Urogynecology (Hagerstown, Md.)最新文献

{"title":"Endometriosis Is Not Associated With Mesh Excision in a Case-control Study.","authors":"Caroline Layding, Morgan Egnot, Leslie Meyn, Pamela A Moalli, Amanda M Artsen","doi":"10.1097/SPV.0000000000001730","DOIUrl":"10.1097/SPV.0000000000001730","url":null,"abstract":"<p><strong>Importance: </strong>Like polypropylene mesh complications, endometriosis is characterized by inflammation and pain. Chronic pelvic pain is overrepresented in patients with mesh complications. It is unknown whether endometriosis specifically is a risk factor for mesh excision.</p><p><strong>Objective: </strong>The objective of this study was to evaluate whether patients undergoing mesh excision have a higher rate of endometriosis diagnosis than those who heal well after mesh implantation.</p><p><strong>Study design: </strong>We conducted an unmatched case-control study on patients undergoing mesh excision (n=179). Our control group consisted of patients with implanted mesh without complications (n=65). Endometriosis diagnosis was abstracted from charts using a comprehensive definition and pathology reports, where available. Logistic regression was used to evaluate the association between endometriosis diagnosis and mesh excision while controlling for patient factors.</p><p><strong>Results: </strong>Patients underwent excision primarily for pain (29%), mesh exposure (67%), or infection (3%). Patients undergoing excision were younger ( P <0.001), had a higher body mass index ( P =0.002), and were current or former smokers ( P <0.001). Although these patients did have a higher rate of endometriosis on univariate analysis (18.4% vs. 7.7%, 0.046), this was no longer significant when controlling for demographic and clinical factors (adjusted odds ratio [aOR]=2.32; 95% CI: 0.70, 7.70). A 5-year decrease in age (aOR=1.35; 95% CI: 1.16, 1.57), current or former smoker status (aOR=2.75; 95% CI: 1.36, 5.57), body mass index (aOR=1.09; 95% CI: 1.02, 1.18), and duration of implantation (aOR=1.18; 95% CI: 1.07, 1.30) were independently associated with mesh excision.</p><p><strong>Conclusion: </strong>Endometriosis diagnosis was not a significant predictor of mesh excision when controlling for other established risk factors.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"720-725"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977795","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":"Stress-Induced Vaginal Remodeling: Fibroblast Mechanotransduction and Mesh Complications.","authors":"Temitope Obisesan, Pamela Moalli","doi":"10.1097/SPV.0000000000001852","DOIUrl":"10.1097/SPV.0000000000001852","url":null,"abstract":"<p><strong>Abstract: </strong>Pelvic organ prolapse (POP) repair using synthetic mesh introduces mechanical mismatches that significantly influence fibroblast behavior. As the primary mechanosensitive cells in vaginal connective tissue, fibroblasts respond to extracellular stiffness via mechanotransduction pathways, such as focal adhesions (FAs), transforming growth factor β (TGF-β) signaling, and others. These pathways regulate key cellular responses, including proliferation, apoptosis, and differentiation into myofibroblasts. While transient myofibroblast activation is essential for normal wound healing, sustained activation driven by mesh can result in complications-primarily pain and fibrosis. This review highlights the molecular and mechanical mechanisms underlying fibroblast-to-myofibroblast transition (FMT), with a focus on integrin-mediated adhesion complexes and cytoskeletal signaling. It also explores how mesh architecture and local mechanical cues contribute to pathological tissue remodeling in POP. Understanding these processes can inform the design of biomechanically compatible meshes and targeted therapeutics such as ROCK or YAP inhibitors to mitigate adverse fibroblast responses and improve surgical outcomes.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":"32 6","pages":"581-592"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984569","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":"Chemodenervation Use for Overactive Bladder in Female Medicare Beneficiaries.","authors":"Nancy E Ringel, Charles D Scales, Cassie B Ford, C Emi Bretschneider, Ekene Enemchukwu, Victoria L Handa","doi":"10.1097/SPV.0000000000001709","DOIUrl":"10.1097/SPV.0000000000001709","url":null,"abstract":"<p><strong>Importance: </strong>Only a fraction of women with overactive bladder (OAB) receive effective treatment for this condition; inequities in access to OAB care must be understood.</p><p><strong>Objective: </strong>The objective of this study was to explore features associated with intradetrusor chemodenervation treatment for OAB among female Medicare beneficiaries from different racial and ethnic groups.</p><p><strong>Study design: </strong>This was a retrospective cohort study of females ≥65 years old from the Center for Medicare & Medicaid Services' 5% Limited Data Set with a diagnosis of OAB between 2012 and 2020. The cumulative incidence of beneficiaries who received intradetrusor chemodenervation within 5 years following OAB diagnosis was compared between race and ethnicity groups. Cox regression analysis was performed to determine predictors for the likelihood of intradetrusor chemodenervation treatment and to adjust for potential confounders.</p><p><strong>Results: </strong>In total, 232,366 females with a new OAB diagnosis were identified. The cumulative incidence of intradetrusor chemodenervation treatment within 5 years of OAB diagnosis was low at 1.4%, with lower rates among Asian (0.6%), Black (0.7%), Hispanic (0.7%), and Other groups (0.9%) ( P < 0.001). After adjustments, non-White race and Hispanic ethnicity (Asian: adjusted hazard ratio [aHR] 0.51, 95% CI: 0.33-0.80; Black: aHR 0.56, 95% CI: 0.45-0.69; Hispanic: aHR 0.62, 95% CI: 0.40-0.96; Other: aHR 0.58, 95% CI: 0.37-0.91) were associated with a lower relative hazard of receiving intradetrusor chemodenervation.</p><p><strong>Conclusions: </strong>Overall utilization of intradetrusor chemodenervation was low in this national cohort. Women from non-White racial and ethnic groups had lower rates of utilization compared with White women. Further research should evaluate barriers patients face in accessing this effective OAB treatment and explore potential interventions that facilitate access to care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"660-667"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294527","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":"Beta-3 Agonists Versus Anticholinergics: A Cost-effectiveness Analysis.","authors":"Brad St Martin, Shannon L Wallace, Lauren A Cadish, Olivia H Chang, Eric R Sokol, Jonathan P Shepherd","doi":"10.1097/SPV.0000000000001723","DOIUrl":"10.1097/SPV.0000000000001723","url":null,"abstract":"<p><strong>Importance: </strong>Medical treatment for overactive bladder (OAB) includes beta-3 agonists and anticholinergic medications; the latter of which has been associated with an increased risk of dementia. With dementia risks included, the cost-effectiveness of these medications has not been determined.</p><p><strong>Objective: </strong>The objective of this study was to evaluate 10-year costs, quality of life, and cost-effectiveness comparing beta-3 agonists to anticholinergics.</p><p><strong>Study design: </strong>A Monte Carlo microsimulation (n=10,000) modeled treatment pathways of anticholinergics versus beta-3 agonists. Both strategies included opportunities to transition to a second same-class medication, third-line therapies, or discontinue treatment. Model inputs were derived from national databases and published literature. Quality-adjusted life-years (QALYs), cost, and incremental cost-effectiveness ratios (ICERs) were modeled from the health care perspective. Secondary outcomes evaluated the marginal increase in the incidence of dementia, time with dementia, and dementia-associated treatment cost.</p><p><strong>Results: </strong>Among patients using anticholinergics, an additional 1.9% developed dementia compared with beta-3 agonists, incurring an additional $250,092 per patient over 10 years. Beta-3 agonists were cost-effective (ICER=$9,132.26/QALY). Furthermore, beta-3 agonists were the dominant strategy, resulting in lower costs and higher QALYs, in 35.9% (3,586/10,000) of patients, compared with 32.3% utilizing anticholinergics.</p><p><strong>Conclusions: </strong>Despite the increased medication cost of beta-3 agonists, the overall costs of treating OAB are comparable over 10 years. Broadened accessibility and coverage of these cost-effective treatments reduce risks and costs associated with dementia.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"712-719"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965855","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":"Development of a Large Animal Rectovaginal Fistula Model.","authors":"Danielle N Westenberg, Tiffany L Sarrafian, Ryan Mahlberg, Paul G Stalboerger, Emanuel C Trabuco, Eric J Dozois, Atta Behfar, John A Occhino","doi":"10.1097/SPV.0000000000001706","DOIUrl":"10.1097/SPV.0000000000001706","url":null,"abstract":"<p><strong>Importance: </strong>Rectovaginal fistulas (RVFs) are challenging to treat, often requiring multiple surgical interventions. Research into novel therapies is limited by the lack of a sizeable and representative animal model. Given the similarities in porcine and human vaginal and rectal tissue, pigs are an ideal species for translation to human patients.</p><p><strong>Objective: </strong>The objective of this study was to develop a feasible and reproducible RVF model in pigs.</p><p><strong>Study design: </strong>Six female pigs underwent RVF creation and were divided into 3 groups according to the following methods: (1) placement of 1-inch disc magnets across the rectovaginal septum, (2) a 1-inch round defect created using electrocautery and placement of a 1-inch stainless-steel gauge stent, (3) a 1-inch round defect using electrocautery without subsequent stenting. Fistulas were evaluated at 6 weeks with measurements and photographic documentation. The animals were euthanized between 12 and 14 weeks. The primary outcome of this study was fistula patency. Secondary outcomes were fistula dimension and histologic appearance of the fistula tract.</p><p><strong>Results: </strong>All pigs did well with no infection or complications related to fistula creation. Both surgical methods reliably resulted in a patent fistula at 14 weeks: cautery alone and cautery with gauge stenting. Only 1 patent fistula in the magnet group was noted at the time of euthanasia. All patent fistulas showed histologic evidence of complete epithelialization of the fistula tract.</p><p><strong>Conclusions: </strong>This study demonstrates 3 safe and feasible methods for RVF creation in pigs, with 2 methods showing increased reliability.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"646-651"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977797","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":"Patient-Reported Goals of Women With Urinary Incontinence in Primary Care.","authors":"Tsung Mou, Tiffany Brown, Ji Young Lee, Stephen D Persell, Kimberly Kenton, Sarah Collins","doi":"10.1097/SPV.0000000000001883","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001883","url":null,"abstract":"<p><strong>Importance: </strong>Understanding women's treatment goals when seeking care for urinary incontinence (UI) is essential to delivering patient-centered care. However, most studies describing patient-reported goals have been limited to specialty settings, leaving a gap in knowledge about women's goals in primary care.</p><p><strong>Objectives: </strong>The objectives of this study were to characterize self-reported treatment goals among women with UI receiving care in primary care settings and to examine differences in patient characteristics by goal type.</p><p><strong>Study design: </strong>This mixed-methods cross-sectional secondary analysis used data from the \"Identify, Teach, and Treat (IT2): Automating Clinical Decision Pathways for the Care of Women\" project. IT2 integrated automated UI screening and a digital educational tool into routine primary care visits. Women aged 18 years and older who screened positive for UI and desired more information between January 2023 and December 2024 provided free-text responses to the question, \"What are your treatment goals for urinary incontinence?\" Responses were categorized into goal domains using qualitative descriptive analysis, followed by quantitative comparison of patient characteristics across goal categories.</p><p><strong>Results: </strong>Among 2,986 women who screened positive for UI, 458 (15.3%) reported treatment goals. Symptom relief (46.1%) and information seeking (33.6%) were most common, followed by lifestyle (4.6%) and emotional goals (0.6%); 15.1% reported overlapping goals. Women prioritizing symptom relief were older (mean: 58.7 y vs 54.6 y) and had higher International Consultation on Incontinence Questionnaire (ICIQ) scores, whereas those emphasizing information seeking preferred to avoid procedural interventions.</p><p><strong>Conclusions: </strong>Women's treatment goals for UI in primary care are diverse, multidimensional, and patient-specific. Recognizing this granularity can improve how clinicians and researchers deliver patient-centered care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159373","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":"Emergency Department Visits for Pelvic Organ Prolapse in the United States.","authors":"Melissa A Markowitz, Brad St Martin, Lisbet S Lundsberg, Nancy E Ringel","doi":"10.1097/SPV.0000000000001703","DOIUrl":"10.1097/SPV.0000000000001703","url":null,"abstract":"<p><strong>Importance: </strong>Little is known regarding patient use of the emergency department for prolapse symptoms and the burden this use places on the health care system.</p><p><strong>Objective: </strong>The aim of the study was to evaluate the incidence of emergency department visits in the United States for pelvic organ prolapse and associated patient and hospital demographics.</p><p><strong>Study design: </strong>This was a cross-sectional study of emergency department presentations from 2016 to 2018 associated with a primary diagnosis of pelvic organ prolapse. Data were obtained using International Classification of Diseases, Tenth Revision, Clinical Modification codes from the Healthcare Cost and Utilization Project Nationwide Emergency Department Samples. Descriptive analysis was used to identify sociodemographic and clinical characteristics of the population presenting to the emergency department for prolapse.</p><p><strong>Results: </strong>Between 2016 and 2018, there were 14,101 annual emergency department visits for prolapse in the United States, which comprised less than 0.01% of all emergency department visits. Overall, 55.5% of patients were <65 years old and 62.5% had a household income of <50th percentile ($0-$58,999). The most common secondary diagnosis was hypertension (12.3%), and the most common secondary urogynecologic diagnosis was urinary tract infection or pyelonephritis (5.7%). No high-risk comorbidities were seen in 78.1% of patients. Most patients with prolapse were discharged (91.8%), although 5.8% were admitted and 1.5% were transferred for further care.</p><p><strong>Conclusions: </strong>Emergency department presentation for pelvic organ prolapse is uncommon. Disproportionate emergency department use was seen for patients <65 years old and with low household income. Further initiatives can optimize outpatient workflows for urogynecologic care and expand community outreach efforts on prolapse education to reduce emergency department use for nonurgent concerns.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"625-634"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201038","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":"Stool Microbiota, Metabolites, and Fecal Incontinence in Women.","authors":"Lily A Arya, Purna C Kashyap, Megan U Carnes, Ravi Mathur, Holly E Richter, Uduak U Andy, J Eric Jelovsek, Nazema Y Siddiqui, Casey D Morrow, Elliot J Lefkowitz, William J Van Der Pol, Corey Broeckling, Benjamin Carper, Sarah E S Jeney, Halina M Zyczynski, Keisha Y Dyer, Cassandra Carberry, Donna Mazloomdoost, Marie G Gantz","doi":"10.1097/SPV.0000000000001885","DOIUrl":"10.1097/SPV.0000000000001885","url":null,"abstract":"<p><strong>Importance: </strong>Stool metabolites influencing gut motility and sensation may contribute to fecal incontinence (FI).</p><p><strong>Objective: </strong>The objective of this study was to test whether FI is associated with higher levels of butyrate and Clostridiales taxa in stool.</p><p><strong>Study design: </strong>Stool metabolites and microbiota were compared between 96 women with FI and 42 controls. FI frequency and subtype (urgency vs insensible) were measured using a 14-day bowel diary, St. Mark's score, and the Accidental Bowel Leakage questionnaire. Metabolite analysis included targeted analysis (8 short-chain fatty acids including butyrate, 17 bile acids, and 8 tryptophan derivatives) and untargeted analysis. Stool microbiota were characterized using 16S rRNA gene sequencing. Multivariable and exploratory multiomics factor analysis were performed with statistical significance defined as false discovery rate (FDR) ≤0.10.</p><p><strong>Results: </strong>The FI group had a higher proportion of Bristol stool types 2 and 6 than controls (P = 0.005). The mean number of leaks for the FI group was 1.7 ± 1.7 per day, 38% had urgency FI, and 39% had insensible FI. There was no significant difference between groups in butyrate levels and Clostridiales taxa. Multiomics analysis identified glycerolipids (monoacylglycerols and diacylglycerols) associated with FI (FDR = 0.08). In addition, insensible FI was associated with glycerolipids, long-chain saturated and monounsaturated fatty acids, phospholipids, and dipeptides (FDR = 0.08-0.09). The top weighted microbiota associated with these metabolites were Lachnospiraceae and Ruminococcaceae; however, these taxa were not directly associated with FI.</p><p><strong>Conclusion: </strong>Butyrate and Clostridiales were not associated with FI. Novel stool metabolite signatures were identified, suggesting new biological pathways and potential therapeutic targets for FI.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148159014","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":"Community Engagement Methods for an Urgency Urinary Incontinence Trial.","authors":"Peter C Jeppson, Jesse Nodora, Heidi Rishel Brakey, Florencia Gonzalez, Tatiana Sanses, Emily S Lukacz, Holly E Richter, Sarah E S Jeney, Celeste Crenshaw, Mary Zaremba, Vivian W Sung","doi":"10.1097/SPV.0000000000001851","DOIUrl":"10.1097/SPV.0000000000001851","url":null,"abstract":"<p><strong>Importance: </strong>Incorporating community engagement (CE) strategies can inform and enhance study design, recruitment, retention, dissemination, and access for diverse populations; however, these approaches are underutilized in pelvic floor disorders trials.</p><p><strong>Objectives: </strong>The objectives of this study are to describe the CE methods used in a multisite randomized trial comparing beta-3 adrenergic agonists and intradetrusor onabotulinumtoxinA for the treatment of urgency urinary incontinence (UUI). Specific objectives of engagement methods included identifying barriers to recruitment and retention and improving study access for underrepresented populations. This study enrollment and community engagement are ongoing.</p><p><strong>Study design: </strong>We describe the formation of strategic CE partnerships with patients, clinicians, CE specialists, community organization leaders locally, and at the national level to guide the development of a randomized trial at 5 U.S. academic medical centers. Insight from these various partners have shaped the implementation of CE studios (listening sessions) with patients, caregivers, and clinicians in English, Spanish, and Amharic, focused on participation barriers and culturally appropriate recruitment materials.</p><p><strong>Engagement approach: </strong>Completed CE studios identified potential participation barriers, including mistrust, UUI stigma, limited health literacy, cultural and linguistic accessibility, financial and logistical challenges, and clinician constraints. Potential solutions identified in the CE studios included partnering with trusted community organizations, tailored study materials, simplified visit scheduling, appropriate compensation, and clinician resources. We have encouraged variation of recruitment strategies across study sites unified by common engagement principles, including tailored recruitment materials, culturally responsive imagery, outreach efforts by local community liaisons, and bidirectional communication with community partners. Throughout study enrollment, we continue our engagement efforts, and ongoing insight from partners continues to shape this trial, including recruitment, retention, and dissemination efforts.</p><p><strong>Conclusions: </strong>Including different voices through CE can help identify varied and culturally tailored opportunities for recruitment and retention in randomized trials for UUI, which will help ensure study feasibility and relevance to diverse patients and community partners.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"593-605"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936135","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":"Primary Care Provider Practice Patterns in the Management of Recurrent UTI.","authors":"Lauren N Tholemeier, Elizabeth J Geller, Leigh A Wall, Christine M Chu","doi":"10.1097/SPV.0000000000001719","DOIUrl":"10.1097/SPV.0000000000001719","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the current practice patterns regarding recurrent urinary tract infection (rUTI) can help providers better manage this burdensome condition.</p><p><strong>Objectives: </strong>The objective was to describe and compare preferences in the management of acute UTI and rUTI in women among primary care providers, and to determine whether various national practice guidelines are being followed.</p><p><strong>Study design: </strong>Physicians and advanced practice providers in family medicine, general internal medicine, general obstetrics and gynecology, and geriatric medicine at a state-wide academic institution and a community health system were invited to complete an online survey that included questions about management of a postmenopausal patient with rUTI. Comparisons were made between demographic groups, including gender, specialty, practice years, patients with rUTI per month, and practice setting.</p><p><strong>Results: </strong>A total of 50 surveys were completed. Most respondents (78%) followed guidelines when choosing an antibiotic for empiric treatment of UTI. Notably, 28% would recommend long-term antibiotic prophylaxis for an uncomplicated patient with rUTI. While a majority (62%) would consider vaginal estrogen as their first option for UTI prophylaxis, few providers would also consider other evidence-based nonantibiotic options such as methenamine hippurate (26%) or D -mannose (17%). Primary care providers with \"focused\" training in menopause care were more comfortable prescribing vaginal estrogen in various clinical scenarios. Providers who saw 6+ patients with rUTI per month were more likely to prescribe methenamine hippurate.</p><p><strong>Conclusions: </strong>While those surveyed generally followed standard practice in the management of UTI in postmenopausal women, our study identified opportunities for improvement. These include prioritizing nonantibiotic prophylaxis and first-line treatments for acute UTI.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"687-696"},"PeriodicalIF":1.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438243","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}