The worldwide COVID-19 pandemic has caused a significant paradigm shift in the delivery of health care. A recent questionnaire-based study found that urologists were significantly affected by the COVID-19 pandemic with decreased outpatient visits, outpatient procedures and surgeries (77%, 84% and 93%, respectively).¹ There has been rapid implementation of telemedicine in urology due to these cancelations, inadequate personal protective equipment and shortage of personnel. Dubin et al found that before the COVID-19 pandemic only 15.8% of surveyed urologists were using telemedicine. However, this number increased to 46% during the pandemic.²

Female pelvic medicine and reconstructive surgery (FPMRS) represents a subspecialty of urology that may be ideally suited for telemedicine. As the pandemic continues to rage, FPMRS providers may face increasing numbers of cancelations of in-person visits due to patients who have either contracted or have been exposed to COVID-19. Additionally, it may prove difficult to keep clinics staffed with appropriate personnel due to similar COVID-19 exposures and mandatory quarantines. FPMRS providers may be disproportionately affected by cancelation of clinic visits/surgeries, as many FPMRS-related issues are elective/non-emergent. Teoh et al found that treatment of benign urological conditions was most affected by COVID-19 related closures/cancelations. Outpatient visits and surgery for female urinary incontinence were reduced by 81% to 85%.¹ Telemedicine will likely play a critical role in optimizing FPMRS patient care during the COVID-19 pandemic to overcome the above mentioned challenges.

Telemedicine can be a valuable tool for many FPMRS-related issues such as overactive bladder (OAB), urinary incontinence and urinary tract infections. Physical exam may be helpful but not absolutely necessary in many of these cases for diagnosis and initial management. Many FPMRS providers use clinical care pathways for these common diagnoses, and these pathways may lend themselves to telemedicine. For example, first line and second line therapies from the AUA/SUFU (Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction) clinical care pathway include behavioral modification (ie fluid intake, timed voiding) and pharmacotherapy.

Limited literature exists for the use of telemedicine in FPMRS-related conditions. Huang et al recently performed a systematic review and meta-analysis of the efficacy of telemedicine for urinary incontinence in women.³ Seven studies involving a total of 836 patients were included. The results revealed that telemedicine intervention significantly reduced the severity of urinary incontinence and improved quality of life compared to in-person visits. Descriptive analysis of this meta-analysis showed that telemedicine led to reduced patient anxiety and depression, which led to improved impression of improvement.

A randomized controlled trial comparing telemedicine to standard followup found that both types of visits yielded similar improvements in symptom bother while the telemedicine group exhibited improved medication compliance and higher progression to third line therapy (intradetrusor botulinumtoxin A injections, percutaneous tibial nerve stimulation and sacral neuromodulation).⁴ A limitation of this study was the small sample size and limited followup.

Current literature regarding the use of telemedicine in FPMRS is sparse. However, by the time of this publication multiple projects on this topic will have been presented at the 2021 SUFU Annual meeting. Please stay tuned for further updates!

Although conditions such as urinary incontinence/OAB are not life-threatening, they can often severely affect quality of life and mental well-being. Our patients deserve timely evaluation and treatment of such issues even in the time of COVID-19. Telemedicine will help us achieve this goal.