Modified Martius Flap Urethroplasty: A New Technique

V06-08 MODIFIED MARTIUS FLAP URETHROPLASTY

Contemporary US resident exposure to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) faculty during urology residency is unknown. Accredited US urology residencies were identified through the American Urological Association (AUA). Accredited, urology-based FPMRS fellowships were identified through the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The number of faculty and residency positions were obtained from program AUA profiles if they were last modified within the current application cycle; this information was obtained from program websites if AUA profiles were outdated. Data on faculty fellowship training was manually extracted from program websites. A quality control cross-check of program and faculty training characteristics was performed through direct communication with 5% of programs. Of 139 accredited residency programs assessed, 10.8% were affiliated with an accredited, urology-based FPMRS fellowship. In total, 29.5% of residency programs, representing 25% of US urology residents, had neither a FPMRS fellowship nor any FPMRS certified faculty. The national FPMRS faculty-to-resident ratio was 1:10.8, and 7.4% of faculty at all residency programs were FPMRS certified. In comparison, faculty-to-resident ratios for other subspecialties were: 1:4.7 for pediatrics, 1:3.6 for oncology, 1:5.9 for minimally invasive surgery/endourology, 1:14.2 for trauma/reconstruction, and 1:11.8 for andrology or male sexual/reproductive health. The FPMRS faculty-to-resident ratio was 1:5.1 in programs with a urology-based FPMRS fellowship compared with 1:13.4 in programs without a FPMRS fellowship. 30% of US urology residency programs lack FPMRS trained faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Further studies are required to ascertain if inadequate exposure to FPMRS cases and mentors during training contribute to the shortage of urology residents who choose to specialize in FPMRS. This link has important implications for the current shortage of FPMRS providers.

The objective of the article is to review key guidelines on the management of urinary incontinence (UI) to guide clinical management in a practical way. Guidelines produced by the European Association of Urology (updated in 2014), the Canadian Urological Association (updated in 2012), the International Consultation on Incontinence (updated in 2012), and the National Collaborating Centre for Women's and Children's Health (updated in 2013) were examined and their recommendations compared. In addition, specialised guidelines produced by the collaboration between the American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction on overactive bladder and the use of urodynamics were reviewed. The Appraisal of Guidelines for Research and Evaluation II (AGREE) instrument was used to evaluate the quality of these guidelines. There is general agreement between the groups on the recommended initial evaluation and the use of conservative therapies for first-line treatment, with a limited role for imaging or invasive testing in the uncomplicated patient. These groups have greater variability in their recommendations for invasive procedures; however, generally the mid-urethral sling is recommended for uncomplicated stress UI, with different recommendations on the approach, as well as the comparability to other treatments, such as the autologous fascial sling. This 'Guideline of Guidelines' provides a summary of the salient similarities and differences between prominent groups on the management of UI.

MP12-04 PHYSICIAN PRACTICE PATTERNS FOR URINARY INCONTINENCE MANAGEMENT FOR PERSONS LIVING WITH DEMENTIA

The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure-flow studies of 1997. Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure-flow study (PFS) for patients in part 1. A pressure-flow plot is recommended for the diagnosis of every patient, in addition to time-based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure-flow scatter graph including every patient's pdet at maximum flow (pdetQmax ) with maximum flow rate (Qmax ) point should be included in all scientific reports considering voiding dysfunction. PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.

Measuring Pelvic Floor Disorder Symptoms Using Patient-Reported Instruments: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction.

Neurourology and UrodynamicsVolume 33, Issue 2 p. 162-266 AbstractsFree Access Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction 2014 Winter Meeting February 25–March 1, 2014 Doral Golf Resort & Spa Miami, Florida First published: 12 February 2014 https://doi.org/10.1002/nau.22577Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume33, Issue2February 2014Pages 162-266 RelatedInformation

Comparison of Microscopic Hematuria Guidelines as Applied in 1018 Patients With Microscopic Hematuria

Updates to Microhematuria: AUA/SUFU Guideline (2025).

To promote the recognition and care of patients with female genital mutilation/cutting (FGM/C), we aimed to evaluate the awareness, clinical experience and knowledge of FGM/C among female pelvic medicine and reconstructive surgery (FPMRS) specialists. FGM/C is a cultural practice whereby there is removal of external female genitalia for non-therapeutic reasons. Despite the high prevalence of urogynecologic complications, there is a paucity of literature discussing FGM/C from the lens of urologists and urogynecologists. By cross-sectional design, we distributed a 27-item survey via email to members of the Society of Urodynamics, Female Pelvic Medicine and Reconstructive Surgery. We collected variables pertaining to previous FGM/C education, clinical confidence, cultural and medical knowledge, and desire for future education. A total of 54 US-based, mostly urologists and FPMRS specialists, completed the survey. All providers had heard of FGM/C; however only 13% received formal education during medical training. Over 50% had encountered a patient with FGM/C in clinical practice. Only 19% and 13% felt completely confident recognizing and discussing FGM/C, respectively. Seventy percent believed religious doctrine informed FGM/C practice and 24% correctly identified FGM/C type on clinical representation. Finally, only 17% of respondents were aware of FGM/C guidelines, and providers expressed a desire for increased availability of multimodal resources. Education regarding FGM/C remains sparse and variable for US FPMRS specialists. Cultural and clinical knowledge is also lacking, which is a detriment to patient care. In order to strengthen awareness and knowledge, we must develop high-quality FGM/C educational resources for urologists and gynecologists.

BackgroundWith the rapid advancement and widespread adoption of artificial intelligence (AI), patients increasingly turn to AI for initial medical guidance. Therefore, a comprehensive evaluation of AI-generated responses is warranted. This study aimed to compare the performance of DeepSeek and ChatGPT in answering urinary incontinence-related questions and to delineate their respective strengths and limitations.MethodsBased on the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/SUFU) and European Association of Urology (EAU) guidelines, we designed 25 urinary incontinence-related questions. Responses from DeepSeek and ChatGPT-4.0 were evaluated for reliability, quality, and readability. Fleiss' kappa was employed to calculate inter-rater reliability. For clinical case scenarios, we additionally assessed the appropriateness of responses. A comprehensive comparative analysis was performed.ResultsThe modified DISCERN (mDISCERN) scores for DeepSeek and ChatGPT-4.0 were 28.24 ± 0.88 and 28.76 ± 1.56, respectively, showing no practically meaningful difference [P = 0.188, Cohen's d = 0.41 (95% CI: −0.15, 0.97)]. Both AI chatbots rarely provided source references. In terms of quality, DeepSeek achieved a higher mean Global Quality Scale (GQS) score than ChatGPT-4.0 (4.76 ± 0.52 vs. 4.32 ± 0.69, P = 0.001). DeepSeek also demonstrated superior readability, as indicated by a higher Flesch Reading Ease (FRE) score (76.43 ± 10.90 vs. 70.95 ± 11.16, P = 0.039) and a lower Simple Measure of Gobbledygook (SMOG) index (12.26 ± 1.39 vs. 14.21 ± 1.88, P < 0.001), suggesting easier comprehension. Regarding guideline adherence, DeepSeek had 11 (73.33%) fully compliant responses, while ChatGPT-4.0 had 13 (86.67%), with no significant difference [P = 0.651, Cohen's w = 0.083 (95% CI: 0.021, 0.232)].ConclusionDeepSeek and ChatGPT-4.0 might exhibit comparable reliability in answering urinary incontinence-related questions, though both lacked sufficient references. However, DeepSeek outperformed ChatGPT-4.0 in response quality and readability. While both AI chatbots largely adhered to clinical guidelines, occasional deviations were observed. Further refinements are necessary before the widespread clinical implementation of AI chatbots in urology.

Do Urodynamic Findings Other Than Outlet Obstruction Influence the Decision to Perform a Transurethral Resection of Prostate?

To provide a comprehensive review of guidelines from various professional organisations on the work-up and management of post-prostatectomy Incontinence (PPI). The following guidelines were included in this review: European Association of Urology (EAU 2023), American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (AUA/SUFU 2019), International Consultation on Incontinence (ICI, 2018), the Canadian Urological Association (CUA, 2012) and the Urological Society of India (USI, 2018). In general, the guidelines concur regarding the significance of conducting a comprehensive history and physical examination for patients with post-prostatectomy incontinence (PPI). However, there are variations among the guidelines concerning the recommended additional investigations. In cases of troublesome PPI, male slings are typically recommended for mild to moderate urinary incontinence (UI), while artificial urinary sphincters are preferred for moderate to severe UI, although the precise definition of this severity remains unclear. The guidelines provided by AUA/SUFU and the ICI have offered suggestions for managing complications or persistent/recurrent UI post-surgery, though some differences can be observed within these recommendations as well. This is a first of its kind review encompassing Guidelines on PPI spanning over a decade. Although guidelines share overarching principles, nuanced variations persist, posing challenges for clinicians. This compilation consolidates and highlights both the similarities and differences among guidelines, providing a comprehensive overview of PPI diagnosis and management for practitioners. It is our expectation that as more evidence emerges in this and other areas of PPI management, the guidelines will converge and address crucial patient-centric aspects.

According to ICI 2017, imaging of the upper urinary tract upper urinary tract (UUT) is indicated in cases of NLUTD and urinary incontinence with high risk of renal damage (due to high storage and/or voiding detrusor pressure, e.g., myelodysplasia, spinal cord injury) (Abrams et al., 6th International Consultation on Incontinence (2017) Tokyo, in Incontinence, 6th edn. (September 2016)).There are, however, only few guidelines suggesting how frequently this evaluation has been indicated and what test included. European Association of Urology (EAU) guidelines (2021) (Blok et al., EAU Guidelines. Edn. Presented at the EAU Annual Congress Milan 2021 (ISBN 978-94-92671-13-4. EAU Guidelines Office, Arnhem, The Netherlands). http://uroweb.org/guidelines/compilations-of-all-guidelines/) and National Institute for Health and Care Excellence (NICE) guidelines (NICE 2012) (Urinary incontinence in neurological disease: management of lower urinary tract dysfunction in neurological disease, 2019 surveillance of urinary incontinence in neurological disease: Assessment and management (2012, NICE guideline CG148). https://www.nice.org.uk/guidance/cg148) have similar although slightly different recommendations. Recently, the Canadian Urological Association (CUA) and the American Urological Association/Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (AUA/SUFU) published their guidelines for NLUTD (Kavanagh et al., Can. Urol. Assoc. J. 13(6) (2019). https://doi.org/10.5489/cuaj.5912; Ginsberg et al., J. Urol. (2021). https://doi.org/10.1097/JU.0000000000002235). Common recommendations of all guidelines are to assess the urinary tract at regular intervals in high-risk patients. This chapter describes imaging techniques in the evaluation of the patients with NLUTD.KeywordsNLUTDImagingUltrasoundComputer tomographyfMRIPETSPECT

Introduction The rarity in detecting female urethral stricture (FUS) backed by the inconsistency regarding the cutoff on the caliber to direct any treatment for its increase poses a challenge to its existence. Therefore, the present study was conducted to determine the caliber of the urethra that clearly identifies aFUS. Materials and method In this prospective observational study conducted between November 2015 and July 2017, women with obstructive lower urinary tract symptoms (LUTS) and a history of relief on at least a single urethral dilatation were included if the American Urological Association (AUA) score was more than seven and the maximum flow rate (Qmax) was less than 20 mL/sec. Of the 71 women recruited, 10 women had recognizable external causes: caruncle (five), mucosal prolapse (three), and meatal stenosis (two). The remaining 61 underwent voiding cystourethrogram (VCUG) and urodynamics followed by urethrocystoscopy, if the findings suggested a stricture. A definitive diagnosis was sought in those without stricture disease. We categorized all patients as either having a "true" stricture or an alternate etiology. Categorical variables were presented in number and percentage (%) and continuous variables as mean ± standard deviation (SD). Results The mean dilatationranged between one and six; the mean AUA score, ~17.82 ± 3.59; mean Qmax, ~10.21 ± 3.39 mL/sec; and the mean post-void residue (PVR), 106.65 ± 51 mL. A total of 29 patients were diagnosed to have stricture (dense = 17; flimsy = 12). None of the patients in this group had a urethral caliber of more than 14 French (Fr). Other etiologies were dysfunctional voiding (17), underactive bladder (seven), cystocele (four), and primary bladder neck obstruction (PBNO) (four). Conclusion Women with voiding LUTS should be screened for FUS only if the urethral caliber is ≤14 Fr.