Urogynecology (Hagerstown, Md.)最新文献

{"title":"Reducing Waste During Midurethral Slings: A Quality Improvement Initiative.","authors":"Sarah Ashmore, C Emi Bretschneider, Oluwateniola Brown, Kimberly Kenton, Margaret Mueller, Julia Geynisman-Tan","doi":"10.1097/SPV.0000000000001695","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001695","url":null,"abstract":"<p><strong>Importance: </strong>The health care industry accounts for 8.5% of U.S. greenhouse gas emissions, with operating rooms being key contributors.</p><p><strong>Objective: </strong>The objective of this study was to decrease surgical waste during synthetic midurethral sling (MUS) surgical procedures.</p><p><strong>Study design: </strong>A quality improvement initiative was implemented to decrease the amount of MUS surgical waste. Waste audits were performed during 20 isolated MUS surgical procedures. Used and unused disposable items and nondisposable instruments were documented from the original packs/trays. All disposable waste was weighed after the completion of each procedure. The utilization rate of each instrument and item were determined. The MUS surgical tray was then updated, and a custom MUS surgical pack was created to include items with a utilization rate >20%. The primary and secondary outcome was the amount of waste generated and health care savings, respectively.</p><p><strong>Results: </strong>A total of 10 of 21 nondisposable instruments on the surgical tray and 7 of 26 disposable items from the surgical pack had a utilization rate <20% during the initial waste audits. There were 12 of 15 added disposable items that had a utilization rate >20%. Preaudit, median weight of waste per case was 5.6 kg. After updating the MUS surgical trays and packs, median weight of waste per case decreased to 4.9 kg (P = 0.04). On average, $348.93 was saved per case after creation of custom surgical packs that included disposable items specific to MUS surgical procedures.</p><p><strong>Conclusion: </strong>A waste audit with pack updates and health care team education significantly reduced the amount of waste and cost generated during MUS surgery.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059463","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 Randomized Controlled Trial of a Novel Device for Stress Incontinence.","authors":"Christina Escobar, Eric R Sokol, Nirit Rosenblum, Douglas Milikien, Karolynn Echols","doi":"10.1097/SPV.0000000000001676","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001676","url":null,"abstract":"<p><strong>Importance: </strong>There is a need for safe and efficacious nonsurgical options for women with stress urinary incontinence (SUI).</p><p><strong>Objective: </strong>This study compared the safety and efficacy of Yōni.Fit, a novel intravaginal insert, with a sham device in treating women's SUI.</p><p><strong>Study design: </strong>In a multicenter, single-blind, randomized, sham-controlled trial, women with SUI for ≥3 months with a positive cough stress test result were enrolled. Participants, using either Yōni.Fit or a sham device, self-fitted from 6 sizes wore the insert daily for 12 hours. The primary outcome was responder rate defined as a ≥ 50% reduction in pad weights. Secondary endpoints were change in pad weight, frequency of SUI episodes, Patient Global Impression of Change, Incontinence-Quality of Life Assessment, proportion of pad dry days, and Usefulness, Satisfaction, and Ease of Use Questionnaire.</p><p><strong>Results: </strong>Fifty-six women completed the treatment phase. The responder rate based on pad weights was higher for Yōni.Fit (53.0% vs 23.3%, P = 0.013). Among Yōni.Fit participants, a greater proportion achieved SUI responder status compared to sham (96.3% vs 27.2%, P < 0.001). Participants using Yōni.Fit rated it higher in usefulness than sham (5.95 vs 4.13, P = 0.008). Although the adverse event rate was 54.8% in Yōni.Fit and 29.6% in sham, most adverse events were mild, with vaginal discomfort reported as most common.</p><p><strong>Conclusions: </strong>Yōni.Fit significantly reduced pad weights and SUI events and was evaluated as more useful when compared to sham. Although adverse events were higher with Yōni.Fit, they were generally mild. Further research is necessary to evaluate long-term safety and efficacy.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060763","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":"Clinical Tools to Diagnose Frailty in Women With Geriatric Urinary Incontinence.","authors":"Mary Namugosa, Christina Mezes, Anita Rong, Timothy Craven, Jesseca Crawford, Candace Parker-Autry","doi":"10.1097/SPV.0000000000001692","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001692","url":null,"abstract":"<p><strong>Importance: </strong>Establishing an efficient and accurate frailty measure in older women with bothersome urinary incontinence (UI) is necessary because frailty increases the risk of UI treatment failure and postoperative morbidity.</p><p><strong>Objective: </strong>This study aimed to primarily observe associations between the clinical frailty measure of gait speed and the electronic frailty index (eFI) to determine if the eFI may be a proxy in determining presence of frailty in older women with moderate-to-severe UI symptoms.</p><p><strong>Study design: </strong>This was a secondary data analysis of a prospective cohort study of women, older than 70 years, seeking treatment for UI between 2016 and 2023. Participants underwent functional geriatric assessment to determine 4-m gait speed, chair stand pace, and UI symptom assessment. Participants with ≥2 UI episodes per day defined severe UI symptoms present with geriatric UI. Those with <2 UI episodes per day defined controls. Univariate analyses compared clinical and functional characteristics based on UI severity. Spearman rank correlated the association between the eFI, UI severity, and functional geriatric impairments. Logistic regression analyses determined the odds of having severe UI based on eFI frailty risk, adjusted for age and body mass index (BMI).</p><p><strong>Results: </strong>Eighty-one participants were included. The eFI was negatively correlated with gait speed ([r] = -0.29, P = 0.02) and did not correlate with chair stand pace. The eFI did not correlate with UI severity ([r] = 0.05, P = 0.74). The odds of having severe UI and at least mild frailty risk based on the eFI was OR of 1.15 (95% CI, 0.71-1.88]).</p><p><strong>Conclusion: </strong>The eFI may have limited clinical utility in frailty risk assessment in women with geriatric UI.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057897","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 Randomized Controlled Trial for Dual-Agent Local Analgesic in Sling Surgery.","authors":"Mildrede N Bonglack, Marlana M Ray, Meredith H Carrel-Lammert, Kelsey E Lewis, Jennifer Yeung, Jonathan M Hoehn, Rachel N Pauls, Catrina C Crisp","doi":"10.1097/SPV.0000000000001691","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001691","url":null,"abstract":"<p><strong>Importance: </strong>Narcotic use after retropubic suburethral sling surgery is not unusual. Surgeons may consider using topical analgesics to minimize narcotic use.</p><p><strong>Objectives: </strong>The aim of the study was to determine if using bupivacaine-meloxicam (Zynrelef) reduces narcotic use in the first 3 days after surgery, measured as morphine milligram equivalents (MME). Secondary aims were to compare, postoperatively, average and worst pain, satisfaction with pain control and quality of recovery between groups.</p><p><strong>Study design: </strong>This was a single-center prospective single-blinded randomized controlled trial for women undergoing retropubic sling surgery. The intervention arm received Zynrelef at the suprapubic incisions, no placebo was used in controls. Participants tracked pain levels, medication use, satisfaction with pain control and Quality of Recovery surveys in the first 3 postoperative days. Appropriate statistical analyses were applied.</p><p><strong>Results: </strong>A total of 119 women were randomized. For primary outcome, totalmedian MME from postoperative days 0-3, the control group used 37.5 MME compared to 30 MME in the Zynrelef group (interquartile range [IQR] 5.63-71.25; P = 0.61). Pain scores were low in both groups, participants were satisfied or very satisfied with pain control. Quality of recovery scores were similar between groups, with improvement by postoperative day 3 to near baseline scores. Patients with anxiety/depression used more oxycodone; 10 mg (IQR 0-30) vs 0 mg (IQR 0-15), P = 0.0027.</p><p><strong>Conclusions: </strong>Use of Zynrelef during retropubic sling surgery does not reduce narcotic use in the first 3 days postoperatively. Patients can be reassured that pain and narcotic use after surgery are low and recovery is quick.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812970","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":"Evaluating Incontinence Abstracts: Artificial Intelligence-Generated Versus Cochrane Review.","authors":"Angelo Cadiente, Catherine Implicito, Abinav Udaiyar, Andre Ho, Christopher Wan, Jamie Chen, Charles Palmer, Qilin Cao, Michael Raver, Katerina Lembrikova, Mubashir Billah","doi":"10.1097/SPV.0000000000001688","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001688","url":null,"abstract":"<p><strong>Importance: </strong>As the volume of medical literature continues to expand, the provision of artificial intelligence (AI) to produce concise, accessible summaries has the potential to enhance the efficacy of content review.</p><p><strong>Objectives: </strong>This project assessed the readability and quality of summaries generated by ChatGPT in comparison to the Plain Text Summaries from Cochrane Review, a systematic review database, in incontinence research.</p><p><strong>Study design: </strong>Seventy-three abstracts from the Cochrane Library tagged under \"Incontinence\" were summarized using ChatGPT-3.5 (July 2023 Version) and compared with their corresponding Cochrane Plain Text Summaries. Readability was assessed using Flesch Kincaid Reading Ease, Flesch Kincaid Grade Level, Gunning Fog Score, Smog Index, Coleman Liau Index, and Automated Readability Index. A 2-tailed t test was used to compare the summaries. Each summary was also evaluated by 2 blinded, independent reviewers on a 5-point scale where higher scores indicated greater accuracy and adherence to the abstract.</p><p><strong>Results: </strong>Compared to ChatGPT, Cochrane Review's Plain Text Summaries scored higher in the numerical Flesch Kincaid Reading Ease score and showed lower necessary education levels in the 5 other readability metrics with statistical significance, indicating better readability. However, ChatGPT earned a higher mean accuracy grade of 4.25 compared to Cochrane Review's mean grade of 4.05 with statistical significance.</p><p><strong>Conclusions: </strong>Cochrane Review's Plain Text Summaries provide clearer summaries of the incontinence literature when compared to ChatGPT, yet ChatGPT generated more comprehensive summaries. While ChatGPT can effectively summarize the medical literature, further studies can improve reader accessibility to these summaries.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143805101","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":"Minimally Invasive Overactive Bladder Therapy After Prolapse Surgery.","authors":"Abigail Shatkin-Margolis, Lufan Wang, Farnoosh Nik-Ahd, Leo D Dreyfuss, Kenneth Covinsky, W John Boscardin, Anne M Suskind","doi":"10.1097/SPV.0000000000001683","DOIUrl":"10.1097/SPV.0000000000001683","url":null,"abstract":"<p><strong>Importance: </strong>Associations between pelvic organ prolapse and overactive bladder exist, yet little is known regarding minimally invasive overactive bladder therapy use among older women following prolapse surgery.</p><p><strong>Objective: </strong>The aim of the study was to determine minimally invasive overactive bladder therapy use (onabotulinumtoxinA injection, percutaneous tibial nerve stimulation, sacral neuromodulation) in older women following prolapse surgery.</p><p><strong>Study design: </strong>This was a retrospective cohort study of a 100% sample of fee-for-service Medicare beneficiaries who had prolapse surgery 2014-2015. The primary outcome was new minimally invasive overactive bladder therapy and the secondary outcome was new overactive bladder diagnosis within Medicare claims data, within 2 years of prolapse surgery. Data were stratified by surgery type (obliterative, apical, anterior/posterior, and apical with anterior/posterior). Modified Poisson regression models were used to calculate relative risk for each outcome.</p><p><strong>Results: </strong>Among the 58,841 beneficiaries who underwent prolapse surgery, 1,120 (1.9%) received minimally invasive overactive bladder therapy within 2 years. Among those who underwent prolapse surgery and did not have a preexisting diagnosis of overactive bladder, 9.2% (2,580/28,160) had a new overactive bladder diagnosis within 2 years. Factors associated with the increased adjusted relative risk (aRR) of new minimally invasive overactive bladder therapy included surgery type (apical aRR 1.6, 95% CI, 1.2-2.2 compared to obliterative repair), concomitant stress urinary incontinence surgery (aRR 1.3, 95% CI, 1.2-1.5), preexisting overactive bladder (aRR 4.1, 95% CI, 3.4-4.8), and frailty (mild to severe frailty aRR 3.4, 95% CI, 2.7-4.3 compared to not frail).</p><p><strong>Conclusion: </strong>Rates of minimally invasive overactive bladder therapy following prolapse surgery were low in a national cohort of female Medicare beneficiaries despite a high prevalence of disease.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058833","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}

{"title":"The Role of Uterine Preservation at the Time of Pelvic Organ Prolapse Surgery.","authors":"Olivia H Chang, Alison Carter Ramirez, Allison Edwards, Henry H Chill, Juraj Letko, Katherine L Woodburn, Geoffrey W Cundiff","doi":"10.1097/SPV.0000000000001667","DOIUrl":"10.1097/SPV.0000000000001667","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to synthesize the current literature and provide surgeons with data to inform counseling of eligible patients for uterine-preserving prolapse surgery (UPPS).</p><p><strong>Methods: </strong>We compared UPPS to similar techniques incorporating hysterectomy, including native-tissue repairs by vaginal, laparoscopic, or open approach; mesh-reinforced repairs by vaginal, laparoscopic, or open approach; obliterative repairs; and the Manchester procedure. Reviewed outcomes include surgical and patient-reported outcomes, complications, uterine pathology, and sexual function. We conducted a structured literature search of English language articles published 1990-2023, combining MeSH terms for pelvic organ prolapse and UPPS. Data were categorized by procedure and approach, and evaluated to provide recommendations and strength of evidence based on group consensus.</p><p><strong>Results: </strong>Patient counseling on prolapse surgery should follow a benefit/risk assessment related to techniques that preserve the uterus. The discussion should include the benefits of hysterectomy for cancer detection and prevention and acknowledgment that patients should continue cervical cancer screening and evaluation of abnormal uterine bleeding following UPPS. The rate of hysterectomy after UPPS is low and most commonly for recurrent prolapse. If cervical elongation is present, trachelectomy should be considered at the time of UPPS. There is no difference in sexual function between UPPS and prolapse repair with hysterectomy. Data on pregnancy outcomes following UPPS are limited.</p><p><strong>Conclusions: </strong>Uterine-preserving prolapse surgery should be a surgical option for all patients considering surgical treatment for symptomatic pelvic organ prolapse unless contraindications exist. Uterine-preserving prolapse surgery should be offered using an individualized benefit and risk discussion of both approaches to help patients make an informed decision based on their own values.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766135","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":"Transvaginal Detrusor Nerve Radiofrequency Ablation for Overactive Bladder.","authors":"Gamal Ghoniem, Mickey Karram, Mauricio Wagner, Rodger W Rothenberger","doi":"10.1097/SPV.0000000000001684","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001684","url":null,"abstract":"<p><strong>Importance: </strong>Autonomic nerves and ganglia that affect bladder sensation and detrusor contractility are present below the proximal urethra and trigone. Radiofrequency energy has been shown to potentially ablate/modulate these nerves in overactive bladder (OAB) patients.</p><p><strong>Objective: </strong>In this study, we intended to establish the safety and efficacy of transvaginal radiofrequency energy delivered via a vaginal Morpheus (Inmode) microneedling device in female patients with OAB.</p><p><strong>Study design: </strong>Women with known OAB, both primary and refractory as well as urge-predominant mixed urinary incontinence, were treated in the office setting using transvaginal detrusor nerve radiofrequency ablation to a depth of 7 mm.The primary outcome was the change in urge incontinence episodes on a 3-day voiding diary at 3 months after procedure. Secondary outcomes were the following at 1 and 3 months: the change in urinary frequency and incontinence, Incontinence Impact Questionnaire-7 (IIQ-7), Urinary Distress Inventory-6 (UDI-6), and Patient's Perception of Bladder Condition (PPBC). A pain assessment was collected immediately after the procedure and a Patient Global Impression of Improvement questionnaire was collected at 3 months.</p><p><strong>Results: </strong>From 07/2023 to 02/2024, 32 were enrolled and 31 were followed for 3 months after treatment. Episodes of urgency incontinence, IIQ-7, UDI-6, PPBC, urinary frequency, and episodes of severe urinary urgency, had statistically significant improvement. Significant Analysis of Variance (ANOVA) testing (P < 0.001) was encountered with the IIQ-7, UDI-6, PPBC, urinary frequency, and urgency incontinence. No adverse events were encountered.</p><p><strong>Conclusions: </strong>Across all outcome metrics, the transvaginal detrusor nerve radiofrequency ablation for treatment of overactive bladder showed statistically significant improvements.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782141","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":"Finish What's Started: American Urogynecologic Society Pelvic Floor Disorder Week Abstract Publishing Rates.","authors":"Alexandra L Tabakin, Jessica Kahan, Jinsol Hyun, Wai Lee, Harvey A Winkler, Dara F Shalom","doi":"10.1097/SPV.0000000000001686","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001686","url":null,"abstract":"<p><strong>Importance: </strong>Little is known regarding the publication rate of abstracts presented at the American Urogynecologic Society (AUGS) Pelvic Floor Disorder Week (PFD).</p><p><strong>Objective: </strong>Our aims were to determine contemporary publication rates of AUGS PFD oral and poster presentation abstracts and factors associated with publication.</p><p><strong>Study design: </strong>In this retrospective study, we reviewed short and long oral and poster abstracts from 2019 and 2020 AUGS PFD. Article publication rates were calculated. Statistical analysis was performed with Kruskal-Wallis and χ2 tests. Multivariable logistic regression was used to assess factors associated with likelihood of publication.</p><p><strong>Results: </strong>We identified 831 abstracts from the 2019 and 2020 PFD. Publication rates were 23.5%, 45.4%, and 53.3% at 1, 2, and 3 years (55.1% overall) with median time to publication of 16 months. For published abstracts, median journal impact factor was 2 with median principal investigator H-index of 15. Long and short podium presentations were 4 (95% confidence interval [CI], 2.2-7.6) and 1.8 times (CI, 1.2-2.5), respectively, as likely to be published than poster presentations (both P < 0.01). Resident/fellow (odds ratio [OR] 1.7, [95% CI, 1.2-2.4], P < 0.01) and female first-authorship (OR 1.4, [95% CI, 1.0-2.0], P = 0.04) and randomized control trials (OR 2.33, [95% CI, 1.2-4.7], P = 0.02) were predictive of publication.</p><p><strong>Conclusions: </strong>Nearly half the abstracts from AUGS PFD 2019 and 2020 are unpublished. Abstracts with oral presentations, female and trainee first authors, and randomized control trials were more likely to be published. Ultimately, timely publication is critical for ensuring reliability of evidence.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782137","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":"Trends in Medicare Coverage of Overactive Bladder Medications in the United States.","authors":"Neha G Gaddam, Megan B Wallace, Alexis A Dieter","doi":"10.1097/SPV.0000000000001643","DOIUrl":"10.1097/SPV.0000000000001643","url":null,"abstract":"<p><strong>Importance: </strong>Strong evidence demonstrates long-term cognitive decline associated with anticholinergics. While prevalent among older populations, medical management of overactive bladder (OAB) is dictated by insurance coverage rather than medical provider and patient preferences.</p><p><strong>Objective: </strong>The aim of this study was to assess Medicare insurance plan coverage for select OAB medications and evaluate coverage of preferred medications to medications with a greater risk of cognitive dysfunction.</p><p><strong>Study design: </strong>This cross-sectional study analyzed formularies and coverage tiers across 6 U.S. insurers for the following OAB medications: oxybutynin instant-release (IR) 5 mg, oxybutynin extended-release (ER) 5 mg, tolterodine IR 1 mg, tolterodine ER 2 mg, fesoterodine ER 4 mg, darifenacin 7.5 mg, solifenacin 5 mg, trospium IR 20 mg, trospium ER 60 mg, mirabegron 25 mg, and vibegron 75 mg. Coverage was compared between nonpreferred (oxybutynin, tolterodine, fesoterodine, darifenacin, solifenacin) and preferred medications (trospium, mirabegron, vibegron). Coverage scores, a weighted distribution based on coverage tier frequency relative to the number of plans investigated, were generated with a lower score indicating better coverage (range, 0.2-1.0).</p><p><strong>Results: </strong>One thousand six hundred nineteen insurance plans representing an estimated 47% of the market share were evaluated. Oxybutynin IR had the best coverage score across insurers (0.4), whereas trospium ER had the worst (0.89). Preferred medications had worse coverage versus nonpreferred medications ( P < 0.001). Centene had the best overall coverage and lowest initiation cost, whereas Aetna/CVS had the best coverage and initiation cost for preferred medications.</p><p><strong>Conclusions: </strong>Beta-3 agonists had worse coverage across insurers nationwide. Current trends in Medicare coverage reveal a need for improved coverage of preferred OAB medications for an aging population already at risk of cognitive dysfunction.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"412-421"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960001","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}