Topic: Female Urology

Developing Clinical Pathways to Improve Management and Outcomes in Women’s Health

Developing Clinical Pathways to Improve Management and Outcomes in Women’s Health

by | Oct 2023

Shirley H. Lee, CRNP-FNP, MPH, discusses developing clinical pathways to improve management and outcomes in women’s health, defining clinical pathways as the translation of complicated algorithms into efficient clinical workflows. Lee then explains the many treatment options for overactive bladder (OAB) for female patients, stating that 80 percent of patients are unsatisfied with their medication at six months, and asserting that clinicians must do a better job at successfully moving patients through the clinical pathway.

She then breaks the OAB clinical pathway into levels based on the invasiveness of treatment, and points out the importance of diagnostics between each of these levels in effectively tailoring treatment to individual patients. Lee explains that the clinical pathways can standardize care, leave fewer data gaps, and allow for earlier detection of treatment efficacy.

She then delves into a case study to illustrate the importance of a guided survey chart review whereby the navigator conducts an OAB symptom survey, instructs the patient on a voiding diary, and discusses OAB treatment options and follow-up. Lee explains the steps involved in executing clinical pathways for female patients, including establishing patient outcomes, ensuring that care pathways align with goals for those patient outcomes, and streamlining the workflow for all involved.

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Recurrent UTIs in Women: Ask the Guideline

Recurrent UTIs in Women: Ask the Guideline

by | Jun 2023

Jennifer Anger, MD, MPH, discusses American Urological Association (AUA) guidelines regarding recurrent urinary tract infections (rUTIS) in women. She begins by discussing antimicrobial stewardship and the consideration of collateral damage, explaining antimicrobial resistance among uropathogens has increased dramatically in the past 20 years.

Dr. Anger characterizes the index patient for the 2019 rUTI guideline as an otherwise healthy adult female with an uncomplicated, culture-proven rUTI associated with acute-onset symptoms. She summarizes guideline highlights, including the recommendation that clinicians obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. Additionally, clinicians should obtain urinalysis, urine culture, and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment for rUTIs.

Dr. Anger outlines first-line therapy (nitrofurantoin, TMP-SMX, and fosfomycin) and explains clinicians should use as short a duration of antibiotics as reasonable for rUTI patients with an acute cystitis episode. For patients with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable.

Dr. Anger discusses use, dosing, and duration of prophylactic antibiotics and points out that clinicians may offer cranberry prophylaxis for rUTIs, but explains that studies are lacking in this area. Clinicians should repeat urine culture to guide further management when UTI symptoms persist following antimicrobial therapy.

In peri- and post-menopausal women with rUTIs, clinicians should consider vaginal estrogen therapy to reduce the risk of recurrence. Dr. Anger then highlights the 2022 UTI Guideline Update and explains randomized, controlled trials that contributed evidence to this amendment report.

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Primer on Testosterone Therapy for Women: Treatment of HSDD

Primer on Testosterone Therapy for Women: Treatment of HSDD

by | Jun 2023

Maria Uloko, MD, discusses testosterone therapy for women with hypoactive sexual desire disorder (HSDD). She explains that people with HSDD have higher rates of impaired body image, low self-confidence and self-worth, relationship stress, depression and anxiety, and increased healthcare costs.

Dr. Uloko shares the Basson Model of Sexual Motivation and emphasizes there is no “quick fix” for low libido. Dr. Uloko advocates a biopsychosocial approach that incorporates the biological, psychological, and social aspects that can affect HSDD. She explains the importance of patient education and therapy as well as medication treatments like flibanserin and testosterone.

Dr. Uloko emphasizes that testosterone is not FDA-approved for women, and it remains challenging to dose women appropriately. She cites studies that conclude testosterone, either alone or in concert with estrogen therapy, can be effective and safe for the treatment of HSDD. Dr. Uloko states that symptomatic improvement takes approximately 12 weeks, and treatment should be discontinued if no improvement occurs within six months.

Dr. Uloko then concludes that HSDD is a common but multifactorial condition for women with significant detriment to quality of life. She re-emphasizes the importance of a biopsychosocial approach to diagnosis and treatment that may include treatment with testosterone therapy.

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Fear and Frustration Among Women with Recurrent UTIs

Fear and Frustration Among Women with Recurrent UTIs

by | Jan 2022

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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Fear and Frustration Among Women with Recurrent UTIs

by | Dec 2021

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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Fear and Frustration Among Women with Recurrent UTIs

by | Nov 2021

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

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

by | Jul 2020

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

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

by | Jul 2020

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

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

by | May 2020

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

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

by | Apr 2020

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

Prevalence of Nocturia in US Women

by | Aug 2019

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

Panel on Women in Urology

by | Apr 2019

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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