Female Pelvic Reconstructive Surgery Research Articles

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)

Performance of chatGPT on female pelvic medicine and reconstructive surgery PROLOG exam

Performance of chatGPT on female pelvic medicine and reconstructive surgery PROLOG exam

Provider Practice Patterns Regarding Over-The-Counter Continence Devices.

Vaginal inserts and continence devices are recommended as a conservative treatment option for the management of stress urinary incontinence (SUI); however, practice patterns for recommendation and use of such devices are currently unknown. Our objectives were to better understand counseling patterns relating to over-the-counter (OTC) continence devices, to assess perceived barriers to recommending these devices, and to estimate clinician familiarity with three such devices currently available in the USA. In this cross-sectional study, an anonymous electronic survey was distributed to all Accreditation Council for Graduate Medical Education-accredited OB/GYN and Urology residency and Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellowship programs. A total of 326 survey responses were collected. Multivariate logistic regression was used to assess respondent characteristics associated with recommending OTC continence devices to patients. Sixty-four percent of respondents expressed familiarity with any OTC continence device. Of respondents who reported regular evaluation and treatment of women with SUI (n = 269), 60% reported ever recommending OTC devices for SUI. On multivariate regression, being a trainee and general OB/GYN provider were associated with being less likely to recommend OTC devices for SUI. Of respondents who did not regularly recommend OTC continence devices, reported barriers to doing so included a lack of training with these devices, leading to clinician discomfort (70%) and not remembering OTC devices as an option (15%). Given the low risk associated with patient use of these easily accessible devices, our study highlights barriers to clinician recommendation with the goal of increasing clinician awareness and consideration of OTC continence devices.

Chinese experts consensus on the complications registry of female pelvic floor reconstructive surgery with prosthesis

Chinese experts consensus on the complications registry of female pelvic floor reconstructive surgery with prosthesis

Postoperative outcomes and urodynamic findings after continence mesh removal.

To analyze urodynamics findings and patient-reported outcomes after removal of a mid-urethral mesh because data regarding outcomes following mesh removal vary in different studies, and mesh removal itself may have risks. Women who were referred to the Female Pelvic Medicine and Reconstructive Surgery Department of University College London Hospital and underwent vaginal removal of a continence mesh between January 2014 and January 2020, were included. Patient clinical data and results of video-urodynamics investigations performed 4 months after mesh removal were collected and analyzed retrospectively. In all, 204 patients were included in the study. After mesh removal, 80.5% of patients reported recurrent stress urinary incontinence (SUI), 10.1% reported prolapse symptoms, 8% reported voiding dysfunction and 2.9% reported overactive bladder (OAB) symptoms. Video-urodynamics investigations confirmed the presence of SUI (67.6%), mixed urinary incontinence (14.3%), detrusor overactivity (DO) (6.8%) and voiding dysfunction in one patient. In two women a urethral stricture was described, and 10 women were deemed to have a significant cystocele. Recurrence of SUI was the most frequent finding after continence mesh removal, both symptomatically and objectively. Women seldom reported OAB symptoms, but urodynamics showed evidence of DO despite this. On the other hand, voiding dysfunction was often reported but less often proven on urodynamics.

Female pelvic medicine and reconstructive surgery fellows' case logs remained stable during the COVID-19 pandemic.

During the COVID-19 pandemic and subsequent staffing shortages there was concern about the case volume, and thus competency, of graduating trainees due to reduced surgical volumes. Elective procedures were particularly affected, which includes Female Pelvic Medicine and Reconstructive Surgery (FPMRS) cases. To understand whether FPMRS fellows were affected, we assessed their case logs for changes during the pandemic. The nationally aggregated case logs of graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), were obtained from the Accreditation Council for Graduate Medical Education. The available academic years (AYs) included 2018-2019, 2019-2020, and 2020-2021. Standard deviation for each index category was derived from the average and 90th percentile data. One-way analysis of variance was used to compare differences in case volumes for tracked index categories between AYs. Graduating fellows logged an average of 517.4 (standard deviation [SD] 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. No significant differences in total surgical procedures were found for either specialty between pre-COVID AY 2018-2019 and COVID-affected AYs 2019-2020 and 2020-2021. For urology fellows, gastrointestinal (GI) procedures was the only index case category with a significant difference, and it was a decrease between the two COVID-affected AYs: 2020-2021 compared to 2019-2020 (8.9 vs. 4.2, p = 0.04). For both urology and OBGYN fellows, there was a statistically significant decrease in graft/mesh augmentation procedures from COVID-affected AY 2019-2020 to AY 2020-2021. This may be attributed to the reclassification of mesh removal cases from graft/mesh augmentation procedures to genital procedures in 2020-2021. There was not a significant decrease in these procedures from pre-COVID AY 2018-2019 to the COVID-affected AYs. There were no other statistically significant differences between AYs for OBGYN fellows. Surgical case volumes for FPMRS urology and OBGYN fellows who trained during the COVID-19 pandemic were comparable to those of their pre-pandemic peers. No significant differences between pre-COVID and COVID-affected years were found for either total surgical procedures or index case categories. Despite disruptions in health care nationwide, FPMRS trainee case volumes were largely unaffected.

Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery: Developed by the AUGS Quality Improvement and Outcomes Research Network.

Surgery for the correction of stress urinary incontinence is an elective procedure that can have a dramatic and positive impact on quality of life. Anti-incontinence procedures, like inguinal hernia repairs or cholecystectomies, can be classified as high-volume/low-morbidity procedures. The performance of a standard set of perioperative tasks has been suggested as one way to optimize quality of care in elective high-volume/low-morbidity procedures. Our primary objective was to evaluate the performance of 5 perioperative tasks-(1) offering nonsurgical treatment, (2) performance of a standard preoperative prolapse examination, (3) cough stress test, (4) postvoid residual test, and (5) intraoperative cystoscopy for women undergoing surgery for stress urinary incontinence-compared among surgeons with and without board certification in female pelvic medicine and reconstructive surgery (FPMRS). This study was a retrospective chart review of anti-incontinence surgical procedures performed between 2011 and 2013 at 9 health systems. Cases were reviewed for surgical volume, adverse outcomes, and the performance of 5 perioperative tasks and compared between surgeons with and without FPMRS certification. Non-FPMRS surgeons performed fewer anti-incontinence procedures than FPMRS-certified surgeons. Female pelvic medicine and reconstructive surgery surgeons were more likely to perform all 5 perioperative tasks compared with non-FPMRS surgeons. After propensity matching, FPMRS surgeons had fewer patients readmitted within 30 days of surgery compared with non-FPMRS surgeons. Female pelvic medicine and reconstructive surgery surgeons performed higher volumes of anti-incontinence procedures, were more likely to document the performance of the 5 perioperative tasks, and were less likely to have their patients readmitted within 30 days.

Current exposure to Female Pelvic Medicine and Reconstructive Surgery faculty during urology residency.

Contemporary US resident exposure to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) faculty during urology residency is unknown. Accredited US urology residencies were identified through the American Urological Association (AUA). Accredited, urology-based FPMRS fellowships were identified through the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The number of faculty and residency positions were obtained from program AUA profiles if they were last modified within the current application cycle; this information was obtained from program websites if AUA profiles were outdated. Data on faculty fellowship training was manually extracted from program websites. A quality control cross-check of program and faculty training characteristics was performed through direct communication with 5% of programs. Of 139 accredited residency programs assessed, 10.8% were affiliated with an accredited, urology-based FPMRS fellowship. In total, 29.5% of residency programs, representing 25% of US urology residents, had neither a FPMRS fellowship nor any FPMRS certified faculty. The national FPMRS faculty-to-resident ratio was 1:10.8, and 7.4% of faculty at all residency programs were FPMRS certified. In comparison, 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. The FPMRS faculty-to-resident ratio was 1:5.1 in programs with a urology-based FPMRS fellowship compared with 1:13.4 in programs without a FPMRS fellowship. 30% of US urology residency programs lack FPMRS trained faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Further studies are required to ascertain if inadequate exposure to FPMRS cases and mentors during training contribute to the shortage of urology residents who choose to specialize in FPMRS. This link has important implications for the current shortage of FPMRS providers.

US patterns of care for urodynamic evaluation for BPH.

Practice patterns around the use of urodynamic evaluation (UDS) for benign prostatic hyperplasia (BPH) surgery are largely undefined. As such, we investigated factors associated with the use of UDS for BPH. We used American Board of Urology case log data from 2008 to 2020, to compare patient- and surgeon-sided factors associated with UDS utilization and BPH surgeries. We performed logistic regression models to identify factors independently associated with UDS usage for BPH. Among urologists performing UDS, the majority (80%) self-identified as general urologists and practiced in a private practice group (69%). Compared with urologists who performed no UDS, urologists who performed any UDS for BPH were more likely to be from the Mid-Atlantic (20.3% vs. 10.6%, p < 0.01) and practice in regions with populations of >1 000 000 (34.7% vs. 28.5%, p < 0.01). Overall, UDS utilization declined over time (odds ratio [OR]: 0.95 year-to-year, 95% confidence interval [CI]: 0.91-0.99). In adjusted analyses, the odds of performing UDS was higher among male (OR: 2.19, 95% CI: 1.17-4.09), older (OR: 1.05, 95% CI: 1.03-1.06), and female pelvic medicine and reconstructive surgery subspecialty (OR: 3.23, 95% CI: 2.01-5.2) urologists. Additionally, performing UDS for BPH was associated with higher BPH surgical case volume (OR: 1.004, 95% CI: 1.001-1.008). There is a significant practice variation in use of UDS for BPH. Although overall BPH surgeries are increasing, urologists are increasingly less likely to perform UDS for BPH. Specifically, urologists who perform UDS have significantly higher BPH case volume than those who do not perform UDS, suggesting that UDS usage may not factor into BPH surgery decision-making.

Patient perceptions of urgency of their pelvic floor disorders during the COVID-19 pandemic.

During the COVID-19 pandemic, many surgical societies released guidelines that included cancellation of elective cases.The aim of this study was to better understand our patients' perceptions of the severity of their pelvic floor disorders (PFDs) and to determine what factors influenced this perception. We also aimed to better understand who might be amenable to telemedicine visits and what factors influenced this decision. This is a cross-sectional quality improvement study that included women at least 18years of age diagnosed with a pelvic floor disorder being evaluated within a university Female Pelvic Medicine and Reconstructive Surgery clinic during the COVID-19 pandemic. Patients whose appointments and procedures were being cancelled were queried on whether they would be willing to answer a telephone questionnaire developed by the clinical and research teams. We gathered descriptive data from 97 female patients with PFDs using a primary phone questionnaire. The data were analyzed using proportions and descriptive statistics. Of the 97 patients, the majority (79%) viewed their conditions as non-urgent. Factors that influenced patients' perception of urgency included race (p=0.037), health status (p≤0.001), a history of diabetes (p=0.011), and willingness to attend an in-person appointment (p=0.010). Further, 52% of respondents were willing to attend a tele-health appointment. Statistically significant factors influencing this decision were ethnicity (p=0.019), marital status (p=0.019), and willingness to attend an in-person appointment (p=0.011). The majority of women did not view their conditions as urgent during the COVID-19 pandemic and were amenable to a telehealth appointment.

Health literacy in women with chronic pelvic pain.

Limited health literacy (HL) is a risk factor for poor patient outcomes, including pain. Chronic pelvic pain (CPP) is a prevalent disorder affecting up to 25% of women and coexists with multiple overlapping conditions. This study aimed to describe health literacy in women with CPP, primarily correlate HL to pain intensity and pain duration, and secondarily correlate HL to mood symptoms and pain catastrophizing. We hypothesized that women with CPP with higher HL would report lower levels of pain intensity and duration. This was a prospective, cross-sectional study. Forty-five women with CPP were recruited from outpatient Physical Medicine & Rehabilitation and Female Pelvic Medicine & Reconstructive Surgery clinics. Validated questionnaires were administered to evaluate pain intensity and duration, pain disability, psychological symptoms, pain catastrophizing, and health literacy. Statistical analyses included descriptive statistics of patient characteristics and summary scores, as well as Spearman's rank correlation coefficients (rho) to assess the strength of associations between summary scores and health literacy. Forty-five women with CPP were enrolled with mean age of 49years, majority non-Hispanic White, and median chronic pelvic pain duration of 7years. Possible or high likelihood of limited health literacy was identified in 20% women with CPP (11.1% and 8.9%, respectively). Limited health literacy was moderately correlated with pain intensity, depressive symptoms, and pain catastrophizing. Pain duration was not significantly correlated with health literacy. The remaining 80% of women with CPP were likely to have adequate health literacy. A majority of women with CPP in this single center study were likely to have adequate health literacy. Limited health literacy was seen in a minority of women with CPP but was moderately correlated with greater pain intensity, more depressive symptoms, and higher pain catastrophizing. This study identified that women with CPP were likely to have adequate HL, but underscores the importance of considering HL screening and interventions in those with higher pain intensity, depression, and pain catastrophizing.

Predictors of urinary outcomes following robotic-assisted laparoscopic prostatectomy.

Incontinence and urgency are common after prostatectomy. The University of Virginia prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimise continence outcomes following robotic-assisted laparoscopic prostatectomy (RALP). Patients are prospectively evaluated by a Female Pelvic Medicine and Reconstructive Surgery specialist. This study assessed for predictors of 3- and 6-month stress urinary incontinence (SUI) and urgency symptom outcomes following RALP. We performed a post hoc review of patients from our PFOP receiving a minimum of 6-month follow-up. Urinary symptoms are prospectively assessed using the validated International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) questionnaire and daily pad use (pads per day [PPD]). Primary study outcomes included ICIQ-MLUTS SUI and urgency domain scores and PPD. Multivariable linear regression was performed to identify variables associated with outcomes at 3 and 6months postoperatively. Variables included patient, oncologic and surgical factors. Each variable was run in a separate model with pelvic floor muscle therapy and surgeon to reduce confounding and prevent overfitting. Forty men were included. In assessment of ICIQ-MLUTS SUI domain score, at 3months, body mass index (BMI) was associated with worse scores, and at 6months, BMI, hypertension and estimated blood loss (EBL) were associated with worse scores, whereas bilateral nerve-sparing technique was associated with better scores. For ICIQ-MLUTS Urgency domain score, at 3months, preoperative use of benign prostatic hyperplasia (BPH) medication was associated with better scores. No covariates predicted 6-month ICIQ-MLUTS Urgency domain scores. For PPD use, at both 3 and 6months, BMI was a positive predictor, while preoperative use of BPH medication was a negative predictor. Increased BMI, EBL and hypertension are associated with worsened SUI outcomes following RALP, whereas bilateral nerve-sparing technique and preoperative BPH medication are associated with improved SUI outcomes. These data may inform patient counselling and help identify patients who may benefit from closer surveillance and earlier anti-incontinence intervention.

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&lt;.01) and positions (225.1±23.6 versus 294.3±22.6, P&lt;.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&lt;.01) and FPMRS (R2=0.60, P&lt;.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.

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.

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 ...

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 ...

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 ...

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 ...

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 ...