Female Pelvic Medicine Research Articles

The Competitiveness of Obstetrics and Gynecology Fellowships: A 15-Year Assessment [ID: 1380331

INTRODUCTION: While subspecialty competitiveness for obstetrics and gynecology fellowships has evolved over the last 15 years, objective competitiveness is poorly understood. This study aimed to assess the competitiveness of obstetrics and gynecology fellowships using the normalized competitive index (NCI). METHODS: Obstetrics and gynecology subspecialty match data for gynecologic oncology (GO), maternal–fetal medicine (MFM), reproductive endocrinology and infertility (REI), and female pelvic medicine and reconstructive surgery (FPMRS) were obtained from the National Resident Matching Program from 2008 to 2022. The competitive index (CI) was determined by the percentage of positions filled divided by the match rate (matched applicants/total). The NCI was determined by the yearly CI divided by the average CI of the particular subspecialty. Statistical analyses included univariate analysis and linear regression. RESULTS: Comparing 2008–2015 versus 2016–2022, fellowship applicants (335.2±27.1 versus 381.4±19.9, P<.01) and positions (225.1±23.6 versus 294.3±22.6, P<.01) significantly increased. Match rate significantly increased for GO, MFM, and FPMRS (0.62±0.05 versus 0.68±0.02, P=.02; 0.67±0.08 versus 0.78±0.08, P=.03; 0.66±0.10 versus 0.79±0.06, P=.01, respectively), but did not change for REI (0.62±0.06 versus 0.69±0.08, P=.06). The NCI decreased for MFM (R2=0.43, P<.01) and FPMRS (R2=0.60, P<.01), from 2008 to 2022 indicating decreased competitiveness. The NCI for REI (R2=0.24, P=.06) and GO (R2=0.09, P=.27) did not significantly change. CONCLUSION: Match rate increased for three of four obstetrics and gynecology subspecialties, but the NCI for MFM and FPMRS decreased, indicating decreased competitiveness in these subspecialties. Therefore, the NCI may be a useful metric, in addition to the match rate, for obstetrics and gynecology subspecialty fellowship applicants to determine program competitiveness.

Use of prophylactic ureteral stents in gynecologic surgery.

The aim of this study was to evaluate rate of complications with the use of prophylactic ureteral localization stents (PULSe) in gynecologic surgery. To compare the occurrence of complications according to the indication of surgery. This retrospective study included 1248 women who underwent 1275 different gynecologic surgeries with PULSe between 2007 and 2020. Data was collected regarding patient characteristics (age, sex, race, ethnicity, parity, previous pelvic surgery, creatinine), operative characteristics (trainee, guidewire use, indication) and complications in the first 30 days (ureteral injury, urinary tract complication, re-stenting, hydronephrosis, urinary tract infection (UTI), pyelonephritis, emergency room visit, re-admission). Median age was 57 years (range: 18-96 years), most women were Caucasian (88.9%), and had previous pelvic surgery (77.7%). Indication of surgery was benign for 459 (36.0%), female pelvic medicine and reconstructive surgery (FPMRS) for 545 (42.7%), and gynecologic oncology (gyn-onc) for 271 (21.3%). Disabling complications occurred rarely with 8 patients (0.6%) having a ≥III Clavien Dindo Grade (CDG), and only 1 (0.08%) ≥IV CDG. Statistically significant differences between benign, FPMRS, and gyn-onc groups were noted for re-stenting (0.9% vs. 0.0% vs. 1.1%, P=0.020), hydronephrosis (0.9% vs. 0.2% vs. 2.2%, P=0.014), UTI (4.6% vs. 9.4% vs. 7.0%, P=0.016), and re-admission (2.4% vs. 1.1% vs. 4.4%, P=0.014). The incidence of 30-day CDG III and IV complications after PULSe placement is low. FPMRS patients had a higher rate of complicated UTI, however gyn- onc patients appear to be at overall higher risk of stent related complications when compared to surgeries for FPMRS or benign indications.

JU Open Plus: American Urological Association Annual Meeting 2023: Time With Our Science and the Mentors that Make It Happen

JU Open Plus: American Urological Association Annual Meeting 2023: Time With Our Science and the Mentors that Make It Happen

A narrative review on surgical treatment options for male stress urinary incontinence.

Stress urinary incontinence (SUI) can occur due to a variety of etiologies. For male patients specifically, SUI is typically thought of as iatrogenic secondary to intrinsic sphincter deficiency occurring after prostate surgery. Given the noted negative impact that SUI can have on a man's quality of life, multiple treatment options have been developed to improve symptoms. However, there is no "One-Size-Fits-All" approach to management of male SUI. In this narrative review, we sought to highlight some of the various procedures and devices available to treat men with bothersome SUI. This narrative review gathered primary resources through Medline search, and secondary resources by cross-referencing citations used in articles of interest. We started our investigation by searching for previous systematic reviews on male SUI and treatments for male SUI. Furthermore, we reviewed societal guidelines, such as the American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines and the recently published European Urological Association guidelines. Our review focused on English-language full-length manuscripts when available. We present multiple surgical options for men with SUI. This review focuses on surgical options including 5 fixed male slings, 3 adjustable male slings, 4 artificial urinary sphincters (AUS), and an adjustable balloon device. This review includes treatment options from across the globe, although not all included devices are available in the United States. A great variety of treatment options exist for men with SUI, although not all Federal Drug Administration (FDA) approved. Shared decision making is paramount to generate the greatest satisfaction for patients.

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 1: Background theory and practice.

The working group (WG) initiated by the International Continence Society Standardization Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction has revised the (1997) ICS Standard for pressure flow studies. Based on the ICS standard for developing evidence-based standards, the WGdeveloped this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in January 2023 to facilitate public discussion and the comments received have been incorporated into this final release. The WG summarizes the theory and recommends the practice and the terms used for the diagnosis of voiding dysfunction for adult female and male patients without relevant neurological abnormalities, in part 1 of this standard. The WG has also recommended standard principles and parameters for objective and continuous grading of urethral resistance and detrusor voiding contraction on the basis of pressure flow studies in part 2. The recommendations for practice in this part have also the aim to increase the understanding of the physiology as well as the psychology of voiding. The potential effects of the laboratory situation of the test on the voiding as well as the role of the urodynamicist in this regard are discussed. The WG has recommended to use for diagnosis only the voidings that are considered representative by the patient. A pressure flow study is the gold standard to assess voiding function and to quantify dysfunction. This part of the standard explains the clinical background, gives recommendations for the execution of a pressure flow study and lists relevant terms, parameters, and units of measurements.

Gender Equity in Academic Female Pelvic Medicine and Reconstructive Surgery Departments: A Cross-Sectional Observational Study

Gender equity in obstetrics and gynecology remains a barrier to career mobility and workplace satisfaction. This study aimed to evaluate gender equity for academic positions in female pelvic medicine and reconstructive surgery (FPMRS) divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship in the United States. This was a cross-sectional observational study of all FPMRS divisions with an Accreditation Council for Graduate Medical Education-accredited fellowship program in the United States in July 2020 using publicly available demographic and academic data collected from online search engines. Gender equity in academic FPMRS was assessed by gender representation, academic appointment, and research productivity of each attending physician within the division. Research productivity was assessed using both the H-index with career length controlled for with the M-quotient. There were 348 attending physicians from 72 FPMRS divisions (198 female [56.9%], 150 male [43.1%]). A large percentage of female attending physicians were at the assistant professor level (75.8% [94 of 124]) when compared with their male counterparts (24.4% [30 of 124]; P < 0.001). Conversely, there were a larger percentage of male attending physicians (62.2% [56 of 90]) at the professor level when compared with their female counterparts (37.8% [34 of 90]; P < 0.001). There was no difference in research productivity between male and female attending physicians after controlling for career length with the M-quotient (P = 0.65). Only age (odds ratio, 1.14; 95% confidence interval, 1.05-1.24) and the M-quotient (odds ratio, 36.17, 95% confidence interval, 8.57-152.73) were significantly associated with professorship. Our study found that there are more female attending physicians in FPMRS and that most are assistant professors. Male and female FPMRS attending physicians had similar research productivity with respect to their career lengths. Gender was not a determinant for achieving a "professor" appointment.

Modified Martius Flap Urethroplasty: A New Technique

Introduction: Female urethral strictures are rare, and there is no consensus on proper surgical treatment. The literature is primarily limited to case reports and small case series. Surgical treatment has frequently been extrapolated from male urethroplasty techniques. However, female urethroplasty differs significantly from male urethroplasty because it is performed directly across the urinary sphincter.1 We describe our rationale and technique for female ventral urethroplasty utilizing a modified Martius flap. Materials and Methods: Two female patients, aged 46 and 58 years, with chronic urethral strictures underwent a ventral modified Martius flap urethroplasty. After guidewire and open-ended ureteral stent placement across the stricture, an inverted U-flap incision was made from the distal urethra to the bladder neck. A full thickness incision into the urethral lumen was made, extending past the bladder neck, and sounded with a 30F urethral sound. An ~5 × 2 cm portion of nonhair bearing inner labia tissue was harvested and mobilized on the anterior pedicle of a Martius flap. This was then tunneled under the vaginal wall and rotated over the area of the urethral defect. The flap was sutured in place with two 4-0 polyglactin running suture lines, covering the entire gap in the urethra with good mucosal apposition. The remaining fatty tissue of the Martius flap was rotated over the suture lines, adding an extra layer to the repair. The inverted U flap incision was closed over the repair and the skin edges of the Martius flap harvest site were closed in two layers with a deep 2-0 polyglactin layer and a superficial 4-0 poliglecaprone subcuticular suture, resulting in a cosmetic closure. Results: Postoperative voiding cystourethrogram revealed an open bladder neck and no recurrent stricture for both patients. Average Uroflow peak flow was 18 mL/s. The patients had no complaints of stress incontinence (SUI) and a negative cough leak test at 1 month follow-up. At 6 months follow-up, both patients continued to deny any SUI and had no obstructive voiding complaints with minimal post-void residuals. Conclusions: Our technique using a ventral approach to urethroplasty in women with a Martius flap is effective in the management of female urethral stricture disease. This approach offers lower risk of damage to the sphincter, avoids possible clitoral nerve injury, allows for better maintenance of urethral support, and is an approach familiar to most female pelvic medicine and reconstructive surgeons. Music utilized in video obtained royalty-free from (www.bensound.com). No competing financial interests exist. The authors have received and archived patient consent for video recording and publication in advance of video recording procedure. Runtime of video: 6 mins 33 mins This project was presented at the following academic conferences: Arizona Urological Society, August 1, 2021; Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), February 25, 2022; American Urological Association (AUA) General Meeting, May 14, 2022 (https://doi.org/10.1097/JU.0000000000002586.08).

PD33-07 DIFFERENCES IN UTILIZATION OF NON-FIRST-LINE THERAPY FOR OVERACTIVE BLADDER AMONG FPMRS AND NON-FPMRS TRAINED UROLOGISTS

You have accessJournal of UrologyCME1 Apr 2023PD33-07 DIFFERENCES IN UTILIZATION OF NON-FIRST-LINE THERAPY FOR OVERACTIVE BLADDER AMONG FPMRS AND NON-FPMRS TRAINED UROLOGISTS Aaron Huang, Arshia Harandi, Jennifer Ramgopal, Jonathan Aronov, Philip Fonseca, Holly Smith, Brian Shkolnik, Inna Tabanskaya, Connelly Miller, and Jason Kim Aaron HuangAaron Huang More articles by this author , Arshia HarandiArshia Harandi More articles by this author , Jennifer RamgopalJennifer Ramgopal More articles by this author , Jonathan AronovJonathan Aronov More articles by this author , Philip FonsecaPhilip Fonseca More articles by this author , Holly SmithHolly Smith More articles by this author , Brian ShkolnikBrian Shkolnik More articles by this author , Inna TabanskayaInna Tabanskaya More articles by this author , Connelly MillerConnelly Miller More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003326.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a disease entity that greatly affects a patient’s quality of life, with some studies citing a prevalence as high as 40% in the United States. The American Urological Association and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction describe a progressive management of OAB from first to third line therapies (second line being pharmacotherapy and third line being procedural intervention). The objective of this study is to expand on the differences in utilization of non-first line therapy for OAB between Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained urologists and non-FPMRS trained urologists. METHODS: We reviewed the records of all adult female patients seen in our urology clinic for OAB symptoms from July 2020 to June 2021. Patients were classified into two groups: (1) those who were first seen by an FPMRS-trained urologist and (2) those who were not. Patient demographics, relevant clinical history, and choice of OAB therapy were also collected from the electronic medical record. Chi-squared tests, t-tests and univariate logistic regression were used to compare the characteristics of patients who were and were not seen by FPMRS-trained urologists. RESULTS: Eight hundred sixteen patients were included in this study, of which six hundred sixty three patients (81.3%) were first seen by a FPMRS-trained urologist. No demographic differences were found between the two groups. There were significantly more patients that proceeded to both second (OR 2.44, CI 1.66-3.58, p<0.001) and third-line therapy (OR 6.98, CI 2.14-22.79, p<0.001) within a year when they were first seen by FPMRS-trained providers. More patients that were first seen by FPMRS-trained providers also had incontinence more often than those seen by non-FPMRS trained urologists (Table 1). CONCLUSIONS: Patients that were first seen by FPMRS urologists were 2 times more likely to proceed to second-line therapy and nearly 7 times more likely to proceed to third-line therapy for OAB within a year when compared to those seen by their non-FPMRS-trained counterparts. This finding suggests that non-FPMRS trained urologists may be providing suboptimal treatment of OAB and necessitates further study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e916 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Huang More articles by this author Arshia Harandi More articles by this author Jennifer Ramgopal More articles by this author Jonathan Aronov More articles by this author Philip Fonseca More articles by this author Holly Smith More articles by this author Brian Shkolnik More articles by this author Inna Tabanskaya More articles by this author Connelly Miller More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

MP66-16 CURRENT EXPOSURE TO FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY DURING UROLOGY RESIDENCY

You have accessJournal of UrologyCME1 Apr 2023MP66-16 CURRENT EXPOSURE TO FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY DURING UROLOGY RESIDENCY Connie Wang, Ariana Smith, Gina Badalato, and Doreen Chung Connie WangConnie Wang More articles by this author , Ariana SmithAriana Smith More articles by this author , Gina BadalatoGina Badalato More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003329.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, few urology programs have had Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained faculty. This analysis aimed to assess contemporary exposure to FPMRS faculty during residency training in the United States (US). METHODS: US urology residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) were identified from the American Urological Association’s (AUA) website and accredited, urology based FPMRS fellowships were identified by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Number of faculty and residency positions per program were identified from AUA program profiles, if last modified within the past year, or manually extracted from program websites. Faculty with subspecialty fellowship training were identified from individual program websites. RESULTS: 9 programs (6%) were excluded from analysis due to incomplete information. Of 139 accredited residency programs assessed, 15 (10.8%) were affiliated with an accredited, urology based FPMRS fellowship. 41 (29.5%) programs had neither a FPMRS fellowship nor any FPMRS certified faculty. 7.4% of faculty at all programs were FPMRS certified. The national faculty to resident ratio was 1:0.8, whereas the national FPMRS faculty to resident ratio was 1:10.8. In comparison, national faculty to resident ratios for other subspecialties were: 1:4.7 for pediatrics, 1:3.6 for oncology, 1:5.9 for minimally invasive surgery/endourology, 1:14.2 for trauma/reconstruction, and 1:11.8 for andrology or male sexual/reproductive health (Table 1). Programs affiliated with a urology based FPMRS fellowship had a FPMRS faculty to resident ratio of 1:5.1 while programs not affiliated with a FPMRS fellowship had a FPMRS faculty to resident ratio of 1:13.4. CONCLUSIONS: 30% of US urology residency programs lack fellowship trained FPMRS faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Inadequate exposure to FPMRS cases and mentors during training may contribute to the shortage of urology residents who choose to specialize in FPMRS and may exacerbate the failure to meet growing FPMRS patient demands nationwide. The long-term effects of lower numbers of FPMRS faculty need further exploration. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e940 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Ariana Smith More articles by this author Gina Badalato More articles by this author Doreen Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

PD26-05 FEMALE SEXUAL DYSFUNCTION: PRACTICE PATTERNS &amp; PATIENT EDUCATION AMONG SUFU AND AUGS MEMBERS

You have accessJournal of UrologyCME1 Apr 2023PD26-05 FEMALE SEXUAL DYSFUNCTION: PRACTICE PATTERNS & PATIENT EDUCATION AMONG SUFU AND AUGS MEMBERS Poone Shoureshi, Alexandra Dubinskaya, Catherine Bresee, Mickey Karram, and Karyn S. Eilber Poone ShoureshiPoone Shoureshi More articles by this author , Alexandra DubinskayaAlexandra Dubinskaya More articles by this author , Catherine BreseeCatherine Bresee More articles by this author , Mickey KarramMickey Karram More articles by this author , and Karyn S. EilberKaryn S. Eilber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The evaluation and treatment of female sexual dysfunction (FSD) has been slow to progress. In 2004, the American Urogynecology Society (AUGS) surveyed its members to assess practice patterns for FSD. The objective of this study was to administer a similar survey to current members of AUGS and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) to evaluate existing practice patterns. METHODS: An electronic survey based on a prior survey administered to AUGS members in 2004 was distributed to current SUFU and AUGS members. The results were compared. RESULTS: 187 physicians responded. The majority were female (75%). Respondent experience was<5 years in practice (25%), 5-10 years (20%), 11-20 years (17%), >20 years (22%), or currently in fellowship (16%). Fifty-four percent were at an academic or university-based practice. Physicians assessed FSD by asking about sexual activity (89%), dyspareunia (89%), arousal (33%), libido (29%), and orgasm (21%), while few reported using validated questionnaires (19%). Most physicians (54%) responded they perceived the overall incidence of FSD ranged 21-50%. Screening practices and barriers are listed in Table 1 and compared to the responses from AUGS members in 2004. The majority of current responders had post-residency training (84% vs. 59% in 2004, p<0.001). 20% of current members consider FSD screening to be extremely important versus 9% in 2004 (p=0.002). Most common reason for not screening was time constraints. Current practitioners also report not screening because they do not know how/what to ask, whereas in 2004 physicians were more unsure about therapeutic options (p<0.001). In regards to post residency training, 52% were less than satisfied, significantly improved compared to 71% in 2004 (p<0.001). Eighty-seven percent of current AUGS/SUFU members would feel comfortable referring patients to an interactive phone application about FSD. CONCLUSIONS: Screening patterns and barriers to treatment of FSD have remained relatively unchanged over the last 18 years, with the most common barrier being time constraints. Many FPMRS/urogynecology trainees continue to feel unsatisfied with FSD training. In the future, phone applications may be a good resource when practitioners are uncomfortable or have a lack of time to discuss FSD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e736 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Poone Shoureshi More articles by this author Alexandra Dubinskaya More articles by this author Catherine Bresee More articles by this author Mickey Karram More articles by this author Karyn S. Eilber More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-14 WHO RECEIVES THIRD LINE THERAPIES FOR OVERACTIVE BLADDER? TRENDS FROM DATA IN THE AUA AQUA REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP19-14 WHO RECEIVES THIRD LINE THERAPIES FOR OVERACTIVE BLADDER? TRENDS FROM DATA IN THE AUA AQUA REGISTRY Katherine Shapiro, Dora Jericevic, Max Bowman, Camille Velez Morell, Rachel Mbassa, Raymond Feng, Michelle van Kuiken, and Benjamin Brucker Katherine ShapiroKatherine Shapiro More articles by this author , Dora JericevicDora Jericevic More articles by this author , Max BowmanMax Bowman More articles by this author , Camille Velez MorellCamille Velez Morell More articles by this author , Rachel MbassaRachel Mbassa More articles by this author , Raymond FengRaymond Feng More articles by this author , Michelle van KuikenMichelle van Kuiken More articles by this author , and Benjamin BruckerBenjamin Brucker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Third line therapies for Overactive Bladder (OAB) include Percutaneous Tibial Nerve Stimulation (PTNS), Sacral Neuromodulation (SNS) and OnabotulinumtoxinA bladder injections (BTX-A). The American Urologic Association (AUA) and Society for Urodynamics, Female Pelvic Medicine and Reconstructive Surgery (SUFU) have jointly developed a guideline to help manage patients with OAB. Using the AUA Quality (AQUA) registry, we aim to assess access and implementation of third line therapies. METHODS: The AQUA registry collects data from participating urologists across practice settings by direct interface with local electronic health record systems. We queried the registry for patients >18 years with a new diagnosis of OAB, urinary urgency, frequency, and urgency urinary incontinence (UUI) from 2014-2020 using ICD9 and ICD10 codes with >1 year follow up. We evaluated patients who proceeded to third line therapy by insurance type, gender, ethnicity, metropolitan status, age and medication type. We excluded patients with a diagnosis of neurogenic bladder. Multivariable regression was performed to determine the odds ratio of progression to third line therapy. Only patients who first received second line therapy prior to third line therapy were included in the analysis. RESULTS: A total of 1,401,168 patients were diagnosed with OAB during the study period. Complete data was available for 641,122 and analysis was performed specifically for this cohort. 112,021 (17.5%) patients received second line therapy with either an anticholinergic, beta-3 agonist or combination therapy. Of those, 7,487 (1.2%) received at least one third line therapy. BTX-A was the most common therapy overall (40%, 32% SNS, 28% PTNS), while PTNS was the most common third line therapy in men (35%), Asian patients (37%), patients aged >80 (40%) and patients seen in solo practitioner (46%) settings. Black and Asian race, male gender and rural setting had lower odds of progressing to third line therapy. Patients seen by providers in multi-specialty settings, single specialty settings and solo practices were approximately 3 times more likely to receive third line therapy than in an academic medical center (Table 1). CONCLUSIONS: In this study, a small percentage of patients progress from second to third line therapy. Rates varied amongst gender, race, metropolitan status and practice setting. These findings highlight opportunities to improve third line therapy implementation. Source of Funding: AUA Data Committee © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e270 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Shapiro More articles by this author Dora Jericevic More articles by this author Max Bowman More articles by this author Camille Velez Morell More articles by this author Rachel Mbassa More articles by this author Raymond Feng More articles by this author Michelle van Kuiken More articles by this author Benjamin Brucker More articles by this author Expand All Advertisement PDF downloadLoading ...

MP57-12 EVALUATING THE PRESENCE OF FEMALE UROLOGISTS IN TOP UROLOGY DEPARTMENTS IN THE UNITED STATES

You have accessJournal of UrologyCME1 Apr 2023MP57-12 EVALUATING THE PRESENCE OF FEMALE UROLOGISTS IN TOP UROLOGY DEPARTMENTS IN THE UNITED STATES Sabika Sadiq, Laura Martin, Katherine Amin, and Raveen Syan Sabika SadiqSabika Sadiq More articles by this author , Laura MartinLaura Martin More articles by this author , Katherine AminKatherine Amin More articles by this author , and Raveen SyanRaveen Syan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Women have been underrepresented in medicine, with that disparity especially evident in Urology. U.S. News World Report (USNWR) evaluates programs based on Medicare data sources and creates ranking based on patient outcomes, patient experience, nursing staff, patient volume and expert opinion. Studies suggest female Urologists are underrepresented in academic institutions, have lower publication numbers, and have slower progression from assistant professor to associate professor than male Urologists. We seek to describe the composition of female versus male attendings in the top 50 Urology departments across the United States using the 2022 USNWR ranking. METHODS: Using the 2022 USNWR top 50 institutions in Urology, we collected data using each institution’s website. We collected number of male attendings, number of female attendings, percentage of female residents in the program, presence of FPMRS fellowships and the gender of the chairperson. For institutions missing information on faculty, an asterisk was placed. Female to male urology residency ratio was calculated by female residents divided by total number of residents in the program. RESULTS: Of the top 50 Urology hospitals by 2022 USNWR ranking, 3 females are chair of their department. 26 of these institutions have a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowship program. The top 25 institutions averaged about 32.3% female residents, similar to 31.7% female residents in institutions ranked from 26-50. The percentage of female faculty in the top 25 institutions ranged from 5-37%, with the mean of 18.7%, similar to institutions ranked 26-50 (0-38% female faculty with the average of 17.9%). Of the programs with chairwomen, female residents represented 22-45% (mean 29.7%), compared to mean 32.2% in programs with chairmen (p=0.73). Female faculty representation was similar between programs with chairwomen (range 9-29%, mean 21%) and chairmen (range 0-38%, mean 18%, p=0.61). CONCLUSIONS: Despite increasing female Urology residency representation over time, women remain underrepresented in academic positions within Urology, especially among top ranked programs. Interestingly, the presence of a chairwomen did not significantly increase the proportion of female residents and faculty. Future directions include examining publication rates and professorial levels in this group. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e789 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sabika Sadiq More articles by this author Laura Martin More articles by this author Katherine Amin More articles by this author Raveen Syan More articles by this author Expand All Advertisement PDF downloadLoading ...

Changes in Education and Consistency Needed in Recurrent Urinary Tract Infection Care: Patient and Expert Physician Perspectives

Purpose: This study seeks to identify barriers to care and possible interventions to improve the treatment of recurrent urinary tract infections. Materials and Methods: Focus groups of twenty-nine women with recurrent urinary tract infections and interviews of fifteen expert physicians subspecializing in female pelvic medicine and reconstructive surgery were performed to assess the current management paradigm. The data were analyzed using the grounded theory methodology. Qualitative studies of physicians and their patients with recurrent urinary tract infection were analyzed in parallel, elucidating areas of convergent and divergent thought and allowing the investigators to identify pertinent areas for clinical improvement. Results: Qualitative analysis of the transcripts identified 3 preliminary themes: patients harbored fear; patients often received fragmented and inconsistent care for acute urinary tract infections; and patients and experts were both frustrated by limited management options and guidance for a chronic problem. Emergent themes included the need for increased patient and physician education in urinary tract infection pathophysiology and treatment and the need for a uniform multidisciplinary approach by experts and primary care physicians. Conclusions: We have identified 2 critical needs in the care of women who suffer from recurrent urinary tract infections. These deficiencies are ameliorated with clear delineation of physician roles in patient management by urologists, primary care physicians, and infectious disease specialists. Our data support the concept that a team-based approach that best uses the strengths of each specialty would dramatically improve both the outcomes and experiences of women suffering with this debilitating chronic condition.

MP37-20 INTRAVESICAL BLADDER ONABOTULINUMTOXINA: INVESTIGATION OF PATIENT RESPONSE AND TREATMENT DOSE OVER TIME

You have accessJournal of UrologyCME1 Apr 2023MP37-20 INTRAVESICAL BLADDER ONABOTULINUMTOXINA: INVESTIGATION OF PATIENT RESPONSE AND TREATMENT DOSE OVER TIME Clarissa Niino, Kai Dallas, Poone Shoureshi, Alexandra Dubinskaya, and Karyn Eilber Clarissa NiinoClarissa Niino More articles by this author , Kai DallasKai Dallas More articles by this author , Poone ShoureshiPoone Shoureshi More articles by this author , Alexandra DubinskayaAlexandra Dubinskaya More articles by this author , and Karyn EilberKaryn Eilber More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical onabotulinumtoxinA is a third-line therapy option for treatment of overactive bladder (OAB), with an average response of 6 months, sustained over 36 months, based on initial trials. However, these studies did not address increases in onabotulinumtoxinA dose over time for progression of disease. The objective of this study was to determine patient factors that are associated with increased onabotulinumtoxinA dose over time. METHODS: After IRB approval, a retrospective chart review was performed of all patients who received onabotulinumtoxinA treatments in a female pelvic medicine and reconstructive urology practice between January 2010 and July 2021. Patients were identified using CPT procedure code 52287 and data was extracted. Data reviewed included age, gender, race, BMI, smoking history, type of incontinence, surgical history, menopausal status, hormone replacement therapy use, number and dose of onabotulinumtoxinA treatments, time between treatments, and prior OAB therapies (type of medication, neuromodulation). Outcomes measured included duration of response and a dose escalation at the second or third onabotulinumtoxinA injection. Univariate comparisons were performed with the chi-square test and T-Test for categorical and continuous variables. Multivariate analysis was performed with logistic regression modeling. RESULTS: A total of 209 patients received intravesical onabotulinumtoxinA injections during the study. Mean age was 73 years. 147 (70.3%) patients underwent more than one treatment. 46 (22.0%) patients were found to have 0-6 months between the first and second treatments, 58 (27.8%) patients had 6-12 months between treatments, and 45 (21.5%) patients had over 12 months between treatments. There were no significant associations between any factors and response time; however, patient age less than 60 (56.2% vs. 26.0%, p=0.01) and dual medical therapy (35.7% vs 22.5%, p=0.04) were both associated with a dose escalation. Both factors remained significant under multivariable analysis. CONCLUSIONS: In our cohort, patients who were younger or receiving dual medical therapy were significantly more likely to have their onabotulinumtoxinA dose increased. Over the course of treatment, no significant difference was found in patient response in the setting of increasing doses. Thus, increased dosage of onabotulinumtoxinA did not directly correlate with response. This information can be used when counseling patients as to post-procedure expectations. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e522 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clarissa Niino More articles by this author Kai Dallas More articles by this author Poone Shoureshi More articles by this author Alexandra Dubinskaya More articles by this author Karyn Eilber More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-07 PRACTICE PATTERNS OF UROLOGISTS SEEKING BOARD CERTIFICATION IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP19-07 PRACTICE PATTERNS OF UROLOGISTS SEEKING BOARD CERTIFICATION IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY Samuel W. Plaska, Patricia Maymi-Castrodad, Alyssa Gracely, Giulia I. Lane, and J. Quentin Clemens Samuel W. PlaskaSamuel W. Plaska More articles by this author , Patricia Maymi-CastrodadPatricia Maymi-Castrodad More articles by this author , Alyssa GracelyAlyssa Gracely More articles by this author , Giulia I. LaneGiulia I. Lane More articles by this author , and J. Quentin ClemensJ. Quentin Clemens More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To identify opportunities to improve surgical access to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) certified urologists through review of clinical practice logs. METHODS: FPMRS clinical practice logs were obtained from the American Board of Urology from 2013-21. We grouped encounters into FPMRS diagnostic groups and calculated the proportion of clinic visits to corresponding procedures. We performed multilevel logistic regression to evaluate variability between surgeons while accounting for surgeon gender, age, certification status, year and patient age. RESULTS: 370 FPMRS urologists submitted 383,424 clinic and 323,929 procedural encounters, of which 49% constituted FPMRS-related diagnoses. Of these urinary incontinence (UI, 30%), overactive bladder (OAB; 26%), and urinary tract infections (14%) were most common. Diagnoses with the highest proportion of procedural visits (%) included pelvic organ prolapse (POP; 30%), UI (39%), and fistulas (50%), while interstitial cystitis (0%), neurogenic bladder (0%), and benign prostatic hyperplasia (4%) had the fewest associated procedures (Figure 1). Multilevel regression found that 15% of variance (intraclass correlation, ICC) in the proportion of FPMRS clinic visits to procedures was explained by clustering at the physician level and that increasing surgeon age was associated with a deceased proportion of clinic visits (Odds Ratio (OR): 0.99p=0.01).When evaluating diagnostic sub-groups, results were similar, with clustering under physicians explaining 14-19% of variance in clinic vs. procedural proportion depending on the diagnostic group. Increasing patient age was associated with increased clinic visits (fewer procedures) for OAB (OR=1.00 p<0.001), UI (OR=1.00 p<0.001), and POP (OR=1.01 p<0.001). Female physicians had 20% increased odds of having a clinic visit per procedure compared to male counterparts for UI (OR=1.25 p<0.001) and POP (OR=1.23 p=0.01). CONCLUSIONS: A large portion of FPMRS-urologists practice is non-operative and not sub-specialty related. Efforts that increase access to FPMRS-trained urologists may benefit from methods to triage non-operative management to physician extenders and focus practices on FPMRS care. Source of Funding: Medtronic Fellowship Educational Grant - AWD016079 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e266 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel W. Plaska More articles by this author Patricia Maymi-Castrodad More articles by this author Alyssa Gracely More articles by this author Giulia I. Lane More articles by this author J. Quentin Clemens More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-03 RADIATION EXPOSURE DURING SACRAL NEUROMODULATION LEAD PLACEMENT: MULTI-INSTITUTIONAL DESCRIPTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP37-03 RADIATION EXPOSURE DURING SACRAL NEUROMODULATION LEAD PLACEMENT: MULTI-INSTITUTIONAL DESCRIPTIVE STUDY Ramzy Burns, Christopher Ferari, Kimberly Kenne, Natalija Kovacevic, Joanna Orzel, Priya Padmanabhan, Charles Peterson, Charles Powell, Hannah Nakatsuka, Annah Vollstedt, Brianna Walter, and Elizabeth Takacs Ramzy BurnsRamzy Burns More articles by this author , Christopher FerariChristopher Ferari More articles by this author , Kimberly KenneKimberly Kenne More articles by this author , Natalija KovacevicNatalija Kovacevic More articles by this author , Joanna OrzelJoanna Orzel More articles by this author , Priya PadmanabhanPriya Padmanabhan More articles by this author , Charles PetersonCharles Peterson More articles by this author , Charles PowellCharles Powell More articles by this author , Hannah NakatsukaHannah Nakatsuka More articles by this author , Annah VollstedtAnnah Vollstedt More articles by this author , Brianna WalterBrianna Walter More articles by this author , and Elizabeth TakacsElizabeth Takacs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fluoroscopy has significantly improved lead placement and decreased surgical time for implantable sacral neuromodulation. Despite the Food and Drug Administration public health advisory encouraging physicians to limit the use of fluoroscopy, there is a paucity of data regarding radiation and safety of fluoroscopy during SNM procedures. The aim of our study is to characterize fluoroscopy time and dose used during SNM surgery. METHODS: Electronic medical records were queried for SNM procedures (Stage 1 and full implant) from 2016-2021 at three academic institutions. Demographic, clinical and intra-operative data and were collected, including fluoroscopy time and radiation exposure in milligray (mGy). The data was entered into a centralized REDCap database. Statistical analyses were performed using STATA/BE 17.0. RESULTS: 524 procedures were performed across three institutions. 456 were Stage 1 lead placement and 68 were full implants. 358 (68.3%) procedures had fluoroscopy details recorded. Mean surgical time was 49.2 minutes±16.8(SD). The mean fluoroscopy time was 46.1 seconds±48.9(SD) and mean dosimetry was 36.8mGy±46.1(SD). Of all procedures, 80.5% were completed by general urologists and urology-trained Female Pelvic Medicine and Reconstructive Surgery (FPMRS) specialists. Surgical specialty was significantly predictive of time and dose with FPMRS-trained urologists utilizing the lowest of both (p<0.001, Table 1). The presence of trainees significantly increased fluoroscopy time. Bilateral lead placement also significantly increased both dose and time. On multivariate analysis for fluoroscopy time, both the placement of bilateral leads and FPMRS-trained urologists had a statistically significant impact (p<0.001). CONCLUSIONS: Fluoroscopy practices in SNM procedures include significant variability in cumulative radiation dose and time based on multiple factors. These findings demonstrate the need for standardized radiation and fluoroscopy training across specialties who perform SNM procedures. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e514 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ramzy Burns More articles by this author Christopher Ferari More articles by this author Kimberly Kenne More articles by this author Natalija Kovacevic More articles by this author Joanna Orzel More articles by this author Priya Padmanabhan More articles by this author Charles Peterson More articles by this author Charles Powell More articles by this author Hannah Nakatsuka More articles by this author Annah Vollstedt More articles by this author Brianna Walter More articles by this author Elizabeth Takacs More articles by this author Expand All Advertisement PDF downloadLoading ...

PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION

You have accessJournal of UrologyCME1 Apr 2023PD14-04 OPTIMIZING ANTIBIOTIC USE IN THE TREATMENT OF OVERACTIVE BLADDER: EVALUATING THE NEED FOR PROPHYLACTIC ANTIBIOTICS PRIOR TO ONABOTULINUMTOXINA INJECTION Justina Tam, Heng Ruan, Matthew Mikula, Hannah Koenig, Alvaro Lucioni, Wai Lee, Jason Kim, Una Lee, and Kathleen Kobashi Justina TamJustina Tam More articles by this author , Heng RuanHeng Ruan More articles by this author , Matthew MikulaMatthew Mikula More articles by this author , Hannah KoenigHannah Koenig More articles by this author , Alvaro LucioniAlvaro Lucioni More articles by this author , Wai LeeWai Lee More articles by this author , Jason KimJason Kim More articles by this author , Una LeeUna Lee More articles by this author , and Kathleen KobashiKathleen Kobashi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intradetrusor injection of onabotulinumtoxinA (BTX) is safe and efficacious in the treatment of neurogenic and non-neurogenic overactive bladder (OAB). Urinary tract infection (UTI) is a known potential adverse event. Published guidelines for cystoscopic procedures with manipulation recommend the use of prophylactic antibiotics, and prophylactic antibiotics are commonly administered pre-BTX. However, there is a paucity of data demonstrating that pre-procedural antibiotic administration decreases the rate of post-procedural UTI after BTX. In the era of antibiotic stewardship and avoidance of antibiotic overuse, we aimed to study the difference in UTI rates between patients asymptomatic for UTI who receive and do not receive antibiotics at the time of BTX in a prospective, randomized multi-institutional study. Here, we report our preliminary study results. METHODS: Patients with OAB undergoing BTX who were not symptomatic for UTI and had urinalysis demonstrating fewer than 2+ leukocyte esterase at the time of injection were randomized to receive either a single dose of pre-procedural prophylactic antibiotics or no antibiotics. Patients who had taken antibiotics within 48 hours of the procedure were excluded from study participation. Symptomatic UTIs within 2 weeks of injection was identified and recorded. Demographics and past medical history were recorded. RESULTS: Of 86 patients who have been enrolled, 40 were randomized to receive antibiotics, and 46 were randomized to not receive antibiotics. Table 1 summarizes the patient demographics, clinical history, and UTI rate. At 2-week follow up, a total of 4 patients developed UTI. One patient in the antibiotic group developed UTI, and 3 patients who did not receive antibiotics developed UTI. CONCLUSIONS: Our preliminary results suggest that the use of a single dose of prophylactic antibiotic may not affect the rate of post-procedural UTI. Patient enrollment is ongoing to determine if these findings hold true in a larger patient cohort. Source of Funding: 2020 Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction Foundation Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e413 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justina Tam More articles by this author Heng Ruan More articles by this author Matthew Mikula More articles by this author Hannah Koenig More articles by this author Alvaro Lucioni More articles by this author Wai Lee More articles by this author Jason Kim More articles by this author Una Lee More articles by this author Kathleen Kobashi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-07 NATIONAL TRENDS OF COMMON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROCEDURES: 2016-2019

You have accessJournal of UrologyCME1 Apr 2023MP48-07 NATIONAL TRENDS OF COMMON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROCEDURES: 2016-2019 Connie Wang, Daniel Schoenfeld, Joseph Marte, and Gregory Joice Connie WangConnie Wang More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Joseph MarteJoseph Marte More articles by this author , and Gregory JoiceGregory Joice More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate national trends in settings and charges of common female pelvic medicine and reconstructive surgery (FPMRS) procedures. METHODS: Common FPMRS procedures were identified by Current Procedural Terminology and International Classification of Diseases (10th Revision) Procedure Coding System codes and classified into 3 categories: 1) stress urinary incontinence procedures (SUI-p) 2) pelvic organ prolapse procedures (POP-p) and 3) overactive bladder procedures (OAB-p). Data from inpatient (IP) and outpatient (OP) encounters for included procedures between 2016-2019 were extracted from the Nationwide Inpatient Sample and Nationwide Ambulatory Surgery Sample from the Healthcare Cost and Utilization Project. Stratified cluster sampling was used to create weighted, national estimates. Student t-tests and multivariable linear regression was performed to compare procedural factors. RESULTS: A total of 893,450 weighted procedures were analyzed, of which 9.3% were performed IP and 90.7% were performed OP. Over the study period, there was a 4.3% increase in total number of procedures, and the proportion performed OP increased from 88.1% to 92.5%. Between 2016-2019, there was a 10.6% and 10.5% increase in SUI-p and POP-p performed OP, respectively. Over the study period, proportion of SUI-p performed OP increased from 96.4% to 99.7%, and proportion of POP-p performed OP increased from 76.5% to 82.8%. 99.9% of OAB-p were performed OP. Charges for SUI-p performed IP were $16,705 higher than those performed OP (p=0.007) and charges for POP-p performed IP were $21,864 higher than those performed OP (p<0.0001). Predictors of SUI-p and POP-p being performed OP included private insurance, fewer co-morbidities, and receiving care at a rural facility or at a center in the Midwest or South. Additionally, SUI-p were more likely to be performed OP for patients < 52 years of age. POP-p were more likely to be performed IP than SUI-p (OR 20.8; 95% CI 20.2 - 21.5), while OAB-p were less likely to be performed IP than SUI-p (OR 0.01; 95% CI 0.01 – 0.02). CONCLUSIONS: An increasing majority of SUI and OAB procedures performed nationwide are performed in OP settings. These procedures performed OP carry less charge than those performed IP and are more likely for younger, healthier patients with private insurance. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e657 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Daniel Schoenfeld More articles by this author Joseph Marte More articles by this author Gregory Joice More articles by this author Expand All Advertisement PDF downloadLoading ...

Social Media Network Analysis of Academic Urologists’ Interaction Within Twitter Microblogging Environment

ObjectiveTo characterize academic urology Twitter presence and interaction by subspecialty designation.MethodsUsing Twitter application programming interface of available data, 94000 specific tweets were extracted for the analysis through the Twitter Developer Program. Academic urologists were defined based on American Urological Association (AUA) residency program registration of 143 residency programs, with a total of 2377 faculty. Two of 3-factor verification (name, location, specialty) of faculty Twitter account was used. Additional faculty information including sex, program location, and subspecialty were manually recorded. All elements of microblogging were captured through Anaconda Navigator. Analyzed tweets were further evaluated using natural language processing for sentiment association, mentions, and quote tweeted and retweeted. Network analysis based on interactions of academic urologist within specialty for given topic were analyzed using D3 in JavaScript. Analysis was performed in Python and R.ResultsWe identified 143 residency programs with a total of 2377 faculty (1975 men and 402 women). Among all faculty, 945 (39.7%) had registered Twitter accounts, with the majority being men (759 [80.40%] versus 185 [19.60%]). Although there were more male academic urologists across programs, women within academic urology were more likely to have a registered Twitter account overall (46% versus 38.5%) compared with men. When assessing registered accounts by sex, there was a peak for male faculty in 2014 (10.05% of all accounts registered) and peak for female faculty in 2015 (2.65%). There was no notable change in faculty account registration during COVID-19 (2019–2020). In 2022, oncology represented the highest total number of registered Twitter users (225), with the highest number of total tweets (24622), followers (138541), and tweets per user per day (0.32). However, andrology (50%) and reconstruction (51.3%) were 2 of the highest proportionally represented subspecialties within academic urology. Within the context of conversation surrounding a specified topic (#aua21), female pelvic medicine and reconstructive surgery (FPMRS) and endourology demonstrated the total highest number of intersubspecialty conversations.ConclusionsThere is a steady increase in Twitter representation among academic urologists, largely unaffected by COVID-19. While urologic oncology represents the largest group, andrology and reconstructive urology represent the highest proportion of their respective subspecialties. Interaction analysis highlights the variant interaction among subspecialties based on topic, with strong direct ties between endourology, FPMRS, and oncology.

Medicaid coverage and access to obstetrics and gynecology subspecialists: findings from a national mystery caller study in the United States

Previous research suggests that access to healthcare may influence the diagnosis and treatment of obstetrical and gynecologic pathologies. Audit studies, a single-blinded and patient-centered design, have been employed to measure access to care for health services. To date, no study has assessed the dimensions of access to obstetrics and gynecologic subspecialty care based on insurance type (Medicaid vs commercial). This study aimed to evaluate the mean appointment wait time for a new patient visit to female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility when presenting with Medicaid vs commercial insurance. Each subspecialty medical society has a patient-facing physician directory of physicians across the United States. Of note, 800 unique physicians were randomly selected from the directories (200 per subspecialty). Of the 800 physicians, each physician was called twice. The caller presented with Medicaid or, in a separate call, with Blue Cross Blue Shield. The order in which the calls were placed was randomized. The caller asked for the soonest appointment available for respective medical conditions based on subspecialty: stress urinary incontinence, new-onset pelvic mass, preconceptual counseling after an autologous kidney transplant, and primary infertility. From 800 physicians initially contacted, 477 responded to at least 1 call in 49 states plus the District of Columbia. The mean appointment wait time was 20.3 business days (standard deviation, ±18.6). A significant difference was found in new patient appointment wait times by type of insurance, with 44% longer wait time for Medicaid (ratio, 1.44; 95% confidence interval, 1.34-1.54; P<.001). When the interaction between insurance type and subspecialty was added to the model, it was also highly significant (P<.01). More specifically, Medicaid patients in female pelvic medicine and reconstructive surgery had a longer wait time than commercially insured patients. Patients seeking care in maternal-fetal medicine had the least difference, but Medicaid-insured patient wait times were still longer than commercial-insured patient wait times. Typically, a patient can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. Callers presenting with Medicaid insurance experienced significantly longer new patient appointment wait times than callers with commercial insurance.