, Varella Pereira GM, Allen-Brady K, Cuffolo R, Siddharth A, Koch M, Chua JWF, Sorrentino F, Dytko O, Ng K-Y, Violette P, Khullar V, Wang ZT, Cartwright Ret al., 2023, Genetic polymorphisms associated with urinary tract infection in children and adults: a systematic review and meta-analysis., Am J Obstet Gynecol

INTRODUCTION: The lifetime risk of urinary tract infection is known from first-degree relative studies to be highly heritable. Associations have also been observed across the life course from pediatric urinary tract infection to recurrent urinary tract infection in adulthood, suggesting lifelong susceptibility factors. Candidate gene studies and genome-wide association studies have tested for genetic associations of urinary tract infection; however, no contemporary systematic synthesis of studies is available. OBJECTIVE: We conducted a systematic review to identify all genetic polymorphisms tested for an association with urinary tract infection in children and adults; and to assess their strength, consistency, and risk of bias among reported associations. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA: PubMed, HuGE Navigator and Embase were searched from January 1, 2005 to November 16, 2023, using a combination of genetic and phenotype key words. STUDY APPRAISAL AND SYNTHESIS METHODS: Fixed and random effects meta-analyses were conducted using codominant models of inheritance in metan. The interim Venice criteria were used to assess their credibility of pooled associations. RESULTS: After removing 451 duplicates, 1821 studies reports were screened, with 106 selected for full-text review, 22 were included in the meta-analysis (7 adult studies and 15 pediatric studies). Our meta-analyses demonstrated significant pooled associations for pediatric urinary tract infection with variation in CXCR1, IL8, TGF, TLR4 and VDR; all of which have plausible roles in the pathogenesis of urinary tract infection. Our meta-analyses also demonstrated a significant pooled association for adult urinary tract infection with variation in CXCR1. All significant pooled associations were graded according to their epidemiological credibility, sample sizes, heterogeneity between studies, and risk of bias. CONCLUSION: This systematic review provides a current synthesis of the known genetic architec

Journal article

Bhide AA, Lemmon B, Rahmanou P, Digesu GA, Khullar Vet al., 2023, Bladder contractility index changes with short-term antimuscarinic therapy in patients with detrusor overactivity: A placebo controlled randomised study, Continence, Vol: 8

Aims: Bladder contractility is altered by high doses of anticholinergics. It is unknown if anticholinergics at doses used for treating overactive bladder alter bladder contractility. This is a randomised, double-blind, placebo controlled cross-over multicentre study with two 2-week treatment periods. Patients with a previous diagnosis of detrusor overactivity and reporting urinary frequency of at least seven times a day, one or more episodes of urge urinary incontinence per week and at least seven episodes of urgency per week were included. Methods: After a two-week washout period, subjects were randomised to receive propiverine 20 mg od, propiverine 15 mg tds, oxybutynin 5 mg tds or placebo for 2 weeks. After a second washout period, they were randomised to receive 2 weeks of another treatment not previously used. Ambulatory urodynamic monitoring was performed according to ICS standards for 4 h, using a standardised protocol before and after treatment. The bladder contractility index (BCI) was given by the formula: BCI = PdetQmax+ 5Qmax. The main outcome measure was the average BCI for the first 2 voids for each of the treatment. Results: 77 participants were recruited. The average BCI for the first two voids was 143 (range 24–314). The BCI was not statistically different before and after antimuscarinic therapy or placebo although there were reductions in urinary frequency and urgency over placebo indicating efficacy over placebo in the treatment of detrusor overactivity. Conclusions: The bladder contractility index did not change significantly in response to antimuscarinic therapy despite a therapeutic effect. This suggests efficacy is mediated by an effect on another system such as sensory rather than motor function.

Journal article

Wyndaele M, Charrua A, Hervé F, Aronsson P, Grundy L, Khullar V, Wein A, Abrams P, Cruz F, Cruz CDet al., 2023, Beyond the urothelium: Interplay between autonomic nervous system and bladder inflammation in urinary tract infection, bladder pain syndrome with interstitial cystitis and neurogenic lower urinary tract dysfunction in spinal cord injury-ICI-RS 2023., Neurourol Urodyn

INTRODUCTION: Inflammation and neuronal hypersensitivity are reactive protective mechanisms after urothelial injury. In lower urinary tract dysfunctions (LUTD), such as urinary tract infection (UTI), bladder pain syndrome with interstitial cystitis (BPS/IC) and neurogenic LUTD after spinal cord injury (SCI), chronic inflammation can develop. It is unclear how the protective reactionary inflammation escalates into chronic disease in some patients. METHODS: During its 2023 meeting in Bristol, the International Consultation on Incontinence-Research Society (ICI-RS) reviewed the urothelial and inflammatory changes after UTI, BPS/IC and SCI. Potential factors contributing to the evolution into chronic disease were explored in a think-tank. RESULTS: Five topics were discussed. (1) Visceral fat metabolism participates in the systemic pro-inflammatory effect of noradrenalin in BPS/IC and SCI. Sympathetic nervous system-adipocyte-bladder crosstalk needs further investigation. (2) Sympathetic hyperactivity also potentiates immune depression in SCI and needs to be investigated in BPS/IC. Gabapentin and tumor necrosis factor-α are promising research targets. (3) The exact peripheral neurons involved in the integrative protective unit formed by nervous and immune systems need to be further identified. (4) Neurotransmitter changes in SCI and BPS/IC: Neurotransmitter crosstalk needs to be considered in identifying new therapeutic targets. (5) The change from eubiosis to dysbiosis in SCI can contribute to UTI susceptibility and needs to be unraveled. CONCLUSIONS: The think-tank discussed whether visceral fat metabolism, immune depression through sympathetic hyperactivity, peripheral nerves and neurotransmitter crosstalk, and the change in microbiome could provide explanations in the heterogenic development of chronic inflammation in LUTD. High-priority research questions were identified.

Journal article

Seifalian A, Basma Z, Digesu A, Khullar Vet al., 2023, Polypropylene Pelvic Mesh: What Went Wrong and What Will Be of the Future?, BIOMEDICINES, Vol: 11

Journal article

Tailor V, Bhide A, Khullar V, 2023, The Urinary Microbiome, Textbook of Female Urology and Urogynecology: Clinical Perspectives, Pages: 384-398, ISBN: 9780367700140

The development of next-generation sequencing methods has improved our ability to study the microbial communities that reside within human hosts. The microbiome describes the genetic material of these microbes. It is now well established that the microbiota can play a role in health and disease. The study of the bladder bacterial microbiota whilst relatively new has started to provide clues to the maintenance of bladder health. With further research, the knowledge could help establish the use of novel treatments for lower urinary tract symptoms.

Book chapter

Seifalian A, Kenyon J, Khullar V, 2022, Dysmenorrhoea: Can Medicinal Cannabis Bring New Hope for a Collective Group of Women Suffering in Pain, Globally?, INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, Vol: 23

Journal article

Karmarkar R, Digesu A, Fernando R, Khullar Vet al., 2022, Ultrasound assessment of urethral structure and bladder neck position in women with different parities, INTERNATIONAL UROGYNECOLOGY JOURNAL, Vol: 33, Pages: 613-618, ISSN: 0937-3462

Journal article

Patel M, Khullar V, 2021, Urogynaecology and Ehlers-Danlos syndrome, AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS, Vol: 187, Pages: 579-585, ISSN: 1552-4868

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, Vol: 32, Pages: 2421-2427, ISSN: 0937-3462

Journal article

Derpapas A, Vijaya G, Nikolopoulos K, Nikolopoulos M, Robinson D, Fernando R, Khullar Vet al., 2021, The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial, JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Vol: 41, Pages: 594-600, ISSN: 0144-3615

Journal article

Tailor VK, Morris E, Bhide AA, Fernando R, Digesu GA, Khullar Vet al., 2021, 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

Cartwright J, Frankin L, Tikkinen K, Kallila I, Miotla P, Rechberger T, Offiah I, McMahon S, O'Reilly B, Lince S, Kluivers K, Post W, Poelmans G, Palmer M, Wessels H, Wong A, Kuh D, Kivimaki M, Kumari M, Mangino M, Spector T, Guggenheim J, Lehne B, De Silva M, Evans D, Lawlor D, Karhunen V, Mannikko M, Marczak M, Bennett P, Khullar V, Jarvelin M, Walley A, on behalf of the IGNITE Consortiumet al., 2021, Genome wide association study identifies two novel loci associated with female stress and urgency urinary incontinence, The Journal of Urology, ISSN: 0022-5347

Background:Genome-wide association studies (GWAS) have not identified replicable genetic risk loci for stress or urgency urinary incontinence.Methods:We carried out a discovery stage case control GWAS in three independent discovery cohorts of European women (n=8,979) for stress incontinence, urgency incontinence, and any incontinence phenotypes. We conducted replication in six additional studies of European ancestry (n=4,069). We collected bladder biopsies from women with incontinence to further investigate bladder expression of implicated genes and pathways (n=50) and used symptom questionnaires for phenotyping. We conducted meta-analyses using inverse variance fixed effects models in METAL, and whole transcriptome analyses using Affymetrix arrays, with replication with TaqMan PCR.Results:In the discovery stage we identified 16 single nucleotide polymorphisms (SNPs) genotyped or imputed at five loci that reached genome-wide significance (p<5x10-8). In replication, rs138724718 on chromosome 2, near the macrophage receptor with collagenous structure (MARCO) gene (replication p=0.003) associated with stress incontinence. In addition, rs34998271 on chromosome 6 near the Endothelin 1 (EDN1) gene (replication p=0.0008) associated with urgency incontinence. In combined meta-analyses of discovery and replication cohorts, associations with genome-wide significance for these two SNPs were confirmed. Transcriptomics analyses showed differential expression of 7 of 19 genes in the endothelin pathway between stress and urgency incontinence (p<0.0001).Conclusion:We uncovered two new risk loci near the genes Endothelin 1 (EDN1), associated with urgency incontinence and Macrophage Receptor with Collagenous Structure (MARCO), associated with stress incontinence. These loci are biologically plausible given their roles in smooth muscle contraction and innate host defense respectively.

Journal article

Karmarkar R, Digesu A, Fernando R, Khullar Vet al., 2020, Urethral sphincter volume and urodynamic diagnosis, INTERNATIONAL UROGYNECOLOGY JOURNAL, Vol: 31, Pages: 2589-2594, ISSN: 0937-3462

Journal article

Tailor V, Morris E, Bhide A, Fernando R, Digesu A, Khullar Vet al., 2020, Does cystoscopy method affect the investigation of bladder pain?, Publisher: SPRINGER LONDON LTD, Pages: 1722-1723, ISSN: 0937-3462

Conference paper

McHayle A, Morris E, Bhide A, Tailor V, Fernando R, Digesu A, Khullar Vet al., 2020, External Anal Sphincter Thickness Measurements as an Independent Assessment of Patient Symptoms in Women following an Obstetric Anal Sphincter Injury, Publisher: SPRINGER LONDON LTD, Pages: 1720-1720, ISSN: 0937-3462

Conference paper

Morris E, Tailor V, McHayle A, Bhide A, Fernando R, Digesu A, Khullar Vet al., 2020, The role of Diamine Oxidase in the pathophysiology and investigation of Bladder Pain Syndrome, Publisher: SPRINGER LONDON LTD, Pages: 1720-1721, ISSN: 0937-3462

Conference paper

Bhide A, Tailor V, Khullar V, 2020, Interstitial cystitis/bladder pain syndrome and recurrent urinary tract infection and the potential role of the urinary microbiome., Post Reproductive Health, Vol: 26, Pages: 87-90, ISSN: 2053-3705

Interstitial cystitis/bladder pain syndrome and recurrent urinary tract infections carry significant burden for those affected. As women enter the menopause, other factors may influence how these conditions manifest. The urinary microbiome has shown that the urine contains extensive numbers of bacteria. There is some evidence to suggest that it is altered depending on the menopausal state of the individual. It is possible that this alteration may go on to influence how the disease course of interstitial cystitis/bladder pain syndrome and recurrent urinary tract infections runs in the post-menopausal group. The review will explore these two conditions and the potential role of the urinary microbiome.

Journal article

Khullar V, Rahnama'i MS, Veit-Rubin N, Cardozo L, Wein AJet al., 2020, Can we harness the placebo effect to improve care in lower urinary tract dysfunction? ICI-RS 2019, NEUROUROLOGY AND URODYNAMICS, Vol: 39, Pages: S80-S87, ISSN: 0733-2467

Journal article

Glazener C, Breeman S, Elders A, Hemming C, Cooper KG, Freeman RM, Smith A, Hagen S, Montgomery I, Kilonzo M, Boyers D, McDonald A, McPherson G, MacLennan G, Norrie J, Reid FM, PROSPECT Study Groupet al., 2020, Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT)., BJOG, Vol: 127, Pages: 1002-1013

OBJECTIVE: To compare standard (native tissue) repair with synthetic mesh inlays or mesh kits. DESIGN: Randomised controlled trial. SETTING: Thirty-three UK hospitals. POPULATION: Women having surgery for recurrent prolapse. METHODS: Women recruited using remote randomisation. MAIN OUTCOME MEASURES: Prolapse symptoms, condition-specific quality-of-life and serious adverse effects. RESULTS: A Mean Pelvic Organ Prolapse Symptom Score at 1 year was similar for each comparison (standard 6.6 versus mesh inlay 6.1, mean difference [MD] -0.41, 95% CI -2.92 to 2.11: standard 6.6 versus mesh kit 5.9, MD -1.21 , 95% CI -4.13 to 1.72) but the confidence intervals did not exclude a minimally important clinical difference. There was no evidence of difference in any other outcome measure at 1 or 2 years. Serious adverse events, excluding mesh exposure, were similar at 1 year (standard 7/55 [13%] versus mesh inlay 5/52 [10%], risk ratio [RR] 1.05 [0.66-1.68]: standard 3/25 [12%] versus mesh kit 3/46 [7%], RR 0.49 [0.11-2.16]). Cumulative mesh exposure rates over 2 years were 7/52 (13%) in the mesh inlay arm, of whom four women required surgical revision; and 4/46 in the mesh kit arm (9%), of whom two required surgical revision. CONCLUSIONS: We did not find evidence of a difference in terms of prolapse symptoms from the use of mesh inlays or mesh kits in women undergoing repeat prolapse surgery. Although the sample size was too small to be conclusive, the results provide a substantive contribution to future meta-analysis. TWEETABLE ABSTRACT: There is not enough evidence to support use of synthetic mesh inlay or mesh kits for repeat prolapse surgery.

Journal article

Tailor V, Bhide A, Rahim A, Fernando R, Digesu A, Khullar Vet al., 2020, CYSTOSCOPIC RESECTION OF SQUAMOUS METAPLASIA TO TREAT RECURRENT URINARY TRACT INFECTIONS, Annual Meeting of the International-Continence-Society (ICS), Publisher: WILEY, Pages: S475-S475, ISSN: 0733-2467

Conference paper

Beattie-Spanjol S, Millar O, Tailor V, Bhide A, Rahim A, Fernando R, Digesu A, Khullar Vet al., 2020, IS ABNORMAL IMMUNOLOGY ASSOCIATED WITH RECURRENT URINARY TRACT INFECTIONS?, Annual Meeting of the International-Continence-Society (ICS), Publisher: WILEY, Pages: S450-S451, ISSN: 0733-2467

Conference paper

Kennelly M, Nitti V, Khullar V, Herschorn S, Karram M, Boroujerdi A, Patel Aet al., 2020, POST VOID RESIDUAL VOLUME AND RATES OF CLEAN INTERMITTENT CATHETERIZATION WITH SPONTANEOUS AND NON-SPONTANTEOUS VOIDING AFTER ONABOTULINUMTOXINA TREATMENT: POOLED ANALYSIS OF TWO PHASE 3 STUDIES, Annual Meeting of the International-Continence-Society (ICS), Publisher: WILEY, Pages: S210-S211, ISSN: 0733-2467

Conference paper

Millar O, Beattie-Spanjol S, Tailor V, Patel M, Bhide A, Rahim A, Fernando R, Digesu A, Khullar Vet al., 2020, DO WE NEED TO BETTER ASSESS PAIN IN UROGYNAECOLOGY?, Annual Meeting of the International-Continence-Society (ICS), Publisher: WILEY, Pages: S259-S261, ISSN: 0733-2467

Conference paper

Tailor V, Gibbs K, Bhide A, Digesu A, Fernando R, Khullar Vet al., 2020, Does the symptom of bladder pain influence the urodynamic diagnosis?, Publisher: WILEY, Pages: E58-E58, ISSN: 1470-0328

Conference paper

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

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

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

Kennelly M, Nitti V, Khullar V, Herschorn S, Karram M, Boroujerdi A, Patel Aet al., 2020, POST VOID RESIDUAL VOLUME AND RATES OF CLEAN INTERMITTENT CATHETERIZATION WITH SPONTANEOUS AND NON-SPONTANEOUS VOIDING AFTER ONABOTULINUMTOXINA TREATMENT, Annual Meeting of the American-Urological-Association (AUA), Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: E477-E477, ISSN: 0022-5347

Conference paper

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