Interstitial cystitis/bladder pain syndrome (IC/BPS) is prevalent and disrupts daily life. Dietary modification is commonly recommended, but evidence is fragmented. We systematically compared dietary interventions; we hypothesized that individualized elimination may improve symptoms, but overall randomized evidence remains limited. We searched PubMed, EMBASE, Cochrane, Web of Science, and Scopus from inception through March 2025. Primary outcomes used validated symptom scales (Genitourinary Pain Index [GUPI], O’Leary–Sant Symptom/Problem Index [OSSI/OSPI], and visual analog scale [VAS]). Hedges’ g with 95

IMPORTANCE:Disparities in urogynecologic care are well documented, but patient-reported barriers remain poorly characterized. OBJECTIVE:The objective of this study was to evaluate how structural and informational barriers to urogynecologic care vary by race and neighborhood socioeconomic disadvantage, measured using the Area Deprivation Index (ADI). STUDY DESIGN:This cross-sectional study surveyed new urogynecology patients at a midwest academic medical center between January 2024 and May 2024 (IRB STUDY20231132). Participants completed a 23-item questionnaire adapted from the National Institutes of Health All of Us survey assessing access, symptom recognition, referral pathways, and perceived barriers. Demographic and clinical data were obtained by chart review. Zip code-linked ADI percentiles were analyzed using nonparametric tests and multivariable logistic regression, with ADI reported per 10-point increase. RESULTS:Among 219 participants, Black patients resided in more disadvantaged neighborhoods than White patients (mean ADI 80.0 vs 53.4; P<0.001). Higher ADI was independently associated with ≥1-hour round-trip travel (odds ratio [OR], 1.42; 95% CI, 1.15-1.79; P<0.001) and seeing ≥2 health care providers before referral (OR, 1.17; 95% CI, 1.03-1.35; P=0.020). The Black race was independently associated with reporting multiple barriers (OR, 4.79; 95% CI, 1.76-13.19; P=0.002) and time off work as a barrier (OR, 4.42; 95% CI, 1.24-15.3; P=0.023). Higher ADI was also associated with a lack of awareness of urogynecology (OR, 1.27; 95% CI, 1.04-1.59; P=0.020). Appointment wait time ≥1 month was not associated with ADI or race. CONCLUSIONS:Race and neighborhood disadvantage were independently associated with distinct barriers to urogynecologic care, supporting targeted, equity-focused interventions. The authors encourage institutions to assess barriers faced by their community patient populations.

OBJECTIVE:To evaluate the revision and removal rates of sacral neuromodulation (SNM) in patients with multiple sclerosis (MS) using a large national administrative dataset. METHODS:This was a retrospective cohort study using the Premier Healthcare Database. There were 13 913 patients analyzed between the years of 2006 and 2022), 218 of whom had diagnosis of MS. Patients were categorized into two groups as with MS and without any neurological disorders including MS (controls). The primary outcome was the relationship of MS on the 1- and 5-year device revision/removal rates. Secondary outcomes were associated complication rates within 1 year and beyond 1 year, the association between type of antibiotic prophylaxis and infectious complications. RESULTS:Patients with MS had similarly low rates of mechanical (within 1 year 1.8% vs. 2.1%; p = 0.98, and beyond 1 year 2.8% vs. 4.5%; p = 0.28), infectious (within 1 year 1.4% vs. 0.84%; p = 0.62, and beyond 1 year 0% vs. 0.29%; p = 0.88), and other complications (within 1 year 0.46% vs. 0.73%; p = 0.95, and beyond 1 year 0.46% vs. 0.93%; p = 0.71) within and beyond 1 year compared to controls, respectively. There was no statistically significant difference in revision/removal rates at 1 and 5 years between MS (11.2% and 29.9%) and for control patients (8.1% and 26.9%), respectively. In multivariable Cox proportional hazards models, MS was not found to be associated with removal/revision. CONCLUSION:Our results suggest that a diagnosis of MS does not appear to impact SNM associated revision/removal rates and is associated with similarly low rates of complications compared to patients without any neurologic condition.

IMPORTANCE:Inflammatory bowel disease (IBD) affects 1.5% of women and results in relapsing inflammation affecting the gastrointestinal (GI) tract, which can lead to intra-abdominal adhesive disease, malnutrition, and immunosuppression, factors associated with adverse surgical outcomes. Whether patients with IBD undergoing pelvic organ prolapse (POP) surgery are at an increased risk of postoperative complications is unknown. OBJECTIVE:The objective of this study was to compare postoperative complication rates up to 12 months after POP surgery between patients with and without IBD. STUDY DESIGN:This was a retrospective cohort study of patients who underwent POP surgery between 2000 and 2020 using the Premier Healthcare Database. Postoperative complications were compared between patients with and without IBD, with a subanalysis of surgical approach and IBD subtype. RESULTS:Among 173,489 POP repairs, 6,349 patients (3.7%) had IBD. Patients with IBD had higher 3-month GI complication rates than those without IBD (1.4% vs 0.99%, P =0.029), which persisted for 12 months (2.9% vs 1.7%, P <0.001). Patients with IBD had a higher risk of ileus (OR: 1.8; 95% CI: 1.2-2.6), small bowel obstruction (OR: 1.8; 95% CI: 1.2-2.1), and wound infection (OR: 2.1; 95% CI: 1.1-4.3) at 12 months. IBD subtype was not associated with increased 3-month GI complications ( P >0.05). GI complications were higher among patients with IBD undergoing intraperitoneal repair at 3 months (2.1% vs 1.0%, P =0.003) and 12 months (3.4% vs 1.7%, P ≤0.001). Multivariable logistic regression revealed IBD was independently associated with increased GI complications (OR: 2.06; 95% CI: 1.67-2.53). CONCLUSION:Patients with IBD have increased GI complication risks after prolapse surgery compared with patients without IBD.

Objective:To evaluate the rate, timing, and predictors of additional therapy among women with idiopathic overactive bladder (OAB) following initial minimally invasive treatments (MIT). Study Design:Retrospective single center cohort study of women with idiopathic OAB treated between 2012 and 2021. Using ICD and procedural codes, we identified women who underwent posterior tibial nerve stimulation (PTNS), sacral neuromodulation (SNM), or intradetrusor onabotulinumtoxinA (BTX). The primary outcome was receipt of additional OAB treatments,OAB medication initiation or a different MIT. Kaplan-Meier analysis estimated time to additional therapies; Cox proportional hazards and random survival forest models identified predictors. Results:1,007 women were included (PTNS: 459; SNM: 192; BTX: 356). At three years, 75% of PTNS patients, 58% of BTX patients, and 40% of SNM women required additional therapies with most patients choosing additional pharmacotherapy rather than crossover to a different MIT. Median time to additional treatments was 10 months (PTNS), 19 months (BTX), and 53 months (SNM). Higher BMI was associated with increased risk of further treatment after SNM (HR 2.1, 95% CI: 1.1-4.2), while recurrent urinary tract infections were associated with needing additional therapies in the BTX cohort (HR 1.8, 95% CI: 1.1-3.2). Random survival forest models resulted in poor model performance. Conclusions:Following initial MIT for idiopathic OAB, many women required additional treatment within three years, many choosing pharmacotherapy rather than transition to another MIT. Why This Matters:Overactive bladder (OAB) affects over 20% of women in the United States, and current AUA/SUFU guidelines have shifted from traditional stepwise therapy toward shared decision-making and multimodal treatment. While minimally invasive therapies (MIT) are effective options for OAB, real-world data on patient trajectories after MIT initiation, including rates of treatment augmentation, crossover, or return to pharmacotherapy, remain limited.This retrospective cohort of 1,007 women with idiopathic OAB provides novel data on post-MIT care-seeking, with 40-75% of patients requiring additional therapy within three years. SNM demonstrated the longest interval before additional therapy and the lowest rate of subsequent care-seeking. Notably, most women who required additional treatment chose pharmacotherapy rather than crossing over to a different MIT. Modifiable risk factors associated with additional care-seeking included higher BMI after SNM and recurrent urinary tract infections after BTX, though whether addressing these factors would reduce the need for additional therapy remains unclear.These findings reinforce that OAB management is a dynamic, ongoing process rather than a one-time intervention, and that multimodal therapy is often necessary for optimal improvement. Clinicians can use these data to set realistic expectations during counseling, framing additional therapy as a common and anticipated part of the treatment trajectory rather than a treatment failure.

IMPORTANCE:Midurethral sling (MUS) is a common procedure to correct stress urinary incontinence but carries a risk of postoperative urinary retention (POUR). OBJECTIVE:The objective of this study was to evaluate the efficacy of perioperative tamsulosin for reducing the incidence of POUR in patients undergoing MUS placement, with or without concomitant pelvic organ prolapse (POP) surgery. STUDY DESIGN:This was a retrospective cohort study of female patients who underwent MUS placement, with or without concomitant gynecologic surgery. Patients were excluded if they underwent transobturator or autologous sling placement or had an intraoperative injury requiring prolonged catheterization. Patients who received perioperative tamsulosin were compared with those who did not. Multivariable logistic regression was performed to assess factors associated with POUR. The primary outcome was the incidence of POUR. RESULTS:A total of 423 patients who underwent MUS placement were eligible for analysis. Of these, 131 (31.0%) patients received perioperative tamsulosin and 292 (69.0%) did not. In the unadjusted analysis, the incidence of POUR was significantly higher in the no-tamsulosin group (18.8% vs 10.6%, P =0.04). However, the multivariable logistic model demonstrated that perioperative tamsulosin was not significantly associated with decreased POUR (OR, 0.61; 95% CI, [0.29-1.28], P =0.19). Patients with a higher body mass index had a reduced likelihood of POUR (OR, 0.94; 95% CI, [0.89-0.99], P =0.02), while patients who underwent a concomitant POP surgical procedure trended toward increased likelihood of POUR (OR, 2.15; 95% CI, [0.97-4.73], P =0.06). CONCLUSIONS:These findings suggest that patient and procedural characteristics may play a more significant role in POUR risk than perioperative tamsulosin use for patients undergoing MUS placement.

IMPORTANCE:Urinary tract infections in adult women are commonlytreated by gynecologists and urologists. OBJECTIVE:The objective of this study was to estimate the frequency of and factors associated with mortality among women hospitalized with a primary diagnosis of a urinary tract infection (UTI). STUDY DESIGN:This was a retrospective cohort study using the National Inpatient Sample of adult women hospitalized with a UTI between 2016 and 2020. Patients' demographic, hospital-level data, comorbidities, and associated diagnoses were identified using International Classification of Diseases, Tenth Revision, (ICD-10) codes. The primary outcome was death during hospitalization. Independent associations with death were analyzed using multivariable logistic regression of variables that occurred in 2% or more of hospitalizations (irrespective of outcome). RESULTS:A total of 330,905 hospitalizations with a primary diagnosis of UTI were identified, including 1,588 deaths (0.48%). Death was most strongly correlated with increasing age: above 85 years (adjusted odds ratio [aOR], 8.37; 95% CI, 5.69-12.30), age 76-85 years (aOR, 5.63; 95% CI, 3.83-8.27), age 66-75 years (aOR, 4.45; 95% CI, 3.01-6.57), age 51-65 years (aOR, 3.17; 95% CI, 2.12-4.73) compared with those 18-50 years. The comorbidities and diagnoses most associated with death included metastatic cancer (aOR, 4.25; 95% CI, 3.50-5.16), pneumonia (aOR, 3.68; 95% CI, 3.17-4.28), and weight loss (aOR, 2.98; 95% CI, 2.65-3.36). Bacteremia (aOR, 0.65; 95% CI, 0.45-0.95), complicated hypertension (aOR, 0.61; 95% CI, 0.52-0.72), depression (aOR, 0.75; 95% CI, 0.65-0.87), and nutritional anemia (aOR, 0.76; 95% CI, 0.60-0.96) were most associated with a decreased probability of death. CONCLUSION:Death during hospitalization for a diagnosis of UTI was rare, even in critically ill and extremely elderly patients.

IMPORTANCE:The incidence of and factors associated with psychotherapy use in women with overactive bladder are unknown. OBJECTIVES:The primary objectives of this study were to determine the incidence of psychotherapy initiation after overactive bladder diagnosis in female Medicare beneficiaries and to analyze clinical and sociodemographic factors associated with initiation of psychotherapy within 3 years from OAB diagnosis. STUDY DESIGN:This was a retrospective cohort study of women diagnosed with OAB between the years 2011 and 2021 using the Medicare 5% Limited Data Set (LDS). ICD codes were used to identify women with OAB, and from that cohort, CPT codes were used to identify incident use of psychotherapy within 5 years from OAB diagnosis. Cox proportional hazards models were used to evaluate clinical and sociodemographic factors associated with use of psychotherapy. Logistic regression was used to evaluate clinical and sociodemographic factors associated with high (≥10 sessions) versus low (<10 sessions) utilization of psychotherapy. RESULTS:There were 374,918 women who met the inclusion criteria for OAB diagnosis; of these, 28,571 (8.7%) attended at least 1 psychotherapy session within 5 years. Factors associated with increased use of psychotherapy included dual Medicaid/Medicare status (aOR 1.26 [1.21, 1.31]), living in the Northeast (vs South) (aOR 1.26 [1.21, 1.31]), being diagnosed with anxiety or depression (aOR 5.14 [5.01, 5.26]), alcohol or drug abuse (aOR 1.66 [1.57, 1.75]), and increasing Charlson comorbidity score (aOR 1.03 [1.03, 1.04]). CONCLUSIONS:Psychotherapy use in older women with OAB is not rare. Demographic factors and psychiatric comorbidities affect the likelihood of psychotherapy use in this population.

INTRODUCTION:Sacral nerve stimulation (SNS) is an established therapy for refractory urinary incontinence, yet the 2025 Wasteful and Inappropriate Service Reduction Model (WISeR) designated it as requiring mandatory prior authorization. No analysis has examined how U.S. payers translate SNS evidence into coverage policies or whether restrictions are evidence-based. We sought to: (1) compare covered and excluded indications, (2) evaluate restriction criteria and conservative therapy requirements, and (3) assess quality of evidence cited. METHODS:This was a systematic, retrospective analysis of publicly available SNS coverage policies. Independent reviewers extracted data from 11 major U.S. payers, including Medicare. Data included indications, contraindications, implantation criteria, and cited references. References were classified using Oxford Centre for Evidence-Based Medicine hierarchy into Levels I-V or "Other" (guidelines, technology assessments, regulatory documents). RESULTS:All payers covered core urinary indications, while 63.6% excluded neurologic disease. All required conservative therapy failure for trial, but specificity varied from specific drug combinations to voiding diaries. All required symptomatic improvement for permanent implantation; 90.9% specified > 50% improvement. References ranged from N = 15-112 per policy. While 90.9% cited Level I evidence, proportions ranged from 0% to 31.6%. Five payers had > 50% of references classified as "Other;" only Medicare had majority primary evidence (89.5%). DISCUSSION:While payers agree on core urinary indications, coverage for neurologic conditions is inconsistently defined. Because FDA labeling does not endorse SNS for neurologic etiologies such as spinal cord injury, variable exclusions are understandable yet create confusion for clinicians navigating prior authorization. Wide variation in therapy and documentation requirements highlights lack of transparency as WISeR expands. LEVEL OF EVIDENCE:Level III. LEVEL OF EVIDENCE:Level IV.

OBJECTIVE:To develop and validate a predictive tool to estimate the risk of ovarian cancer in a screening setting. METHODS:Machine learning was leveraged to create a predictive model for ovarian cancer diagnosis within one year of screening. Data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial were used in model creation. Participants in this trial were comprised of females aged 55-74 years who underwent annual screening and prospective follow up for development of ovarian cancer. Stratified 15-fold cross validation was performed followed by external validation on a retrospective cohort. RESULTS:A random forest model was created using data from 150,907 screening events with a mean age of 62.5 ± 5.6 years. Ovarian cancer was diagnosed in 112 participants within one year of screening. The primary model was strongly predictive of ovarian cancer diagnosis, noting AUC of 0.930 (95% CI 0.886-0.974), sensitivity of 77.7% (66.4-88.9%), specificity of 98.0% (97.9-98.2%), positive predictive value of 2.9% (2.4-3.4%), negative predictive value of 99.9% (99.98-99.99%), and a positive likelihood ratio of 38.9. This model retained strong predictive value in external validation with AUC 0.910, sensitivity of 91.9%, and specificity of 72.6%, positive predictive value 29.6%, and negative predictive value of 98.6%. CONCLUSIONS:This model utilizes artificial intelligence to predict the risk of development of ovarian cancer within one year of screening demonstrating high levels of discrimination, sensitivity, and specificity. Machine learning techniques should be considered in the development of a multimodal approach to the early detection and prevention of ovarian cancer.

BACKGROUND:Supracervical hysterectomy (SCH), commonly performed during sacrocolpopexy, involves removal of the uterine corpus, leaving the cervix in-situ. Significant anatomic variation exists in remnant tissue, which may develop into a uterine malignancy. No prior studies have sought to describe the future risk of developing de novo uterine cancer after SCH with benign pathology. This study aims to describe the incidence rate of uterine cancer following SCH performed for benign indication. METHODS:Retrospective cohort study of patients who underwent SCH between June 2000 and December 2022 using the Premier Healthcare Database. Demographics and covariates were compared between patients who did and did not develop malignancy. Primary outcome was incidence rate of uterine cancer after benign SCH. Kaplan-Meier estimates were used to assess uterine cancer risk following SCH. RESULTS:Among 25,126 benign SCHs, 92 patients (0.37%) were found to have incidental malignancy at the time of hysterectomy, and 35 (0.14%) patients subsequently developed de novo malignancy despite benign pathology at index surgery with an incidence rate of 0.44 per 1000 person-years (95% CI 0.31-0.61). Patients with uterine cancer were older (54.7 vs. 48.8 years, P<0.001) with lower rates of pelvic organ prolapse (17.3% vs. 35.7%, P<0.001) and higher rates of postmenopausal bleeding (19.7% vs. 3.0%, P<0.001), endometrial hyperplasia (11.2% vs. 1.2%, P<0.001), and cervical abnormalities (16.5% vs. 5.6%, P<0.001). CONCLUSIONS:Incidence of incidental and de novo uterine cancer after benign supracervical hysterectomy are low, occurring in 0.51% of patients, and can augment counseling regarding hysterectomy approach.

IMPORTANCE:Urinary tract infections (UTIs) are common yet preventable complications after pelvic organ prolapse (POP) surgery. OBJECTIVE:The objective of this study was to compare hospital-based postoperative UTI rates among patients undergoing POP surgery by perioperative antibiotic regimen received: cefazolin (C), gentamicin + clindamycin (GC), or cefazolin + metronidazole (CM). STUDY DESIGN:This was a retrospective cohort analysis of patients undergoing POP surgery from 2000 to 2022 using a U.S. national database. The primary outcome was UTIs within 30 days postoperatively. Secondary outcomes included emergency department (ED) visits, inpatient admissions, and UTIs within 90 days postoperatively. Inverse probability of treatment weighting (IPTW) was performed to balance on potential confounding preoperative characteristics. RESULTS:Of 166,673 POP surgery patients, 3.0% (n=4,953) were diagnosed with a 30-day postoperative UTI. The UTI rate differed by perioperative antibiotic regimen: C 2.9% (n=4,197), CM 2.5% (n=295), and GC 3.8% (n=461), P <0.001. GC was associated with a higher 90-day UTI rate (4.9%, n=601, P <0.001), UTI-related ED visits (1.8%, n=219, P <0.001), and UTI-related hospitalization (0.73%, n=89, P =0.0014) compared with cefazolin-based antibiotic cohorts. After IPTW, cefazolin-based regimens remained associated with decreased odds of postoperative UTI-related complications compared with GC. Compared with cefazolin, GC was associated with increased odds of 30-day UTIs (OR, 1.27; 95% CI, 1.14-1.42), 90-day UTIs (OR, 1.30; 95% CI, 1.18-1.43), UTI-related ED visits (OR, 1.40; 95% CI, 1.19-1.63), and UTI-related inpatient admissions (OR, 1.36; 95% CI, 1.06-1.74). CONCLUSIONS:Among patients undergoing POP surgery, cefazolin-based antibiotic regimens were associated with a lower probability of hospital-based UTI-related complications compared with the group receiving GC.

Importance Residential segregation influences health outcomes. Objective The objective of this study was to examine the relationship between residential segregation and prolapse surgery complications and readmissions among older Black women. Study Design This retrospective study included non-Hispanic Black women who underwent prolapse surgery from 2011 to 2018 in the Medicare 5% Limited Dataset. The primary outcome was 90-day complications. Other outcomes of interest were 30- and 90-day readmissions. We calculated the Index of Concentration at the Extremes (ICE) for each beneficiary’s U.S. county of residence to measure geographic segregation by race, income, and both combined. We stratified the cohort into quintiles based on the ICE measures. Descriptive and comparative analyses were used to compare the demographic and clinical characteristics for each group. Poisson regression models were used to test the association between ICE measures and complications and readmissions. Results There were 872 Black women included in the analysis. Black women living in counties with the highest concentrations of Black residents had a 44% and 55% increased relative risk of 90-day complications compared to those in counties with the highest concentrations of White residents. Conversely, Black women living in the least segregated counties by race and income combined experienced 70% and 57% decreased risk of 30- and 90-day readmissions, respectively. Conclusions The findings support our hypothesis that structural racism (measured by levels of residential racial and economic segregation) is associated with poorer outcomes after pelvic organ prolapse surgery. Further research is needed to identify neighborhood-level factors that contribute to and protect against inequities in postoperative outcomes after prolapse surgery.

Conventional urinary tract infection (UTI) diagnostics include urinalysis and urine culture; however, cultures can take up to 72 hours, or longer, to result leading to delays in appropriate treatment, inappropriate empiric therapy and misdiagnosis of conditions that may mimic UTI symptoms. Prior studies have also suggested that conventional urine cultures may be suboptimal compared to advanced diagnostic testing using polymerase chain reaction (PCR), particularly for non-Escherichia coli (E. coli) bacteria. The objective was to assess the utility of using a syndromic PCR panel for managing women presenting with symptoms of uncomplicated acute cystitis, in comparison to conventional urine culture. This was a prospective, paired, within-subject study of female patients >/=60 years of age presenting with symptoms of acute UTI. Patients were excluded due to history of urinary diversion, current indwelling catheter, symptoms of pyelonephritis, or antibiotic use within 21 days. For all patients, urine culture and PCR using the ABXAssist™ technology platform were collected, and results were provided to the treating clinician. Treatment for the UTI was at the clinician’s discretion and part of the patient’s clinical care. Initial treatment was based on the results of the first available test, either urine culture or PCR. Treatment changes were made if there were discrepancies between test modalities. Baseline demographics and treatment information within 30 days were collected. Patients completed baseline UTI-SIQ-8 and the UTI Symptom Assessment questionnaires, which were completed again 30 days after enrollment. The primary outcome was time from initial presentation to optimal antibiotic prescription. Secondary outcomes included patient perception of symptoms, antibiotic regimen changes, time to urine culture and PCR results and discrepancy between the two tests. A total of 95 patients completed the 30-day follow-up and were eligible for analysis and the demographic information is found in Table 1. Forty (42.1%) symptomatic patients had a positive urine culture and 81 (85.2%) had a positive urine PCR, with 44.2% of patients having a discrepancy in their testing. The most common discrepancy was a negative culture with a positive PCR (N=41). The time from initial visit to optimal treatment was not different between the groups (80.2 hours vs 71.4 hours, p=0.12). However, in the case of a positive urine culture, the time from initial visit to optimal treatment was significantly shorter with PCR (62.6 hours vs 72.0 hours, p=0.04). Patients who had a negative culture were more likely to have a PCR positive test for a non-E.coli bacteria compared to those with a positive culture (64.8% vs 42.5%, p=0.03). Patients with culture directed treatment or negative urine cultures with PCR directed treatment reported a similar rate of improvement in their symptoms (72.2% for culture negative vs 72.5% for culture positive, p=0.54). For positive cultures, there was fair to substantial agreement for pathogen type: Cohen’s kappa for E. coli (k=0.63), Enterococcus sp. (k=0.22), Enterobacteriaceae (k=0.47), Klebsiella sp. (k=0.54) and Proteus mirabilis (k=0.47). PCR may be an effective method of identifying urinary pathogens in symptomatic patients, particularly those with non-E.coli bacteria.