Faculty Bibliography

OBJECTIVE:To evaluate trends in Urogynecologic and Reconstructive Pelvic Surgery (URPS) among early-career urologists, comparing URPS-trained and non-URPS urologists using American Board of Urology case logs from 2009-2020. MATERIALS AND METHODS/METHODS:Six-month American Board of Urology case logs from 3113 early-career urologists were analyzed. Procedures included sling placement and urethral bulking for stress urinary incontinence (SUI), transvaginal prolapse repair and sacrocolpopexy for pelvic organ prolapse, and intravesical Botox injection and sacral neuromodulation for overactive bladder (OAB). RESULTS:URPS urologists performed higher mean case volumes for SUI (sling: 11 vs 5, P <.01; bulking: 8 vs 4, P <.01), prolapse (transvaginal: 8 vs 4, P <.001; sacrocolpopexy: 6 vs 3, P <.001), and OAB procedures (Botox: 10 vs 4.5, P <.001; sacral neuromodulation: 13.2 vs 7.9, P <.001) than non-URPS urologists. URPS training was associated with higher odds of performing these procedures (odds ratios (ORs) 8.3-25.2, 95% confidence interval (CI) [5.97-45.84] P <.01). The proportion of non-URPS urologists performing SUI and prolapse procedures declined over the years (Spearman's ρ = -0.79 to -0.94, P <.01), while the adoption of OAB procedures increased. CONCLUSION/CONCLUSIONS:Our findings revealed a gradual shift in practice patterns toward increasing subspecialization, particularly for SUI and prolapse surgeries. Interestingly, minimally invasive OAB treatments are increasingly adopted by non-URPS urologists, likely due to improvements in surgical techniques and the development of new technology.

PURPOSE/OBJECTIVE:Overactive bladder (OAB) is a prevalent condition that can have a significant impact on quality of life. Sacral neuromodulation (SNM) is proven as an effective treatment option for OAB patients. Rechargeable devices have gained popularity in recent years. However, there is a paucity of data investigating revision rates for rechargeable SNM devices and associated impacting factors. MATERIALS AND METHODS/METHODS:We conducted a retrospective cohort study to investigate the revision rates of SNM devices in patients diagnosed with OAB. Patients who underwent implantation of rechargeable or non-rechargeable SNM devices at our institution between January 2019 and June 2023 were included. Revision events, reasons for revisions, and patient demographics were analyzed and compared between the device groups. RESULTS:The study included 246 patients. One hundred fifty received rechargeable SNM devices and 96 received non-rechargeable devices. Revision rates were significantly different between the two groups, with 34% of patients in the rechargeable device group requiring revisions compared to 13.5% in the non-rechargeable group (p < 0.001). The most common reasons for revision in the rechargeable group included difficulty charging (35.3%) and reduction of symptom improvement (23.5%). Having a rechargeable device resulted in a significantly higher probability of requiring a revision over time compared to non-rechargeable (p < 0.001). CONCLUSION/CONCLUSIONS:Our study demonstrated that patients who received rechargeable SNM devices were more likely to require revision. Factors such as device malfunction or difficulties connecting to the device may contribute to the higher revision rates. Further studies are needed to elucidate factors affecting revision rates in SNM devices.

BACKGROUND:Female sexual dysfunction (FSD) is a prevalent and multifaceted condition affecting women's sexual well-being. This randomized controlled trial aimed to evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS) compared to a validated sham control in the treatment of FSD. METHODS:We conducted a single-center randomized controlled trial. Participants with FSD were recruited and randomly assigned at a 1:1 allocation ratio to either PTNS or a validated sham control using transcutaneous nerve stimulation (TENS). Treatment was performed through weekly 30-min session for 12 weeks total. Sexual function was assessed at baseline, 6 weeks, and 12 weeks primarily using the Female Sexual Function Index (FSFI) questionnaire. Urogenital distress inventory-6 was collected to evaluate for any baseline urinary incontinence/voiding dysfunction. Linear mixed-effect models for longitudinal data were used to compare FSFI scores across different time points. Statistical analysis was performed using SAS 9.4 (SAS Institute Inc. Cary, NC). RESULTS:In total, 34 PTNS and 31 TENS subjects were included in our final analysis. Overall, 48% (16/34) of PTNS subjects versus 29% (11/33) of TENS subjects were no longer at risk for FSD (FSFI > 26.55) after 12 weekly treatments. Both PTNS and TENS subjects demonstrated similar improvements in FSFI total scores after 12 weeks of treatments. Interestingly, patients who did not present with baseline urogenital distress symptoms reported a statistically significant larger improvement in sexual satisfaction after PTNS treatments as compared to placebo (p = 0.017). CONCLUSION/CONCLUSIONS:This study demonstrated a sustained efficacy of PTNS in improving sexual function. Specifically, patients who did not have coexisting urinary dysfunction reported significant improvement in sexual satisfaction after PTNS. Our study suggested that PTNS may have a direct neuromodulation effect on sexual dysfunction and may hold promise as a treatment modality for FSD.

Iatrogenic causes of male infertility can include medications, chemotherapy, radiation, and surgery. In this review, we discuss commonly performed urologic cancer surgeries and nonurologic surgeries that harbor a high risk of iatrogenic infertility. These include radical prostatectomy, radical cystectomy, retroperitoneal lymph node dissection, pelvic colon surgery, and anterior spine surgery. In addition, we review the anatomy and surgical strategies that help to reduce the risks of infertility. With an increase in life expectancy and improvements in fertility preservation, it is important to properly counsel patients about the risks of infertility and provide options for fertility preservation before surgery.

OBJECTIVES:To investigate the utilization of mesh slings for stress urinary incontinence (SUI) across time - before and after the 2011 US Food and Drug Administration (FDA) public health notification regarding an increase in adverse events related to transvaginal mesh (TVM) for pelvic organ prolapse (POP) repair - and among FPMRS-certified urologists and gynecologists and non-FPMRS counterparts using a statewide database. METHODS:The New York Statewide Planning and Research Cooperative System all-payer database was utilized to extract outpatient Current Procedural Terminology procedure codes for SUI mesh sling utilization and revision or removal performed between 2007 and 2015. RESULTS:After the 2011 FDA warning on POP with TVM, sling placement decreased by 43% from 5214 cases in 2011 to 2958 in 2015. However, over the study period, the rate of sling revision remained stable relative to total sling placement. The rise and fall in mesh sling usage for SUI was primarily driven by non-FPMRS providers. FPMRS providers performed a higher proportion of sling procedures. The number of FPMRS physicians also increased from 2011 to 2015, and each individual physician had a higher median case volume for sling placements and revisions. CONCLUSION:In New York state, utilization of mesh slings for SUI has significantly decreased since the 2011 FDA public health notification, without any specific warning for the utilization of mesh in this setting. This trend was mainly driven by a decrease in mesh usage among non-FPMRS physicians, although the specific causality is likely complex.

AIMS:Third-line therapies are efficacious in improving overactive bladder (OAB) symptoms; however, OAB patients have poor follow-up and rarely progress to these therapies. Clinical care pathways (CCP) may improve OAB follow-up rates and third-line therapy use. We sought to determine how new OAB patients follow up and utilize third-line therapies with the implementation of an OAB CCP in a fellowship Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained urologist's academic practice. METHODS:We identified new OAB patients using ICD-9 and 10 codes. They were placed into two groups: pre- and post-CCP use. Basic demographic data were collected. Patients were evaluated in a retrospective longitudinal fashion over 12 months to determine follow-up and third-line therapy utilization. RESULTS:A total of 769 new OAB patients (261 pre-CCP and 508 post-CCP) were identified. The mean number of follow-up visits increased significantly at 6 months (0.94 vs. 1.64 visits, p = .001) and 12 months (1.26 vs. 2.46 visits, p < .003). Follow-up rates increased significantly at 3 months (38.7% vs. 50.2%, p = .002). Mean time to third-line therapy decreased significantly (280 days vs. 160 days, p = .016). Third-line therapy utilization therapy rates increased at 6 months (7.7% vs. 13.4%, p = .018) and at 12 months (11.1% vs. 16.5%, p = .044). CONCLUSIONS:New OAB patients follow-up and progress to third-line therapies faster and more frequently with the use of a CCP in an FPMRS-trained urologist practice. However, many OAB patients still fail to follow up and overall utilization of third-line therapies remains low. Future studies are warranted to identify factors to why overall OAB compliance remains low.