A. Lenore Ackerman, MD, PhD

A. Lenore Ackerman, MD, PhD

UCLA

Los Angeles, California

Dr. A. Lenore Ackerman is Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles. She was born in Los Angeles, but spent her childhood throughout the US, from southern California to Maine. After settling in New Haven, Connecticut, she earned her degree in Molecular Biophysics and Biochemistry at Yale University. She later completed her PhD in Immunology at Yale, focusing on molecular mechanisms of antigen presentation in dendritic cells. After realizing a desire to pursue translational medicine, she joined the Medical Scientist Training Program at Yale, receiving her MD. She completed her internship in General Surgery and began residency in Urology at the University of California, Los Angeles. Under the mentorship of Dr. Larissa Rodriguez, her research during this residency focused on changes in the central nervous system of an animal model due to interstitial cystitis induced by psychological stress. After the completion of residency, she continued at UCLA as a fellow in Pelvic Medicine and Reconstructive Surgery. Her current research focuses on the role of host-microbe interactions in the etiology of benign lower urinary tract disorders. She specializes in the treatment of incontinence, voiding dysfunction, and pelvic floor disorders.

Disclosures:

Articles by A. Lenore Ackerman, MD, PhD

Fear and Frustration Among Women with Recurrent UTIs

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

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Mycoplasma and Ureaplasma Molecular Testing Does Not Correlate with Irritative or Painful Lower Urinary Tract Symptoms

A. Lenore Ackerman, MD, PhD, Director of Research for FPMRS in the Department of Urology at the University of California, Los Angeles, shares data from her research group evaluating diagnostic testing patterns for ureaplasma and mycoplasma and characterizing the associations of these bacteria with irritative lower urinary tract symptoms (LUTS) using molecular detection techniques. Dr. Ackerman explains the context and rationale for the study and reviews how it illustrates Robert Koch’s postulates. She also addresses topics such as how physicians should approach LUTS in culture-negative patients, the significance of the bacteria detected through new sensitive methods, and whether symptoms are proof of infection or if they could be related to something else. Ultimately, she concludes with two main points: that the physician’s focus should be on treating the patient, not on treating a test; and that not all bacteria are bad, as some healthy genitourinary commensal bacteria play an important role in preventing urinary tract infections.

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Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline 2019

Jennifer T. Anger, MD, MPH, Associate Professor of Urology at Cedars-Sinai Medical Center, discusses recurrent uncomplicated urinary tract infections (UTIs) in women. Dr. Anger chairs the AUA committee on guidelines for infections, and she discusses the rationale behind recent changes to recommendations. She outlines how the thinking about recurrent infections has changed over time, and highlights the collateral damage that a one-size-fits-all antibiotic treatment can cause, noting that the new guidelines emphasize treating individual urinary cultures. She goes on to discuss patient profiles, common symptoms, and what the guidelines recommend for initial work-ups as well as treatments. Dr. Anger further delves into ways to prevent or decrease the risk of UTIs with antibiotic prophylaxis, along with the possible risks of doing so.

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