Jeanette S. Brown, MD
Clinical Interests
Brown is the founder and Director of the UCSF Women's
Continence Center (WCC). The UCSF WCC is a multidisciplinary practice
that incorporates physicians from gynecology, urology, and colorectal
surgery to provide expert, timely and innovative care for patients.
The center offers uniquely tailored services through its pelvic
floor rehabilitation and behavioral treatment program, which incorporate
the use of behavioral therapy, pelvic floor exercises, and biofeedback.
The UCSF Women’s Continence Center is committed to combining
up-to-date medical treatments and evidence-based medicine with
collaborative decision-making and individualized treatment.
Research Interests
UCSF Specialized Center of Research (SCOR) in Lower Urinary
Tract Function in Women
Established in 2002, the UCSF SCOR is one of two SCOR programs
focused on lower urinary tract function in women and designated
by the National Institutes of Health's (NIH) Office of Research
on Women’s Health (ORWH). The UCSF SCOR is funded as a partnership
by the ORWH and the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK).
As director of the UCSF SCOR, Brown coordinates the multidisciplinary,
multi-institutional group of basic and clinical investigators
studying the female urethra, bladder, pelvic floor, and female
urinary incontinence. UCSF SCOR researchers are investigating
the underlying molecular mechanisms which cause urinary incontinence,
including the epidemiology of the disorder and clinical outcomes
of treatment. One of the strengths of the UCSF SCOR is the physical
proximity of several nationally recognized clinical and laboratory
researchers with a similar research interest in lower urinary
tract function. Prior to the UCSF SCOR there was very little cross-disciplinary
research between epidemiology and basic science in lower urinary
tract function. The SCOR's “bench to bedside” collaborative
research paradigm will move the field forward by facilitating
translation of epidemiologic and laboratory research into clinically
important improvements in prevention and treatment.
The UCSF SCOR includes senior clinical and basic researchers
from inside and outside of UCSF. The multidisciplinary group of
investigators includes members of UCSF departments, including:
Obstetrics, Gynecology and Reproductive Sciences; Urology; Family
Medicine; Geriatrics; Epidemiology; as well as members of the
UCSF Women's
Health Clinical Research Center, and the Northern California
Kaiser Division of Research. Members of the highly productive
SCOR team have received substantial NIH grant support and many
intra- and extramural awards. SCOR investigators have published
extensively in leading scientific journals
Urologic Outcomes of Diabetes
Brown’s primary research focus is on lower urinary tract
dysfunction and urinary incontinence among women with diabetes.
This focus was founded in her early research findings which indicated
that diabetes is associated with a 30-70% increased risk of lower
urinary tract dysfunction. This dysfunction includes lower urinary
tract symptoms, urinary incontinence, and ultimately, bladder
cystopathy. Type 2 diabetes and urinary incontinence are prevalent
and growing health care issues for our aging population.
Little is known about the natural history, risk factors, and
possible mechanisms of lower urinary tract dysfunction, or about
how these may differ among women with diabetes as compared to
women without diabetes. In particular, there has been limited
research on how the specific aspects of diabetic severity may
contribute to the development or severity of lower urinary tract
dysfunction. Indicators of diabetic severity include: duration,
treatment, glycemic control, presence of microvascular complications
including retinopathy, nephropathy and neuropathy. Details about
a number of studies Brown is currently conducting to address these
issues follow.
Diabetes: Lower Urinary Tract Dysfunction and Infections
This study is a longitudinal follow-up of 400 women with type
2 diabetes and 400 age- and race-matched controls. It offers a
unique opportunity to understand the natural history and possible
mechanisms for lower urinary tract dysfunction and urinary tract
infections in women with and without type 2 diabetes. Lower urinary
tract dysfunction is being precisely evaluated using postvoid
residual, uroflow, urodynamic testing, validated questionnaires,
diaries, and laboratory data. A better understanding of risk factors
for, and pathogenesis of, lower urinary tract dysfunction and
urinary tract infections will help guide the development of preventive
interventions, especially for women at higher risk because of
type 2 diabetes.
Diabetes Prevention Program (DPP) Urinary Incontinence Study
The DPP is a 3,234 participant randomized
trial of interventions to prevent the development of diabetes
in adults with glucose intolerance. A urinary incontinence study
was funded and implemented for the DPP end-of-study visit. Brown
will be able to determine if interventions that reduce the risk
of developing diabetes also reduce the risk of developing incontinence.
The DPP was funded for long-term follow-up of the cohort study.
The urinary incontinence study was approved to repeat incontinence
measures from the DPP outcomes study.
Action for Health in Diabetes (Look AHEAD): Urinary Incontinence
Study
This study is a randomized trial to test the effect of weight
reduction versus control on cardiovascular events in 5,000 obese
participants with type 2 diabetes. An incontinence study has been
approved, funded, and implemented at baseline and for annual evaluations
with approximately 12 years of follow-up. The primary objective
of the study is to determine if weight loss reduces the development
or severity of urinary incontinence. Most importantly, we will
be able to determine if interventions that reduce weight also
reduce the risk of developing incontinence. Weight loss has the
potential to change the participants' health risk and disease
progression.
Diabetes and Urinary Incontinence. K-24 Mid-career Investigator
Award in Patient-Oriented Research
Brown serves as a senior mentor to junior clinical investigators
and will develop a unique joint urogynecology and urology 3-year
clinical research fellowship with this funding. The research project
is designed to determine for women with diabetes: the prevalence
and incidence of urinary incontinence by type for all study participants
and by racial subgroup; risk factors associated with incontinence,
especially aspects of diabetic severity that are associated with
greater risk or severity of urinary incontinence; and whether
interventions, including glycemic control or weight reduction,
prevent or reduce severity of urinary incontinence among women
with diabetes. Questionnaire, laboratory, and outcome data will
be analyzed from a triad of NIDDK diabetes and 2 population-based
cohort studies. Data will include women with impaired glucose
tolerance, type 2 diabetes, type 1 diabetes and without diabetes.
Other Research Areas
Brown’s research interests also include understanding the
mechanisms by which incontinence develops in women, determining
how common incontinence is, identifying factors that increase
risk and developing effective treatments. Her studies have demonstrated
that nearly 50% of women over 60 years old have some incontinence
and about 15% have daily incontinence. To identify potential strategies
to prevent and treat incontinence, Brown has focused her investigations
on the modifiable or avoidable risk factors described below.
Hysterectomy
Hysterectomy has been thought to be a safe surgical procedure.
But Brown's group has found that women who undergo hysterectomy
have an increased risk of developing urinary incontinence later
in life. This finding indicates that women should carefully consider
long-term consequences before undergoing hysterectomy.
Falls and Fractures
Brown and her collaborators have found
that older women with urge incontinence have a 26% increased risk
for falls and a 34% increased risk for fractures. These findings
suggest that identification and treatment of urge incontinence
may be an effective intervention for reducing the risk of falls
and fractures.
Hormone Therapy
Hormone therapy has long been thought to be
a good treatment for incontinence in postmenopausal women. In large
clinical trials of oral hormone therapy, Brown has shown that it
does not prevent the development of incontinence and is not effective
treatment. In fact, women who took postmenopausal hormone therapy
for 4 years were more likely to develop incontinence and have more
severe incontinence than women who took placebo.
Additional Ongoing Studies
Reproductive Risk Factors for Pelvic Organ Prolapse
This study will use a 1,100 woman population-based sample
to objectively assess pelvic organ prolapse to determine the prevalence
of prolapse by vaginal segment and severity (stage I-IV), and
age group. Ethnic diversity of study subjects will allow for a
comparison of prevalence estimates between major ethnic groups.
Additional aims of the study are to determine the association
between specific aspects of parturition and development of prolapse
in later life; to ascertain the association between hysterectomy
(type and indication) and subsequent prolapse; to identify other
potential risk factors for prolapse, especially those that are
preventable or modifiable; and to describe the associations of
pelvic organ prolapse with urinary and fecal incontinence. Identification
of risk factors for prolapse will help guide the development of
preventive intervention trials to test the efficacy of modifying
risk factors for pelvic organ prolapse.
Urinary Incontinence: Reproductive/Hormonal Risk Factors
Brown is a co-investigator on this study led by David H. Thom,
MD, PhD. They will ascertain the incidence of, and risk factors
for, urinary incontinence in a well-characterized cohort of 2,100
racially and ethnically diverse middle-aged and older women. Risk
factors of special interest include parturition variables, hormones,
pelvic surgeries, pelvic organ prolapse, obesity, urinary tract
infections, and physical activity. Additional studies will be
performed to assess the relationship between serum estradiol levels
and urinary incontinence in a nested case-control study, and to
compare utilization of medical services and costs of care for
women with urinary incontinence to continent women.
Diagnostic Aspects of Urinary Incontinence Study
This study is a cross-sectional multicenter study of the accuracy,
reproducibility, cost and acceptability of a questionnaire as
compared to an extensive evaluation for the diagnosis for incontinence.
Brown is co-principal investigator and will coordinate the study
at six U.S. sites and study approximately 300 community-dwelling
women with incontinence. The long-term goal of the study is to
develop a simple, inexpensive, non-invasive and accurate test
for the diagnosis of urinary incontinence that will be widely
used by primary care physicians.
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