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Clinical Focus

® Assistant Editor Janelle Hart spoke with 

about a study that was presented at the 2022 Society of Women in Urology Annual Clinical Mentoring Conference. The study investigates the quality of information regarding recurrent urinary tract infections on the social media platform Reddit. Malik is an assistant professor of surgery and director of female pelvic medicine and reconstructive surgery at the University of Maryland School of Medicine in Baltimore.

“I think we as urologists have to be proactive in providing information to our patients so that they avoid financial harm and potentially bodily harm from this sort of misinformation,” says Rena D. Malik, MD.

 Dr. Malik evaluates quality of Reddit content on recurrent UTIs

. He discusses the stigmas associated with vaginal mesh surgery, and how it is the urologist’s responsibility to set the expectations for their patients in terms of possible complications with different slings. Blaivas is a professor of urology in the Icahn School of Medicine at Mount Sinai in New York City, New York.

“To me, the overwhelming thing is understanding that treatments are, by and large, effective,” says Jerry G. Blaivas, MD, FACS.

Destigmatizing Urology: Dr. Blaivas discusses vaginal mesh surgery 

In this episode, we continue a series of podcasts on the topic of genitourinary syndrome of menopause, or GSM. Over the course of this series, 

 will discuss why it is important for urology providers to be educated regarding this condition, how to diagnose it in patients, and how to treat it. Rubin is a board-certified urologist with fellowship training in sexual medicine. She is an assistant clinical professor in urology at Georgetown University and has a private practice in the Washington DC area. In this episode, Rubin discusses common symptoms of GSM to look for and how a physical exam for GSM should be conducted. She spoke with 

"Many people do not examine patients who come in with urinary tract infections or overactive bladder symptoms, and it’s a mistake,” says Rachel S. Rubin, MD.

How to diagnose and treat patients with genitourinary syndrome of menopause

They discuss the efficacy of telehealth visits and how their 

 study, “Patient satisfaction and savings, and clinical outcomes of televisits in female pelvic medicine and reconstructive surgery at an urban academic center,” supports a bright future for telemedicine. Abraham is an associate professor and residency director of the department of urology at Montefiore Medical Center, and Shin is a medical student at the Albert Einstein College of Medicine, Bronx, New York.

“Our study strongly suggests that telemedicine can become the mainstay of treatment within FPMRS even after the COVID-19 pandemic has ended,” says Christina Shin, BA.

How FPMRS patients are reacting to televisits

® Managing Editor Ben Saylor spoke with 

 She discusses the safety and feasibility of same-day discharge after female pelvic medicine and reconstructive surgery cases. Zillioux is a urologist at Cleveland Clinic.

“Same-day discharge is safe and feasible across a broad spectrum of FPMRS cases,” says Jacqueline Zillioux, MD.

Dr. Jacqueline Zillioux discusses same-day discharge after FPMRS cases

"UH is working on starting clinics throughout rural Northeast Ohio, and we're meeting to develop a FPMRS program, both virtual and in-person, so patients can have access to this point of care," says David Sheyn, MD.

New studies and specialty clinics at University Hospitals look at FPMRS, OAB, and more

"Given that PCR testing may have a benefit for specific cohorts, it is recommended that more clinical evidence be provided to better guide Medicare in defining 'medical necessity,' ” write Stephanie Gleicher, MD, MPH, and Roger R. Dmochowski MD, MMHC, FACS.

The status and future direction of advanced urine testing: multiplex PCR

Urinary tract infections (UTIs) are among the most common human infections. But the urine culture, the cornerstone for laboratory diagnosis of UTI, is imperfect.

Diagnostic stewardship for urinary tract infection: A snapshot of the expert guidance

The American Urogynecologic Society has developed the following guidelines, committee opinions, and statements to promote the highest quality patient care in FPMRS. 

AUGS new clinical guidance documents for FPMRS

Black race was identified as an independent predictor of 30-day readmission even after investigators controlled for differences in patient demographics, clinical factors, and comorbidities.

Racial and ethnic disparities observed in patients undergoing pelvic organ prolapse surgery

 discusses genitourinary syndrome of menopause and medications for hypoactive sexual desire disorder. Pope is an associate professor of obstetrics and gynecology and director of Female Sexual Health at University Hospitals in Cleveland, Ohio.

[Menopause is] an important life milestone. Menopause is associated with recurrent UTIs [urinary tract infections]. I would just burn it into everyone's brain that pain with intercourse is also going to be associated with genitourinary syndrome of menopause. So if you are seeing a patient for an issue like that, and she thinks it's just about her bladder, just ask her. Normalize it. You could say, "A lot of women who have recurrent UTIs after menopause also notice vaginal dryness. Are you sexually active? Is this keeping you from being sexually active?" I find [it helpful to] put it into that sort of normalizing introduction, so she doesn't think you're presuming that she has a problem. I think that would be wonderful for everyone listening to be able to clue into. Also, clinicians should learn the basic medications for hypoactive sexual desire disorder. We really only have a few options, and I think it would be great if more people were providing them. We have flibanserin [Addyi]; we have bremelanotide [Vyleesi], and we have testosterone. They work for men and women; the studies were done on men and women, but the FDA has approved them for premenopausal women, except for testosterone—that's considered off label for women. It would be good for those listening to look into those medications [and] know that that's something that they could prescribe. They don't have to be a sexual health expert to be able to prescribe those. The risks, benefits, and contraindications are all pretty simple. Just like any new medication when it comes onto the market, we all have to do the reading and learn how to prescribe it. It's great to have those medications in our pocket as well to be able to prescribe to women.

Videos

“I would just burn it into everyone's brain that pain with intercourse is also going to be associated with genitourinary syndrome of menopause,” says Rachel Pope, MD, MPH. 

Dr. Rachel Pope on genitourinary syndrome of menopause and HSDD medications    

 discusses key takeaways from the recent study, “Path to parity: Trends in female representation among physicians, trainees, and applicants in urology and surgical specialties” and postulates ways to build off the findings moving forward. Findlay is a urology resident at Mayo Clinic in Rochester, Minnesota.

“We need to be focusing our efforts on early exposure to the field for women and underrepresented groups,” says Bridget Lang Findlay, MD.

Dr. Findlay on the lack of female representation in urology: “We still have a lot of room to grow"

discusses how clinicians can minimize the adverse events associated with radical cystectomy. Avulova is an assistant professor of surgery in urologic oncology at the Albany Medical Center in Albany, New York.

“I think discussing it and talking about the different techniques out there [is important],” says Svetlana Avulova, MD.

How to mitigate adverse events associated with radical cystectomy in women 

 discusses the key points of his lecture, “How imaging and computer modeling help improve your pelvic floor surgery,” presented at the 2021 International Continence Society Meeting. DeLancey is a professor of gynecology and urology and the director of male pelvic medicine and reconstructive surgery and the Pelvic Floor Research Group at the University of Michigan Medical School, Ann Arbor.

“I think it's important for people to recognize this revolution that's going on, to see that we're going from what fell to why it fell,” says John O. L. DeLancey, MD.

Dr. Delancey on improving success rates in pelvic floor surgery 

At the 2021 LUGPA Annual Meeting Jennifer Miles-Thomas, MD, FPMRS, president, Urology Of Virginia, participated in a panel discussion titled, “Strategies to Recruit and Retain Female Urologists in your Practice.” In this video, Miles-Thomas discusses the gender pay gap in urology. 

"It depends on how you're paid and the structure of the compensation model," says Jennifer Miles-Thomas, MD, FPMRS. 

Dr. Jennifer Miles-Thomas discusses the gender pay gap in urology

At the 2021 LUGPA Annual Meeting Jennifer Miles-Thomas, MD, FPMRS, president, Urology Of Virginia, participated in a panel discussion titled, “Strategies to Recruit and Retain Female Urologists in your Practice.” In this video, Miles-Thomas explains why urology practices need to have female urologists and approaches for recruiting them.

Jennifer Miles-Thomas, MD, FPMRS, explains why urology practices need to have female urologists and approaches for recruiting them.

Strategies for recruiting female urologists to your practice

discuss the strategies provided by surgeons and their own advice for facilitating good patient-physician relationships. Una Lee is a urologist in the departments of urology, pelvic floor center, and transgender health at the Virginia Mason Medical Center, Bellevue, Washington, and Wai Lee is the director of female pelvic medicine & reconstructive surgery at the Smith Institute for Urology, Northwell Health, New Hyde Park, New York.

“I think that a lot of the best practices that the surgeons had developed and honed were really excellent communication skills, and…building a trusting physician-patient relationship, where they truly provided an informed consent of all the risks, all the benefits, [and] all the alternatives,” says Una Lee, MD, FPMRS.

Dr. Una Lee and Dr. Wai Lee on mid-urethral slings and the importance of open communication

 study, “The evolving story of mesh mid-urethral slings: the surgeon’s perspective.” Una Lee is a urologist in the departments of urology, pelvic floor center, and transgender health at the Virginia Mason Medical Center, Bellevue, Washington, and Wai Lee is the director of female pelvic medicine & reconstructive surgery at the Smith Institute for Urology, Northwell Health, New Hyde Park, New York.

“I think the surgeon voice is an important voice to be heard because there's not a lot of avenues for surgeons to be able to be honest and share all the things they've learned and all the things they've experienced with their patients,” says Una Lee, MD, FPMRS.

Surgeons weigh in on MUS surgery for patients with stress urinary incontinence

 discusses the safety of the MV140 vaccine, used to treat patients with recurrent urinary tract infections. Nickel is a professor of the department of urology at Queen’s University and urologist at Kingston and Hotel Dieu General Hospitals, Kingston, Ontario, Canada.

“It is a vaccine that is self-administered by the patient sublingual over 3 months, and that is why it appears to be so safe,” says J. Curtis Nickel, MD.

Dr. Nickel discusses the safety of novel recurrent UTI vaccine

 assess the factors involved in patient satisfaction of telehealth phone and video calls. Abraham is an associate professor and residency director of the department of urology at Montefiore Medical Center, and Shin is a medical student at the Albert Einstein College of Medicine, Bronx, New York.

“This is an important form of providing health care, especially for people who have a lot of limitations in coming for in-person visits,” says Nitya E. Abraham, MD.