Urogynecology (Hagerstown, Md.)最新文献

{"title":"Third-Line Overactive Bladder Therapies on TikTok: What Does the Public Learn?","authors":"Alexandra L Tabakin, Sharon Choi, Arshia Sandozi, Kelli Aibel, Michael A Weintraub, Harvey A Winkler, Dara F Shalom, Justina Tam, Wai Lee","doi":"10.1097/SPV.0000000000001431","DOIUrl":"10.1097/SPV.0000000000001431","url":null,"abstract":"<p><strong>Importance: </strong>Millions of people rely on social media platforms, including TikTok, for health-related information. TikTok has not yet been evaluated as an information source for overactive bladder (OAB) third-line therapies.</p><p><strong>Objectives: </strong>Our aim was to assess TikTok videos on third-line therapies for OAB for misinformation and quality.</p><p><strong>Study design: </strong>In this cross-sectional analysis, we abstracted the top 50 TikTok videos for keywords: \"Axonics,\" \"sacral neuromodulation,\" \"Interstim,\" \"PTNS,\" \"posterior tibial nerve stimulation,\" and \"bladder Botox.\" Videos were scored for quality by 3 independent reviewers using the Medical Quality Video Evaluation Tool (MQ-VET). Two reviewers determined if videos contained misinformation.</p><p><strong>Results: </strong>Of 300 videos screened, 119 videos were included. Twenty-four (21%) were created by medical professionals (MPs). Medical professional videos were more frequently shared (5 vs 1, P < 0.01) but had similar views, likes, comments, and length. Although MP videos had significantly higher MQ-VET scores (43 vs 27, P < 0.01), there was no difference in the rate of misinformation between MP and non-MP videos (21% vs 18%). Twenty-two videos (18.4%) contained misinformation, which were 3 times longer (50.5 vs 15 seconds, P < 0.01) and had higher MQ-VET scores (34.5 vs 27, P = 0.03) than those without misinformation. Common themes of misinformation pertained to therapy indication, mechanism of action, and patient limitations after undergoing therapy.</p><p><strong>Conclusions: </strong>Many TikTok videos on OAB third-line therapies contain misinformation. Most of these videos were not of high quality and created by the public. Medical professionals should be aware of misinformation permeating TikTok, given its large audience, and aim to promote or offer educational material of better accuracy and quality.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"557-563"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Cohort Study of At-Home Catheter Removal After Urogynecologic Surgery.","authors":"Abigail P Davenport, Yi W Li, Lucie T Lefbom, Cheryl B Iglesia, Alexis A Dieter","doi":"10.1097/SPV.0000000000001430","DOIUrl":"10.1097/SPV.0000000000001430","url":null,"abstract":"<p><strong>Importance: </strong>In-office postoperative voiding trials (VTs) increase health care burden for patients and physicians. Adoption of an at-home VT option may decrease burden without increasing adverse events postoperatively.</p><p><strong>Objective: </strong>The purpose of this study was to compare 30-day postoperative outcomes between participants who performed an at-home autofill VT after catheter self-discontinuation during the Assessing Healthcare Utilization and Feasibility of Transurethral Catheter Self-discontinuation (FLOTUS) study and a \"historic\" control cohort of patients who presented to the office for backfill-assisted VT on postoperative day (POD) 1.</p><p><strong>Study design: </strong>This was a retrospective cohort study of women with postoperative urinary retention after urogynecologic surgery between June 2020 and March 2022. Outcomes from the FLOTUS study were compared with a \"historic\" control cohort of patients that were identified on chart review from the year before FLOTUS initiation. Demographic, medical history, and procedure-related data were collected. Thirty-day outcome data included office calls/messages, office visits, emergency department visits, complications, and catheterization outcomes.</p><p><strong>Results: </strong>Forty-six participants were included in the FLOTUS cohort and 65 participants in the historic cohort. There was no difference in the POD1 VT pass rate, number of office calls/messages, emergency department visits, or postoperative complications between the 2 cohorts. The FLOTUS patients attended 1 less office visit (1 vs 2 office visits, P <0.001), and this difference persisted on regression analysis (-0.87 office visits; 95% CI, -1.18 to -0.56, P <0.001).</p><p><strong>Conclusion: </strong>Patients who had backfill-assisted VTs on POD1 attended 1 additional office visit compared with those who removed their catheters at home.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"550-556"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139907101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a Digital Conversational Agent for the Management of Overactive Bladder.","authors":"David Sheyn, Natalie Chakraborty, Yufan Brandon Chen, Sangeeta T Mahajan, Adonis Hijaz","doi":"10.1097/SPV.0000000000001428","DOIUrl":"10.1097/SPV.0000000000001428","url":null,"abstract":"<p><strong>Importance: </strong>Conservative therapy is effective for the treatment of overactive bladder (OAB) but may be limited by accessibility to care.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the efficacy of a digital conversational agent (CeCe) for the treatment of OAB.</p><p><strong>Study design: </strong>This was a prospective observational trial utilizing a digital conversational agent developed by Renalis University Hospitals (Cleveland, Ohio) for the treatment of OAB. Patients were given access to CeCe over an 8-week period and were instructed on how to perform bladder training and pelvic floor exercises and taught about bladder health. The primary outcome was a decrease in the International Consultation on Incontinence-Overactive Bladder Quality-of-Life Questionnaire (ICIQ-OAB-QoL) score from week 1 to week 8. Patients also completed the 36-item Short-Form Health Survey and Generalized Anxiety Disorder Questionnaire at the same intervals and voiding diaries at weeks 1, 4, and 8. A power analysis was performed and determined that a total of 30 patients would be needed to demonstrate a significant difference in symptom scores after use of CeCe with 80% power and an α error of 5%.</p><p><strong>Results: </strong>Twenty-nine patients completed all data collection. The ICIQ-OAB-QoL scores were significantly different between weeks 1 and 8 (62 [IQR], 49-75) vs 32 [IQR, 24-43]; P < 0.001). Patients also reported a decrease in frequency pretreatment and posttreatment (7 [IQR, 6-10] vs 5 [IQR, 4-7]; P = -0.04), nocturia (2 [IQR, 1-3] vs 1 [IQR, 1-2]; P = 0.03), and urge urinary incontinence (2 [IQR, 1-5] vs 0 [IQR, 0-3]; P = 0.04). Consumption of alcohol decreased from week 1 to week 8 (24 oz [IQR, 12-36 oz) to 14 oz (IQR, 9-22 oz]; P = 0.02).</p><p><strong>Conclusion: </strong>The use of a digital conversational agent effectively reduced the severity of symptoms and improved quality of life in patients with OAB.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"536-544"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71489754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retropubic Versus Transobturator Midurethral Slings at Time of Colpocleisis.","authors":"Jennifer W H Wong, Douglas A Stram, Minita S Patel","doi":"10.1097/SPV.0000000000001509","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001509","url":null,"abstract":"<p><strong>Importance: </strong>This study aimed to evaluate if there is a difference between outcomes when retropubic or transobturator midurethral sling surgery is performed at the time of colpocleisis.</p><p><strong>Objectives: </strong>The purpose of this study was to compare the surgical outcomes of the retropubic midurethral sling (RP-MUS) versus the transobturator midurethral sling (TO-MUS) in women who underwent concomitant colpocleisis, specifically 2-year MUS failure and 1-year lower urinary tract symptoms (LUTSs). A secondary aim was to identify factors associated with these surgical outcomes.</p><p><strong>Study design: </strong>All cases of concomitant MUS and colpocleisis within a closed, integrated health care delivery system were reviewed between April 1, 2010, and March 31, 2020. Postoperative MUS failure was defined as (1) postoperative stress urinary incontinence symptoms and/or (2) additional anti-incontinence surgery. Postoperative LUTSs were defined as (1) MUS lysis and/or (2) overactive bladder requiring management with a new treatment.</p><p><strong>Results: </strong>Of the 558 women included, 454 (81%) received RP-MUS and 104 (19%) received TO-MUS. Cohort demographics were similar. Neither MUS failure (7% RP-MUS and 9% TO-MUS, P = 0.450) nor LUTSs (7% RP-MUS and 12% TO-MUS, P = 0.171) were significantly different between RP-MUS and TO-MUS. In multivariable analysis, age was found to be significantly associated with LUTSs (odds ratio 0.29, 95% confidence interval 0.09-0.93, P = 0.038 among 70-74-year-olds; odds ratio 0.28, 95% confidence interval 0.09-0.83, P = 0.022 among 75-79-year-olds).</p><p><strong>Conclusions: </strong>At the time of colpocleisis, both RP-MUS and TO-MUS were highly successful and associated with a low incidence of LUTSs, including MUS lysis. The findings of this large study support RP-MUS and TO-MUS as similarly effective anti-incontinence options at time of colpocleisis.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Analysis of Bladder Catheterization After Pelvic Floor Surgery.","authors":"Anouk Benseler, Zi Ying Zhao, Muhammad Harris Sheikh, Brian Chan, George Tomlinson, Colleen D McDermott","doi":"10.1097/SPV.0000000000001519","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001519","url":null,"abstract":"<p><strong>Importance: </strong>Approximately 15-45% of female patients develop transient postoperative urinary retention (POUR) following pelvic reconstructive surgery. Catheter options for bladder drainage include transurethral indwelling catheter (TIC), intermittent self-catheterization (ISC), and suprapubic tube (SPT). Each strategy has risks and benefits; none have been shown to be clinically superior, and to date, no comprehensive comparative economic analysis has been published.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the cost of these different bladder catheterization strategies after transvaginal pelvic surgery.</p><p><strong>Study design: </strong>A Canadian universal single-payer (government funded) health system perspective was taken, and a decision tree model was constructed to evaluate the costs associated with each catheterization strategy over a 6-week horizon. Base-cases were set based on recently published clinical data of our institutions, 2 academic tertiary care centers, and based on systematic reviews and meta-analyses. Costs were established in consultation with process stakeholders, in addition to published values.</p><p><strong>Results: </strong>The average cost calculated for management of transient POUR after outpatient pelvic reconstructive surgery was 150.69 CAD (median 154.86; interquartile range [IQR] 131.30-176.33) for TIC, 162.28 CAD (median 164.72; IQR 144.36-189.39) for ISC and 255.67 CAD (median 270.63; IQR 234.32-276.82) for SPT. In costing inpatient surgical data, the average cost calculated was 134.22 CAD (median 123.61; IQR 108.87-151.85) for TIC and 224.61 CAD (median 216.07; IQR 203.86-231.23) for SPT.</p><p><strong>Conclusion: </strong>TIC and ISC were found to be significantly less costly than SPT in managing transient POUR following transvaginal pelvic reconstructive surgery.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Postoperative Urinary Retention Rates Between Robotic Apical Prolapse Repairs.","authors":"Kaythi Khin, Shaun T Adair, Laura Dhariwal, Erika Wasenda, Ellie Leong, Stephanie Chiu, Carolyn Botros","doi":"10.1097/SPV.0000000000001529","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001529","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the risk of urinary retention with different prolapse repair surgical procedures is important for perioperative counseling.</p><p><strong>Objective: </strong>The study compared postoperative urinary retention rates between robotic sacrocolpopexy and robotic uterosacral ligament suspension.</p><p><strong>Study design: </strong>This institutional review board-exempt retrospective cohort study compared patients who underwent pelvic organ prolapse repair with robotic sacrocolpopexy (RSCP) and robotic uterosacral ligament suspension (RUSLS) between June 2018 and March 2022. Our primary outcome was the rate of acute postoperative urinary retention (POUR) in these groups. Secondary outcomes were the number of days needed to resolve urinary retention and persistent voiding dysfunction.</p><p><strong>Results: </strong>Out of 298 patients, 258 underwent RSCP and 40 underwent RUSLS. Acute POUR was found in 73 patients (24%): 46 patients (18%) in the RSCP group versus 26 patients (65%) in the RUSLS group (P < 0.001). Multivariate analysis demonstrated a significantly higher rate of acute POUR after RUSLS (odds ratio [OR] = 17.92, confidence interval [CI] = 3.06-104.86; P = 0.001). Patients with an elevated preoperative postvoid residual volume >100 mL or concomitant midurethral sling were more likely to develop POUR (OR = 2.93, CI = 1.43-5.98; P = 0.003 and OR = 2.19, CI = 1.16-4.14; P = 0.016, respectively). While patients with higher parity were less likely to have urinary retention (OR = 0.71, CI = 0.53-0.96; P = 0.024), age, body mass index, prolapse stage, and concurrent posterior repair did not affect the urinary retention rate significantly. The number of days needed to resolve POUR and persistent voiding dysfunction were similar.</p><p><strong>Conclusions: </strong>Acute POUR appears more likely to develop after RUSLS compared to RSCP. Elevated preoperative postvoid residual volume and concomitant midurethral sling surgery independently increase the risk of POUR.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Activity Restrictions After Slings: A Randomized Controlled Trial.","authors":"Erica Lai, Katherine McDonald, Vini Chopra, Lindsay Robinson, Alejandro Alvarez, Danielle O'Shaughnessy, Nirmala Pillalamarri, Allison Polland, Dara Shalom, Harvey Winkler","doi":"10.1097/SPV.0000000000001515","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001515","url":null,"abstract":"<p><strong>Importance: </strong>Restricting activity after midurethral slings is an unproven practice.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the effect of postoperative activity restriction on satisfaction and outcomes after slings.</p><p><strong>Study design: </strong>This was a multicenter, 2-arm, noninferiority randomized controlled trial. Patients aged 18-85 years undergoing treatment with a midurethral sling were randomized 1:1 to postoperative activity restriction or liberal activity. Restrictions included avoidance of strenuous exercise and heavy lifting. The liberal group was allowed to resume activity at their discretion. Our primary outcome was satisfaction with postoperative instruction at 2 weeks. Secondary outcomes included surgical failure, mesh exposure rates, and other adverse events.</p><p><strong>Results: </strong>In total, 158 patients were randomized with 80 to the liberal group and 78 to the restricted group. At 2 weeks, 54 (80.6%) of patients in the liberal group and 48 (73.9%) of patients in the restricted group were satisfied. We found statistical evidence supporting the hypothesis that postoperative liberal activity instruction is noninferior to activity restriction with regard to patient satisfaction (P = 0.0281). There was no significant difference in strenuous activity at 2 weeks (P = 0.0824). The liberal group reported significantly more moderate activity at 2 weeks (P = 0.0384) and more strenuous activity at 6 weeks and 6 months (P = 0.0171, P = 0.0118, respectively). The rate of recurrent or persistent stress incontinence for liberal versus restricted groups was 18.52% versus 23.53% (P = 0.635). There were no statistically significant differences in complication rates.</p><p><strong>Conclusions: </strong>Postoperative liberal activity was noninferior to activity restriction with regard to patients' satisfaction. There was no evidence supporting a statistically significant association between postoperative instruction and negative surgical outcomes.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Stress Urinary Incontinence: Does Race Matter?","authors":"Brittni Boyd, Noelani Guaderrama, Zimin Zhuang, Stephanie Tovar, Emily Whitcomb","doi":"10.1097/SPV.0000000000001525","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001525","url":null,"abstract":"<p><strong>Importance: </strong>The importance of this study was to examine treatment patterns and surgical complications for stress urinary incontinence (SUI).</p><p><strong>Objectives: </strong>The aim of this study was to describe the treatment of SUI and associated complications in a racially and ethnically diverse population.</p><p><strong>Study design: </strong>This was a retrospective cohort study of patients with a new diagnosis of SUI. We identified patients who received treatment with a pessary, pelvic floor physical therapy, or surgery. Surgical complications were abstracted. Logistic regression was used to examine the association between race/ethnicity and treatment, as well as surgical complications.</p><p><strong>Results: </strong>A total of 67,187 patients with a new diagnosis of SUI were included. The population was predominately Hispanic (47.5%) followed by White, Asian, Black, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native. Comparing no treatment to any treatment, all racial/ethnic groups, except American Indian/Alaska Native, had decreased odds of receiving treatment compared with White women. Hispanic and Native Hawaiian/Pacific Islander women had increased odds of referral for pelvic floor physical therapy compared with White women. All racial/ethnic groups, except for American Indian/Alaska Native women, had decreased odds of receiving a sling procedure compared with White women. When these racial/ethnic minority groups did receive treatment, it was more likely to be conservative treatment compared with White women. There were no significant differences in individual surgical complications.</p><p><strong>Conclusions: </strong>Racial minority women were 20-50% less likely to undergo a sling procedure, commonly posited as the gold standard surgical treatment. Racial minority women were 40-100% more likely to receive conservative management and 20-50% less likely to receive any treatment compared with White women.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Obesity on Midurethral Sling Failure in a Highly Hispanic Population.","authors":"Jun Song, Xuemei Song, Zhu Wang, Alexandriah Alas","doi":"10.1097/SPV.0000000000001523","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001523","url":null,"abstract":"<p><strong>Importance: </strong>Mixed data exist in the literature regarding the impact of obesity on midurethral sling (MUS) failure rates.</p><p><strong>Objective: </strong>The aim of this study was to evaluate the impact of obesity and Hispanic ethnicity on MUS failure.</p><p><strong>Study design: </strong>This was a retrospective cohort study of females who underwent MUS surgery, alone or with concomitant prolapse repair, with at least 1 year of follow-up. Body mass index (BMI) classes were categorized as normal (<25 kg/m2), overweight (25-29.9 kg/m2), obese (30-39.9 kg/m2), and severe obesity (≥40 kg/m2). The primary outcome was MUS failure, defined as a composite of subjectively unchanged or worsened symptoms or need for additional procedures. Secondary outcomes included risk factors related to MUS failure and the effect of ethnicity on MUS failure rates.</p><p><strong>Results: </strong>A total of 322 women were included for analysis. The mean age was 52.3 years. Increasing BMI was associated with higher MUS failure, with multivariate logistic regression showing a 5% increased risk for each 1 kg/m2 BMI increase. Failure rates were significantly different between normal BMI and severe obesity (16.7% vs 36.4%, P = 0.04). After adjusting for other variables, transobturator slings had a higher risk of failure compared with retropubic slings, whereas surgeon training and patient ethnicity did not affect failure rates.</p><p><strong>Conclusions: </strong>We found that increasing BMI was associated with higher MUS failures, with significantly higher failure rates in the severely obese population. Although MUS remains the standard of care for treatment of SUI, based on our findings, counseling should be individualized to the patient, taking into account each patient's unique characteristics.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referral and Prescription Patterns for Female Patients With Urinary Incontinence.","authors":"Marie C Luebke, Emily R W Davidson, Bradley H Crotty, Nicole Fergestrom, R Corey O'Connor, Emily Schmitt, Aaron N Winn, Kathryn E Flynn, Joan M Neuner","doi":"10.1097/SPV.0000000000001423","DOIUrl":"10.1097/SPV.0000000000001423","url":null,"abstract":"<p><strong>Importance: </strong>Although behavioral modifications, medications, and other interventions can improve urinary incontinence (UI), many women never receive them.</p><p><strong>Objectives: </strong>To better characterize UI treatment patterns in primary care, we examined prescriptions and referrals to pelvic floor physical therapy (PFPT) and specialist physicians within a large Midwestern academic health system.</p><p><strong>Study design: </strong>Electronic health records were queried to identify a cohort of adult female patients receiving a new UI diagnosis during outpatient primary care visits from 2016 to 2020. Urinary incontinence referrals and referral completion were examined for the overall cohort, and medication prescriptions were examined for women with urgency or mixed UI. Logistic regression was used to assess the association of prescriptions and/or referrals with patient demographics, comorbidities, and UI diagnosis dates.</p><p><strong>Results: </strong>In the year after primary care UI diagnosis, 37.2% of patients in the overall cohort (n = 4,382) received guideline-concordant care. This included 20.6% of women who were referred for further management: 17.7% to urology/urogynecology and 3.2% to PFPT. Most women who were referred attended an initial appointment. Among those with urgency (n = 2,398) or mixed UI (n = 552), 17.1% were prescribed medication. Women with stress (odds ratio [OR], 3.10; 95% CI, 2.53-3.79) and mixed UI (OR, 6.17; 95% CI, 4.03-9.66) were more likely to be referred for further management, and women diagnosed during the COVID-19 pandemic were less likely to be referred for further care (OR, 0.39; 95% CI, 0.29, 0.48).</p><p><strong>Conclusion: </strong>Only slightly above 1 in 3 women with a new diagnosis of UI in primary care received guideline-based medications or referrals within 1 year, suggesting missed opportunities for timely care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"489-497"},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11002977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50164072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}