IMPORTANCE:Prior studies of patient decision aids in urogynecology have not shown benefit, but these tools may have been written at a reading level above that of the average patient. OBJECTIVES:The primary aim was to determine if consent using an audiovisual decision aid (AVDA) written below eighth-grade reading level in English or Spanish affects patient preparedness for surgery. Secondary aims included correlating health literacy with preparedness and assessing patient satisfaction with the decision for surgery. STUDY DESIGN:We conducted a randomized controlled trial on patients undergoing surgery for pelvic organ prolapse or urinary incontinence. We compared standard informed consent (control) with watching the AVDA. The primary outcome was the overall response on the "Preoperative Preparedness For Surgery" questionnaire. Health literacy was assessed using the Short Test of Functional Health Literacy in Adults. Postoperatively, satisfaction with the decision for surgery was assessed. RESULTS:One hundred fifty-one participants completed the study. In each group, 98.7% of participants strongly agreed or agreed that they felt prepared for surgery (AVDA 74/75, control 75/76, P = 0.364). Most participants had adequate health literacy (AVDA 82.1%, control 81.8%). Among those with low health literacy, there was no significant difference in preparedness for surgery between AVDA and control ( P = 0.363). Most participants in both groups were satisfied with their decision for surgery (AVDA 98.6%, control 100%, P = 0.737). CONCLUSIONS:Use of an audiovisual decision aid written below eighth-grade reading level did not significantly affect preparedness for surgery, even among participants with low health literacy. Preparedness for surgery was high in both groups.

Objective Barriers to toilet access and suboptimal toilet environments in workplaces and schools may contribute to unhealthy toileting behaviors and poorer bladder health in women, but quantitative evidence is limited. We examine associations between workplace toilet access, autonomy, and environment with women’s toileting behaviors and test whether these behaviors mediate relationships with bladder function. Methods Data from 1,772 women (mean age 51 years) in the RISE FOR HEALTH study were analyzed. Participants completed Toilet Environment and Access Scales (TEAS), Toileting Behaviors–Women’s Elimination Behaviors (TB-WEB), and the Bladder Function Index (BFI). Regression and structural equation modeling tested associations among TEAS domains (access/autonomy and toilet environment), TB-WEB subscales, and BFI. Results Mean TEAS scores indicated high access and favorable environments (4.1 and 4.4 on a 0–5 scale). Greater access/autonomy and more favorable environments were associated with less delayed voiding (b=–0.26, –0.15), straining (b=–0.17, –0.15), and premature voiding (b=–0.13, –0.08). All unhealthy behaviors were associated with lower BFI scores, with delayed voiding showing the strongest association (b=–8.0). Higher TEAS scores were associated with higher BFI (b=3.3–3.8 per unit). Mediation analyses indicated that toileting behaviors, particularly delayed voiding, partially mediated associations between TEAS domains and BFI. Conclusions Favorable toilet environments and greater toilet access and autonomy were associated with healthier toileting behaviors and better bladder function. Policies and practices that support toilet access and autonomy in workplaces and schools may promote bladder health by reducing unhealthy toileting behaviors.

To compare the bladder microbiomes of participants with and without a gynecological cancer at the time of diagnostic surgery to determine their suitability as control participants in urobiome research studies. IRB-approved clinical sample of continent adult female patients undergoing surgery for suspected gynecologic malignancy. Participants contributed clinical data (abstracted from the electronic medical record), and a catheterized urine sample obtained prior to antibiotic administration on the day of surgery. The study urine sample underwent DNA sequencing following amplification of hyper-variable region 4 (V4) of the bacterial 16S rRNA gene. The sequences were processed, annotated, and decontaminated. Alpha (within-sample) and beta (between-sample) diversity indices were computed, and the microbiome compositions across all participants were compared. Ninety-two women participated, including 20 with a gynecological cancer diagnosis and a comparison group of 72 without gynecologic cancer detected. The mean age was 53 years old (range 22–92) with a mean BMI of 31 kg/m2 (26–38 kg/m2); the majority (62

(Abstracted from Urogynecology (Phila) 2025;31(7):650–659) Microbiota regulate many processes in the body. Resiliency refers to how well microbiota can return to a baseline state after disruption, and understanding resilience is necessary to determine how to modulate microbiota to optimize healing and prevent disease.

Background: Little is known about women's decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app "Where I Go" captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with "Where I Go", variation in novel parameters collected, and readiness for the data collection tool's use in population-based studies. Methods: "Where I Go" has three components: (1) real-time data, (2) short look-back periods (3-4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant's self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86%, on day 1 and 40/44, 91%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61%, on day 1 and 129/171, 75%, on day 2) due to a need to go (114/140, 66%, on day 1 and 153/171, 74%, on day 2). The most common reasons for delaying toileting were "work duties" (33/140, 21%, on day 1 and 21/171, 11%, on day 2) and "errands or traveling" (19/140, 12%, on day 1 and 19/171, 10%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93%, on day 1 and 42/44, 95%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95% CI 3.0-3.5; mean on day 2=4.3, 95% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in "Where I Go" showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: "Where I Go" has potential to increase the understanding of factors that affect women's toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies.

BACKGROUND:Bladder health encompasses total bladder well-being and not merely the absence of urinary symptoms. While much is known about the prevalence of urinary symptoms in women, little is known about the distribution of bladder health (eg, optimal to poor). OBJECTIVE:We report the distributions of multiple dimensions of bladder health and function in a population-based sample of community-dwelling women, overall and separately in women without urinary symptoms to begin to explore bladder health dimensions that may precede the onset of symptoms. STUDY DESIGN:RISE FOR HEALTH is a regionally-representative cohort study of US women aged 18 and older. Baseline surveys included the validated Bladder Health Scales/Bladder Function Indices, the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and additional study items. Bladder well-being was assessed across 10 scales and bladder function across 6 indices. Bladder Health Scale scores were adjusted for adaptive/coping behaviors (eg, using/carrying pads, staying close to a toilet) to account for the perceived impact of urinary symptoms on well-being. Scores for scales and indices ranged from 0 (poor well-being/function) to 100 (optimal well-being/function). We calculated summary statistics for each scale (with and without adaptive behavior adjustment) and each index in the full study population and subset of women without urinary symptoms. RESULTS:The mean age of 3027 eligible participants was 49.8 years (standard deviation 17.9). The median global Bladder Health Scale score was 72 (interquartile range: 56, 84) before adjustment for adaptive/coping behaviors and 55 (interquartile range: 34, 78) after adjustment. Median scores for the other scales ranged from 75 to 100 before and 61 to 72 after adjustment. Sixty-nine percent of participants reported using adaptive/coping behaviors, including using pads (40%), toilet mapping (58%), and staying close to a toilet (3%). The median overall Bladder Function Index score was 77 (interquartile range: 63, 89); individual median scores ranged from 63 to 68 for frequency, sensation, continence, and emptying indices to 100 for biosis/urinary tract infection and comfort indices. Among participants without reported urinary symptoms (n=700), scores were higher across all scales (unadjusted medians=88-100 and adjusted medians=82-100) and indices (medians=93-100), indicating better, but not optimal health; however, 38% of asymptomatic women reported using adaptive/coping behaviors: 11% using pads, 30% toilet mapping, and 2% staying close to a toilet. CONCLUSION:We observed a wide range of bladder well-being and function in RISE participants and high utilization of adaptive/coping behaviors. Bladder health variability and utilization of adaptive/coping behaviors was also observed in women without urinary symptoms, highlighting bladder health dimensions not captured by traditional urinary symptom tools and potentially identifying a group of women with "subclinical" symptoms who may be at greater risk of developing urinary symptoms. Future prospective analyses should investigate this novel group of women further.

IMPORTANCE:Little is known about the resilience of the urogenital microbiota in response to urogynecologic surgery. OBJECTIVES:The aim of this study was to determine if the urogenital microbiota are disrupted after surgery and if the postoperative composition returns to a preoperative baseline. We also sought to determine if the process of recovery differs in premenopausal women versus postmenopausal women. STUDY DESIGN:Women undergoing surgery for pelvic floor disorders were invited to participate in this longitudinal descriptive study. Catheterized urine specimens and vaginal swabs were obtained at 4 timepoints: (1) day of surgery prior to antibiotic administration and surgical preparation; (2) immediately postoperatively; (3) 3-week postoperative visit; and (4) 12-week postoperative visit. Bacterial DNA was extracted, sequenced by 16S rRNA gene sequencing and classified taxonomically. Longitudinal data analyses were performed using linear mixed-effects models evaluating Jensen-Shannon divergence and α diversity measures. RESULTS:Forty women, 50% of whom were postmenopausal, were included. There were significant alterations in α diversity over time (P time ≤0.05 for all comparisons), except richness in the bladder. There was perturbation immediately postoperatively, with a return to preoperative baseline at 3 and 12 weeks postoperatively. At each timepoint, premenopausal participant microbiota were not diverse, whereas postmenopausal women had diverse compositions. Jensen-Shannon divergence indices were stable in both the bladder (P = 0.95) and vagina (P = 0.88) over time in premenopausal women but showed divergence from the preoperative vagina for postmenopausal women (P = 0.004). CONCLUSIONS:The urogenital microbiome is altered after urogynecologic surgery. In premenopausal versus postmenopausal women, the composition, stability, and process of recovery differ.

BACKGROUND:Studies have shown up to a 40% discordance between patients' preferred roles in decision-making before and their perceived roles after their visit. This can negatively affect patients' experiences; interventions to minimize this discordance may significantly improve patient satisfaction. OBJECTIVE:We aimed to determine whether physicians' awareness of patients' preferred involvement in decision-making before their initial urogynecology visit affects patients' perceived level of involvement after their visit. STUDY DESIGN:This randomized controlled trial enrolled adult English-speaking women presenting for their initial visit at an academic urogynecology clinic from June 2022 to September 2022. Before the visit, participants completed the Control Preference Scale to determine the patient's preferred level of decision-making: active, collaborative, or passive. The participants were randomized to either the physician team being aware of their decision-making preference before the visit or usual care. The participants were blinded. After the visit, participants again completed a Control Preference Scale and the Patient Global Impression of Improvement, CollaboRATE, patient satisfaction, and health literacy questionnaires. Fisher exact, logistic regression, and generalized estimating equations were used. Based on a 21% difference in preferred and perceived discordance, we calculated the sample size to be 50 patients in each arm to achieve 80% power. RESULTS:Women (n=100) with a mean age of 52.9 years (standard deviation=15.8) participated in the study. Most participants identified as White (73%) and non-Hispanic (70%). Before the visit, most women preferred an active role (61%) and few preferred a passive role (7%). There was no significant difference between the 2 cohorts in the discordance between their pre- and post-Control Preference Scale responses (27% vs 37%; P=.39) or whether their symptoms were much better or very much better following the visit (18% vs 37%; P=.06). However, when asked whether they were completely satisfied with the visit, those assigned to the physician awareness cohort reported higher satisfaction than those in the treatment as usual cohort (100% vs 90%; P=.03). CONCLUSION:Although there was no significant decrease in discordance between the patient's desired and perceived level of decision-making following physician awareness, it had a significant effect on patient satisfaction. All patients whose physicians were aware of their preferences reported complete satisfaction with their visit. Although patient-centered care does not always entail meeting all of the patients' expectations, the mere understanding of their preferences in decision-making can lead to complete patient satisfaction.

ABSTRACTIntroductionUroflowmetry is often used to assess lower urinary tract symptoms (LUTS). Criteria for characterization of flow patterns are not well established, and subjective interpretation is the most common approach for flow curve classification. We assessed the reliability of uroflowmetry curve interpretation in adult women.Materials and MethodsUroflowmetry studies were obtained in 296 women who participated in an observational cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for interrater reliability. A random subset of 50 tracings was re‐reviewed by each investigator for intrarater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous fluctuating, interrupted, and prolonged. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters is summarized with kappa (k) statistics and percentage where at least three raters agreed.ResultsThe mean age of participants was 44.8 ± 18.3 years. Participant age categories were 18–24 years: 20%; 25–34 years: 17%; 35–64 years: 42%; 65+ years: 18%. Nine percent described their race as Asian, 31% Black, 62% White, and 89% were of non‐Hispanic ethnicity. The interrater reliability was highest for the continuous flow category (k = 0.65), 0.47 for prolonged, 0.41 for continuous fluctuating, and 0.39 for interrupted flow curves. Agreement among at least three raters occurred in 74.3% of uroflow curves (69% for continuous, 33% for continuous fluctuating, 23% for interrupted, and 25% for prolonged). For intrarater reliability, the mean k was 0.72 with a range of 0.57–0.85.ConclusionsCurrently accepted uroflowmetry pattern categories have fair to moderate interrater reliability, which is lower for flow curves that do not meet “continuous” criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use in research and as a screening tool for LUTS and voiding dysfunction.Trial RegistrationParent trial: Validation of Bladder Health Instrument for Evaluation in Women (VIEW); ClinicalTrials.gov ID: NCT04016298.

IMPORTANCE:Bladder health in high school and collegiate females is not well understood. OBJECTIVE:The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes. STUDY DESIGN:English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake. RESULTS:One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes ( P < 0.01) versus more stress fractures in athletes ( P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids ( P = 0.03). CONCLUSIONS:Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.

Background Although surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. Objective The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women’s decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when “thinking about my bladder” and shortly before “I just peed,” (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. Methods The development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study. Results Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. Conclusions WhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. International Registered Report Identifier (IRRID) RR1-10.2196/54046

PURPOSE:We aimed to estimate the prevalence of a wide range of lower urinary tract symptoms (LUTS) in US women, and explore associations with bother and discussion with health care providers, friends, and family. MATERIALS AND METHODS:We analyzed baseline data collected from May 2022 to December 2023 in the RISE FOR HEALTH study-a large, regionally representative cohort study of adult female community members. LUTS and related bother were measured by the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index, and discussion was assessed by a study-specific item. RESULTS:Of the 3000 eligible participants, 73% (95% CI 71%-74%) reported any storage symptoms, 52% (95% CI 50%-53%) any voiding or emptying symptoms, and 11% (95% CI 10%-13%) any pain with bladder filling, for an overall LUTS prevalence of 79% (95% CI 78%-81%). This prevalence estimate included 43% (95% CI 41%-45%) of participants with mild to moderate symptoms and 37% (95% CI 35%-38%) with moderate to severe symptoms. Over one-third of participants reported LUTS-related bother (38%, 95% CI 36%-39%) and discussion (38%, 95% CI 36%-40%), whereas only 7.1% (95% CI 6.2%-8.1%) reported treatment. Urgency and incontinence (including urgency and stress incontinence) were associated with the greatest likelihood of bother and/or discussion (adjusted prevalence ratios = 1.3-2.3), even at mild to moderate levels. They were also the most commonly treated LUTS. CONCLUSIONS:LUTS, particularly storage LUTS such as urgency and incontinence, were common and bothersome in the RISE study population, yet often untreated. Given this large burden, both prevention and treatment-related interventions are warranted to reduce the high prevalence and bother of LUTS.

In the past few years, very rapid advances have been made in determining the primary structure of protein tyrosine phosphatases (PTPases). PTPase genes have now been isolated from bacteria, viruses, yeasts and insects as well as vertebrates. The cytosolic PTPases have a catalytic domain associated with various accessory domains that are believed to be involved in protein-protein interaction or subcellular localization. The transmembrane PTPases have either one or two cytoplasmic PTPase domains and an extracellular receptor-like structure. The existence of a large number of structurally diverse PTPases suggests that they play specific and crucial roles in signal transduction. In this article, the structural features of the PTPases from higher eukaryotes are reviewed.

Iatrogenic injuries of the ureter is a known and dreaded complication of the female pelvic surgery due to the close proximity of the ureter to gynecological structures. Understanding the anatomy, anatomic variations, patient and procedural risk factors can aid pelvic surgeons. In addition, the ability to detect a ureteral injury intraoperatively can prevent many but not all postoperative complications. Advances in the treatment of iatrogenic ureteral injury have occurred due to the increasing laparoscopic skills of pelvic surgeons.

OBJECTIVES:To explore the impact of nocturnal polyuria (NP) on health-related quality of life (HRQoL), work productivity, mental health, fatigue, bother, and daytime sleepiness.MATERIALS AND METHODS:This large-scale, US population-representative epidemiologic study was conducted in two parts: a web-based survey and 3-day bladder diary. Consenting participants completed the baseline Epidemiology of NP (EpiNP) survey online (Lower Urinary Tract Symptoms [LUTS] Tool, comorbidities, burden, and multiple HRQoL measures). Participants who reported ≥2 voids/night, and a random sample of 100 respondents each reporting 0 or 1 void/night, were sent urine measurement containers and asked to complete the 3-day bladder diary. NP was defined as Nocturnal Polyuria Index >0.33 (NPI33) or nocturnal urine production >90 ml/h (NUP90). Five subgroups were created: Idiopathic NP (NP with no underlying cause), NP associated with symptoms of overactive bladder (NPOAB) or bladder outlet obstruction (NPBOO; men only), NP associated with other comorbidities (NPCOM; e.g., diabetes, hypertension, heart disease, sleep apnea), and no NP (did not meet NP criteria).RESULTS:A total of 4893 men and 5297 women completed the EpiNP survey; mean age was 54.4 (SD = 14.7). Significantly greater patient burden (p < 0.0001) was evidenced in the nocturia group (≥2 voids/night) versus no nocturia group (0-1 void/night) on daily impact of nocturia, LUTS Bother, prostate symptoms (men only), work productivity, physical and mental health component scores, depression, fatigue, and daytime sleepiness. NP subgroup analyses showed men in the NPBOO group and women in the NPOAB group reported the greatest impact on LUTS bother, fatigue, physical health, work productivity impairment, daytime sleepiness, and depression (women only).CONCLUSION:This was the first large-scale, epidemiologic study to explore the impact of different forms of NP on patients' HRQoL. Findings demonstrate that NP associated with other urologic or comorbid conditions appears to have greater patient burden than idiopathic NP, in particular for women.

The magnitude of caregiver burden, defined as the negative sequelae of providing informal care, has not been well studied in urogynecology. Our primary aim was to determine the overall severity of burden experienced by the informal caregivers of patients with pelvic floor disorders. We also sought to quantify and correlate quality of life metrics with the degree of caregiver burden. We conducted a cross-sectional study of patients and their informal caregivers who presented to a urogynecology clinic. Subjects were included if each member of a patient/informal caregiver dyad was over 18 years old and able to complete the study questionnaires. The informal caregiver self-identified as providing emotional, financial, physical, or social support to the patient and indicated they did so without financial payment. Demographic information was collected from the patient's chart. Patients also completed three surveys: the Patient Reported Outcome Measurement Information System – 29 (PROMIS - 29) questionnaire, the Pelvic Floor Disability Index (PFDI), and the Patient Global Impression of Severity (PGIS). Informal caregivers completed the Zarit Burden Interview (ZBI), a validated tool used to measure caregiver burden. A one-sample t-test was used to test the observed ZBI mean against a historical mean of 55 points. Univariable and multivariable general linear models were used to measure the associations between patients' ZBI scores and their demographic information, PFDI scores, PGIS responses, and PROMIS domains. From May 2021 to April 2022, we studied 40 patient/informal caregiver dyads. The average age of the patient was 77.1 (SD = 11.9), with 83% (n = 33) identifying as white. Additionally, the patient population was 93% (n = 33) Non-Hispanic, and 58% (n = 23) had completed an Associate degree or higher in education. 65% (n = 26) characterizing the severity of disease as moderate or severe on the PGI-S. The average ZBI score of the caregiver was 18.3 (SD = 14.4), which was significantly lower than the historical average of 55 points (p < .001). Thirteen (33%) caregivers expressed mild to moderate burden on the ZBI, while only two (5%) expressed moderate to severe burden; only one (3%) caregiver expressed severe burden. On multivariable analysis, every 1-point increase in the PROMIS physical function score decreased the ZBI score by 0.60 (95% CI: -0.98 to -0.23) points (p = .003) even after controlling for a history of prolapse and presence of comorbidities. The negative impact of pelvic floor disorders on patients is well described, however there is a lack of information on the burden these disorders place on informal caregivers. In our sample, 40% of caregivers indicated a measurable amount of burden as indicated by the ZBI. Furthermore, improvement in the patient's physical function domain as measured by PROMIS was correlated with decreased caregiver burden.

The pelvic organ prolapse quantification system (POP-Q) exam is the preferred modality to describe pelvic organ prolapse (POP). However, the three-dimensional nature of the POP-Q exam can be difficult to understand. Visual aids and models may be helpful in teaching the POP-Q exam to trainees. We propose the Interactive Pelvic Organ Prolapse (iPOP) Model as an educational tool for new learners (Figure 1). We sought to investigate the use of the iPOP model as a teaching tool to improve OB/GYN resident physician performance of the POP-Q exam. A prospective cohort study enrolling all eligible OB/GYN residents in our program was performed. All residents were provided two iPOP models demonstrating different stages of POP (stage 1 and 3). They were asked to complete a POP-Q grid for each model. An education session was conducted with the use of the iPOP model as a passive and active teaching aid. Residents were again asked to complete a POP-Q grid for the same two iPOP models used initially. Two urogynecology-trained physicians performed a POP-Q exam on each model to evaluate the accuracy of participant-reported measurements. If measurements differed among both experts, answers were deemed correct if they were within the range of measurements reported by the experts. Resident performance improvement on the POP-Q exam was evaluated via their completed POP-Q grids, comparing their scores of 0-9 points using the Wilcoxon test. Improvement in the correctness of each compartment delineated in the POP-Q grid was analyzed individually using the McNemar test. From August to September 2022, all eligible subjects (n=18) participated in the study. There was a statistically significant improvement in POP-Q grid correctness scores in both models. There was a mean difference of +2.67 for the stage 1 model (p <0.05) and +2.83 for the stage 3 model (p <0.05). The trend is similar for the subpopulation of junior residents (1st and 2nd year), who had not been exposed to the POP-Q grid prior to the study (stage 1 model mean difference +3.50, stage 3 model mean difference +4.40, p<0.05 for both). POP-Q grid correctness scores for senior residents (3rd and 4th year) showed a statistically significant improvement in the stage 1 model (+1.63, p<0.05), but not the stage 3 model (+0.88, p = 0.090). We then stratified the POP-Q grid scores by compartments and found a statistically significant improvement in certain compartments. For the stage 3 model, at least 10 residents improved their scores in the anterior compartment and 8 residents in the posterior compartment. For the stage 1 model, at least 6 residents improved their scores in the apical compartment and 9 residents in the posterior compartment. The iPOP model helps learners become more adept at performing POP-Q exams and to identify the subtle differences when evaluating each compartment. This in turn may lead to a more accurate evaluation of patients with pelvic organ prolapse.Figure 1biPOP model depicting pelvic structures, including bladder (B), vagina (V), uterosacral ligaments (U), rectum (R), sacrum (S), and cervix (C). The iPOP model allows for the educator to mobilize the compartments to simulate different types and degrees of pelvic organ prolapse.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

You have accessJournal of UrologyCME1 Apr 2023MP37-13 INTER-RATER AND INTRA-RATER RELIABILITY OF UROFLOWMETRY INTERPRETATION IN ADULT WOMEN Leslie M. Rickey, Elizabeth R. Mueller, Diane K. Newman, Alayne D. Markland, Chloe Falke, Kyle Rudser, and Emily S. Lukacz Leslie M. RickeyLeslie M. Rickey More articles by this author , Elizabeth R. MuellerElizabeth R. Mueller More articles by this author , Diane K. NewmanDiane K. Newman More articles by this author , Alayne D. MarklandAlayne D. Markland More articles by this author , Chloe FalkeChloe Falke More articles by this author , Kyle RudserKyle Rudser More articles by this author , and Emily S. LukaczEmily S. Lukacz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Non-invasive uroflowmetry is often used to assess lower urinary tract symptoms (LUTS). However, interpretation and characterization of flow patterns is not well established. Subjective interpretation is the most common approach for flow curve classification, and variable parameters have been reported for uroflowmetry curves. We sought to describe the reliability of uroflowmetry curve interpretation in adult women. METHODS: Uroflowmetry studies were obtained in 296 adult women who participated in an observational Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for inter-rater reliability and a random subset of 50 tracings were re-reviewed by each investigator for intra-rater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous with fluctuation, interrupted, and prolonged. Tracings could also be categorized as uninterpretable or ambivalent if the voided volume was <150ml or the reviewer could not assign one of the pattern categories. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters was summarized with kappa (k) statistics and percentage where at least 3 raters agreed. RESULTS: The mean age of participants was 44.8±18.3years. Participant age categories were: 18-24y 20%; 25-34y 18%; 35-64y 43%; ≥65y 19%. Nine percent described their race as Asian, 31% Black, 62% White and 95% non-Hispanic origin. The inter-rater reliability was highest for the continuous flow category (k=0.65), 0.41 for continuous with fluctuation, 0.47 for interrupted, and 0.41 for prolonged flow curves. Agreement amongst at least 3 raters occurred in 74.3% uroflow curves (45.9% for continuous, 13.5% for continuous with fluctuation, 3.4% for interrupted, and 4.1% for prolonged). For intra-rater reliability, the mean kappa across the four raters was 0.72 with a range of 0.57-0.85. CONCLUSIONS: Currently accepted uroflowmetry curve categories have fair to moderate inter-rater reliability and is lower for flow curves that don’t meet “continuous” criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use as a research parameter. Algorithms that can process numerical and pattern data may also improve the reliability of uroflowmetry studies as a diagnostic and predictive tool for LUTS interventions. Source of Funding: The content of this [abstract/ presentation/ poster] is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is supported by the National Institutes of Health (NIH) through cooperative agreements (grants U24DK106786, U01DK106853, U01DK106858, U01DK106898, U01DK106893, U01DK106827, U01DK106908, U01DK106892, U01DK126045). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e519 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leslie M. Rickey More articles by this author Elizabeth R. Mueller More articles by this author Diane K. Newman More articles by this author Alayne D. Markland More articles by this author Chloe Falke More articles by this author Kyle Rudser More articles by this author Emily S. Lukacz More articles by this author Expand All Advertisement PDF downloadLoading ...

Data from a large US population-based, cross-sectional, epidemiological study (the EpiNP Study) were used to assess the symptoms and bother experienced by women with nocturnal polyuria (NP). Consenting participants recruited from an online panel completed the baseline EpiNP survey online (Lower Urinary Tract Symptoms Tool and urological comorbidities). All reporting ≥2 voids/night and a random sample of 100 respondents, each reporting 0 or 1 void/night were asked to complete a 3-day web-based bladder diary recording time, volume, and urgency rating of each void. NP was calculated by the proportion of urine production that occurred during nocturnal hours using a Nocturnal Polyuria Index (NPI33) threshold of >0.33 or nocturnal urine production of >90 ml/h (NUP90). The frequency of participants reporting LUTS and bother was determined by age and NP: idiopathic NP, NP associated with overactive bladder (NPOAB), NP associated with comorbidities (NPCom), and no NP (did not meet NP criteria). A total of 5,290 women completed the baseline survey. Mean age (range) was 54.9 (30–95) years; 1,841 (34.8%) reported ≥2 nocturnal voids. The prevalence of LUTS increased across the lifespan; however, bother associated with each LUTS decreased with increasing age. The percentage of women rating bother by nocturia episodes ≥2 “> somewhat” ranged from 40.3% to 68.3%, with bother ratings highest in the NPOAB and No NP groups. NP is prevalent in women with considerable bother and is often associated with other urinary symptoms. Multifactorial causes and potential treatments of NP should be considered, particularly at a later age.