Citations

ABSTRACTIntroduction and ObjectiveProcedural therapies for overactive bladder (OAB) most often include intradetrusor onabotulinumtoxinA (BTX) injections, sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS). Despite their proven efficacy, real‐world data on therapy continuation and crossover rates between these modalities remain limited. This study aimed to evaluate longitudinal patterns of treatment continuation and therapy crossover among women receiving procedural OAB treatments.MethodsWe conducted a multi‐institutional retrospective cohort study of women with idiopathic OAB who underwent index BTX, SNM, or PTNS between 2014 and 2022. Patients were identified using electronic medical records, and follow‐up data were collected through December 31, 2023. The primary outcomes included duration of maintenance treatments and crossover to another procedural therapy for OAB. Kaplan–Meier survival analysis estimated rates of continued treatment, and a log‐rank test assessed differences in crossover rates among treatment groups.ResultsA total of 506 women met inclusion criteria: 266 (52.6%) received BTX, 114 (22.5%) underwent SNM, and 126 (24.9%) received PTNS. Ongoing treatment rates were lowest for PTNS, with only 17.1% maintaining therapy between 3 and 5 years and 26.1% crossing over to another procedure within 3 years. Among BTX patients, 65.2% underwent repeat treatment within 3 years, and 9.5% of patients crossed over to another procedure within 3 years. Of those with 5 or more years of follow‐up, 39.1% of patients continued with BTX procedures in the 3–5‐year follow‐up timeframe. Among SNM patients, the cumulative revision rates were 7.6% at 1 year and 10.9% at 2 years. 13.1% of patients crossed over from SNM to another procedure within 3 years (the vast majority to BTX).ConclusionsPTNS had the lowest ongoing therapy rates and the highest crossover rates. BTX and SNM demonstrated similar crossover rates. These findings underscore the importance of individualized patient counseling and treatment selection based on expectations of therapy persistence. Future research should focus on optimizing patient selection, improving long‐term adherence strategies, and evaluating novel or combined therapeutic approaches for OAB management.

Objective: There is little existing literature describing the evaluation and treatment of patients referred to surgical subspecialities for recurrent urinary tract infections (rUTIs). We hypothesised female patients referred to urology and urogynaecology for rUTI undergo multiple diagnostic tests and few would undergo surgery. Materials and Methods: This is a retrospective review of female patients referred to urology or urogynaecology at a single institution between 2016 and 2019. Data on demographics, provider speciality, diagnostic tests performed, and surgeries were abstracted. Descriptive statistics were used and a logistic regression was performed to determine the adjusted odds ratio of undergoing a surgery. Results: A total of 990 patients were included with a mean age of 62 and on average underwent 3.7 different testing modalities, including genitourinary (GU) examination (62.3%), urodynamic testing (72.7%), cystoscopy (66.0%), and imaging (70.7%). Urologists more commonly pursued urodynamic testing, cystoscopy, and imaging than urogynaecologists. Ultimately, 21.4% of all patients underwent a surgical procedure. Patients who were seen by urogynaecology, underwent GU examination, urodynamic testing, or cystoscopy had higher likelihoods of eventually undergoing surgery (procedure under anaesthesia). Conclusion: Female rUTI patients referred to urology or urogynaecology undergo considerable evaluation and testing. The majority of patients are ultimately managed medically rather than surgically, indicating continued need for resource stewardship. Level of evidence: Not applicable.

Abstract This study explores the prevalence of urinary incontinence among multi-ethnic refugee women and their comfort levels in discussing this topic with their healthcare providers. Between July and November 2021, 58 refugee women were recruited within community spaces using convenience sampling and word-of-mouth. They completed a 20-item questionnaire in Arabic, Burmese, Swahili, or Somali. Urinary incontinence was identified by an affirmative response to any of the 6-item Urogenital Distress Inventory questions or the report of at least one episode of stress or urgency incontinence per month. The observed prevalence of urinary incontinence in this cohort was 50%. Despite 59.6% of participants expressing comfort in discussing these symptoms, 82.8% of them revealed that they had never spoken with a healthcare provider about them. Moreover, 77.6% of these women reported never being queried about these symptoms by a healthcare professional. Based on these results, urinary incontinence is notably prevalent among refugee women, either surpassing or at least aligning with the prevalence observed in the general female population. Healthcare professionals serving refugee women should consider incorporating screening for this condition into routine office visits. Notably, the limited sample size of this study underscores the necessity for further research on this subject.

Objective: To evaluate and compare parental leave policies from the top United States (US) hospitals with a focus on inclusivity of all types of parents. Methods: In September and October of 2021, the parental leave policies of the top 20 US hospitals, ranked by the 2021 US News & World report, were evaluated. Parental leave policies were obtained and reviewed through the hospitals' public websites. Hospitals' Human Relations (HR) departments were contacted to confirm the policies. Hospital policies were scored against a rubric created by the authors. Results: Among the top US hospitals (21 total hospitals), 17 (81%) had publicly available policies, and one policy was obtained by contacting HR. Fourteen of the 18 hospitals (77.8%) had a parental leave policy distinctive from short-term disability and offered paid paternity or partner leave. Thirteen hospitals (72.2%) offered parental leave for parents whose children were carried through surrogacy. Fourteen hospitals (77.8%) included adoptive parents; however, only five hospitals (27.8%) specifically included foster parents. The average paid leave for birthing mothers was 7.9 weeks compared to 6.6 weeks for nonbirthing parents. Only three hospitals offered the same leave for birthing and nonbirthing parents. Conclusion: While a few of the top 20 hospitals have paid parental leave policies that are inclusive and equivalent to all parents, many do not and represent an area for improvement. As healthcare industry leaders, these hospitals should strive for inclusive parental leave policies that care for their employees with the same high standards they set for caring for patients.

Abstract Purpose: To assess the quantitative and qualitative components of in-person focus groups as a potential intervention for female patients with urinary incontinence.Methods: Women over the age of 18 seeking treatment for UI were randomized to standard care with focus group participation or to standard care alone. All participants completed validated questionnaires: MESA, UDI-6, OAB-SAT-q, PGI-S, PGI-I, SQoL-F, PHQ-9, IPAQ at the beginning and conclusion of the study. Questionnaires were analyzed with repeated measures of ANOVA models in an intention-to-treat manner. Three moderated focus group sessions were held and audio recorded. Recordings were transcribed and categorized by frequency into themes using grounded theory methodology. Results: A total of 10 control and 8 intervention participants agreed to participate. Seven women attended all three focus group sessions and were included in the final analysis. Transcripts from focus group sessions observed women identified most with (1) urinary incontinence (UI) as a chronic disease, (2) shame managing UI, and (3) social constraints of toileting. Participants self-reported appreciation of focus group participation and desire for on-going sessions. Analysis of the questionnaires did not demonstrate statistically significant differences.Conclusion: Data ascertained from questionnaires was unable to demonstrate a meaningful effect in improved treatment outcomes for control and intervention participants. Grounded theory analysis of transcripts identified four primary themes: (1) appreciation of the focus group, (2) UI as a gendered issue, (3) lack of public awareness, and (4) history of negative provider interactions. All focus group participants self-reported interest in attending future focus group sessions.

Abstract Background To assess the feasibility and acceptability of in-person support groups as a potential intervention for female patients with urinary incontinence. Methods Women over the age of 18 seeking treatment for UI were randomized to standard care with support group participation or to standard care alone. All participants completed validated questionnaires at the beginning and conclusion of the study. Questionnaires were analyzed with repeated measures of ANOVA models in an intention-to-treat manner. Three moderated support group sessions were held and audio recorded. Recordings were transcribed and categorized by frequency into themes using grounded theory methodology. Results A total of 10 control and 8 intervention participants agreed to participate. Seven women attended all three support group sessions and were included in the final analysis. Transcripts from support group sessions observed women identified most with (1) urinary incontinence (UI) as a chronic disease, (2) shame managing UI, and (3) social constraints of toileting. Support participants self-reported appreciation of support group participation and desire for on-going sessions. Analysis of the questionnaires did not demonstrate statistically significant differences. Conclusion Data ascertained from questionnaires was unable to demonstrate a meaningful effect in improved treatment outcomes for control and intervention participants. Grounded theory analysis of transcripts identified four primary themes: (1) appreciation of the support group, (2) UI as a gendered issue, (3) lack of public awareness, and (4) history of negative provider interactions. All support group participants self-reported interest in attending future support group sessions.

Abstract Aim Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. Methods This is a multi‐institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan–Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. Results Two‐hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% ( n = 115/180) of women remained recurrence free at median follow‐up of 14.6 months (IQR, 3–37). In unadjusted analysis, recurrence‐free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. Conclusion This retrospective multi‐institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.

Introduction Prevalence rates of pelvic floor disorders in women in nonmetropolitan communities compared with metropolitan communities are unknown. We hypothesize that the rates are higher in women in nonmetropolitan communities. Methods We accessed the health survey data from the NHANES (National Health and Nutrition Examination Survey) from 2009 to 2010 divided by geocodes into nonmetropolitan (<50,000 inhabitants) and metropolitan communities (>50,000). Responses were analyzed for the following conditions: urinary incontinence and nocturia, bowel urgency and anal incontinence, and symptomatic vaginal bulge. Age-adjusted prevalence rates were estimated using logistic regression. Results The 2009–2010 NHANES survey was completed nationwide by 302 women in nonmetropolitan communities and 2201 women in metropolitan communities. Overall, prevalence rates of PFDs did not significantly differ between groups. Prevalence rates of urinary incontinence and nocturia at least weekly were similar between metropolitan and nonmetropolitan groups (16.2% vs 14.6%, P = 0.47), with stress incontinence being more common than urgency and other types of incontinence (40% vs 23% and 8%). Women in metropolitan communities reported more bowel urgency than women in nonmetropolitan communities (33.3% vs 26.8%, P = 0.02); however, prevalence rates between both groups are similar with regards to anal incontinence at least once a month or more (9.2% vs 9.0%, P = 0.76). Prolapse symptoms were also not significantly different between the groups (2.4% in both). There was an increase in prevalence in each of the pelvic floor disorder symptoms with age. Conclusions Pelvic floor disorders are prevalent and increase with age in women in nonmetropolitan communities at rates similar to women in metropolitan communities.