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Purpose: Neurogenic lower urinary tract dysfunction (NLUTD) is highly prevalent among patients with neurologic disorders. Some studies have demonstrated that implantable neuromodulation can improve symptoms of NLUTD. We seek to describe our experience with sacral and pudendal neuromodulation in patients with NLUTD. Methods: A retrospective chart review of patients with "neurogenic bladder" ICD-9/10 (International Classification of Diseases, Ninth Revision/10th Revision) code was performed at a single institution. This included patients from 2008 to 2020 who underwent stage 1 neuromodulation trial. Demographic and clinical information was collected, including neurologic diagnosis, the character of patients' voiding symptoms, the presence or absence of fecal incontinence, the need for intermittent catheterization, and whether patients had sufficient (>50%) improvement in their symptoms to undergo stage 2 implantable pulse generator (IPG) placement. Results: We identified 82 patients with neurologic diagnoses who underwent stage 1 neuromodulation. The most common diagnoses were diabetic cystopathy (17.07%), spinal surgery (17.07%), and spinal cord injury (12.20%). The most commonly reported symptoms were urinary urgency, and urge urinary incontinence. Overall, 59 patients (71.95%) advanced to stage 2 IPG placement including 72% of patients with sacral leads and 76% with pudendal leads. Conclusions: Neuromodulation is feasible and effective in the treatment of NLUTD. Further investigation into its utilization is warranted. [ABSTRACT FROM AUTHOR]

Purpose: SARS‐CoV‐2 infection can result in genitourinary symptoms, such as frequency, urgency, nocturia, and pain/pressure. In this study, we followed the progression of overactive bladder (OAB) symptoms in patients that reported new or worsening OAB symptoms after coronavirus disease‐19 (COVID‐19) diagnosis. Materials and Methods: Individuals from a COVID‐19 serology study were invited to participate in a follow‐up study. Respondents were divided into three groups based on prior COVID‐19 testing. Patients scored symptoms retrospectively before the pandemic, at study onset, and prospectively during 12‐month follow‐up. Genitourinary symptoms were assessed using international consultation on incontinence questionaire for OAB (ICIQ‐OAB). Change in ICIQ‐OAB scores from baseline were calculated. The minimal important difference of one on ICIQ‐OAB is considered a significant change. Results: 26.0% of participants previously had positive COVID polymerase chain reaction (PCR) test (PCR+), 5.6% a positive serology test only (Ser+), and 65.5% were COVID naïve (COVID−). 23.8% of participants reported a significant increase in ICIQ‐OAB score at study onset compared to prepandemic. ICIQ‐OAB scores were similar at prepandemic but significantly higher at study start (p < 0.001) in PCR+ group. During follow‐up, change in ICIQ‐OAB scores from baseline remained unchanged for COVID− group, but gradually reduced for PCR+, reaching similar levels as COVID− group by 12 months. By 12 months, 71.4% of PCR+, 42.9% of Ser+, and 68.8% of COVID− participants still reported significant increase in ICIQ‐OAB scores. Conclusions: Most COVID‐19 patients experienced return of symptoms to baseline, indicative of the potential resolution of COVID‐associated cystitis. A subset of cases did not, raising questions about the underlying factors contributing to this outcome. Additional research is needed to assess long COVID on urological health. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous Tibial Neuromodulation (PTNM) is used to treat Overactive Bladder (OAB). This analysis summarizes patient adherence to PTNM treatment and examines trends of other third‐line therapy use during and after PTNM. Methods: Optum's deidentified Clinformatics® Data Mart Database (CDM) and CMS Research Identifiable Files were queried for adults with OAB symptoms and who underwent PTNM treatment (2019–2020). We evaluated the proportion of patients who completed 12 visits within 1 year, and defined patients as treatment compliant if 12 PTNM visits were completed within 12 weeks. We then identified the proportion of patients who used other third‐line therapies after PTNM and stratified these patients based on their PTNM therapy compliance status. Results: 2302 patients met selection criteria from CDM and 16,473 patients from CMS. The proportion of patients completing a full PTNM treatment course increased over time; from 16% at week 12% to 42% by week 52 (CDM) and 24% to 38% (CMS). Other third‐line therapy use increased over time and was higher for PTNM noncompliant versus compliant patients at 52 weeks: onabotulinumtoxinA was 6.5% versus 5.7% for noncompliant versus compliant (CMS, p = 0.0661) and 6.4% versus 4.9% (CDM, p = 0.035), SNM trial procedure was 6.5% versus 2.5% (CDM, p = 0.002) and 4.2% versus 2.0% (CMS, p = 0.010). Conclusions: Most patients are noncompliant with recommended PTNM treatment regimen. Albeit low, third‐line therapy was pursued more frequently by noncompliant patients. Given low compliance, the effectiveness of PTNM may be compromised. Alternative implantable technologies may be needed to assure effectiveness of neuromodulation. [ABSTRACT FROM AUTHOR]

Introduction: Onabotulinumtoxin A (BTX‐A) is a well‐established treatment for overactive bladder (OAB). The American Urological Association (AUA) 2008 Antibiotic Best Practice Statement (BPS) recommended trimethoprim‐sulfamethoxazole or fluoroquinolone for cystoscopy with manipulation. The aim of the study was to evaluate concordance with antibiotic best practices at the time of BTX‐A injection and urinary tract infection (UTI) rates based on antibiotic regimen. Methods: Men and women undergoing first‐time BTX‐A injection for idiopathic OAB with 100 units in 2016, within the SUFU Research Network (SURN) multi‐institutional retrospective database were included. Patients on suppressive antibiotics were excluded. The primary outcome was concordance of periprocedural antibiotic use with the AUA 2008 BPS antimicrobials of choice for "cystoscopy with manipulation." As a secondary outcome we compared the incidence of UTI among women within 30 days after BTX‐A administration. Each outcome was further stratified by procedure setting (office vs. operating room; OR). Results: Of the cohort of 216 subjects (175 women, 41 men) undergoing BTX‐A, 24 different periprocedural antibiotic regimens were utilized, and 98 (45%) underwent BTX‐A injections in the OR setting while 118 (55%) underwent BTX‐A injection in the office. Antibiotics were given to 86% of patients in the OR versus 77% in office, and 8.3% of subjects received BPS concordant antibiotics in the OR versus 82% in office. UTI rates did not vary significantly among the 141 subjects who received antibiotics and had 30‐day follow‐up (8% BPS‐concordant vs. 16% BPS‐discordant, CI −2.4% to 19%, p = 0.13). A sensitivity analysis of UTI rates based on procedure setting (office vs. OR) did not demonstrate any difference in UTI rates (p = 0.14). Conclusions: This retrospective multi‐institutional study demonstrates that antibiotic regimens and adherence to the 2008 AUA BPS were highly variable among providers with lower rates of BPS concordant antibiotic use in the OR setting. UTI rates at 30 days following BTX‐A did not vary significantly based on concordance with the BPS or procedure setting. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare maternity leave satisfaction between physicians and nonphysicians. Currently, paid maternal leave is not guaranteed in the United States, resulting in palpable dissatisfaction among parents. Previous studies have shown associations between length of paid leave and career satisfaction and maternal happiness. Materials and Methods: A Qualtrics® electronic survey was distributed to female professionals through email and social media from April 2019 to March 2020. Inclusion criterion was ≥1 child by birth or adoption, or active pregnancy. Continuous and categorical data were analyzed using two-sample t-test and chi-square, respectively. Results: Of 808 respondents, 77% were physicians. Mean age at birth/adoption of first child was higher in physicians versus nonphysicians (32.1 years vs. 29.7 years; p < 0.001). Physicians took shorter maternity leave than nonphysicians (10.9 weeks vs. 12.0 weeks, p = 0.017) with half of that time paid by employers (5.4 weeks vs. 5.9 weeks, p = 0.2). Dissatisfaction was high among physicians (85.1%) and nonphysicians (92.4%) that correlates with maternity leave compensation dissatisfaction (49% vs. 71.3%, p < 0.001). Thirty-four percent of physicians versus 41% of nonphysicians stated that their health was negatively impacted by maternity leave length. Physicians and nonphysicians reported similar incidences of depression, and breastfeeding, delivery, and other postpartum complications. When queried, 38.8% of physicians and 57% of nonphysicians said they would desire >16 weeks of paid maternity leave (p < 0.001). Conclusions: In conclusion, dissatisfaction among professional women on maternity leave duration and compensation is high in the United States. Given health implications for both mother and child, this should invite further discussion and changes. [ABSTRACT FROM AUTHOR]