The annual clinical meeting of the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) was held in person (with a remote virtual option) in San Diego from February 22 to 26, 2022. As is the case for most professional organizations, this was the first opportunity for an in-person gathering since the SUFU meeting in February 2020, just before the outbreak of COVID-19. In all, 482 persons attended the clinical meeting in person and 208 virtually, with about 170 being trainees.

The clinical program was comprised of keynote lectures, panel discussions, clinical debates, expert video theaters and break-out sessions, covering all the major topical areas inherent in the subspecialty. The scientific program included presentations of a total of 250 abstracts over 6 podium sessions, 2 video abstract sessions and 13 poster sessions by members, fellows, residents and students. Most of the plenary sessions were recorded and are available for viewing through the SUFU website (https://sufuorg.com/meetings/past.aspx).

The clinical meeting opened with a thought-provoking session on the Social Ecology of Pelvic Floor Disorders chaired by Dr. Casey Kowalik (University of Kansas). Dr. Tamara Bavendam and Dr. James Hokanson (Marquette University and Medical College of Wisconsin) presented conceptual frameworks for how noncancerous genitourinary conditions impose often underappreciated burdens on individuals and their interpersonal relationships, social organizations, communities and society as a whole, as well as impacts on the environment. Dr. Nitya Abraham (Montefiore Medical Center) discussed the barriers that social determinants of health and unmet social needs pose to patients with overactive bladder and incontinence.

Several sessions addressed the changing landscape of interstitial cystitis/bladder pain syndrome (IC/BPS) management. Dr. H. Henry Lai (Washington University School of Medicine in St. Louis) reviewed an approach to clinical phenotyping of IC/BPS patients to drive clinical care: bladder-centric versus systemic versus pelvic floor dysfunction versus psychosocial. He then moderated an insightful panel, including Dr. Elise J. B. De (Harvard Medical School), Dr. Priyanka Gupta (University of Michigan) and Dr. Lindsey C. McKernan (Vanderbilt University), that emphasized the need for multidisciplinary teams when treating nonbladder-centric IC/BPS. Key takeaway: one size certainly does not fit all and phenotyping can optimize intervention outcomes.

In a session focused on care for transgender/nonbinary patients, Dr. Polina Reyblat (Southern California Kaiser Permanente Medical Group) reviewed that nearly a quarter of transgender/nonbinary patients do not seek medical care due to fear of being mistreated, including patients with oncologic needs. Many of these patients face urological issues, including overactive bladder, urethral strictures, pelvic floor dysfunction, vaginal atrophy, erectile dysfunction and need for prostate specific antigen screening. Dr. Reyblat emphasized the need for sensitivity with examinations, including involving the patient in the physical examination and assuming prior trauma.

The meeting included a review of the recent AUA Neurogenic Lower Urinary Tract Dysfunction Guidelines by Dr. Anne Cameron (University of Michigan). By risk stratifying patients with neurogenic bladder, providers have clear guidelines on how to best manage these patients safely. Risk categories are based on urodynamic findings, upper tract imaging and renal function.

Neurostimulation for lower urinary tract dysfunction was a major theme at the meeting. Over 20 presentations featured sacral neuromodulation products and multiple vendors exhibited emerging technologies, including advances with implantable peripheral tibial nerve stimulation devices. Dr. Kathleen Kobashi (Houston Methodist Hospital) moderated a great session titled “When Neuromodulation Stops Working,” which featured various algorithms for troubleshooting common sacral neuromodulation issues.

Many colleagues were celebrated with the award sessions: Dr. Toby C. Chai (Boston Medical Center) was awarded the Continence Care Champion Award; Dr. Kathleen C. Kobashi (Houston Methodist Hospital) was awarded the Distinguished Service Award; Dr. William Steers was posthumously awarded the Lifetime Achievement Award and Dr. Benjamin B. Brucker (NYU) the McGuire-Zimskind Award. In addition, Dr. Phillip Smith was recognized for his lifetime contributions to the field with a SUFU Special Recognition Award.

Lastly and perhaps most importantly, a major emphasis of the program was recognizing the contributions of several of the “giants” who forever changed the field of what has variously been known as “Female Urology,” “Functional Urology” and, more recently, “Female Pelvic Medicine and Reconstructive Surgery.” Highlights of this included keynote lectures by Dr. Linda Cardozo (King’s College Hospital) on vaginal rejuvenation and genitourinary syndrome of the menopause, as well as Dr. Shlomo Raz (UCLA) on flaps in female pelvic medicine. In a particularly special session entitled “Where We Were, Where We Are and Where We are Going,” 4 thought leaders sat on stage with their mentees (each a thought leader in their own right) and discussed changes to the field. This inspiring session included Dr. Victor W. Nitti (UCLA) with Dr. Shlomo Raz (UCLA), Dr. Jeffrey P. Weiss (SUNY Downstate Health Sciences University) with Dr. Jerry G. Blaivas (Mount Sinai), Dr. Ariana L. Smith (University of Pennsylvania) with Dr. Alan J. Wein (University of Pennsylvania) and Dr. Leslie M. Rickey (Yale Medicine) with Dr. Linda Cardozo (King’s College Hospital). In addition, stirring tributes were delivered to the late Dr. Edward J. McGuire by Dr. J. Quentin Clemens (University of Michigan) and to the late Dr. William D. Steers by Dr. Adam P. Klausner (Virginia Medical Center), all of whom have contributed so much to the field. For the audience, these were rare opportunities to learn from the masters and absorb wisdom from the greats. Dr. Raz probably summed it up best with 6 pearls: 1) “be humble,” 2) “study and work hard,” 3) “open your mind,” 4) “innovate,” 5) “love your patients” and “6) formulate an idea and run with it.”

We look forward to the next SUFU Meeting in 2023 in Nashville, Tennessee!