Urinary incontinence (UI) is a very prevalent disorder affecting women. Based on epidemiologic data, about 30% of U.S. women report history of UI. Experiencing symptoms of UI has a substantial effect on quality of life and poses social, mental, physical, and economic burdens on the individual. Although there are well-established environmental risk factors associated with health and lifestyle that impact onset and progression of UI, less is known about predisposing inherited or genetic risk factors. Data from genetic linkage studies are mixed and there is even less information from genome-wide association studies (GWAS) of UI. Understanding genetic determinants of UI is crucial for developing targeted treatments and prevention strategies for individuals predisposed to this condition.
The findings from our study demonstrate the presence of specific single nucleotide polymorphisms (SNPs) in the human genome, and across different chromosomes, with a high likelihood of an association with UI subtypes. When crude definitions of any UI subtype were applied in the first GWAS run, five unfiltered SNPs appeared on chromosomes 1, 7 and 9 for mixed UI, and three appeared on chromosomes 15 and 16 for urge UI. Interestingly, when we used more specific UI definitions, disallowing overlap of patients across different UI subtype groups, 1 SNPs appeared on chromosome 10 for mixed UI and 1 SNP appeared on chromosome 17 for stress UI. Additional studies with larger and more diverse populations are needed to validate the existing findings, and to better characterize this relationship across UI subtypes.
Missed appointments pose a significant challenge for patients, providers, and healthcare systems alike. For patients, missed appointments lead to delays in receiving necessary care and result in worse health outcomes. For providers, missed appointments impede clinic efficiency, productivity, and financial resources. Furthermore, missed appointments financially drain health care system resources. In a recent study involving patients in an academic multisite urogynecology practice, risk factors for missed appointments included Black race, Hispanic ethnicity, a primary language other than English, and Medicaid insurance. By identifying determinants of missed appointments, we can better design interventions to improve overall healthcare delivery to our patients. This study aims to develop a better understanding of patient-perceived barriers to urogynecology appointment attendance through qualitative interviews.
Patients identified three major barriers to appointment attendance: community and environmental, patient-related, and clinic-related factors. Community and environmental barriers [n=20 (77%)] included unforeseen circumstances and transportation issues, with 52% citing transportation difficulties. Patient-related factors [n=16 (62%)] included family obligations, personal illness, mental health concerns, confusion with appointments, or competing job responsibilities. Clinic-related factors [n=9 (35%)] included scheduling and timing issues. Participants proposed changes to facilitate attendance, which included clinics offering transportation assistance, providing interpersonal support through support groups, and improving the internet-based portal to make patient communication easier.
Urinary incontinence (UI) is a common condition that many women suffer from. Though prior studies have suggested that inequities in UI treatment exist, it currently remains unknown if there are racial disparities in the rates of surgeries performed for UI, and no recent population-based studies examine the current epidemiology of surgical procedures performed for UI in the United States. Previous studies that examined the association between race and surgical treatment of urinary incontinence are over 20 years old and do not adjust for the incidence of UI in these populations. To address this gap in the literature, the goal of this study is to investigate racial and ethnic differences in time from presentation with UI (patients’ first clinical visit) to surgery for UI, as well as racial and ethnic differences in the number of clinical visits chiefly for UI prior to receiving surgery.
There has been increased interest in research examining the effect of physician gender on health care delivery and patient outcomes in various fields of medicine including primary care and general and gynecologic surgery. This topic is becoming more relevant given the percentage of women enrolling in medical schools is surpassing that of men and the recognized need for emphasis on diversity, equity, and inclusion in medicine. Despite the increasing proportion of female physicians, a growing body of evidence continues to highlight the persistent pay gap that exists between male and female physicians in various specialties.
Previous studies have shown female physicians are more likely to engage in patient-centered and emotionally-focused communication and to participate in shared decision making compared with their male colleagues. Female physicians also spend more time discussing family and social issues, which are often important to female patients. In a multicenter cross-sectional study of patients seeking outpatient urogynecologic care, 65% reported they preferred seeing a female provider. Nevertheless, it is unknown whether patients with specific urogynecologic complaints prefer to be evaluated by female versus male surgeons. Additionally, it is unknown if women with surgical conditions may prefer seeing male surgeons. If female surgeons encounter more patients who do not require surgical intervention, this has implications for surgical productivity, revenue generation, and overall procedural expertise over time. Dr. Miranne and other investigators are conducting this multi-center study as part of the Society of Gynecologic Surgeons (SGS) Collaborative Research in Pelvic Surgery (CoRPS) Consortium to describe the visit diagnosis types evaluated by urogynecologic surgeons in an outpatient setting and to determine whether female urogynecologic surgeons see more patients who have nonsurgical complaints compared with their male counterparts.
Urinary tract infections (UTIs) account for more than 8.5 million visits to health care providers in the United States every year. UTIs are also one of the most common hospital-acquired infections. Treatment for UTIs is an economic burden on the U.S. healthcare system accounting for $2.6 billion in annual costs. One of the most common complications of urogynecologic surgery is UTI and the risk of UTI with transurethral catheterization is well known. In patients undergoing urogynecologic surgery, the risk of UTI ranges from 10 to 64%. Different strategies to lower this risk include antibiotic prophylaxis, or using antibiotic medicine to prevent an infection before it occurs, and the use of cranberry products. Several studies have been conducted investigating the use of antibiotic prophylaxis and cranberry products for UTI risk reduction after urogynecologic surgery.
The results from these studies are conflicting. Dr. Miranne and The Brigham Urogynecology Group are conducting this study to compare the effectiveness of cranberry capsules versus nitrofurantoin (antibiotic) prophylaxis in women who require transurethral catheterization after urogynecologic surgery. We are conducting this study to hopefully reduce the number of UTIs women have after urogynecologic surgery. Reducing the risk of UTIs can have a significant impact on surgical recovery and quality of life. This can also help decrease or reduce health care costs.
With grant funding from American Urogynecologic Society, Dr. Kim assembled a multidisciplinary team to build a smartphone-based program to help patients self-manage their symptoms of chronic bladder pain condition. While this study has concluded, given the success of this platform, it is now being expanded to address other conditions such as recurrent urinary tract infections. This project demonstrated that delivering healthcare content to patient’s mobile devices is not only feasible but also effective in treating their conditions. This innovative approach for healthcare also has a potential to optimize healthcare resource utilization but also promote greater equity in healthcare access. This paper describes Phase 2, the feasibility trial aspect, of the project.
Dr. Kim leverages his expertise in clinical statistics and data science to identify and highlight potential disparities in healthcare. In this study, Dr. Kim and his team analyzed the medical data of over half a million patients and found that urinary incontinence is significantly under-recognized by primary care providers. They also found that being diagnosed with urinary incontinence varied by patients’ race, insurance status, insurance type, and preexisting access to healthcare. This study underscores the ongoing need for equity in recognition of urinary incontinence, which affects a substantial number of women across the globe.
In this study, Dr. Kim employed advanced statistical methods to a national surgical database to demonstrate that same-day discharge after minimally invasive (robotic and laparoscopic) reconstructive surgery for women with prolapse is safe. This research has contributed to practice changes, supporting same-day discharge after minimally invasive prolapse surgeries.
For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.
About BWH
