The Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) hosted a great afternoon of content on the Friday afternoon of the AUA Annual Meeting in Chicago. The program, which was planned by Dr Karyn Eilber, very nicely highlighted many topics and challenging issues that our members commonly see in their practices. The first panel, moderated by Dr David Sussman, focused on office-based therapies. Some of the highlights from that session included Dr Nirit Rosenblum discussing the use of vaginal laser therapies for vaginal rejuvenation and sexual function, Dr Dean Elterman describing the indications and outcomes of office-based therapies available for benign prostatic hyperplasia, and Dr Priyanka Gupta discussing how she performs injection of bulking agents in the office, which included a great video demonstrating how local anesthetic is delivered prior to the injection.

Another outstanding panel, New Developments in IC [Interstitial Cystitis], was moderated by Dr Larissa Rodriguez and included Drs Lysanne Campeau, Robert Moldwin, and Karl Kreder. The indications and use of over-the-counter supplements was discussed as was the recent update of the IC Guidelines (and the removal of tiered recommendations) and a summary of recent finding from the MAPP (Multidisciplinary Approach to The Study of Chronic Pelvic Pain) with some of the take-homes including the importance of widespread pain vs localized pain as unique phenotypes, utilizing a standard physical examination template to assess for pelvic muscle tenderness. A panel on neurogenic lower urinary tract dysfunction (NLUTD) included Dr Anne Cameron reviewing the risk stratification system from the AUA/SUFU NLUTD guidelines, which helps providers understand how these patients should undergo routine surveillance, Dr Angelo Gousse discussing the optimal use of botulinum toxin, and Dr Stephanie Kielb describing the potential increasing use of neuromodulation in the NLUTD population, especially now that we have devices that are MRI-compatible (Figure 1). Dr Gary Lemack was the moderator for a panel that discussed the care for a 70-year-old man with urinary retention, an enlarged prostate, and history of a cerebrovascular accident. Dr Doreen Chung discussed the pros and cons of including cystoscopy and urodynamics in the evaluation of this patient, Dr Bilal Chughtai discussed minimally invasive options for this patient with a prior cerebrovascular accident, and Dr Ricardo Gonzalez advocated for holmium laser enucleation of the prostate, which would benefit this patient independent of this prostate size. The final panel of the afternoon, moderated by Dr Una Lee, focused on recurrent urinary tract infection (UTI). Dr Quentin Clemens discussed nonantibiotic strategies such as the benefits of increased water intake, methenamine, and cranberry, Dr Curtis Nickel introduced the very exciting concept of a vaccine for UTI (that we are all waiting to be available to use clinically!), Dr Lenny Ackerman discussed the microbiome (lots of interesting data in this space, but it is still not clear how we are to use these when evaluating and treating patients with recurrent UTI), and Dr Blayne Welk’s strategies to deal with catheter-related UTIs included judicious testing of the urine for infection (including changing to a new catheter before obtaining the urine specimen) and various bladder irrigation strategies.

Figure 1. Panel on office-based therapies including Drs Nirit Rosenblum, Siobhan Hartigan, Priyanka Gupta, Michael Ehlert, and David Sussman.

The afternoon also included 3 entertaining debates. With Dr Polina Reyblat moderating, Drs Jennifer Anger and Christi Butler debated the need to have had fellowship training to participate in transgender surgery. The consensus was that the critical aspects of training to gain proficiency in gender affirming surgery, whether in an FPRMS or a gender affirming–focused fellowship, include surgical expertise, patient access, earning community trust, understanding the importance of interdisciplinary care teams, and building life-long relationships with colleagues within the field. The subject of the debate between Drs Seth Cohen and Anne Suskind was “Anticholinergics: Do they Really Cause Dementia?” This question, and the potential concern that medications we are prescribing for our overactive bladder patients may result in worsening cognition, continues to be a significant issue for many AUA members. The consensus from this debate, which was moderated by Dr Howard Goldman, was that while there are clearly data demonstrating an association with some of the anticholinergics to dementia, one must balance the small risks with the improved quality of life many patients experience when treated. All things being equal, most would preferentially utilize β-3 agonists, but cost is an important factor that limits adopting that approach. One of the highlights of the afternoon was the debate between Drs CR Powel and Aqsa Kahn, and included t-shirts that Dr Powell made just for the debate (Figure 2). Moderated by Dr Ariana Smith, the debate was “Bothersome Prolapse and Incontinence in Women of Childbearing Age.” Dr Powel had the side of “Help a Girl Out” and Dr Khan advocated for “Deal With it Until After Childbearing.” Both sides made great arguments in favor of their position, and it was clear that this is a challenging situation that could be handled with either strategy and clearly requires conversations between the provider and the patients so decisions can be made in a shared decision-making manner.

Figure 2. Drs CR Powel and Aqsa Khan ready to debate.

We were happy to highlight such a wonderful variety of topics and young speakers. The afternoon provided a great array of educational content within the many disorders that are seen by SUFU members, and for those who want to continue to learn in this space we look forward to seeing you at our winter meeting, February 20-24, 2024, in Fort Lauderdale, Florida.