Year in review: Female pelvic medicine and reconstructive surgery 2022 highlights - Urology Times

The past twelvemonth has brought astir immoderate unthinkable strides successful urology, spanning everything from advances successful treatments to changes successful signifier management. To observe these achievements, Urology Times® is closing retired 2022 by highlighting immoderate of the objective and probe milestones from antithetic areas of urology implicit the past year.

In this iteration, Michelle E. Van Kuiken, MD, discusses immoderate of the objective and probe highlights successful pistillate pelvic medicine and reconstructive country (FPMRS) implicit the past twelvemonth and looks up to what mightiness beryllium connected the skyline for the tract successful 2023. Van Kuiken is simply a urologist astatine University of California, San Francisco Health, specializing successful FPMRS.

Could you picture your objective practice?

I'm a urologist who specializes successful pistillate pelvic medicine and reconstructive surgery, besides known arsenic urogynecology. My objective signifier is astir 70% women and 30% men. I absorption connected each aspects of little urinary tract and pelvic level dysfunction specified arsenic urinary incontinence, neurogenic bladder, pelvic organ prolapse, and bladder/pelvic symptom syndromes. I besides execute analyzable reconstruction surgeries for fistulae, pelvic radiation injuries, vaginal mesh complications, and execute urinary diversion surgery.

Over the past year, what person been immoderate objective and probe highlights regarding FPMRS?

One of the areas that has gotten much attraction this twelvemonth is pistillate intersexual medicine. Issues with pistillate intersexual dysfunction (FSD) person been highlighted more, some successful the media and astatine our objective meetings. There's been a humanities paucity of information successful respect to pistillate intersexual dysfunction, on with the question of who owns pistillate intersexual dysfunction arsenic a specialty. Is it gynecologists? Is it urologists? Is it superior care?

There was a large nonfiction that came retired precocious successful The New York Times that featured Dr. Rachel Rubin and focused connected the contented of disparities successful intersexual wellness attraction betwixt men and women.¹ At caller objective meetings, there's been expanding treatment astir however to code and dainty pistillate intersexual dysfunction. Additionally, we’re starting to admit that not a batch of clinicians are getting grooming successful this area, and intelligibly determination needs to beryllium an summation successful some acquisition and probe surrounding pistillate intersexual dysfunction. A caller survey by Dr. Shoureshi et al presented astatine the AUA Western Section Meeting² recovered that lone 14% of FPMRS trained clinicians considered FSD grooming to beryllium highly oregon precise satisfactory, and 25% recovered it to beryllium somewhat satisfactory.Additionally, clinicians cited not knowing what oregon however to inquire astir FSD and uncertainty of therapeutic options arsenic barriers to screening for FSD.

Another important country of absorption is wellness attraction disparities and however patients with pelvic level disorders (PFDs) entree care. A caller systematic reappraisal and metanalysis by Mou et al published successful Urogynecology³ highlighted some promoters and barriers to attraction for patients with PDFs.They recovered that accrued cognition and consciousness of PFDs, accrued grounds severity, entree to primary/secondary care, and bully societal enactment were promoters for seeing care.Conversely, patients who were employed, had deficiency of cognition oregon embarrassment surrounding PFDs, oregon were of Black oregon Asian contention were little apt to question care. Importantly, the authors noted that lone astir 1/3 of each women with symptomatic PFDs sought care.

This survey and galore others item however entree to attraction successful this state whitethorn alteration depending connected race/ethnicity, geographic location, socioeconomic status, security type, and more. This is an highly important taxable of speech that's fortunately being addressed much and much astatine meetings, successful publications, and remains an country of ongoing probe that we’ll proceed to spot much of successful 2023 and beyond.

Another country of absorption is continuing to measure and innovate attraction offerings that we person for patients with PDFs. While determination haven’t been immoderate sweeping changes to however we execute pelvic level surgeries implicit the past year, determination are a mates of caller innovative technologies and treatments that person seen expanding popularity. One illustration is the single-incision sling for accent urinary incontinence. A caller proceedings published successful the NEJM⁴ showed that determination was non-inferiority of single-incision slings compared with accepted TVT [tension-free vaginal tape] slings for attraction of accent incontinence. While not caller to the market, location pelvic level musculus grooming devices stay fashionable with patients owed to dense direct-to-consumer marketing. Fortunately, a caller meta-analysis by Pennycuff et each successful Obstetrics and Gynecology⁵ found an wide simplification successful urinary incontinence episodes and betterment successful prime of beingness among users of these devices. While incapable to authorities which instrumentality is superior, clinicians tin consciousness comfy recommending these devices to patients particularly erstwhile entree to pelvic level PT is lacking.

What advances successful FPMRS are you anticipating successful 2023?

Going backmost to the thought of however patients entree care, 1 country of accrued involvement and absorption is however we dainty patients with overactive bladder (OAB) and impulse incontinence. Unfortunately, the program of attraction for patients with OAB is often dictated by security companies, particularly successful respect to prime of medications and treatments offered. The American Urological Association and the Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU), person a line connection that outlines a tiered attraction algorithm for patients with OAB. Currently, however, this line is successful the process of being revised.One imaginable result of this revision whitethorn beryllium to alteration the “tiered” strategy, which could let patients to much easy entree definite medications and much precocious therapies earlier successful the attraction pathway.

Ultimately, arsenic discussed above, the tract of FPMRS needs to proceed to amended recognize barriers to attraction for patients with PFDs, and I expect continued probe and innovation successful this abstraction successful 2023 and beyond.

Could you picture your ain probe interests?

I americium funny successful Health Services Research, e.g. however patients entree care. Currently, I americium moving with the American Urological Association’s AQUA Registry, which is simply a database of practicing urologists successful the United States, to analyse signifier trends successful OAB management. Using this dataset, we’re assessing however patients with OAB entree attraction based connected a assortment of antithetic factors including race/ethnicity, gender, age, geographic location, and security type.We’re besides examining what leads to deficiency of progression oregon delays successful progression done the OAB pathway.We're hoping to usage these information to make a baseline of however patients are accessing attraction by urologists successful the US truthful that we tin amended pass interventions successful the future.

References

1. Gross RE. Half the satellite has a clitoris. Why don’t doctors survey it? The New York Times. October 26, 2022. Accessed November 15, 2022. https://www.nytimes.com/2022/10/17/health/clitoris-sex-doctors-surgery.html

2. Shoureshi P, Dubinskaya A, Karram M, et al. Female intersexual dysfunction: Practice patterns past and now. Presented astatine the Western Sectional Meeting of the American Urological Association successful Los Angeles, California. Accessed November 29, 2022. https://virtual.oxfordabstracts.com/#/event/3112/submission/234

3. Mou T, Gonzalez J, Gupta A, et al. Barriers and promotors to wellness work utilization for pelvic flood disorders successful the United States: Systematic reappraisal and meta-analysis of qualitative and quantitative studies. Urogynecology. September 2022. Accessed November 29, 2022. doi: 10.1097/SPV.0000000000001215

4. Abdel-Fattah M, Cooper D, Davidson T, et al. Single-incision mini-slings for accent urinary incontinence successful women. The New England Journal of Medicine. March 31, 2022. Accessed November 29, 2022. doi: 10.1056/NEJMoa2111815

5. Pennycuff JF, Borazjani A, Wang H, et al. Commercially disposable location pelvic grooming devices for the attraction of pelvic level disorders. Obstetrics and Gynecology. August 2022. Accessed November 29, 2022. doi: 10.1097/AOG.0000000000004860