Topic: Female Urology

Non-surgical Modalities for Pelvic Floor Disorders

by Oscar A. Aguirre, MD | Nov 2024

Oscar A. Aguirre, MD, discusses managing female stress urinary incontinence and related pelvic floor issues, including non-surgical treatments. In this 11-minute talk, Aguirre notes a shift away from surgeries as non-invasive options have proven effective in alleviating urinary symptoms.

Dr. Aguirre began using laser treatments for vaginal tightening in 2013, which unexpectedly improved patients’ sexual function, lubrication, and incontinence. Over time, these experiences revealed the utility of various non-surgical options, including radiofrequency and platelet-rich plasma (PRP) therapies, for enhancing both sexual health and urinary symptoms. He emphasizes that these treatments, though not FDA-approved for incontinence, have shown promising results in improving symptoms without invasive intervention.

Genitourinary Syndrome of Menopause

by Kelly J. Casperson, MD | Nov 2024

Kelly J. Casperson, MD, emphasizes the essential role of vaginal estrogen in treating genitourinary syndrome of menopause (GSM). In this 9-minute talk, she explains that many women are misdiagnosed or undertreated because physicians often lack education about menopause. Vaginal estrogen, an inexpensive and effective treatment, can address multiple symptoms, including urinary tract infections (UTIs), overactive bladder, and pain during intercourse, often misinterpreted as separate issues.

Casperson highlights how GSM affects not only sexual health but also urological function, with estrogen deficiency leading to significant anatomical changes such as urethral dysfunction and vaginal atrophy. She critiques outdated misconceptions and stresses the importance of proper hormone replacement therapy over antibiotics or invasive interventions for recurrent UTIs in postmenopausal women.

Furthermore, Casperson advocates for revisiting FDA guidelines on vaginal estrogen, noting the misleading and harmful warning labels that deter its use. She encourages physicians to integrate vaginal estrogen as a first-line treatment for many menopausal symptoms.

Emerging Therapies for Female SUI – Myosites, ACT

by Michael P. Feloney, MD | Oct 2024

Michael P. Feloney, MD, focuses on Adjustable Continence Therapy (ACT) for women, specifically dual-balloon adjustable continence therapy. Dr. Feloney is noted for his experience with ACT, particularly during the initial investigational trials in the early 2000s. In this 12-minute presentation, Dr. Feloney describes the implantation procedure and provides photographs and graphics illustrating the correct placement of the silicone elastomer balloons.
A notable feature of this therapy is its adjustability. Once the balloons are in place, adjustments can be made post-operatively in the office, allowing for fine-tuning based on the patient’s response. Feloney emphasizes this advantage and its potential to enhance improved continence.
Dr. Felony addresses complication rates and notes that the rates of intraoperative perforations decrease with increased experience. The therapy, currently approved in Europe, Canada, Australia, and New Zealand, shows promise as a minimally invasive option for women with recurrent stress urinary incontinence who have failed previous surgeries.

Female Stress Urinary Incontinence 2023

by Brian J. Flynn, MD | Oct 2024

Brian J. Flynn, MD, provides a comprehensive update on managing female stress urinary incontinence (SUI) as of 2023. His 24-minute presentation meticulously reviews the latest advancements in both diagnostic and therapeutic approaches.

Dr. Flynn compares the advantages and disadvantages of current treatment options for SUI, including bulking agents, TVT, MUS, and TOT. While mid-urethral slings remain the gold standard for treatment, Dr. Flynn highlights emerging alternatives, including adjustable slings and ACT, which offer tailored solutions for patients with varying degrees of SUI.

Dr. Flynn stresses the importance of individualized treatment planning, which considers patient preferences, comorbidities, and previous surgical history when choosing a treatment plan to optimize patient outcomes.

SUI – AUA/SUFU Guidelines 2017 — Amendment 2023

by Suzette E. Sutherland, MD, MS, URPS | Sep 2024

Suzette E. Sutherland, MD, MS, URPS, discusses the AUA and SUFU guidelines for evaluating and treating stress urinary incontinence (SUI). In this five-minute talk, Dr. Sutherland reviews the five key components for evaluating a patient with SUI and discusses indications for advanced diagnostic tools such as cystoscopy and urodynamics.
Dr. Sutherland’s discussion continues with the Guideline’s treatment options, both non-surgical (pessaries, vaginal inserts, and pelvic floor muscle exercises), and surgical (bulking agents, midurethral slings). The recent amendment to the guidelines now allows clinicians to offer single-incision slings alongside retropubic and transobturator slings for patients, reflecting their comparable safety and effectiveness.

Female SUI: Bulking

by Alexandra Rogers, MD | Sep 2024

Alexandra Rogers, MD, focuses on female stress urinary incontinence and treatment options. In this 12-minute presentation, she begins by reviewing updates in the American Urological Association (AUA) guidelines for treatment options.

Dr. Rogers discusses slings, a longstanding treatment since 1998, which remain effective. Rogers also highlights the growing popularity of bulking agents, particularly the polyacrylamide hydrogel approved in 2020, noting its safety and repeatability. As a less invasive alternative that can be performed in an office setting, bulking agents offer an acceptable risk-benefit ratio for many patients, especially those hesitant to undergo invasive procedures.
Rogers discusses the importance of offering multiple treatment options to those with SUI, with a focus on minimizing complications and recovery time.

Contemporary Management and Prevention of Artificial Urinary Sphincter Erosion

by Jeffrey Loh-Doyle, MD | Sep 2024

Jeffrey Loh-Doyle, MD, provides a detailed analysis of artificial urinary sphincter (AUS) erosion, focusing on its causes, risk factors, management, and prevention. In this 18-minute presentation, Dr. Loh-Doyle examines this complication of the gold standard treatment for moderate to severe male stress urinary incontinence.
Dr. Loh-Doyle stresses the importance of identifying and managing AUS erosion. Patients may present with symptoms such as worsening incontinence, perineal or scrotal swelling, or, in more subtle cases, no symptoms at all. Cystoscopy is necessary to confirm erosion, especially in cases of severe discomfort or urinary retention. He discusses treatment, which involves removing the AUS device, draining the bladder with a catheter, and, depending on the severity of the erosion, repairing the urethra.
Prevention is key, especially in high-risk patients. Loh-Doyle advocates for conservative management, including using lower-pressure balloons, delayed activation, and educating patients on deactivating the device to reduce compressive forces. He also shares that, while AUS is effective, repeated erosions increase the likelihood of poor outcomes.

Emerging Therapies: Autologous Derived Muscle Cells

by Christopher E. Wolter, MD | Sep 2024

Christopher E. Wolter, MD, discusses using autologous muscle-derived cells as a promising treatment for stress urinary incontinence.

In this 7-minute talk, Dr. Wolter reviews the steps for the therapy procedure, which involves procuring muscle cells through a minimally invasive biopsy, expanding the cells in culture, and re-injecting them into the patient. He notes that stress urinary incontinence is considered an ideal target for this therapy.
Wolter shares the promising results from Initial studies, including a pilot trial in 2008. Later trials using higher doses of injected cells demonstrated even better outcomes. He also references the MYOCYTE trial, a large multicenter, multi-institutional randomized study, which suggested that patients with previous stress incontinence treatments, such as slings, respond better to the therapy.

Single Incision Slings

by Jason M. Kim, MD | Sep 2024

Jason M. Kim, MD, discusses single-incision slings, a less invasive option for treating stress incontinence in women. In this 9-minute presentation, Dr. Kim offers single-incision slings as a less invasive option than traditional retropubic and transobturator slings, eliminating many of the complications associated with traditional methods. He begins with a short background of midurethral slings, including possible complications and why a single incision option would be preferable.
Dr. Kim discusses the benefits of the single-incision sling and shows examples of possible options. He asserts that this less invasive therapy eliminates many complications associated with traditional methods. He also shares studies that have demonstrated its efficacy, including the 2022 Cochrane review and a randomized trial published in The New England Journal of Medicine.

“Just Drink a Glass of Wine” and Other Things Doctors Get Wrong About Sex Med

by Kelly J. Casperson, MD | Apr 2024

Kelly J. Casperson, MD, discusses the complexities surrounding female sexual health, addressing both societal misconceptions and medical gaps. In this 21-minute talk, she emphasizes that sex education, even for medical professionals, has been inadequate, with little attention paid to female anatomy.

Casperson highlights the medical community’s oversimplification of female sexual dysfunction, dividing it into issues of desire, arousal, orgasm, and pain. She critiques the cultural tendency to prescribe medications for low sexual desire without first addressing lifestyle, relational dynamics, and patient understanding of their own sexual health.

In her discussion on treatments, Casperson points out the challenges women face in getting access to effective therapies for sexual dysfunction. Additionally, Casperson addresses misconceptions about menopause and the effects of declining hormones on sexual and urinary health.

Native Tissue Approaches for Pelvic Organ Prolapse: What’s New?

by Oluwarotimi S. Nettey, MD, MHS | Dec 2023

Oluwarotimi S. Nettey, MD, MHS, discusses the anatomy and pathophysiology of pelvic organ prolapse. She underscores the importance of native tissue repair, as opposed to the use of mesh, in maintaining the pelvic floor’s natural anatomical integrity and function. This approach minimizes the risks associated with synthetic materials, such as mesh erosion and infection.
The lecture details various native tissue repair techniques, including vaginal, such as anterior and posterior colporrhaphy, and uterosacral ligament suspension, and abdominal approaches, such as sacrocolpopexy. Dr. Nettey highlights recent innovations in suture materials and surgical instruments that enhance the precision and durability of native tissue repairs.

Urological Emergencies in the Pregnant Patient

by Michael Coburn, MD, FACS | Dec 2023

Michael Coburn, MD, FACS, explores the complexities and management strategies of urological emergencies in pregnant patients. He highlights the anatomical and physiological alterations during pregnancy, such as increased renal blood flow and ureteral dilation, which predispose pregnant patients to specific urological emergencies.

One primary focus of the lecture is urinary tract infections (UTIs), renal colic, and obstructive uropathy and their impact on both maternal and fetal health. Dr. Coburn also delves into rare but serious conditions like urological trauma and acute urinary retention. He underscores the necessity of a multidisciplinary approach, involving obstetricians, urologists, and neonatologists, to optimize outcomes.

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