Topic: Female Urology

Treatment of the Ureteral Stone: What Do the AUA Guidelines Say?

Nicole L. Miller, MD, FACS, Associate Professor of Urology at Vanderbilt University Medical Center, discusses AUA guidelines for the treatment of ureteral stones, and compares and contrasts them to the EAU guidelines, examining several cases to illustrate similarities and differences in treatment approaches. She observes that the EAU guidelines are updated more frequently than the AUA guidelines, which often puts them ahead in terms of pain management. Dr. Miller emphasizes that shock wave lithotripsy (SWL) treatment has the least morbidity and lowest complication rate, but ureteroscopy (URS) has a higher stone-free rate in all ureteral locations. She discusses which special cases would be best treated with URS, and why a ureteral stent is not necessary after uncomplicated URS. Finally, Dr. Miller looks at how multimodal therapy for stent pain can significantly reduce narcotic usage.

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Pelvic Organ Prolapse Surgery in Women: Defining Success and Patient Satisfaction

Una Lee, MD, FPMRS, urologist and researcher at Virginia Mason Medical Center, reviews the evidence on non-mesh alternatives for stress urinary incontinence (SUI). She provides an overview of the causes of female SUI, presents an effective treatment tree addressing both overactive bladder and stress incontinence, and discusses treatment options. Dr. Lee encourages physicians to consider how they present treatment decisions in order to allow patients to make the choice that fits best for them. In addition to covering all possible risks and benefits, she advises physicians to also educate patients on their condition and help manage their expectations for treatment outcomes.

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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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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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Prevalence of Nocturia in US Women

Timothy K. Byler, MD, discusses the significant quality of life impact associated with nocturia, as well as underlying diseases and causative factors. He then reviews findings on the epidemiology of nocturia and its prevalence in women in the United States.

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Panel on Women in Urology

Sigrid V. Carlsson, MD, PhD, MPH, Faina Shtern, MD, and Wendy L. Poage, MHA, three leaders in the urologic field, each with a unique background, discuss the challenges faced and successes accomplished for women working in urology and medicine as a whole. They also share advice for younger women aspiring to enter these fields.

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Which Sling to Use – What, When, Why and Who?

Larissa V. Rodriguez, MD, discusses considerations for midurethral sling surgery to treat stress urinary incontinence (SUI) that the American Urological Association (AUA) guidelines do not cover, including how to treat non-index patients and choosing optimal slings for individual cases. Specifically, she compares the outcomes of retropubic, transobturator, and autologous fascia pubovaginal slings in various patient demographics. She also summarizes the evolution of sling surgery and how it came into widespread use.

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Recurrent UTI in the Setting of Mesh Implants

Larissa V. Rodriguez, MD, discusses risk factors of recurrent urinary tract infections after midurethral sling surgery, when and how to evaluate patients that present with recurrent infections, and imaging options like translabial ultrasound. She also evaluates indications for sling removal and whether or not it safe and beneficial option.

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Stressing About the Bladder: Neurovisceral Interactions in Persistent Pelvic Pain Syndromes

Larissa V. Rodriguez, MD, discusses the role of environmental stress in lower urinary tract symptoms (LUTS) and interstitial cystitis (IC) and the development of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. She explains how the neurovisceral interactions involved in processing, emotion, and attention affect bladder function, and how studying this link help develop future treatment options.

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